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									                                                             The Texas Access to Recovery (ATR) Project: A Comparison of
                                                           Characteristics and Treatment Outcomes of Criminal Justice Clients
                                                   Laurel Mangrum,                            Ph.D. a,      Michelle Steinley-Bumgarner,                       M.A. a,      & Karen Eells, M.S.S.W,                                              L.M.S.W b
                                                      aUniversity                     of Texas at Austin, Addiction Research Institute;                       bTexas       Department of State Health Services

Introduction                                                                              Client Characteristics                                                                  Results and Conclusions
The Access to Recovery (ATR) grant funded by the Substance Abuse and
Mental Health Services Administration (SAMHSA) is designed to expand system                   Demographic and Social           Problem Days During Month Prior to Admission       On demographic variables, analyses revealed that ATR clients were more
capacity to improve access to addiction treatment and recovery support                                                                                                            likely to be Hispanic and employed, whereas non-ATR clients were more
services. Core components of the ATR program include: 1) independent
                                                                                                 Characteristics                                                                  often White, male, and older. ATR clients reported more problem days in the
assessment to determine appropriate levels and types service needed; 2)                                                                                                           month prior to admission related to social issues and substance use;
genuine, free, and independent client choice among treatment and recovery                                                                                                         conversely, non-ATR clients reported greater problem days associated with
support service providers; 3) establishment of a wide network of community and                                                                                                    physical illness and psychological issues. In the area of substance use
faith based providers to ensure clients have at least one service provider choice                                                                                                 patterns, the ATR group was more likely to use cocaine and marijuana as
among the array for which the client has no religious objection; and 4) a voucher
                                                                                                                                                                                  their primary substance and the non-ATR group reported a greater history of
program that provides voucher monies directly to clients for independent
purchase of all assessment, treatment, and recovery support services.                                                                                                             IV drug use. Both groups demonstrated similar percentages of
Allowable services under the Texas ATR voucher program include clinical                                                                                                           polysubstance use. Although the groups did not differ in the frequency of
assessment, care coordination, residential and outpatient addiction treatment,                                                                                                    primary substance use over the past 6 months, the non-ATR clients reported
individual recovery coaching, spiritual support group, relapse prevention group,                                                                                                  more days of use during the month prior to admission to treatment. Non-
life skills group, recovery support group, transitional housing, GED preparation,                                                                                                 ATR clients had higher rates of both previous detox and non-detox addiction
employment coaching, and marital/family counseling. In Texas, the ATR                                                                                                             treatment, whereas a greater proportion of ATR clients had attended AA/NA
program targets individuals involved in the criminal justice system, either through                                                                                               during the month prior to treatment entry. The groups were equivalent in the
drug court, probation, or Child Protective Services.                                                                                                                              incidence of emergency room visits during the past year. At discharge, ATR
                                                                                                                                                                                  clients had higher percentages of treatment completion, past 30-day
The ATR program design reflects a recovery oriented systems of care model,
                                                                                                                                                                                  abstinence, and AA/NA attendance during the month prior to discharge. The
which includes provision of individualized recovery support services in addition
to traditional addiction treatment. Although limited research has been conducted                                                                                                  ATR group also had a significantly shorter length of stay in treatment relative
examining the effect of wrap-around services and peer support on client                                                                                                           to the non-ATR group. Analyses of voucher expenditures among the ATR
outcomes in mental health treatment, studies assessing the role of recovery                                                             Primary Substance of Abuse                client group indicated that ATR clients who completed treatment were
support services in enhancing addiction treatment outcomes are lacking. The                                                                                                       significantly more likely to receive recovery support services rather than
current study compares client characteristics and outcomes of two groups of                                                                                                       treatment services alone.
criminal justice clients receiving state-funded addiction treatment; clients who
participated in the ATR program and legally-involved clients who did not receive
                                                                                         Treatment History and Substance Use
ATR services.                                                                                                                                                                     Results indicate that in this sample, criminal justice clients who participated
                                                                                                                                                                                  in the ATR program achieved more successful addiction treatment outcomes
                                                                                                                                                                                  at discharge relative to criminal justice clients who did not participate in the
                                                                                                                                                                                  program. These findings suggest that the components of independent
                                                                                                                                                                                  assessment, free client choice of service providers, and the provision of
Sample and Method                                                                                                                                                                 voucher funds to procure treatment and recovery support services may
                                                                                                                                                                                  improve client outcomes. Further, ATR clients who completed treatment
                                                                                                                                                                                  were more likely to receive recovery support services rather than treatment
Data from the Behavioral Health Integrated Provider System (BHIPS) were
available for 1,049 ATR adult clients who entered and were discharged from                                                                                                        alone, suggesting that the receipt of recovery support in addition to treatment
addiction treatment during the period of June 2005 and November 2006. BHIPS                                                                                                       may also enhance outcomes. Future controlled studies are needed
is the mandatory data collection and outcomes monitoring system for addiction                                                                                                     examining the individual components of the ATR recovery-oriented systems
treatment providers funded by the Texas Department of State Health Services                                                                                                       of care model to determine specific features that contribute to improved
(DSHS). Types of data collected through the BHIPS system include client                                                                                                           client outcomes, as well as longitudinal studies to explore the effect of these
demographics, drug and alcohol use patterns, addiction treatment characteristics,                                                                                                 services on sustaining the process of recovery.
and client reported levels of functioning in a variety of areas such as employment,
living situation, medical concerns, and psychological health. Data regarding
voucher services received through the ATR program were also available from                                                        Percentage of ATR Clients Receiving Recovery
BHIPS. A comparison group of non-ATR DSHS criminal justice clients was
generated through random selection of 1,049 clients who entered DSHS-funded
                                                                                                                                   Support Services by Treatment Completion
treatment during the same time period. Non-ATR criminal justice clients were
identified through a BHIPS data element indicating the client is legally involved.            Discharge Characteristics
The comparison group was created using the SAS statistical software random
selection procedure to provide a group of equivalent size. Further, the groups
were matched according to the levels of care at treatment entry that existed in the
ATR client group (24% intensive residential, 2% supportive residential, and 74%                                                                                                    The authors acknowledge Lesli San Jose, Decision Support Research Specialist for the
outpatient).                                                                                                                                                                       Texas Department of State Health Services (DSHS), Mental Health and Substance Abuse
                                                                                                                                                                                   Services Division, for her extensive assistance in retrieving data for this study. The author
                                                                                                                                                                                   has no financial relationships associated with the topic of this presentation.
ATR clients were compared to non-ATR criminal justice clients on demographic
                                                                                                                                                                                   The findings and conclusions of this in this presentation are the opinions of the authors and
and social characteristics, addiction treatment history, substance use patterns,
                                                                                                                                                                                   do not necessarily reflect the official position of DSHS.
and treatment outcomes at discharge. Continuous variables were analyzed using
t-tests for independent groups and categorical variables were assessed using X2
tests. In addition, among ATR clients only, treatment completers and non-
completers were compared on incidence of receiving recovery support services in
addition to addiction treatment.

                                                                                                                                                                                   Presented at the Addiction Health Services Conference, Athens,
                                                                                                                                                                                   Georgia, October 16, 2007

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