Recovery Support Services and Client Outcomes: What do the Data Tell Us? Recovery Community Services Program Grantee Meeting December 14, 2007

Recovery Oriented Systems of Care Projects in Texas Access to Recovery (ATR) Co-Occurring State Incentive Grant (COSIG)

Texas ATR Project

 Targets individuals who are involved in the criminal justice system through drug courts, probation, or child protective services  Provides independent assessment to determine service needs and client choice among an array of service providers, including faith-based and community organizations

Texas ATR Voucher System  Clinical Assessment  Care Coordination  Addiction Treatment  Individual Recovery Coaching  Spiritual Support Group  Relapse Prevention Group  Life Skills Group  Recovery Support Group  Transitional Housing  GED Assistance  Employment Coaching  Marital and Family Counseling

ATR Study 1 Study compares addiction treatment outcomes of ATR clients (n = 1049) with a randomly selected sample of criminal justice clients (n = 1049) receiving state funded treatment services who did not participate in the ATR program Study compares addiction treatment outcomes of ATR clients (n = 1049) with a randomly selected sample of criminal justice clients (n = 1049) receiving state funded treatment services who did not participate in the ATR program

Client Characteristics  ATR clients were more likely to be Hispanic and employed, whereas non-ATR clients were more often White, older, and male  Non-ATR clients had a greater history of both detox and non-detox addiction treatment  Non-ATR clients reported more days of primary substance use during the month prior to admission; however, the groups did not differ in the frequency of use over the past six months

Number of Days in Addiction Treatment *

Percentage of Clients Completing Addiction Treatment *

Abstinence Rates (Past 30 Days) at Discharge from Treatment *

AA/NA Attendance Rates (Past 30 Days) at Discharge from Treatment *

Percentage of ATR Clients Receiving Recovery Support Services in Combination with Treatment by Completion Status *

Summary of ATR Study 1: ATR vs. Non-ATR Criminal Justice Clients  ATR clients had shorter lengths of stay in treatment  ATR clients had more successful outcomes in the areas of treatment completion and past month abstinence and AA/NA attendance at discharge  ATR clients who completed treatment were more likely to receive recovery support services in combination with treatment rather than treatment alone

ATR Study 2  Study examines outcomes of 825 individuals who received ATR services during the period of June 2005 and September 2006  Successful completers of the ATR program (n = 311) were compared to non- completers (n = 514) on client and voucher service characteristics

Client Characteristics  Completers were more likely to be Hispanic, employed, living independently, and to have higher levels of education  Drug court participants had higher completion rates (61%) relative to probationers (20%) and individuals involved with child protective services (38%)

Number of Days in ATR Program *

Treatment and Recovery Support Services Combinations *

Categories of Recovery Support Services Emotional / Affiliational  Individual Recovery Coaching  Recovery Support Group  Relapse Prevention Group  Spiritual Support Group  Life Skills Group  Family and Marital Counseling Instrumental / Informational  Employment Coaching  Transportation  Transitional Housing  GED Assistance  Childcare

Categories of Recovery Support Services Received * *

Summary of ATR Study 2: Factors Associated with Successful ATR Outcomes  Retention in the ATR program  Receiving treatment only or treatment in combination with recovery support services  Receiving emotional and affiliational recovery support services that are more directly centered on the process of recovery  Drug court supervision  Client employment and higher education levels

Texas COSIG Project

Texas COSIG Project Key Components  Training of addiction counselors on co- occurring disorders and the use of diagnostic and assessment instruments to improve identification of comorbidity and monitor client progress  A voucher system that provides recovery support services to enhance the treatment process ($1800 per client)

Voucher Service Categories  Child Care  Housing Support  Transportation  Food Assistance  Education Support  Employment Assistance  Clothing  Medical Care  Prescriptions  Peer Mentoring

COSIG Study  Data were obtained for 424 COSIG clients who entered and were discharged from addiction treatment during the period of February 2005 through October 2006  76% of the sample completed treatment  Treatment completers (n=323) and non- completers (n=101) were compared on client and service characteristics

Client Characteristics  Treatment completers were more likely to be male and homeless  Treatment completers had a greater history of both detox and non-detox addiction treatment  Treatment completers reported greater primary substance use during the 30 days prior to admission

Diagnostic Characteristics

Recovery Support Services Received During Treatment

Recovery Support Service Combinations

Summary of COSIG Study: Service and Client Characteristics Associated with Treatment Completion  Peer mentoring had the strongest association with treatment completion  Instrumental and informational support services, particularly in the absence of peer mentoring, were associated with non-completion  Treatment completers were more likely to male and have depression and anxiety diagnoses, whereas non-completers were more often diagnosed with bipolar and posttraumatic stress disorders

Conclusions

What Do the Data Tell Us About Recovery Support Services?  Recovery support services can play a significant role in the continuum of care  Emotional and affiliational support services may be essential components in an individual’s service array  Provision of instrumental and informational supports only may be less effective in sustaining the process of recovery

Why is Evaluation Important?  Provides evidence that your services are making a difference  Provides feedback regarding meeting your project’s goals  Provides information to guide program planning:  Effectiveness of various services and service combinations  Identification of potential subgroups of participants who are less responsive to services  Informs outreach efforts

What More Do We Need to Know?  Successful completion of the ATR program or treatment is only one method of defining outcomes; other studies are needed using a wider array of outcome measures  More studies are needed to explore the effect of various service combinations on client outcomes  Longitudinal studies are needed to examine the lasting effects of recovery support services on sustaining the process of recovery

Acknowledgements Texas Department of State Health Services Karen Eells, MSSW, LMSW ATR Project Director Kwame Bruce, Psy.D. COSIG Project Director Lesli San Jose Decision Support Research Specialist Substance Abuse and Mental Health Services Administration