Workforce and Professionalism in Drug Treatment Services: Impact of California's Proposition 36

Background and Purpose: The California Substance Abuse and Crime Prevention Act (SACPA), also known as Proposition 36, was enacted after voters' approval in November 2000. Under this law, adults convicted of non-violent drug possession offenses can choose community-based substance abuse treatment in lieu of incarceration. While existing evaluation research has often focused on whether the new law had reduced incarceration and related costs, the impact of Proposition 36 on the drug treatment system has not been studied. This study investigates whether this major policy change has promoted the professionalization of the drug treatment system in California during its first five years of implementation.

Methods: Data were drawn from a larger longitudinal, multi-site study (i.e.,Treatment System Impact and Outcome Study or TSI study) which assesses both the effectiveness and system impact of California's Proposition 36. The TSI study was conducted in five counties (San Diego, Riverside, Kern, Sacramento, and San Francisco) selected based on geographic location, population size, and Proposition 36 implementation strategies. All treatment programs in these counties that serve Proposition 36 clients were invited to participate in the survey in 2003 and 2005. A total of 118 program personnel representing 102 drug treatment programs completed the program surveys in both 2003 and 2005. The program survey, which is a one-hour self-administered questionnaire, inquired about general organizational information in five areas: program resources, intake assessment and outcome evaluation, staff professionalism, program qualification, and information and technology. A Generalized Estimating Equations (GEE) model was utilized to detect overtime changes in California's drug treatment system. GEE can handle correlated observations such as repeated measures and is flexible with multilevel data.

Results: California drug treatment staff perceived their programs as being more adequately equipped. They reported increases in their overall ability to monitor services, serve various clients, provide culturally competent services, and secure state licensing and certificate requirements. A very high percentage (93.5%) of treatment programs participated in our survey had an intake assessment and an outcome evaluation system at 2005. We also found a growing tendency to standardize assessment and evaluation instruments. Significantly more staff in recovery was hired to handle the increasing number of clients due to Proposition 36. There were also more staff with special training and higher degrees in the system, but the increase was not statistically significant. Programs also reported to have more computers and laptops and more computers with internet access, indicating a significant enhancement in the application of technology. However, some areas remain problematic, such as the persistent lack of adequate resource in the treatment system to serve women with children and clients with severe drug problems.

Conclusions and Implications: Study results suggest that Proposition 36 had had a positive influence on California's drug treatment system during the first five years of its implementation. All the organizational aspects measured in this study showed significant improvement over time. The study results also identify areas needing further attention both in research and practice.