Clinical Assessment and Substance Abuse Treatment: The Target Cities Experience

6. Effects of Centralized Intake on Participant Satisfaction with Treatment and Ancillary Services

C H A P T E R 6 Effects of Centralized Intake on Participant Satisfaction with Treatment and Ancillary Services Christy K Scott, Mark A. Foss, and Richard E. Sherman Monitoring participants’ satisfaction with service components is an important aspect of managing any treatment system, but it is of particular importance when implementing systemic changes of the magnitude proposed in the Chicago Target Cities project. As with any demonstration program, prior to implementation, the extent to which the project’s desired goals would be achieved or whether the interventions would have unintended negative effects was unknown. Consequently , during the development phase of the Chicago Target Cities project, several staff members representing treatment programs across the city debated the potential advantages and disadvantages of centralizing intake and controlling access to treatment, as well as the other proposed components of the model. At the forefront of many of these debates were the potential negative impacts that a single access point could have on participants and treatment providers. It was argued that a single location would inconvenience participants, forcing them to learn and negotiate a new “system ” for accessing treatment, which would result in increased no-show rates to assessment and ultimately lower the numbers of participants who successfully entered treatment. Concern was also expressed that some individuals would have to travel across different gang territories to reach the Centralized Intake Unit (CIU). In addition, some believed that a single access point would create a bottleneck, so that instead of decreasing the amount of time a participant waited to access treatment, the wait time would increase. It was also unclear whether staff at a 87 single site could efficiently handle the participant flow that was currently being managed by a number of programs. The addition of an extra set of steps in the process could slow the rate of admissions. Specific concerns were expressed about the length of the proposed “comprehensive ” assessment that was designed for persons who could be suffering from substance abuse as well as co-occurring conditions. During the pre-CIU phase, in some treatment agencies the intake-assessment process required only 30 minutes to complete, while the proposed CIU assessment required over 2 hours. Providers expressed concerns about participants being mismatched to treatment programs and the ability of the CIU to assess enough participants to fill empty treatment slots. Treatment staff also raised concerns about the proposed assessment’s sensitivity to gender, racial, and ethnic issues. It was possible that the proposed system changes could negatively impact participants’ experiences at the front end and result in perceptions that could carry over into their treatment experience. For this reason, evaluators focused not only on the intended positive impacts of the proposed system interventions but also on ways in which these changes could potentially negatively impact the participants ’ perceptions of their treatment experience. To take this into account , a study of participant satisfaction with treatment and other services was included as part of the Chicago Target Cities evaluation. This study compares a cohort of participants who entered treatment directly through the treatment programs, prior to centralizing intake, with a cohort of participants who entered treatment through the CIU. It was hypothesized that the systemic changes brought about by the CIU would, at a minimum, not decrease participant satisfaction nor the perceived adequacy of services delivered. Publicly funded substance abuse treatment participants typically have little choice or input into the treatment they receive, and publicly funded substance abuse treatment programs have virtually no financial incentive to satisfy participants. The demand for publicly funded substance abuse services is so high that most programs suffer no financial penalty when participants leave treatment prematurely , because they can readily fill vacated treatment slots with waiting participants. For these reasons, Larsen, Attkisson, Hargreaves , and Nguyen (1979) recommended satisfaction surveys as one of the few ways participants can have input into the system. Given the various system changes proposed, it was possible that participants’ satisfaction with their treatment experience would increase in certain domains, while decreasing or not changing in other domains. For example, participants who entered treatment through the CIU could report greater satisfaction with the services they re88 Christy K Scott et al. ceived to address their medical needs and less satisfaction with the services to address their family/social needs than those who entered treatment directly through the programs. Method Design The instrument used in this study was designed to address problems commonly...