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Rockville, MD – The Substance Abuse and Mental Health Services Administration (SAMHSA) announced today the award of contracts to 14 States for a total of $6.09 million to conduct pilot studies designed to help develop performance and outcome measures for substance abuse treatment services.

Arizona, Arkansas, Connecticut, Kansas, Maryland, Massachusetts, Minnesota, Missouri, North Carolina, North Dakota, Oklahoma, Rhode Island, Utah and Washington were selected through a competitive process by SAMHSA's Center for Substance Abuse Treatment (CSAT). These States will develop methods to monitor the impact of substance abuse treatment services, using measures that are relevant to the State's needs. Specifically, these pilots will focus on the effectiveness of treatment for pregnant women and women with dependent children, the impact of managed care initiatives on substance abuse treatment effectiveness, the usefulness of various intake assessment instruments, and the impact of culturally sensitive counseling on treatment outcomes for special populations.

"In the area of substance abuse treatment services, States have asked that the Federal Government assist them in identifying performance measures, developing data reporting systems and establishing a sound basis for outcome oriented, Federal-State partnerships. The awards we are announcing today represent a tremendous step forward in building Federal - State partnerships and providing the American taxpayer with measures of their government's performance", said Nelba Chavez, Ph.D., SAMHSA's Administrator.

CSAT funds 37 percent of all substance abuse treatment services provided by State agencies through the Substance Abuse Prevention and Treatment Block Grant. SAMHSA's 1998 budget request proposes to modify this block grant into a "Performance Partnership Block Grant." This change would increase States' flexibility and accountability by allowing the Secretary of the U.S. Department of Health and Human Services to waive specific Federal Block Grant requirements. In exchange for a waiver, States would be required to report on progress made in achieving performance objectives. The pilot projects represent an important step in identifying State specific needs while developing performance measures and reporting systems.

"As the States work with CSAT to enhance the efficiency and effectiveness of treatment, initiatives such as these will result in greater emphasis on outcome, and our capacity to quantify the significant impact of treatment on patients' lives. We will also encourage our pilot States to share their findings and lessons learned with other States in order to leverage findings and extend States' use of outcome measures," said David J. Mactas, CSAT's Director.

SAMHSA, a public health agency within the U.S. Department of Health and Human Services, is the federal government's lead agency for improving the quality and availability of substance abuse prevention, addiction treatment and mental health services. More information about SAMHSA, its Centers and its programs is available on the Internet at: www.samhsa.gov.

STATE PERFORMANCE AND SUBSTANCE ABUSE TREATMENT OUTCOME PILOT STUDIES

1. ARIZONA Award- $881,404

   The Arizona Behavioral Health Services currently collects admissions and follow up data from all treatment programs in the State. This data base will be used to draw a random sample of 1200 patients from admissions records of selected residential and outpatient treatment programs for the purpose of analyzing treatment outcomes. Data will be collected at four points in time, admission, discharge, and post-discharge for two quarters employing a pre-post test design. The Service Level Checklist from the Arizona Level of Functioning Assessment will be employed in this study.

2. ARKANSAS Award - $298,367

   The project will identify 200 pregnant and or parenting women from 5 specialty treatment centers and an additional sample of 200 pregnant and/or parenting women admitted to non specialty, residential facilities from approximately the same geographic regions within the State. The two samples will be matched on variables pertinent to recovery. The Addiction Severity Index (ASI) will be used at admission to match these samples. The Treatment Services Review instrument will be employed six times during the course of treatment to evaluate the women on the nature and amounts of treatment services provided. All women will be contacted at 6 months following discharge from treatment and be re interviewed with the ASI to provide an estimate of change in status from pre to post treatment as well as a functional evaluation of their outcome status following treatment, in the dimensions of substance use, personal health, social function, health and social service utilization.

3. CONNECTICUT Award - $306,285

   The State will develop and pilot test two sets of instruments crucial for a comprehensive evaluation of the State's emerging managed system of care. The first set will make it possible to collect information about substance use from clients being treated within a full range of addiction services and mental health programs. The second set is a special assessment module designed to provide detailed information about the substance use histories, treatment services, and treatment outcomes specific to the unique needs of pregnant women and women with dependent children. An instrument design phase will use the collaborating team of University of Connecticut researchers and the Connecticut State staff to develop core prototypes of the core assessment instruments. A pilot testing phase of the instruments will then be implemented. The refinement phase will consist of a review of all information obtained in pilot testing phase to make modifications in proposed instruments before recommending them for wide scale use within the Connecticut addiction treatment system. Five different types of facilities, each representing a different level of service, will be selected as sites including an inpatient medical detoxification unit, a state operated hospital residential unit, a partial hospitalization program, an outpatient substance abuse clinic, and a special residential program for pregnant women. A total of 125 clients will be recruited, 25 from each program site.

4. KANSAS Award - $299,259

   The State will use available secondary State data to study what kind of treatment is best for which patients, what treatment components are essential to recovery, what combinations of services improve outcome, the impact managed care has on outcome of services, and the impact of culturally sensitive treatment on treatment outcome. A minimum expected sample size of 500 is proposed. Outcome variables such as client functioning data, environmental influences such as social support and availability of illicit drugs, intensity of treatment and treatment modality, components and management will be developed and measured within the Addiction Severity Index and other indices. The State will address the impact of managed care on services by comparing Wichita, the area currently under a managed care system, before and after implementation of the system and also compare it to Topeka, an area not under a managed health care system. Culturally specific services for Native Americans and African Americans will be studied by comparing outcomes for criminal justice and non-criminal justice clients as well as compare minority and non minority criminal justice clients.

5. MARYLAND Award - $141,050

   This pilot study will create a method for identifying successful programs while controlling for client characteristics and identifying program and client characteristics that are related to successful treatment outcomes. The study will design a system for comparing treatment outcomes across adult drug-free outpatient programs through: (1) program-based comparisons and (2) client-based comparisons. An analysis of short term outcomes will be studied using the available Maryland Substance Abuse Management Information System and the Addictions Severity Index. All clients discharged from State funded adult drug free outpatient programs in FY 1995 and 1996 will be included.

6. MASSACHUSETTS Award - $569,918

   The pilot study will develop treatment services checklists to collect information on treatment services, discharge status and post treatment functioning that is responsive to the operating principles and needs of the State. Information on 600 clients in 15 outpatient and 15 residential programs in the metropolitan Boston area will be collected. All clients in treatment on a selected day will be asked about treatment services received during the past two weeks and their satisfaction with those services. The program care givers will also be asked similar questions about the client. These clients will then participate in a follow-up study three months after discharge to determine client substance use and social, physical, emotional and vocational functioning. The discharge MIS form will be redesigned at this time. Once data collection is completed, the predictive ability of type and intensity of treatment services with discharge status will be examined as well as the relationship between status at discharge and after treatment follow up at three months.

7. MINNESOTA Award - $389,538

   Two studies are proposed: (1) One study would specifically address the role of parents/guardians in adolescent treatment, and the relationship between their involvement and adolescent treatment outcome. The sample will be parents/guardians of 30 adolescents from each participating treatment program. It is estimated that 1,050 parents/guardians will participate. Parents/guardians will have data collected at three points in time, when the adolescent is admitted to treatment, when the adolescent is discharged from treatment, and 3 months after discharge. The pilot study will include existing and/or new instruments that will be designed for parents/guardians. The 3 month posttreatment interview with the adolescent will be developed to coincide with the parent/guardian follow up interval. (2) The second study would analyze existing data sets to address issues of treatment accountability, especially for managed care clients. The study will cover adult public pay treatment admissions for the calendar years 1993 through 1996. The State's Client Assessment/Placement Form, the Client Placement Authorization form and the Drug and Alcohol Abuse Normative Evaluation System will be used to collect data from this sample. This study will answer the question of what differences exist in treatment placement patterns, treatment services, lengths of stay and treatment outcomes between public pay clients enrolled in Prepaid Health Plans administered by not for profit private entities, Prepaid Health Plans administered by county governments, and the fee for service system administered by the State and counties.

   8. MISSOURI Award - $306,130

   The State will develop and pilot test a case mix adjustment methodology in which they can assess provider performance while accounting for differences among providers associated with the initial condition of their patient populations. The State will pilot test the women's population of Missouri's Comprehensive Substance Abuse Treatment and Rehabilitation programs in the city of St. Louis. The State will collect data using dimensions of the Addiction Severity Index and the Global Assessment Functioning scale. Client demographics will be obtained from the State Client Tracking , Registration, and Commitment database. Baseline admissions score, discharge scores and 6 months follow up scores will be taken to predict clients' outcome scores. Approximately 1,080 clients would be available for follow up.

8. NORTH CAROLINA Award - $784,939

   The State will identify, test, and recommend an approach to develop performance and outcome monitoring that can be implemented throughout the treatment system in North Carolina. Three pilot studies will be planned and conducted and the overall review and evaluation should provide the information to select one or a combination of approaches to implement Statewide by FY 1999. The State will use existing program and State data bases to study four areas of North Carolina. Approximately 3-6 programs within each area will be involved with samples of 150 patients from each area. A total of 800 patients will be included in the sample. The study will also provide information on treatment performance and outcomes monitoring appropriate for juveniles and adults in the criminal justice system.

9. NORTH DAKOTA Award - $303,520

   The State has designed the pilot study with the central goal to assess the effects of formal and informal support on clients' functioning after treatment. Effects will be measured by comparing clients' outcome functioning as measured by the Addiction Severity Index at intake and 4 months after discharge from treatment, adjusting for the case mix and treatment variables. The State will also study how support service indicators, measures, and their effect on recovery vary by ethnicity (Native American vs. Non-Native American), sex and age. Data will be collected from a sample of 100 cases in the State Hospital's patient record files.

10. OKLAHOMA Award - $388,646

    This pilot study is designed to develop an Outcome Management System (OMS) that includes Addiction Severity Index scores, ASAM PPC-2 results and posttreatment information, such as employment and criminal justice system involvement after discharge. Client, problem, treatment, environment and outcomes data will also be collected and analyzed to evaluate and modify the OMS. The State will also measure the managed care network performance versus non-managed care areas of the State. A region of the State with State operated and private, non profit behavioral health treatment agencies in rural and urban locations has been selected as the pilot site. The impact of managed care will be compared with the results in the rest of the State.

11. RHODE ISLAND Award - $395,049

    This pilot study is designed to expedite the refinement and implementation of assessment based on the Addiction Severity Index (ASI) and tracking of performance indicators as indications of favorable post-treatment outcomes. Developing, in a limited number of facilities, the pilot version of an electronic data system, this study will develop the infrastructure for conducting clinical outcomes evaluations. It will also develop and pilot performance indicators, instruments, and a methodology for such evaluations. The pilot study will be implemented to examine the treatment of parenting women. The State will design and pilot an electronic system to collect and maintain an assessment, tracking, and outcomes database on all public patients. The ASI will be modified to use as the core assessment instrument in baseline assessment on all public patients. They will also adapt a set of additional data elements to enrich the core instrument for the assessment of outcomes for parenting women. They will modify the Treatment Services Review to use as a tracking instrument. The ASI will be modified as a follow up instrument to assess clinical outcomes. A sample of 600 women will be studied.

12. UTAH Award - $367,267

    The pilot study will develop a patient administered Addictions Severity Index (ASI Self) to compare the ASI information provided by the patient to those performed by skilled ASI interviewers. It will also develop an instrument to supplement the ASI (ASI-PPM) to guide the treatment program clinician in obtaining information to create treatment plans or make placement decisions based on ASAM criteria. The clinician will also be able to make decisions on what instruments should be used in the State. A clinical outcomes evaluation will also be implemented. A total of 12 treatment programs will be studied. Six will pilot the ASI Self and the Soft PPM (a software package to support treatment planning and placement) and six matching programs will use the ASI Self with treatment placement and planning decisions unsupported by the Soft PPM. A sample of 40 new admissions per program will be recruited totaling 480 patients. The Self ASI will be implemented at admission and the Treatment Services Review will be performed during treatment. The ASI will be implemented again 7 months after admission.

13. WASHINGTON Award - $662,085

    Two State clinical tracks will be evaluated during and following treatment: (1) the Full Continuum of Care, starting at inpatient care and continuing through aftercare and (2) the Partial Continuum of Care, clients placed (due to lack of residential bed availability) in Intensive Outpatient care to start and are expected to continue through aftercare. Approximately 200 patients will be sampled from each group and will be recruited from the King County Assessment Center. The full Addiction Severity Index and a measure of physical and craving symptoms following alcohol and drug cessation (Withdrawal and Craving Measure) will be added to the initial assessment battery that is already in place. The Treatment Services Review will be implemented on a bi-weekly basis throughout the course of treatment. Clients will also be evaluated at the completion of each stage of the continuum of care. The effectiveness of the initial phase of treatment will be assessed with this approach. Patients will be re-evaluated at approximately 30 days following the initial assessment measuring levels of physiological and emotional symptoms, motivation/stage of change and drop-out/involvement in treatment. Re-evaluation will occur again in months 2, 3 and 9 to measure improvement and functional status.

Last Updated 11-7-02