Research That Matters (January 17 - 20, 2008)

Background and Purpose: Clients in the specialty substance abuse treatment system frequently enter treatment with substance abuse problems that co-occur with health, mental health and social problems. Increasingly, the provision of comprehensive services, i.e., the provision of health, mental health and social services, along with substance abuse treatment is seen as a service approach that will result in more effective treatment. This study focuses on the relation of matched services to outcomes for clients of different racial/ethnic groups served in the specialty substance abuse service system. Specific purposes are: (1) To assess the extent to which comprehensive substance abuse treatment programs implemented as part of the National Treatment Improvement Evaluation Study (NTIES) address (or match) client-identified needs. (2) To examine the impact of matched services on outcomes of substance use and client satisfaction. Methods: The study uses NTIES longitudinal data collected between 1992 and 1995 on a purposive sample of U.S. treatment programs and the clients within those treatment programs. Data were collected on organizational factors, service factors and client characteristics. The analytic sample consists of 3,142 clients from 59 service delivery units. Descriptive statistics were used to assess the “need-service gap”, i.e., the percentage of clients reporting they had received services at the end of treatment that they had reported needing at intake in 6 different service areas: physical health, mental health, family service, vocational service, housing, financial service. Hierarchical linear modeling was used to assess the impact of matched services on service outcomes of substance use and client satisfaction. Results: Results indicate that of those reporting a need in a particular area, a limited percentage received matched services: 21% of those needing financial and housing services received them, 53% of those needing family services received them, 32% of those needing mental health services received them, and 63% of those needing medical services received them. Further, receipt of matched services had a positive impact on both reductions in substance abuse and client satisfaction for the total sample. Conclusions and implications: This study explicates effective strategies for delivering ancillary health and social services in specialty substance abuse treatment programs. The study advances understanding of the value of assessing client-identified needs and then providing the services to meet those needs. Findings suggest that program efforts addressed at reducing the need-service gap are likely to increase the effectiveness of comprehensive service programs in substance abuse and child welfare.