Session: Access Services in Substance Abuse Treatment in Specialty and Non-Specialty Settings (Society for Social Work and Research 15th Annual Conference: Emerging Horizons for Social Work Research)

Examining the role of access services in substance abuse treatment is important given shifts in the nation's service system to more outpatient treatment in non-specialty settings. During the 1990's, managed care organizations sought to control costs by limiting expensive inpatient services and promoting the use of outpatient treatment. Between 1990 and 2002, the National Drug Abuse System Survey identified 22,000 substance abuse treatment programs, a reduction from the 35,000 that had been identified in 1995. This reduction resulted from increased competition created by managed care as well as from increased provision of substance abuse services within other non-specialty health and social service systems (child welfare, health, mental health, welfare, criminal justice). During the same period, the proportion of programs offering residential treatment dropped from 55% to 10%.

A broad base of research has demonstrated that substance abuse treatment can be provided effectively – in inpatient and outpatient settings as well as in specialty and non-specialty settings -- particularly when comprehensive health and social service needs are addressed. However, access to treatment across all settings remains a concern. Estimates indicate that as few as 10% of people with substance abuse and dependence disorders obtain services for their condition. Access has been conceptualized and measured in a variety of ways, both in terms of services designed to reduce barriers to treatment as well as time delays from point of referral to treatment entry. Questions remain regarding differential access to substance abuse treatment in specialty and non-specialty settings as well as factors that may improve or limit access for those most in need of services. Addressing these questions is crucial for improving service access in both inpatient and outpatient as well as specialty and non-specialty settings. Given social workers are the providers often responsible for designing and organizing these services, the need is great for social work services research to expand knowledge in this area.

This symposium will bring together analyses of service access across three large-scale data sets of substance abuse treatment programs: the National Treatment Improvement Evaluation Study (NTIES), a large, prospective study of substance abuse treatment programs; the Treatment Episode Data Set, with a specific focus on the Illinois treatment system; and, the Illinois Title IVE Alcohol and Other Drug Abuse (AODA) Waiver Study, an experimental comparative effectiveness study in Illinois designed to evaluate integrated child welfare and substance abuse service provision. All are studies that include measures of service access and factors related to access across diverse subpopulations of clients. The papers in the symposium will address the following three questions:

(1) What are conceptualization and measurement considerations in research on access services? (2) To what extent do analyses inform understanding of differential access across settings and factors contributing to improvements and limitations to service access? (3) What are implications of the findings for developing strategies to increase service access in the provision of substance abuse treatment services.