Recovery Support Services Recovery Support Services and Client Outcomes:and Client Outcomes:

What do the Data Tell Us?What do the Data Tell Us?

Recovery Community Services Program Recovery Community Services Program Grantee MeetingGrantee Meeting

December 14, 2007December 14, 2007

Recovery Oriented Systems of Recovery Oriented Systems of Care Projects in TexasCare Projects in Texas

Access to Recovery (ATR)Access to Recovery (ATR)

Co-Occurring State Incentive Grant (COSIG)Co-Occurring State Incentive Grant (COSIG)

Texas ATR ProjectTexas ATR Project

Texas ATR ProjectTexas ATR Project

Targets individuals who are involved in the Targets individuals who are involved in the criminal justice system through drug criminal justice system through drug courts, probation, or child protective courts, probation, or child protective servicesservices

Provides independent assessment to Provides independent assessment to determine service needs and client choice determine service needs and client choice among an array of service providers, among an array of service providers, including faith-based and community including faith-based and community organizationsorganizations

Texas ATR Voucher SystemTexas ATR Voucher System

Clinical AssessmentClinical Assessment Care CoordinationCare Coordination Addiction TreatmentAddiction Treatment Individual Recovery Individual Recovery

CoachingCoaching Spiritual Support Spiritual Support

GroupGroup Relapse Prevention Relapse Prevention

GroupGroup

Life Skills GroupLife Skills Group Recovery Support Recovery Support

GroupGroup Transitional HousingTransitional Housing GED AssistanceGED Assistance Employment Employment

CoachingCoaching Marital and Family Marital and Family

CounselingCounseling

ATR Study 1ATR Study 1

Study compares addiction treatment Study compares addiction treatment outcomes of ATR clients (n = 1049) with a outcomes of ATR clients (n = 1049) with a randomly selected sample of criminal randomly selected sample of criminal justice clients (n = 1049) receiving state justice clients (n = 1049) receiving state funded treatment services who did not funded treatment services who did not participate in the ATR programparticipate in the ATR program

Client CharacteristicsClient Characteristics

ATR clients were more likely to be Hispanic and ATR clients were more likely to be Hispanic and employed, whereas non-ATR clients were more employed, whereas non-ATR clients were more often White, older, and maleoften White, older, and male

Non-ATR clients had a greater history of both Non-ATR clients had a greater history of both detox and non-detox addiction treatmentdetox and non-detox addiction treatment

Non-ATR clients reported more days of primary Non-ATR clients reported more days of primary substance use during the month prior to substance use during the month prior to admission; however, the groups did not differ in admission; however, the groups did not differ in the frequency of use over the past six monthsthe frequency of use over the past six months

Number of Days in Addiction Number of Days in Addiction TreatmentTreatment

54.9

72.4

ATR Non-ATR

*

Percentage of Clients Completing Percentage of Clients Completing Addiction TreatmentAddiction Treatment

64%

54%

ATR Clients Non-ATR Clients

*

Abstinence Rates (Past 30 Days) at Abstinence Rates (Past 30 Days) at Discharge from TreatmentDischarge from Treatment

71%66%

ATR Clients Non-ATR Clients

*

AA/NA Attendance Rates (Past 30 Days) AA/NA Attendance Rates (Past 30 Days) at Discharge from Treatmentat Discharge from Treatment

75%70%

ATR Non-ATR

*

Percentage of ATR Clients Receiving Percentage of ATR Clients Receiving Recovery Support Services in Combination with Recovery Support Services in Combination with

Treatment by Completion StatusTreatment by Completion Status

31%

22%

Treatment Completers Treatment Non-Completers

*

Summary of ATR Study 1:Summary of ATR Study 1:ATR vs. Non-ATR Criminal Justice ClientsATR vs. Non-ATR Criminal Justice Clients

ATR clients had shorter lengths of stay in ATR clients had shorter lengths of stay in treatmenttreatment

ATR clients had more successful outcomes in ATR clients had more successful outcomes in the areas of treatment completion and past the areas of treatment completion and past month abstinence and AA/NA attendance at month abstinence and AA/NA attendance at dischargedischarge

ATR clients who completed treatment were more ATR clients who completed treatment were more likely to receive recovery support services in likely to receive recovery support services in combination with treatment rather than treatment combination with treatment rather than treatment alonealone

ATR Study 2ATR Study 2

Study examines outcomes of 825 Study examines outcomes of 825 individuals who received ATR services individuals who received ATR services during the period of June 2005 and during the period of June 2005 and September 2006September 2006

Successful completers of the ATR Successful completers of the ATR program (n = 311) were compared to non-program (n = 311) were compared to non-completers (n = 514) on client and completers (n = 514) on client and voucher service characteristicsvoucher service characteristics

Client CharacteristicsClient Characteristics

Completers were more likely to be Completers were more likely to be Hispanic, employed, living independently, Hispanic, employed, living independently, and to have higher levels of educationand to have higher levels of education

Drug court participants had higher Drug court participants had higher completion rates (61%) relative to completion rates (61%) relative to probationers (20%) and individuals probationers (20%) and individuals involved with child protective services involved with child protective services (38%)(38%)

Number of Days in ATR ProgramNumber of Days in ATR Program

162

119

Completers Non-Completers

*

Treatment and Recovery Support Treatment and Recovery Support Services CombinationsServices Combinations

40%

50%

10%17%

78%

5%

Treatment Only Recovery Support Only Treatment andRecovery Support

Completers Non-Completers

*

Categories of Recovery Categories of Recovery Support ServicesSupport Services

Emotional / AffiliationalEmotional / Affiliational

Individual Recovery Individual Recovery CoachingCoaching

Recovery Support GroupRecovery Support Group Relapse Prevention Relapse Prevention

GroupGroup Spiritual Support GroupSpiritual Support Group Life Skills GroupLife Skills Group Family and Marital Family and Marital

CounselingCounseling

Instrumental / InformationalInstrumental / Informational

Employment CoachingEmployment Coaching TransportationTransportation Transitional HousingTransitional Housing GED AssistanceGED Assistance ChildcareChildcare

Categories of Recovery Support Categories of Recovery Support Services ReceivedServices Received

34%

22%

7%

44%

Emotional / Affiliational Instrumental / Informational

Completers Non-Completers

**

Summary of ATR Study 2:Summary of ATR Study 2:Factors Associated with Successful Factors Associated with Successful

ATR OutcomesATR Outcomes

Retention in the ATR programRetention in the ATR program

Receiving treatment only or treatment in Receiving treatment only or treatment in combination with recovery support servicescombination with recovery support services

Receiving emotional and affiliational recovery Receiving emotional and affiliational recovery support services that are more directly centered support services that are more directly centered on the process of recoveryon the process of recovery

Drug court supervisionDrug court supervision

Client employment and higher education levelsClient employment and higher education levels

Texas COSIG ProjectTexas COSIG Project

Texas COSIG Project Texas COSIG Project Key ComponentsKey Components

Training of addiction counselors on co-Training of addiction counselors on co-occurring disorders and the use of occurring disorders and the use of diagnostic and assessment instruments to diagnostic and assessment instruments to improve identification of comorbidity and improve identification of comorbidity and monitor client progressmonitor client progress

A voucher system that provides recovery A voucher system that provides recovery support services to enhance the treatment support services to enhance the treatment process ($1800 per client)process ($1800 per client)

Voucher Service CategoriesVoucher Service Categories

Child CareChild Care

Housing SupportHousing Support

TransportationTransportation

Food AssistanceFood Assistance

Education SupportEducation Support

Employment AssistanceEmployment Assistance

ClothingClothing

Medical CareMedical Care

PrescriptionsPrescriptions

Peer MentoringPeer Mentoring

COSIG StudyCOSIG Study

Data were obtained for 424 COSIG clients Data were obtained for 424 COSIG clients who entered and were discharged from who entered and were discharged from addiction treatment during the period of addiction treatment during the period of February 2005 through October 2006February 2005 through October 2006

76% of the sample completed treatment76% of the sample completed treatment

Treatment completers (n=323) and non-Treatment completers (n=323) and non-completers (n=101) were compared on completers (n=101) were compared on client and service characteristicsclient and service characteristics

Client CharacteristicsClient Characteristics

Treatment completers were more likely to Treatment completers were more likely to be male and homelessbe male and homeless

Treatment completers had a greater Treatment completers had a greater history of both detox and non-detox history of both detox and non-detox addiction treatmentaddiction treatment

Treatment completers reported greater Treatment completers reported greater primary substance use during the 30 days primary substance use during the 30 days prior to admissionprior to admission

Diagnostic CharacteristicsDiagnostic Characteristics

0%

10%

20%

30%

40%

50%

60%

BIPOLAR DEPRESSION HYPOMANIC DYSTHYMIA PANIC OCD PSYCHOTIC GENANXIETY

PTSD

COMPLETER NON-COMPLETER

*

**

*

Recovery Support Services Recovery Support Services Received During TreatmentReceived During Treatment

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

CHILDCARE

VOCATIONAL

PRESCRIPTIONS

MEDICAL

CLOTHING

EDUCATION

PEER MENTORING

FOOD

TRANSPORTATION

HOUSING

COMPLETER NON-COMPLETER

**

*

*

*

Recovery Support Service Recovery Support Service CombinationsCombinations

0%

10%

20%

30%

40%

50%

60%

70%

PEER MENTORING + INSTRUMENTAL / INFORMATIONALSUPPORTS

INSTRUMENTAL / INFORMATIONAL SUPPORTS ONLY

COMPLETER NON-COMPLETER

*

*

Summary of COSIG Study:Summary of COSIG Study:Service and Client Characteristics Service and Client Characteristics

Associated with Treatment CompletionAssociated with Treatment Completion

Peer mentoring had the strongest association with Peer mentoring had the strongest association with treatment completiontreatment completion

Instrumental and informational support services, Instrumental and informational support services, particularly in the absence of peer mentoring, were particularly in the absence of peer mentoring, were associated with non-completionassociated with non-completion

Treatment completers were more likely to male and Treatment completers were more likely to male and have depression and anxiety diagnoses, whereas have depression and anxiety diagnoses, whereas non-completers were more often diagnosed with non-completers were more often diagnosed with bipolar and posttraumatic stress disordersbipolar and posttraumatic stress disorders

ConclusionsConclusions

What Do the Data Tell Us About What Do the Data Tell Us About Recovery Support Services?Recovery Support Services?

Recovery support services can play a Recovery support services can play a significant role in the continuum of caresignificant role in the continuum of care

Emotional and affiliational support services Emotional and affiliational support services may be essential components in an may be essential components in an individual’s service arrayindividual’s service array

Provision of instrumental and informational Provision of instrumental and informational supports only may be less effective in supports only may be less effective in sustaining the process of recovery sustaining the process of recovery

Why is Evaluation Important?Why is Evaluation Important?

Provides evidence that your services are making Provides evidence that your services are making a differencea difference

Provides feedback regarding meeting your Provides feedback regarding meeting your project’s goalsproject’s goals

Provides information to guide program planning:Provides information to guide program planning: Effectiveness of various services and service combinationsEffectiveness of various services and service combinations Identification of potential subgroups of participants who are Identification of potential subgroups of participants who are

less responsive to servicesless responsive to services Informs outreach effortsInforms outreach efforts

What More Do We Need to Know?What More Do We Need to Know?

Successful completion of the ATR program or Successful completion of the ATR program or treatment is only one method of defining treatment is only one method of defining outcomes; other studies are needed using a outcomes; other studies are needed using a wider array of outcome measureswider array of outcome measures

More studies are needed to explore the effect of More studies are needed to explore the effect of various service combinations on client outcomesvarious service combinations on client outcomes

Longitudinal studies are needed to examine the Longitudinal studies are needed to examine the lasting effects of recovery support services on lasting effects of recovery support services on sustaining the process of recoverysustaining the process of recovery

AcknowledgementsAcknowledgements

Texas Department of State Health ServicesTexas Department of State Health Services

Karen Eells, MSSW, LMSWKaren Eells, MSSW, LMSW

ATR Project DirectorATR Project Director

Kwame Bruce, Psy.D.Kwame Bruce, Psy.D.

COSIG Project DirectorCOSIG Project Director

Lesli San JoseLesli San Jose

Decision Support Research SpecialistDecision Support Research Specialist

Substance Abuse and Mental Health Substance Abuse and Mental Health

Services AdministrationServices Administration