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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
                                                                                                                                ATR                  Non-ATR                    14
assessment to determine appropriate levels and types service needed; 2)                                                    (n = 1049)                (n = 1049)                                                                                         ATR         Non-ATR                  month prior to admission related to social issues and substance use;
genuine, free, and independent client choice among treatment and recovery                 Male                                  61%                    67%         **                                                                                                                        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
                                                                                          Age                                                                      †
faith based providers to ensure clients have at least one service provider choice                                               31                      33
                                                                                                                                                                                                                                                                                             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         Race/Ethnicity
                                                                                                                                                                                                                                                                                             their primary substance and the non-ATR group reported a greater history of
program that provides voucher monies directly to clients for independent                     Black                              19%                    22%         †

purchase of all assessment, treatment, and recovery support services.
                                                                                                                                                       49%                       8                                                                                                           IV drug use. Both groups demonstrated similar percentages of
Allowable services under the Texas ATR voucher program include clinical
                                                                                             Other                               1%                    1%                                                                                                                                    polysubstance use. Although the groups did not differ in the frequency of
assessment, care coordination, residential and outpatient addiction treatment,            Education                                                                              6                                                                                                           primary substance use over the past 6 months, the non-ATR clients reported
                                                                                             Less Than High School              14%                    10%
individual recovery coaching, spiritual support group, relapse prevention group,             Completed High School              62%                    66%                                                                                                                                   more days of use during the month prior to admission to treatment. Non-
                                                                                             College Level                      24%                    24%
life skills group, recovery support group, transitional housing, GED preparation,                                                                                                4                                                                                                           ATR clients had higher rates of both previous detox and non-detox addiction
employment coaching, and marital/family counseling. In Texas, the ATR                     Employment                                                                                                                                                                                         treatment, whereas a greater proportion of ATR clients had attended AA/NA
                                                                                             Employed                           48%                    42%         *
program targets individuals involved in the criminal justice system, either through          Unemployed                         46%                    50%                       2                                                                                                           during the month prior to treatment entry. The groups were equivalent in the
drug court, probation, or Child Protective Services.                                         Not In Labor Force                  6%                    8%
                                                                                                                                                                                                                                                                                             incidence of emergency room visits during the past year. At discharge, ATR
                                                                                          Living Situation                                                                       0
                                                                                             With Family                        81%                    77%
                                                                                                                                                                                                                                                                                             clients had higher percentages of treatment completion, past 30-day
The ATR program design reflects a recovery oriented systems of care model,                                                                                                             Physical      Employment           Family   Social**     Psychological**      Substance Use*
                                                                                             Group Quarters                      2%                    2%                              Illness***                                                                                            abstinence, and AA/NA attendance during the month prior to discharge. The
which includes provision of individualized recovery support services in addition             Living Alone                       11%                    11%

to traditional addiction treatment. Although limited research has been conducted
                                                                                             Insitutional Setting
                                                                                                                                                                                                                                                       * p < .02, ** p < .01, *** p < .001   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
                                                                                          * p=.02, ** p = .01, † p=.0001
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                                                                                                                                                                                           ATR        Non-ATR     treatment services alone.
criminal justice clients receiving state-funded addiction treatment; clients who                                                                                                35%

participated in the ATR program and legally-involved clients who did not receive
                                                                                         Treatment History and Substance Use                                                                                                                                                   p < .0001

ATR services.                                                                                                                                                                                                                                                                                Results indicate that in this sample, criminal justice clients who participated
                                                                                                                                                                                                                                                                                             in the ATR program achieved more successful addiction treatment outcomes
                                                                                                                                       ATR              Non-ATR
                                                                                                                                     (n = 1049)         (n = 1049)                                                                                                                           at discharge relative to criminal justice clients who did not participate in the
                                                                                          Substance Abuse Treatment                                                                                                                                                                          program. These findings suggest that the components of independent
                                                                                             Previous Detox                            10%                15%           †                                                                                                                    assessment, free client choice of service providers, and the provision of
Sample and Method
                                                                                             Previous Non-Detox                        34%                40%           *       20%
                                                                                             Attended AA Past 30 Days                  43%                36%           *                                                                                                                    voucher funds to procure treatment and recovery support services may
                                                                                          Emergency Room Visit Past Year               23%                 25%                                                                                                                               improve client outcomes. Further, ATR clients who completed treatment
                                                                                          Polysubstance Use                            58%                 56%                                                                                                                               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
                                                                                          History of IV Drug Use                       14%                24%
addiction treatment during the period of June 2005 and November 2006. BHIPS                                                                                                                                                                                                                  may also enhance outcomes. Future controlled studies are needed
                                                                                          Frequency of Use of Primary
is the mandatory data collection and outcomes monitoring system for addiction                No Use                                    16%                 17%
                                                                                                                                                                                                                                                                                             examining the individual components of the ATR recovery-oriented systems
                                                                                             Less than Monthly                         8%                  9%                   5%                                                                                                           of care model to determine specific features that contribute to improved
treatment providers funded by the Texas Department of State Health Services                  1-3 Times Per Month                       15%                 12%
(DSHS). Types of data collected through the BHIPS system include client                      1-2 Times Per Week                        15%                 15%                                                                                                                               client outcomes, as well as longitudinal studies to explore the effect of these
                                                                                             3-6 Times Per Week                        16%                 17%
demographics, drug and alcohol use patterns, addiction treatment characteristics,            Daily                                     29%                 29%                  0%                                                                                                           services on sustaining the process of recovery.
                                                                                                                                                                                         Alcohol        Cocaine            Crack    Opiates         Marijuana                  Other
and client reported levels of functioning in a variety of areas such as employment,       Average Days of Use of Primary
living situation, medical concerns, and psychological health. Data regarding               Past 30 Days                                 4.5                  6.2        ‡

voucher services received through the ATR program were also available from                * p=.002, † p=.001, ‡ p=.0001                                                                   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                                                 35%

The comparison group was created using the SAS statistical software random
selection procedure to provide a group of equivalent size. Further, the groups                                                                                                  30%
                                                                                                                                                                                                                                                                                 p < .01

were matched according to the levels of care at treatment entry that existed in the                                                       ATR             Non-ATR
                                                                                                                                        (n = 1049)           (n = 1049)
ATR client group (24% intensive residential, 2% supportive residential, and 74%                                                                                                 25%
                                                                                                                                                                                                                                                                                             The authors acknowledge Lesli San Jose, Decision Support Research Specialist for the
outpatient).                                                                               Completed Treatment                            66%                  54% †                                                                                                                         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
                                                                                           Length of Stay in Treatment (Days)             54.9                 78.6         †   20%                                                                                                          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,           Abstinent Past 30 Days                         71%                  66%          *
                                                                                                                                                                                15%                                                                                                          do not necessarily reflect the official position of DSHS.
and treatment outcomes at discharge. Continuous variables were analyzed using              Attended AA Past 30 Days                       75%                  70%          *
t-tests for independent groups and categorical variables were assessed using X2
tests. In addition, among ATR clients only, treatment completers and non-                  * p < .02, † p < .0001                                                               10%

completers were compared on incidence of receiving recovery support services in
addition to addiction treatment.                                                                                                                                                 5%

                                                                                                                                                                                                    Treatment Completer                       Treatment Non-Completer

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

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