Defacto client-treatment matching: how clinicians make referrals to outpatient treatments for substance use

Despite the fact that there is no clear consensus from clinical trials on c lient-treatment matching guidelines for substance use problems, qualitative research with clinicians has begun to identify the factors that influence treatment placement decisions. The purpose of the present study was to use ethnographic decision tree modeling to describe and predict decisions to re fer clients to either a brief or a longer substance use program. Eleven cli nicians who complete intakes at an addiction treatment agency engaged in tw o semi-structured interviews regarding actual referral decisions; one inter view was to develop a decision tree model and the other was to test the acc uracy of the model. The setting for the referrals was an addiction treatmen t facility with both a brief and a longer outpatient program. Results showe d that the decision tree was accurate in predicting 85% of new referral dec isions. The decision tree indicated that clinicians tended to use the longe r outpatient treatment as the default, with a series of constraints being p ut on referral to the briefer treatment program. The decision tree also sug gested that there are a number of contextual factors that arise in decision s that present a challenge for simple implementation strategies of general clinical guidelines in substance use treatment. (C) 2000 Elsevier Science L td. AII rights reserved.