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From the SAAS/NIATx conference: Agencies cope with possible loss of residential treatment

July 13, 2011
by Gary A. Enos, Editor
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Maine programs learn lessons from attempt to unbundle services

Budget pressures affecting addiction treatment have become so acute in the state of Maine that one program director there now says matter-of-factly, “We anticipate that the state won’t have residential treatment in the near future.”

While such an outcome hardly would please Barbara Dacri, executive director of Crossroads for Women, she and colleagues are not simply sitting back or tossing darts at lawmakers. Crossroads is part of a consortium of three organizations that have used a $1 million federal grant to test the “unbundling” of housing and treatment services in order to maintain services for clients, given that state leaders are indicating that they consider traditional residential treatment too costly to maintain.

At this week’s joint conference of State Associations of Addiction Services (SAAS) and the quality improvement collaborative NIATx, the Maine agencies shared initial findings from their effort. Two recent program clients joined the providers to say that preserving such programs for individuals who have nowhere else to turn is essential.

In the case of 22-year-old “Hannah,” she entered the Crossroads for Women program following her third detox (“I was pretty broken at that point,” she told an overflow audience in a conference breakout session on July 11). Now four months clean, Hannah lives in sober housing and has a job and a regular doctor and dentist—signs of progress that she said she couldn’t have dreamed of just months ago.

The initiative, also involving Portland-based Mercy Hospital and treatment agency Youth Alternatives Ingraham, essentially seeks to duplicate for clients the services they would receive in a residential treatment setting, but in this case with a sober-living site serving as the housing and with treatment being delivered off-site in a community setting.

The effort, funded by a Substance Abuse and Mental Health Services Administration (SAMHSA) grant, has had the capacity to serve four women and five men at a time, in separate housing programs. A Mercy Hospital staff member told the conference audience that preliminary outcomes, measured from program intake through discharge, have been encouraging. Employment among the studied group increased from 0 to 18 percent, with no client arrested while in treatment.

In addition, nearly half of program participants have been able to return to their own home upon completion of the program.

Those involved with the initiative have witnessed some advantages and some pitfalls. The unbundled services turn out to be less tightly regulated by the state than residential treatment would be, thus removing some administrative hurdles. On the other hand, the unbundling has forced program leaders to get creative in order to pay for services such as client medications, which were not funded as part of the grant.

And in what might be the most ironic finding at this point, the unbundled rate for services could be even higher than the state’s typical residential treatment rate. So it remains to be seen whether a different service model could save the state money, or if the traditional residential model actually constitutes a bargain, given the number of services it encompasses under one roof.

Besides, as Crossroads’ Dacri puts it, “Not everyone in my opinion can be served at an outpatient level.”

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