PROJECT ASSERT - AN ED-BASED INTERVENTION TO INCREASE ACCESS TO PRIMARY-CARE, PREVENTIVE SERVICES, AND THE SUBSTANCE-ABUSE TREATMENT SYSTEM

Study objective: To test the feasibility and effectiveness of Project ASSERT, an innovative program developed by us to facilitate access to the substance abuse treatment system and to primary care and preventiv e services for emergency department patients with drug- and alcohol-re lated health problems. Method: Multicultural health promotion advocate s (HPAs) were trained by ED personnel to screen patients using a healt h needs history, to administer a brief negotiated interview based on r eadiness-to-change principles, and to use an active referral process t o capture the marginal capacity of the substance abuse treatment syste m. Outcome measures included (1) number of referrals to the substance abuse treatment system, (2) patient self-report of satisfaction with s ervices received from Project ASSERT and utilization of treatment reso urces, and (3) changes in self-reported frequency of drug and alcohol use and in Drug Abuse Screening Test scores between enrollment and fol low-up at 60 to 90 days. Results: Between March 1, 1995, and February 29, 1996, 7,118 adult ED patients were screened. Substance abuse was d etected among 2,931 patients (41%), and 1,096 (37% of detected patient s) were enrolled. A total of 8,848 referrals were made: 3.189 to prima ry care, 2,018 to a variety of substance abuse treatment services, 2,2 53 for smoking cessation, 339 for mammography, and 689 to other suppor t services (eg, psychiatric nurse, social worker, battered women's adv ocate or shelter). Comparison of enrollment and follow-up scores for t he 245 enrollees who kept a follow-up appointment demonstrated signifi cant reductions, including a 45% reduction in severity of drug problem , a 56% reduction in alcohol use, and a 64% reduction in the frequency of drinking six or more drinks at one sitting. At follow-up, patients expressed satisfaction with Project ASSERT: 91% were satisfied with t heir referrals; 93% thought the HPAs explained things well; and 99% th ought the HPAs respected them as individuals. Among the follow-up grou p, 50% self-reported that they had kept an appointment for treatment. Conclusion: Project ASSERT is an innovative approach to link ED patien ts with the substance abuse treatment system and with primary care and other preventive services. Its success is further demonstrated by its adoption by Boston Medical Center as a funded ED value-added service.