DHS-Substance Abuse Treatment Programs Performance Audit Highlights

Az Auditor General

Informations

• Publié par: Orde
• Nombre de lectures: 11
• Langue: English

Extrait

Department of
Health Services
Division of Behavioral Health Services—
Substance Abuse Treatment Programs
REPORT Focusing on strategies that improve outcomesHIGHLIGHTS
PERFORMANCE AUDIT
The Department of Health Services, Changes in substance use—Fifty-four
Division of Behavioral Health Services percent of the consumers were not usingOur Conclusion
(Division) provides substance abuse drugs or alcohol when they entered
The Division should focus on services mainly to consumers enrolled in treatment, and 93 percent of them
three strategies that the state Medicaid program (AHCCCS). remained abstinent by the end of
improve substance abuse The number of people receiving some type treatment. However, nearly 46 percent oftreatment outcomes and
of state-provided substance abuse service the consumers were using drugs orhold treatment providers
has increased by nearly 300 percent from alcohol when they entered the program,more accountable for
consumer outcomes. fiscal years 2001 to 2008. However, and only 25 percent of these consumers
Treating substance abuse is Arizona, like many other states, struggles had reduced or stopped use by the end
very difficult, and most to obtain positive treatment outcomes. of treatment.
consumers showed little
change after treatment. Three strategies for improviinngg
Over half of the consumers Substance Abuse Enrollment outcomes—Research shows thewere abstinent when they
70,000 Division can improve outcomes
65,696entered treatment, and
63,571
60,105
59,661 by:treatment appeared to help 60,000
them stay abstinent.
50,000
 Increasing retention andHowever, most (75 percent)
41,172
40,000 completion rates—Studies show
36,375of the consumers who were
32,772 that consumers who remain inusing alcohol or drugs when
30,000
treatment at least 3 to 6 monthsentering treatment either
20,000
16,115continued or increased their have better outcomes.
10,000use. Three strategies can Unfortunately, most consumers
increase treatment (58 percent) drop out of treatment
0
effectiveness: (1) retaining
2001 2002 2003 2004 2005 2006 2007 2008 well before then. The Division’s
consumers in programs Fiscal Year average stay is 29 days for
longer, (2) providing a outpatient treatment and 78 days
continuum of care to meet Most consumers showed little change— for long-term residential treatment.consumers’ changing levels
We analyzed four outcome measures forof need, and (3) using Several factors affect whether consumers
adult substance abuse consumers who didtherapies proven by stay in treatment, including motivation to
research to have positive not have a serious mental illness and were change behavior, family/friends’ support,
effects. The Division can enrolled in fiscal years 2006, 2007, or 2008: and pressure by the criminal justicealso hold treatment substance use, employment, criminal system. However, treatment programs canproviders more accountable
activity, and housing. We found a slight also affect retention by making treatmentfor treatment outcomes by
improvement in substance use, and little or attractive, offering options, increasingusing incentives and
monitoring, and giving feedback.penalties. no change in the other three measures.
Generally, consumers who were doing well
 Monitoring continuum of care—The
in a measured area before starting Division should also monitor how services
treatment maintained their status, are matched to a consumer’s particular
particularly if they completed treatment. treatment needs. Successfully matching the
Consumers who were not doing well in an consumer to appropriate treatment helps to
area when they entered treatment were ensure positive outcomes. For example,2009
such a continuum of care may includemore likely to improve if they completed
acute detoxification, followed bytreatment, and to stay the same or worsenJuly • Report No. 09 – 07
stabilization, rehabilitation, and continuingif they did not complete treatment.
recovery support.
EnrollmentA lack of continuous care can lead to poor  Ensuring use of evidence-bbased
outcomes. For example, we identified one practices—Scientific research has shown
homeless consumer who received medical certain practices can improve treatment
detoxification 54 times in 3 years (about success. Such practices include
every 3 weeks) at a cost of over $82,000. motivational interviewing, cognitive
He typically received 2 to 3 days of behavioral therapy, community
detoxification, but chose not to complete reinforcement therapy, and 12-step
treatment or receive follow-up care. facilitation therapy. The Division requires
providers to use evidence-based practices,
but it does not monitor and enforce this
requirement.
Division should focus its oversight on
outcomes and costs
The Division should develop, monitor, The Division should also increase its review
and hold the Regional Behavioral Health of cases with very high costs. Auditors
Authorities accountable for meeting discovered 14 consumers who received
outcome measures. It should also substance abuse treatment totaling over
enhance its reviews of treatment costs— $100,000 each during fiscal years 2006
TTOO OOBBTTAAIINN both costs for individual treatment cases through 2008. For fiscal years 2006 throughMORE INFORMATION
and costs for specific types of treatments 2008, $100 million (72 percent) of the
or services. money for substance abuse treatment wasA copy of the full report
used to provide services to 20 percent ofcan be obtained by calling The Division largely monitors processes the consumers, and 45 percent of those(602) 553-00333 rather than treatment outcomes. For did not complete treatment. The Division
example, the Division monitors the began monitoring high- and low-cost
timeliness of services, but not whether substance abuse cases in March 2009.
the treatment is effective. Three other
states—Colorado, Delaware, and The Division should also continue to reviewor by visiting
Maine—have established goals for those types of treatments that have highour Web site at:
providers that focus on such things as costs. For example, between fiscal yearswww.azauditor.gov
treatment retention, continuation of care, 2006 and 2008, 2,600 consumers (5
Contact person for and abstinence. For example, Colorado percent of all substance abuse consumers)
this report: has a goal concerning the percentage of received methadone treatment at a cost of
Shan Hays clients who had a reduction in primary over $9.5 million. The Division is
drug use at discharge. Further, Delaware transitioning to buprenorphine, an
and Maine have incorporated financial alternative to methadone treatment, which
incentives into their goals. Specifically, will be less costly and easier to administer.
Delaware provides an incentive for
treatment retention/completion, and in
Maine, providers can also incur penalties
for underperforming.
Department of REPORT
Health Services HIGHLIGHTS
PERFORMANCE AUDITDivision of Behavioral Health Services—
July 2009• Report No. 09 – 07Substance Abuse Treatment Programs
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