Participant Choice – Access to Recovery as a Voucher Service Delivery Model Presented to National Summit on Prisoner Re-Entry Sponsored by the White House Office of Faith Based and Community Initiatives November 27, 2007 Texas Department of State Health Services Mental Health and Substance Abuse Division

Texas Access to Recovery (ATR) Program Texas awarded $7.6 million per year for 3 years Goal to serve of 8,928 clients (15,000 served thru 10/07) Proposal “Creating Access to Recovery Through Drug Courts”

Texas ATR Program Services in 13 counties Single Assessment Provider for each county Agreements with licensed treatment programs Agreements with community and faith based recovery support providers Original Drug Court Program has now expanded to include other referral sources

ATR Referral Sources 30 participating Drug Courts 13 County Adult Probation Departments 5 County Juvenile Probation Departments 13 County Child Protective Services Offices

ATR Process Flowchart Client Referred Assessment Provider Conducts assessment Facilitates client choice of providers Generates voucher Coordinates services and updates voucher Clinical Treatment Recovery Support Voucher

Web-based Client Record Standardized documentation Collect consistent data Submit automated billing Monitor by on-line desk review Utilization by provider Appropriate billing Appropriate documentation

Implementing Cultural Change Education on Program Model Staff Stakeholders: Courts, CPS, Probation Providers Dispel Myths Recovery support is not treatment Not all Recovery Service Providers are alike Not all Faith Based Organizations are alike Not all government agencies are alike

Recovery Support Services Individual recovery coaching Spiritual support group Relapse prevention Life Skills Recovery Support Group Drug-free Transitional Housing Education training (GED) Employment coaching Family/marital counseling Child Care Transportation

Assuring Client Choice Assessment independent of service provider Service plan developed by assessment provider At intake, client receives brochure explaining right to choose provider Client given directory of providers with program description written by the provider Client satisfaction survey conducted

Bridging the Gap Learn the language Embrace technology Reframe services Identify similarities Respect diversity

Pre-Application Training for Providers Establish relationship with providers Explain services, requirements and qualifications Facilitate local networks and partnerships Provide technical assistance Marketing services Matching their “services” to our “program” Writing program description Completing application Internet tools – sample application, etc.

Ongoing Technical Assistance for Providers 1:1 Technical assistance Monthly conference calls Training CD on documentation requirements Internet tools for monitoring, training, and sample policies Local assessment provider serves as resource

Interim Evaluation Results N= 825 clients served 6/05-9/06 ATR clients achieved better outcomes in the areas of treatment completion, past month abstinence, and AA attendance at discharge relative to both non-ATR DSHS criminal justice and non-criminal justice clients. In addition to enhanced outcomes, ATR clients had significantly shorter lengths of stay in treatment relative to non-ATR DSHS criminal justice clients. Among ATR clients, drug court clients achieved the highest completion rates relative to CPS and probation clients, suggesting that higher levels of court supervision may enhance treatment outcomes.

Factors Associated with Successful ATR Outcomes Retention in the ATR program Receiving treatment only or treatment in combination with recovery support services Receiving direct recovery support services that are most closely related to the process of recovery Drug court supervision Client employment and higher education levels

Percentage of Clients Completing Substance Abuse Treatment for ATR and Non-ATR DSHS Criminal Justice Clients

Mean Length of Substance Abuse Treatment in Days for ATR and Non-ATR DSHS Criminal Justice Clients

Employment Rates at Treatment Discharge for ATR and DSHS Non-Criminal Justice Clients

Homelessness Rates at Treatment Discharge for ATR and DSHS Non-Criminal Justice Clients

Substance Abuse Treatment Completion Rates by ATR Referral Source

Provider Network as of 11/1/07 Providers 140 FBO (63%) 83 Secular (37%) 223 Total Providers

ATR Voucher Expenditures as of 11/1/07 Treatment Expenditures = $7,361,822 28% to FBO Recovery Services Expenditures = $8,050,422 51% to FBO

Most Common Services as of 11/1/07 Outpatient Treatment Transportation Individual Recovery Coaching Recovery Support Group Relapse Prevention Group

Client Satisfaction Survey as of 11/1/07 N=730 83% felt they had a choice of providers Strongly Agreed, Agreed and Neutral 97% received services right for them Strongly Agreed, Agreed and Neutral 98% services helped me become drug free Strongly Agreed, Agreed and Neutral 98% satisfied with services received Strongly Agreed, Agreed and Neutral

Acknowledgements Karen Eells, MSSW, LMSW-AP ATR Project Director Texas Department of State Health Services Laurel Mangrum, Ph.D. and Michelle Steinley-Bumgarner, M.A. Authors of Interim Evaluation Gulf Coast Addiction Technology Transfer Center Center for Social Work Research School of Social Work University of Texas at Austin Substance Abuse and Mental Health Services Administration