Can addiction treatment centers address all of a client's diverse clinical needs, remain true to their core mission, and stay financially viable? Many participants in Addiction Professional's 2011 Treatment Center Survey clearly are expanding the reach of their services, while trying to determine whether these enhancements represent their organizations' path to financial security or pose a further threat to their long-term vitality.
At Avenues to Recovery, a Kansas business that started in 2003 with programs in court-ordered assessment and treatment, the organization has expanded both geographically within Kansas and programmatically, with director David Brown now conducting interventions as well as the core activities targeting offenders. “We had all our eggs in one basket at the beginning-we were naïve,” says Brown.
At First Step Recovery, a five-employee outpatient treatment practice in Fargo, N.D., leaders have talked on many occasions about possibly moving into residential services as well, but they also see concerns about whether residential substance use treatment will be de-emphasized in the health reform era. “It's hard to keep your doors open as a small agency,” says First Step Recovery clinical director Patti Senn.
For this year's survey, our third annual report on treatment center demographics and trends, 289 respondents identified themselves as working in an addiction treatment facility (as opposed to a private counseling practice or other health and human services organization). Respondents completed a 27-item online questionnaire, with items covering their facilities' levels of service, treatment populations, and trends in areas such as staff hiring and spending on continuing education and training.
Direct comparisons of Treatment Center Survey results from year to year are avoided because the makeup of the responding group of centers differs somewhat in each year's survey. Yet this year's results clearly indicate that most treatment centers are offering multiple levels of care, in many cases venturing beyond what they would have defined years ago as their primary mission.
Most categories under the level-of-treatment question saw greater penetration in 2011 than in 2010, in terms of the percentage of facilities reporting that they offer the level of service. A total of 38 percent of facilities participating in the 2011 survey now offer some form of sober living or aftercare services, for example. Also, a total of 38 percent now offer detox services, usually in addition to primary treatment.
Avenues to Recovery's Brown has avoided offering mental health services in addition to addiction services, but he has seen numerous opportunities to expand the ways his agency can work with local justice systems on behalf of substance-using offenders. “The key is we're always flexible, always thinking, always looking,” he says.
First Step Recovery is a for-profit agency offering mainly insurance-reimbursable outpatient services; clients tend to stay in treatment for about three months, says Senn. The organization has stayed true to its 12-Step based mission since its establishment in 2000, offering most of its services in group-based settings.
“We're constantly looking to do better, tweaking the types of groups we bring in,” says Senn. The program, which is staffed full-time by three counselors and a registered nurse, does offer some mental health counseling by virtue of having dual-licensed counselors, while cases requiring psychiatric consultation are referred out.
Among all Treatment Center Survey respondents, 64 percent report that they customarily treat clients who have co-occurring addiction and mental health disorders in a concurrent fashion with their own cross-trained staff. A total of 21 percent of respondents refer these clients to an outside mental health agency for their mental health services, while 15 percent treat mental health issues within the agency but with separate staff for mental health and addiction services.
Both Brown and Senn responded that their agencies do not include mind-body treatments/wellness services as a formal part of their clinical program. That is becoming a more prominent feature of the larger treatment center population in the survey, with 58 percent of survey respondents stating that these services are now a formal part of their program.
Senn's First Step Recovery does not have a significant marketing arm, depending largely on referrals from the physician community and client self-referral for its client base. The provider community is highly competitive in the Fargo area, Senn says, and the possible new business that could be acquired by initiating a residential program is tempered by concerns over declining reimbursements for more intensive levels of care in the marketplace.
Brown's Avenues to Recovery has benefited in recent years from relatively stable funding for criminal justice programs in Kansas. This has allowed the agency to expand into multiple counties and to identify new service opportunities, such as work with probationers in Kansas City, Kan., as they leave custody.
A program for multiple DUI offenders took a funding hit a couple of years ago and saw a significant decrease in capacity, but some of that lost support has begun to be restored, says Brown. Still, he sees some of his agency's new work in intervention as helping to offset instability that might occur with other programs.
Here are some of the other key results reported in the 2011 Treatment Center Survey: