/ GulfCoastAddictionTechnologyTransferCenter
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Austin, Texas78703
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Final Evaluation Report

Creating Access to Recoverythrough Drug Courts

Texas Department of State Health Services

Mental Health and Substance Abuse Services Division

June 2008

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Executive Summary

The Access to Recovery (ATR) grant is part of a Presidential initiative to address clients’ difficulty in accessing substance abuse treatment and recovery support services. The purpose of the ATR project is to implement a service structure to achieve the following goals:

  • Expand service capacity using grant funds to supplement (not supplant) current funding, including the recruitment of new treatment and recovery support providers in the service network.
  • Ensure clients receive independent assessment for determining the appropriate levels and types of services needed.
  • Provide clients genuine, free, independent choice among treatment and recovery support providers.
  • Establish a wide network of community organizations and faith-based providers to ensure clients have at least one service provider choice among the array for which the client has no religious objection.
  • Institute a voucher program that provides voucher monies directly to clients for independent purchase of all assessment, treatment, and recovery support services.

In fiscal year 2004, the Texas Department of State Health Services (DSHS) was awarded an ATR grant in the amount of $7.6 million per year for three years, with the goal of serving 8,928 clients by August 2, 2007. The Texas project was designed to implement an ATR service structure targeting criminal justice populations. Initially, ATR clients were identified exclusively through participating drug courts. By December 2005, the ATR program expanded to accept non-drug court referrals from probation departments and Child Protective Services (CPS) offices.

This final evaluation report examines ATR client outcomes to provide information regarding program effectiveness. To evaluate program outcomes, ATR clients who received substance abuse treatment were compared to samples of non-ATR DSHS criminal justice and non-criminal justice clients receiving state-funded treatment services. Further, ATR clients who successfully completed the ATR program were compared to those with unsuccessful outcomes. Next, ATR program outcomes were contrasted by the three referral sources to explore potential differences in response for CPS, drug court, and probation clients. Finally, ATR program outcomes were examined for males and females separately to explore potential gender differences in services related to outcomes. Below are statistically significant results from these analyses.

ATR Substance Abuse Treatment Outcomes

  • Analyses of baseline characteristics suggested that the ATR client group may have entered treatment with less severe substance abuse symptomatology compared to non-ATR clients, particularly in relation to the DSHS non-criminal justice group. Participation in drug court supervision, however, may have affected the levels of substance use reported by ATR clients at treatment entry, confounding measures of severity at admission. Despite the potential lower levels of substance abuse severity, ATR clients in this sample displayed sufficient symptomatology during assessment to meet criteria for state-funded treatment services, indicating that their substance use was at a severe enough level to warrant treatment.
  • ATR clients achieved better outcomes in the areas of treatment completion andpast month abstinenceat discharge relative to both non-ATR DSHS criminal justice and non-criminal justice clients.
  • In addition to enhanced outcomes, ATR clients had significantly longer lengths of stay in treatment relative to both non-ATR DSHS criminal justice and non-ATR DSHS criminal justice clients.

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  • Among ATR clients, drug court and probation clients achieved higher completion rates relative to CPS clients, suggesting that that legal supervision may enhance treatment outcomes. Substance abuse treatment completion for ATR clients was also associated with the provision of direct recovery support services (individual recovery coaching, relapse prevention group, recovery support group, spiritual support group, life skills group, and marital/family counseling) in combination with treatment rather than social support services (transitional housing, transportation, employment coaching, and childcare).

ATR Program Outcomes

  • Contrasts of ATR program completion and referral source groups indicated that retention in the ATR program and the provision of treatment only or treatment in combination with recovery support services were associated with positive outcomes.
  • Among the specific types of recovery support services, those services that are most closely related to the process of recovery, such as individual recovery coaching, recovery support group, relapse prevention group, and spiritual support group were more strongly associated with successful outcomes.
  • Provision of recovery support services only, rather than in combination with treatment, was associated with unsuccessful outcomes. Specifically, recovery support services that provide social supports, such as transitional housing, transportation, and employment coaching, appear to be more highly associated with negative outcomes, particularly in the absence of substance abuse treatment.
  • Analyses of client characteristics suggested that drug court clients and individuals who are employed, living independently, and have higher education levels may be more likely to achieve positive outcomes in the ATR program.
  • Gender analyses revealed the same pattern of results as found in the total sample, suggesting that client and service characteristics associated with successful ATR program completion are comparable for females and males.

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TABLE OF CONTENTS

Federal Grant Overview

Access to Recovery Grant Objectives

Creating Access to Recovery through Drug Courts

Award Details

Service Delivery Model

Allowable Services

Assessment Providers

Licensed Treatment Providers

Recovery Support Providers

Client Eligibility

Drug Court Participants

Probationers

CPS Clients

Provider Network

Licensed Treatment Providers

Recovery Support Providers

Map of Program Coverage: ATR Counties

Drug Court Overview

General Description

Effectiveness

Texas Drug Courts

Civil Family Drug Courts

Criminal Adult or Juvenile Drug Courts

Pre-Adjudication

Post Adjudication

ATR Drug Courts by County and Program Type

ATR Client Outcomes

Substance Abuse Treatment Outcomes for ATR Clients

ATR Criminal Justice Clients versus Non-ATR DSHS Criminal Justice Clients

ATR Clients versus DSHS Non-Criminal Justice Clients

Referral Source and Voucher Service Characteristics of ATR Substance Abuse Treatment Completers versus Non-Completers

Summary of ATR Client Substance Abuse Treatment Outcomes

ATR Program Outcomes

ATR Program Completers versus Non-Completers

ATR Client and Service Characteristics by Referral Source

Recovery Support Services Associated with ATR Program Outcomes

ATR Program Outcomes by Gender

Summary of ATR Program Outcomes

Summary of ATR Client Outcomes

Acknowledgements

References

Appendix

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list of Figures

FIGURE 1. Percentage of Clients Completing Substance Abuse Treatment for
ATR Criminal Justice and Non-ATR DSHS Criminal Justice Clients...... 13

FIGURE 2. Percentage of ATR Criminal Justice and Non-ATR DSHS Criminal Justice
Clients Abstinent for Past 30 Days at Discharge from Treatment...... 14

FIGURE 3. Percentage of ATR Criminal Justice and Non-ATR DSHS Criminal Justice
Clients Attending AA in Past 30 Days at Discharge from Treatment...... 15

FIGURE 4. Mean Length of Substance Abuse Treatment in Days for ATR Criminal Justice
and Non-ATR DSHS Criminal Justice Clients...... 16

FIGURE 5. Percentage of Clients Completing Substance Abuse Treatment for ATR and
DSHS Non-Criminal Justice Clients...... 17

FIGURE 6. Percentage of ATR and DSHS Non-Criminal Justice Clients Abstinent for
Past 30 Days at Discharge from Treatment...... 18

FIGURE 7. Percentage of ATR and DSHS Non-Criminal Justice Clients Attending AA
in Past 30 Daysat Discharge from Treatment……………...... 19

FIGURE 8. Mean Length of Substance Abuse Treatment in Days for ATR and DSHS
Non-Criminal Justice Clients...... 20

FIGURE 9. Substance Abuse Treatment Completion Rates by ATR Referral Source...... 21

FIGURE 10.Percentage of ATR Clients ReceivingRecovery Support Service Combinations for
Treatment Completers and Non-Completers...... 22

FIGURE 11. Mean Number of Days in ATR Program for Completers and Non-Completers...... 24

FIGURE 12. Percentage of Clients Receiving Substance Abuse Treatment and Recovery
Support Service Combinations for ATR Program Completers and Non-Completers...... 25

FIGURE 13. Percentage of Clients Successfully Completing ATR Program by Referral Source...... 26

FIGURE 14. Mean Number of Days in ATR Program by Referral Source...... 27

FIGURE 15. Percentage of ATR Clients Receiving Substance Abuse Treatment and
Recovery Support Service Combinations by Referral Source...... 28

FIGURE 16. Percentage of Clients Receiving Recovery Support Service Combinations for ATR
Program Completers and Non-Completers...... 29

FIGURE 17. Mean Number of Days in ATR Program for Female Completers
and Non-Completers...... 30

FIGURE 18. Percentage of Clients Receiving Substance Abuse Treatment and Recovery
Support Service Combinations for Female ATR Program Completers and Non-Completers...... 31

FIGURE 19. Percentage of Female Clients Receiving Recovery Support Service Combinations
for ATR Program Completers and Non-Completers...... 32

FIGURE 20. Mean Number of Days in ATR Program for Male Completers
and Non-Completers...... 33

FIGURE 21. Percentage of Clients Receiving Substance Abuse Treatment and Recovery
Support Service Combinations for Male ATR Program Completers and Non-Completers...... 34

Figure 22. Percentage of Male Clients Receiving Recovery Support Service Combinations
for ATR Program Completers and Non-Completers...... 35

Figure 23 Profile of the Successful ATR Program Completer...... 37

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list of tables

TABLE 1. Demographic and Social Characteristics of ATR and Non-ATR DSHSCriminal
Justice Clients at Admission to Treatment...... A 42

TABLE 2. Substance Abuse Treatment History and Substance Use Patterns of ATR and
Non-ATR DSHS Criminal Justice Clients...... A 43

TABLE 3. Demographic and Social Characteristics of ATR and DSHS Non-Criminal Justice Clients at Admission to Treatment A 44

TABLE 4. Substance Abuse Treatment History and Substance Use Patterns of ATR and DSHS
Non-Criminal Justice Clients...... A 45

TABLE 5.Voucher Service Characteristics of ATR Substance Abuse Treatment
Completers and Non-Completers...... A 46

TABLE 6. Demographic and Social Characteristics of ATR Program Completers
and Non-Completers...... A 48

TABLE 7.Voucher Service Characteristics of ATR Program Completers and Non-Completers...... A 49

TABLE 8. Demographic and Social Characteristics of ATR Clients by Referral Source...... A 51

TABLE 9.Voucher Service Characteristics of ATR Clients by Referral Source...... A 52

TABLE 10. Demographic and Social Characteristics of Female ATR Program Completers
and Non-Completers...... A 54

TABLE 11. Voucher Service Characteristics of Female ATR Program Completers
and Non-Completers...... A 55

TABLE 12. Demographic and Social Characteristics of Male ATR Program Completers
and Non-Completers...... A 57

TABLE 13. Voucher Service Characteristics of Male ATR Program Completers
and Non-Completers...... A 58

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Section
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Federal Grant Overview

United States Department of Health and Human Services (HHS)

Substance Abuse and Mental Health Services Administration(SAMHSA)

Center for Substance Abuse Treatment (CSAT)

Access to Recovery Grant Objectives

The Access to Recovery (ATR) grant is part of a Presidential initiative to address clients’ difficulty in accessing substance abuse treatment and recovery support services.States receiving the ATR grant are awarded funds over a three year period to implement a service structure targeting the following objectives:

  • Expand service capacity by using grant funds to supplement (not supplant) current funding, including the recruitment of new treatment andrecovery support providers in the service network.
  • Ensure clients receive independent assessment for determining the appropriate levels and types of services needed.
  • Provide clients genuine, free, independent choice among treatment and recovery support providers.
  • Establisha wide network of community organizations and faith-based providers to ensure clients have at least one service provider choice among the array for which the client has no religious objection.
  • Institute a voucher program that provides voucher monies directly to clients for independentpurchaseof all assessment, treatment, and recovery support services.

In summary, ATR attempts to minimize barriers to treatment and recovery by engaging all available resources within the community to assist clients, including faith-based providers. The program seeks to empower clients with choice, so that clients can participate more fully in ensuring the services they receive best meet their individual needs.

Access to Recovery ensures that a full range of clinical treatment and recovery support services are available, including the transforming powers of faith. It allows consumers in need of treatment to choose the best services for them. This way recovery can be pursued through many different and personal pathways.1

Charles G. Curie
SAMSHA Administrator

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Section
2

Creating Access to Recovery through Drug Courts

Award Details

During fiscal year 2004, SAMSHA funded 15 separate awards for the ATR program.The Texas Department of State Health Services (DSHS) received the maximum per year award amount of $7.6 million per year for three years, with the goal of serving 8,928 clients by August, 2, 2007.

Service Delivery Model

As illustrated in the diagram above, clients may be identified through involvement in drug court, probation, or Child Protective Services (CPS). (See Client Eligibility for more details.)

After being referred to the ATR program independent assessment provider, clients receivea clinical assessmentand client placement guidelines for treatmentand/or an abbreviated intake for recovery support services to determine level of care and service needs. The assessment provider then presents clients with a listing of enrolledlicensed treatment providers and/or recovery support providers from which they may attain services.

Once clients choose, the assessment provider authorizes vouchers for the provision of needed services and contacts the chosen providers with client referrals. Note: During this reporting period, the maximum total voucher amount available perclient was $20,000. Vouchers are effective for one year.

When clients present for services, treatment begins usingan individualized treatment plan that is created in collaboration with clients. Both treatment providers and recovery support providers document services and bill DSHS for payment from client vouchers.

Throughout client enrollment in ATR, the assessment provider coordinates care by maintaining regular contact with clients, treatment providers, and recovery support providers. The assessment provider monitors progress and adjusts vouchers as determined by client choices and evolving service needs. The assessment provider also reports back to the referring drug court, probation, or CPS personnel with status updates regarding client progress.

Allowable Services

Assessment Providers

Clinical assessmentusing the client assessment and client placement guidelines for DSHS-funded substance abuse treatment and/or an abbreviated intake for recovery support services.

Care coordination, including arrangements for transportation and child care as needed.

Licensed Treatment Providers

Clinical treatment servicesinclude adult intensive and supportive residential, adult specialized female residential, adult individual and group outpatient, adult specialized female outpatient, women with children services, youth intensive and supportive residential, youth specialized female residential, youth individual and group outpatient, and youth specialized female outpatient.

Recovery Support Providers

Recovery support services, including individual recovery coaching, spiritual support group, relapse prevention group, life skills group, recovery support group, transitional housing, educational training (GED), employment coaching,transportation, childcare and marital / family counseling.

Client Eligibility

Initially, ATR clients were identified exclusively through participating drug courts. By December 2005, the ATR program expanded to accept referrals from non-drug court probation and CPS offices.

Drug Court Participants

Clients must be involved in and referred by a drug court thathas a Memorandum of Agreement (MOA) with DSHS. Participating drug courts are located in Bexar, Burnet, Collin, Dallas, El Paso, FortBend, Grayson, Harris, Brooks/Jim Wells, Lubbock, Tarrant, and Travis counties. Client eligibility ends either when drug court participation is terminated or when the maximum total voucher amount is reached.

Probationers

Adult clients must be under community supervision in one of the following counties: Bexar, Brooks, Burnet, Collin, Dallas, El Paso, Ft.Bend, Grayson, Harris, Jim Wells, Lubbock, Tarrant, or Travis. Juvenile probationers are eligible for services in Bexar, Dallas, Lubbock, Tarrant, and Travis counties.Probationers may be referred for an assessment by probation officers, court officers, treatment providers, or recovery support providers. Probationers may also self-refer for an assessment or be identified directly by assessment providers. Probationers may participate regardless of offense type. Client eligibility ends when the maximum total voucher amount is reached.

CPS Clients

Adult clients must have an active CPS case in one of the following counties: Bexar, Brooks, Burnet, Collin, Dallas, El Paso, Ft.Bend, Grayson, Harris, Jim Wells, Lubbock, Tarrant, or Travis. CPS clients may be referred for an assessment by CPS caseworkers, court officers, treatment providers, or recovery support providers. CPS clients may also self-refer for an assessment or be identified directly by assessment providers. Eligible CPS clients may or may not be involved in Family Court. Client eligibility ends when the maximum total voucher amount is reached.

Provider Network

As of May 2008, 236 total providers were participating in serving ATR clients.