Friday, 14 January 2005 - 10:00 AM

This presentation is part of: Substance Abuse, Mental Health and Prostitution

Service Pathways and Treatment Outcomes of Women with Co-Occurring Mental Health and Substance Abuse Disorders Who Are Survivors of Interpersonal Trauma

Purpose The aim of the present study was to examine the psychiatric and substance abuse service utilization pathways of women with recent co-occurring disorders and trauma histories.. Burdened with multiple needs, these women often have treatment pathways in both the psychiatric and substance abuse. This paper draws from Andersen's (1995) model of the determinants of health care utilization to investigate the determinants of pathways of care and also investigates the relationship of these pathways to outcomes of care.

Methods The findings reported here are drawn from the SAMHSA multi-site, Women, Co-Occurring Disorders and Violence study, a longitudinal study of the impact of trauma-informed interventions on a sample of 2,729 treatment-seeking women with recent histories of co-occurring disorders who also have lifetime histories trauma. The study included a baseline interview at initiation of treatment and subsequent 6 and 12 month follow-ups. Indicators for past psychiatric and substance abuse service pathways were developed from treatment history items in the interview schedule. Following Andersen's framework, baseline characteristics were categorized into predisposing, enabling, and need for care factors. A series of hierarchical regression models predicting scores on service use were estimated.

To assess the relationship of pathway to symptom reduction the three standardized symptom scales measuring current mental health post- traumatic stress alcohol addiction and drug addiction symptoms at baseline and 6 month were examined. Repeated measures ANOVA were run on the scores at two levels of each of the psychiatric and substance abuse pathways.

Findings Overall 9% of the variance in mental health service pathway and 8% in substance abuse service pathway was explained by all three categories of factors combined. The predisposing variables explained the greatest portion of the variance and the enabling variables explained the rest. The particular variables of greatest importance within categories were not identical and will be presented in detail in the presentation. For example, the more abuse experienced over a woman's life, the more frequently she sought mental health services. However, the more children under eighteen years old she had, the less likely she used mental health services. The impact of service paths on the reduction of mental health symptoms and substance use at 6 months post treatment entry was examined. Women who had been in substance abuse treatment more frequently in the past improved more on all three symptom scales over the six months than women who had fewer previous treatment experiences. By contrast, women with more prior mental health service episodes, showed less improvement than women with fewer prior mental health episodes.

Implications These findings help identify the barriers and facilitators of service paths and suggest important policy shifts to maximize service utilization. Access to health insurance is a significant factor enabling women to access treatment. Having children is a significant constraint to service access. More attention to mother-friendly programs in both substance abuse and mental health is clearly important. .

Andersen, R.M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior 36, 1-10

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