EFFECT OF CENTRALIZED INTAKE ON OUTCOMES OF SUBSTANCE-ABUSE TREATMENT

Objective: State governments are exploring the potential of various fo rms of case management to control the costs of substance abuse treatme nt programs, This report describes an experimental program in one Iowa county in which clients are assessed and referred elsewhere if treatm ent is needed. Outcomes of clients in that county are compared with th ose of clients served elsewhere in the state. Methods: All claims subm itted by provider agencies to the Iowa Department of Public Health for substance abuse treatment of eligible clients in 1994 were analyzed t o test the effect of the experimental intake-and-referral program on c lients' utilization of outpatient treatment, rate of treatment complet ion, and rate of abstention at discharge from treatment, Results: In t he county with the experimental program, 27 percent of clients recomme nded for treatment actually attended, compared with 48 percent in othe r counties. Clients who used the experimental program were also less l ikely to complete treatment. These differences persisted after adjusti ng for baseline differences in client characteristics, Conclusions: Lo wer utilization arising from failure to attend recommended treatment m ay reduce treatment costs but is not the intended outcome of the intak e-and-referral program, Failure to complete treatment also is an adver se outcome. Outcomes of various types of case management programs shou ld be carefully evaluated before statewide implementation is considere d.