Field of Work: State-provider partnerships to increase access and retention in outpatient addiction treatment
Problem Synopsis: Access to quality substance abuse treatment is a persistent problem in the United States. In 2003, according to the federal Substance Abuse and Mental Health Services Administration (SAMHSA), only slightly more than 10 percent of the estimated 22.2 million Americans age 12 and older who needed treatment actually received it. Outpatient treatment facilities play a major role in efforts to increase access to high-quality treatment. They account for 80 percent of all substance abuse treatment programs in the United States and in 2002 served 89 percent of the 1.1 million clients in care on any day, according to SAMHSA.
Synopsis of the Work: By leveraging their roles as the purchasers of nearly 70 percent of addiction treatment services, state governments are in a unique position to spread practices that improve access and retention as well as guide performance improvement. Working together with outpatient substance abuse treatment providers, states can remove systems barriers, streamline administrative procedures, provide incentives, and assist provider networks in their efforts to improve access and retention performance outcomes.
Strengthening Treatment Access and Retention—State Implementation (STAR-SI) funded nine state agencies that had responsibility for establishing policies and disbursing funds for alcohol and other drug abuse treatment within their states. STAR-SI was a partnership between RWJF and the Center for Substance Abuse Treatment (CSAT). RWJF funded partnerships in two states: the New York Office of Alcoholism and Substance Abuse Services and the Oklahoma Department of Mental Health and Substance Abuse Services.
The state-provider partnerships were required to use a process improvement model developed under an earlier RWJF national program, Paths to Recovery, by NIATx (Network for the Improvement of Addiction Treatment), based at the University of Wisconsin-Madison. STAR-SI supported these agencies in process-focused activities aimed at building collaborative infrastructures and learning environments that would promote improvement.
Key Results: State agencies in New York and Oklahoma recruited outpatient treatment providers and organized them into peer learning networks.
- New York agencies conducted 63 change projects. On average, providers decreased the time between first contact with a client and the client's entry into treatment by 20 percent. Clients' continuation in treatment rose by 10 percent increase over baseline.
- Oklahoma providers completed 38 change projects. Participating providers increased admissions an average of 31 percent and cut the number of days between admission and first treatment in half (from an average of 5.9 days to three days).
- New York and Oklahoma participated in the NIATx "Whole Systems Change: Community of Commitment" initiative to help sustain and spread the NIATx model after STAR-SI funding ended.