The University of Georgia Wraparound Services in the Public and Private Treatment Sectors: Are Patients Receiving Comprehensive Care? Lori J. Ducharme,

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The University of Georgia Wraparound Services in the Public and Private Treatment Sectors: Are Patients Receiving Comprehensive Care? Lori J. Ducharme, Ph.D. Hannah K. Knudsen, Ph.D. Paul M. Roman, Ph.D. American Public Health Association, November 2004 Support from NIDA Research Grants R01DA13110 and R01DA14482 is gratefully acknowledged.

The University of Georgia Introduction Significant attention has been paid to the availability of “comprehensive services” for substance abuse clients, as wraparound services have been shown to improve both retention and treatment outcomes. However, availability of only a limited number of services has been studied, and nearly always in isolation from one another. –In other words, prior research has not measured the actual comprehensiveness of services available, nor the predictors of comprehensiveness. As a result, researchers and providers lack a clear understanding of the extent to which programs are meeting patients’ many and varied service needs.

The University of Georgia Research Questions To what extent are various wraparound services being offered in U.S. treatment centers? To what extent are programs providing a comprehensive array of wraparound services? To what extent does the availability of these services vary across the public and private sectors?

The University of Georgia Data Sources UGA’s National Treatment Center Study N=746 substance abuse treatment programs Administrators provided data on the availability of various “wraparound” services: –Provision of, or linkages to, services for medical, legal, vocational, financial, and family/social issues –Provision of transportation, child care, programs for HIV/AIDS patients, and integrated care for co- occurring addiction/psychiatric disorders

The University of Georgia Descriptives: Organizational Structure, by Center Type Gov’tPublic NPPrivate NPFor Profit Sample distribution:13.5%33.9%36.9%15.7% % public revenue**84.2%84.5%11.7%5.9% Size (FTEs) Age (years)** % master’s**40.8%35.7%53.2%48.1% Accredited**29.7%28.1%73.8%52.1% Hospital-based**14.9%4.7%52.0%22.2% Use ASI at intake**64.4%57.3%35.6%36.8% Collect satisfaction data76.2%78.3%75.6%80.0% Rural area8.9%10.3%14.5%8.5%

The University of Georgia Descriptives: Case Mix by Center Type

The University of Georgia Descriptives: Wraparound Services, by Center Type

The University of Georgia Descriptives: Wraparound Services, by Center Type

The University of Georgia Modeling Availability of Wraparound / Support Services Does apparent variation across center types persist after controlling for differences in organizational structure and caseload? Logistic regression models including center type as predictor variable, and controlling for organizational & caseload characteristics –Private Non-Profits = reference group, compared to Gov’t, Public Non-Profit, and Private For Profit Additional model considers comprehensiveness of service availability (total number of support services offered) –Sum of services, possible range=0 to 9

The University of Georgia Results: Multivariate Models ServicePublic/Private differences Other significant predictors Medical caren.s.% women Legal assistancen.s.% women, % opiate, Accred(-) Vocationaln.s.% women, Accred(-) Financial assistancen.s.% women, % opiate(-), ASI Family/Social servicesn.s.% women, % opiate(-), Survey buyers/suppliers

The University of Georgia Results: Multivariate Models ServicePublic/Private differences Other significant predictors TransportationGovt (OR=1.97) PubNP (OR=1.93) % women, % Masters(-) ChildcareGovt (OR=2.15) PubNP (OR=1.88) % women, ASI, % Masters(-), Hospital(-), Rural(-) HIV programPubNP (OR=1.92)% opiate, Rural(-), Surveys Integrated Dual Dxn.s.% women, % Masters(-) TOTAL ServicesGovt (p<.05) PubNP (p<.01) % women, ASI, Surveys

The University of Georgia Summary Data suggest greater provision of wraparound/support services in public-funded programs –Government and/or nonprofits relying on public dollars Transportation, child care, and HIV programs are clearly more prevalent in the public sector –Other correlations were attenuated in multivariate models Overall levels of service comprehensiveness were higher among public sector programs when organizational differences were controlled –However, overall “comprehensiveness” was low –Average program offered fewer than 4 of 9 services measured These findings contradict what is generally perceived about service delivery in the public sector.

The University of Georgia Percentage of female clients in caseload was a nearly uniform predictor of service availability and comprehensiveness. Units with more Master’s-level counselors, and those that were accredited, were less likely to offer comprehensive services (net of other org. characteristics). Units that used the ASI at intake, and those that collected satisfaction data, were more likely to offer comprehensive services (net of other org. characteristics). Future research should consider: –Between-sector differences in availability of “core” treatment services –Implications of service “comprehensiveness” on retention and outcomes.