Participant Choice – Access to Recovery as a Voucher Service Delivery Model

Presented to National Summit on Prisoner Re-Entry

Sponsored by the White House Office of Faith Based and Community Initiatives

November 27, 2007

Texas Department of State Health Services

Mental Health

and Substance Abuse Division

Texas Access to Recovery (ATR) Program

Texas awarded $7.6 million per year for 3 years

Goal to serve of 8,928 clients (15,000 served thru 10/07)

Proposal “Creating Access to Recovery Through Drug Courts”

Texas ATR Program

Services in 13 counties

Single Assessment Provider for each county

Agreements with licensed treatment programs

Agreements with community and faith based recovery support providers

Original Drug Court Program has now expanded to include other referral sources

ATR Referral Sources

30 participating Drug Courts

13 County Adult Probation Departments

5 County Juvenile Probation Departments

13 County Child Protective Services Offices

ATR Process Flowchart

Client Referred

Assessment Provider

•Conducts assessment•Facilitates client choice of providers

•Generates voucher •Coordinates services and updates voucher

Clinical Treatment Recovery Support

Voucher

Web-based Client Record

Standardized documentation Collect consistent data Submit automated billing Monitor by on-line desk review

Utilization by provider Appropriate billing Appropriate documentation

Implementing Cultural Change

Education on Program Model Staff Stakeholders: Courts, CPS, Probation Providers

Dispel Myths Recovery support is not treatment Not all Recovery Service Providers are alike Not all Faith Based Organizations are alike Not all government agencies are alike

Recovery Support Services

Individual recovery coaching Spiritual support group Relapse prevention Life Skills Recovery Support Group

Drug-free Transitional Housing Education training (GED) Employment coaching Family/marital counseling Child Care Transportation

Assuring Client Choice

Assessment independent of service provider

Service plan developed by assessment provider

At intake, client receives brochure explaining right to choose provider

Client given directory of providers with program description written by the provider

Client satisfaction survey conducted

Bridging the Gap

Learn the language

Embrace technology

Reframe services

Identify similarities

Respect diversity

Pre-Application Training for Providers

Establish relationship with providers

Explain services, requirements and qualifications

Facilitate local networks and partnerships

Provide technical assistance Marketing services Matching their “services” to our “program” Writing program description Completing application Internet tools – sample application, etc.

Ongoing Technical Assistance for Providers

1:1 Technical assistance

Monthly conference calls

Training CD on documentation requirements

Internet tools for monitoring, training, and sample policies

Local assessment provider serves as resource

Interim Evaluation ResultsN= 825clients served 6/05-9/06

ATR clients achieved better outcomes in the areas of treatment completion, past month abstinence, and AA attendance at discharge relative to both non-ATR DSHS criminal justice and non-criminal justice clients.

In addition to enhanced outcomes, ATR clients had significantly shorter lengths of stay in treatment relative to non-ATR DSHS criminal justice clients.

Among ATR clients, drug court clients achieved the highest completion rates relative to CPS and probation clients, suggesting that higher levels of court supervision may enhance treatment outcomes.

Factors Associated with Successful ATR Outcomes

Retention in the ATR program

Receiving treatment only or treatment in combination with recovery support services

Receiving direct recovery support services that are most closely related to the process of recovery

Drug court supervision

Client employment and higher education levels

Percentage of Clients Completing Substance Abuse Treatment

for ATR and Non-ATR DSHS Criminal Justice Clients

64%

54%

0%

10%

20%

30%

40%

50%

60%

70%

ATR Clients Non-ATR DSHS CJ Clients

Mean Length of Substance Abuse Treatment in Days

for ATR and Non-ATR DSHS Criminal Justice Clients

54.9

72.4

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

ATR Clients Non-ATR DSHS CJ Clients

Employment Rates at Treatment Discharge for ATR and

DSHS Non-Criminal Justice Clients

49%

32%

0%

10%

20%

30%

40%

50%

60%

ATR Clients DSHS Non-CJ Clients

Homelessness Rates at Treatment Discharge for ATR and DSHS Non-Criminal Justice Clients

1%

6%

0%

2%

4%

6%

8%

10%

ATR Clients DSHS Non-CJ Clients

Substance Abuse Treatment Completion Rates by ATR Referral Source

50%

31%

19%

0%

10%

20%

30%

40%

50%

60%

CPS Drug Court Probation

Provider Networkas of 11/1/07

Providers 140 FBO (63%) 83 Secular (37%)

223 Total Providers 

ATR Voucher Expendituresas of 11/1/07

Treatment Expenditures = $7,361,822 28% to FBO

Recovery Services Expenditures = $8,050,422 51% to FBO

Most Common Servicesas of 11/1/07

Outpatient Treatment

Transportation

Individual Recovery Coaching

Recovery Support Group

Relapse Prevention Group

Client Satisfaction Surveyas of 11/1/07N=730

83% felt they had a choice of providers Strongly Agreed, Agreed and Neutral

97% received services right for them Strongly Agreed, Agreed and Neutral

98% services helped me become drug free Strongly Agreed, Agreed and Neutral

98% satisfied with services received Strongly Agreed, Agreed and Neutral

Acknowledgements

Karen Eells, MSSW, LMSW-APATR Project Director

Texas Department of State Health Serviceshttp://www.dshs.state.tx.us/sa/atr2/

Laurel Mangrum, Ph.D. and Michelle Steinley-Bumgarner, M.A. Authors of Interim Evaluation

Gulf Coast Addiction Technology Transfer CenterCenter for Social Work Research

School of Social WorkUniversity of Texas at Austin

Substance Abuse and Mental Health Services Administration