Access Services as Active Ingredient in Comprehensive Service Model of Substance Abuse Treatment

Background and Purpose: Clients in the specialty substance abuse treatment system face barriers that limit their access to treatment including lack of transportation and child care. Yet, many models of service delivery fail to include these important access services or to examine how they interact with other aspects of service delivery. In this study a model of comprehensive substance abuse treatment was conceptualized that measured access services, targeted substance abuse service as well as matched services on the intermediate outcome of treatment duration and the ultimate outcome of reduction in substance use. Analyses focus on the relation of access services of transportation and child care to intermediate and ultimate outcomes for clients in the specialty substance abuse service system. Specifically, the purpose of the study was to: (1) assess the extent to which access services were received, (2) examine the process of service delivery by assessing the impact of access services on receipt of other health and social services, and (3) examine the impact of access services on outcomes of treatment duration and post-treatment substance use.

Methods: The study uses NTIES longitudinal data collected between 1992 and 1995 on a 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 receipt of access services transportation and child care), services targeted to outcome (substance abuse counseling) and matched services (a ratio of specific health and social services received to those identified by client). Organizational and control variables were used as control variables. Structural equation modeling was used to assess the impact of access services on service outcomes of treatment duration and post-treatment substance use.

Results: Results indicate that 51% of female clients and 40% of male clients received transportation and/or child care services. Further, receipt of access services had a positive direct effect on receipt of substance abuse services. Further, receipt of targeted substance abuse treatment led to longer treatment duration and reduced substance use when clients through the receipt other health and social services matched to client-identified needs.

Conclusions and implications: This study examines effect of reducing barriers to substance abuse treatment by including transportation and child care in service delivery model. When the conceptualization and measurement of services includes targeted and matched health and social services, access services increase the effectiveness of comprehensive service programs by increasing the receipt of both targeted substance abuse services as well as matched health and social services. Implications highlight the importance of including access services in treatment models as well as a continued research on the service delivery process.