Clinical Assessment and Substance Abuse Treatment: The Target Cities Experience

9. Outcomes Before and After Implementing Centralized Intake Services

C H A P T E R 9 Outcomes Before and After Implementing Centralized Intake Services Christy K Scott, Mark A. Foss, and Richard E. Sherman The Chicago Target Cities Project was designed as a system-level change and was implemented primarily with the intent of altering the method by which individuals access publicly funded substance abuse treatment. Although it was not intended to specifically change the treatment services participants received, there were reasons to believe that centralized intake could impact treatment outcomes. It was difficult, however, to predict the direction and intensity of these outcomes , because the existing research had produced contradictory findings (cf. Rohrer et al., 1996; Wickizer et al., 1994). Two centralized intake units (CIUs) were established as part of the Chicago Target Cities Project (designated as Network A and Network B). One unit served a network of treatment providers on the north side of Chicago, and the other served a provider network on the west side. Interventions implemented through the centralized intake system included comprehensive assessment and referral, objective participant treatment-matching procedures, a centralized wait list managed through a management information system (MIS), and increased coordination among substance abuse treatment programs and other health and human service providers. Evaluators sought to determine the effects of the central intake process on participant treatment outcomes. One aspect of centralized intake—a more comprehensive assessment process—was expected to improve identification of individual participant problems in domains other than substance abuse, 149 such as health, legal, employment, and so forth. This information would then provide the basis for developing detailed individualized treatment plans. A second advantage of centralized intake in Chicago was the numerous linkages the CIU staff had developed with other health and human service providers. These providers could provide referrals and services to meet the participants’ ancillary needs as identified through the comprehensive assessment. Centralized intake, therefore , provided the opportunity to address a much broader array of needs than simply substance abuse problems. An example of the screening and linkages was in the area of medical/psychiatric problems . Screening at the CIU led to the identification and referral to appropriate ancillary services of participants with severe medical and psychiatric problems. Third, the use of objective participant treatment-matching criteria by staff who were not employed by treatment programs could also improve the treatment experience. According to state data, prior to this demonstration project approximately 90% of the persons who presented for treatment were served at the agency to which they originally presented. The issue that often drove admission to treatment was whether or not the participant met the program ’s admission criteria, not whether the agency was the best match for the participant. It was hypothesized that a more objective match between participants’ needs and characteristics and level of care would result in improved treatment outcomes. Lastly, a centralized wait list was also expected to increase the efficient utilization of available treatment resources and, thereby, decrease the wait for treatment. Based on these expectations, changes from intake to 6-month postintake in the following seven problem areas or domains of lifefunctioning were included in the study hypotheses: Alcohol Use, Drug Use, Legal, Employment, Family/Social, Medical, and Psychiatric. Within each of the two Chicago Target Cities CIU networks, treatment outcomes for participants who accessed treatment directly through agencies prior to the opening of the centralized intake unit (pre-CIU cohort) were compared to those of participants who accessed treatment though the centralized intake unit (CIU cohort). It is important to note that the pre-CIU participants were expected to show improvements over time. The research question was whether the CIU participants had even greater improvement than that of the pre-CIU participants. 150 Christy K Scott et al. Method Design The Chicago Target Cities project evaluation used a quasi-experimental sequential cohort design. Prior to the implementation of each CIU, participants were recruited from all participating network programs and interviewed at intake and again 6 months later (pre-CIU cohort). After assessment data for the pre-CIU cohort had been collected , centralized intake was implemented, and participating programs closed intake and directed all those seeking treatment to the network CIU for assessment and referral. Both CIU cohorts and the pre-CIU cohort from Network B represented participants who completed an intake assessment. Nearly one fourth, approximately 200, of the participants in these three cohorts did not show to the referent treatment program (see Scott...