Access to Recovery: Enhancing Consumer Choice
By Rebecca A. Clay
SAMHSA's Access to Recovery (ATR) program offers multiple ways for individuals with substance abuse problems to seek treatment.
Some individuals prefer to receive treatment from a traditional clinic in their community. Others prefer to seek help from a faith-based organization. Some may need intensive in-patient treatment. Others may need "recovery support services," such as peer support groups, job training, housing assistance, or even something as simple as transportation to a treatment session.
"Providing people who have substance abuse problems with choices regarding their treatment and recovery supports makes sense," said SAMHSA Administrator Terry L. Cline, Ph.D. "It helps empower them from the very beginning to find their own path to recovery."
Launched in 2004 by SAMHSA's Center for Substance Abuse Treatment (CSAT), ATR uses a voucher system to give people greater choice when it comes to choosing the substance abuse treatment and recovery support services they need.
The program, a presidential initiative, exceeded expectations in its first round. Hoping to serve 125,000 people, the first group of grantees instead served 190,144 individuals. Now the program has expanded. In September 2007, SAMHSA announced $98 million in new 3-year grants to more than 20 states and tribal organizations.
Expanding Access to Services
ATR is based on three principles, according to CSAT Director H. Westley Clark, M.D., J.D., M.P.H.
- Giving consumers a choice. "ATR empowers the consumer to purchase the care they need," he explained. Each consumer receives a voucher worth approximately $1,600, chooses a provider from a list of approved providers, and then uses the voucher to pay for whatever care is needed. That choice, added Dr. Clark, also encourages providers to provide high-quality care to attract and retain consumers.
- Expanding capacity. "ATR acknowledges that there are many pathways to recovery-mental, physical, emotional, and spiritual," said Dr. Clark. The program allows hundreds of new faith-based and community-based organizations to participate. In addition, ATR emphasizes recovery support services as well as clinical services.
- Focusing on outcomes. ATR relies on data to measure success, said Dr. Clark. Outcomes measured include abstinence from drugs and alcohol, employment or enrollment in school, stable housing, social support, no or decreased involvement in the criminal justice system, access to care, and retention in services.
The focus on recovery support services is especially important, added Jack B. Stein, Ph.D., Director of the Division of Services Improvement at CSAT. "ATR is an opportunity to expand the concept of a recovery-oriented system of care nationwide," he explained. "We have learned over the last number of years that recovery support services are an essential component of truly comprehensive care."
Designed to prevent relapse and promote recovery, recovery support encompasses a wide range of nonclinical services.
These may be services directly related to recovery from substance abuse, such as self-help groups, mentoring and coaching, or case management. They may be services that make it easier for people to stay in treatment, such as transportation to treatment appointments or child care while they're there. Or, they may be services that help people rebuild their lives, such as job training or housing-related assistance.
The people offering these services can be just about anyone: professionals, faith leaders, family members, or peers who are themselves in recovery.
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That new approach is paying off, according to data from the 15 grantees in the first round of ATR.
Data on 130,978 clients show that their lives changed dramatically as a result of participation in ATR. Among clients who were using alcohol or drugs at intake, for instance, more than 73 percent were abstinent by the time they were discharged.
Substance abuse wasn't the only area of improvement, however. Of clients who were involved with the criminal justice system at intake, almost 86 percent reported no involvement at discharge. Of those who reported not being connected to friends they could turn to in times of trouble, self-help groups, or other sources of social support, more than 62 percent reported being socially connected at discharge. Of those who were unemployed at intake, 30 percent were employed at discharge. More than 23 percent of those who didn't have stable housing at intake had it at discharge.
Data show important shifts within the service delivery system. For example, the data show the importance of recovery-oriented services within ATR. About 65 percent of clients had received recovery support services. And nearly half the dollars paid were for such services.
The data also reveal the active participation of faith-based organizations. A third of dollars spent on recovery support and clinical services went to faith-based organizations. Faith-based providers accounted for 23 percent of the recovery support providers involved in ATR and 31 percent of the clinical treatment providers.
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