1. Paying for Performance -- Sounds Good …. But What Performance Are WE Paying For? Nancy Wolff, Ph.D. Complexities of Co-occurring Conditions Conference, June 23-25, 2004, Washington D.C.

2. Performance Level 1 Facility Level Public Funding Private Funding Primary Specialty Substance Abuse Tx Primary Specialty Mental Health Tx

3. èDistribution of Need èDistribution of Services èDistribution of Funding 6Which is leading? 6Which should lead? 6Efficient relative to what? 6 Demand 6 Need Target Efficiency

4. Performance Level 2 Client Level Primary Specialty Substance Abuse Tx Primary Specialty Mental Health Tx Immediate Client Outcomes Sustained Client Outcomes

5. èImmediate: Effectiveness of treatment and their combinations èSustainability: Effectiveness of treatment on recovery Return on Investment

6. Performance Level 3 Societal Level Immediate Client Outcomes Sustained Client Outcomes Social Outcomes Increased Productivity Reduced Crime Improved Family Welfare

7. èConnection between: 6 Immediate and Sustained Client Outcomes 6 Client Outcomes and Treatment èConnection between: 6 Client and Social Outcomes 6 Client and Social Outcomes and Other Contextual Factors Return on Investment

8. Performance Level 3 Societal Level Immediate Client Outcomes Sustained Client Outcomes Social Outcomes Increased Productivity Reduced Crime Improved Family Welfare Contextual Factors

9. Rewarding Performance Social Outcomes Substance Abuse Treatment Mental Health Treatment Immediate Client Outcomes Sustained Client Outcomes Public Funding Private Funding FacilityClientSocietalFunding

10. èLevel of performance? èCriteria for performance? èRelationship among the levels? èEffect of contextual factors on client and social outcomes? For What Performance are WE Paying ?