Management and Supervision of Health Services in Community-Based Substance Abuse Treatment Programs

Hall, James A.

Background. Most of the attention regarding the Affordable Care Act has been on the change in the service delivery structure – with the focus on services. Although the quantity and quality of these services are very important, the delivery system will impact their effectiveness. For example, what is the recommended management system for health services organizations to implement when integrating substance abuse and mental health services in the health care home? How much supervision is optimal for these additional services and does supervision vary by type of service delivered (e.g., group treatment, screening, individual counseling, etc.)? By understanding the findings from intervention research, health services providers can implement management and supervision systems that could be designated as best practices or even evidence-based models. This study is aimed at health services systems but builds on intervention research over the past twenty years.

Methods: This study evaluates data collected in three previous intervention evaluations. First, data from the Iowa Case Management Project (NIDA) will address the implementation of a comprehensive case management program in four research conditions based upon the home location and supervision of case managers working with clients in a community-based drug treatment facility. Second, additional data from the Case Management Project (SAMHSA/CSAT) will compare the management and supervision of comprehensive case management with brokerage case management. Finally, the management and supervision systems will be evaluated from the comparison of Strengths Oriented Family Therapy (SOFT) with the Seven Challenges group treatment program (SAMHSA/CSAT). This study will describe these management and supervision systems, provide process data and compare these processes with outcomes.

Findings: In the Iowa Case Management Project, two case managers were located at the drug treatment facility, two others at a local social service agency and one case manager worked through a telecommunication system with a double caseload (compared with the other four case managers). Case managers were supervised weekly by a clinical social worker and then met as a group for administrative issues once per month. Sessions were audiotaped for weekly supervision and later rated using an intervention fidelity rating system. This close supervision of case managers resulted in equivalent outcomes – a significant reduction in substance use from baseline to 3 months and maintained to one year. Interestingly, clients in the treatment as usual condition also improved from baseline to 3 months – most likely due to intervention bleeding . The other two projects had similar results although management and supervision differed.

Implications: The findings from intervention research to inform the delivery of health services in the expanded system due to the Affordable Care Act should provide guidance for those involved in the development of these systems. Unfortunately, in most social and health service organizations, little attention is given to the quality of management and supervision – primarily due to the lack of financial support.

Society for Social Work and Research 18th Annual Conference: Research for Social Change: Addressing Local and Global Challenges

January 15 - 19, 2014