By: Christine Grella, Ph.D., CLARE Ambassador and Professor of Psychiatry and Biobehavioral Sciences, UCLA Integrated Substance Abuse Programs
[message_box title=”CLARE PARTNERS WITH UCLA” color=”yellow”]CLARE Foundation has partnered with the UCLA Integrated Substance Abuse Programs (ISAP) on three evaluation studies of treatment processes and outcomes for clients who are served at CLARE programs. Two projects, which received Federal funding, target individuals with the highest levels of severity – those with a history of chronic homeless and both substance use and mental disorders.[/message_box]
Community Bridges. In 2006, CLARE obtained a 5-year grant from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) to develop a collaborative system of care for homeless individuals with co-occurring substance abuse and mental health problems. This project recruited and served 233 participants who were referred by one of the participating partner agencies along with CLARE: Ocean Park Community Center, Edelman Mental Health Center, and Venice Family Clinic. Participants were successfully cross-referred across the partner agencies for services as needed, consistent with SAMHSA’s “no wrong door” approach to service delivery. Overall alcohol and drug use was substantially reduced, with two thirds reporting no alcohol or drug use at the 6-month follow-up; participants also improved their psychological and social functioning. Fewer participants were literally homeless (i.e., living on the streets or in unstable housing) and nearly half were housed either in treatment or sober living at the 6-month follow-up. Yet few participants were able to successfully transition into permanent housing, given the shortage of housing options in the community.
Bridges to Housing. In 2011, CLARE obtained a second grant from SAMHSA to develop a collaborative program for homeless individuals with co-occurring disorders, which directly targeted the need for stable housing that was identified in the Community Bridges project. In partnership with Step-Up on Second, St. Joseph’s Center, Venice Community Housing Corporation, the Edelman Center, and New Directions, Bridges to Housing participants receive intensive case management services to address their complex service needs. Primary goals include helping participants to obtain needed benefits and to increase their ability to sustain stable housing. At present, the project has successfully recruited 40 individuals; about two thirds were either housed or moved into stable housing at intake and over half were receiving public assistance at the time of admission. Participants expressed a high need for services at intake, with over half indicating they were considerably bothered by psychological problems and 65% indicating it was important for them to receive psychological services. Over 70% indicated a need for medical services as well. The ongoing evaluation study will continue to track the services participants receive, their housing status, and social and psychological functioning at follow-up.
CLARE Follow-up Study. The aim of this study was to evaluate the overall treatment model provided at CLARE Foundation and to identify areas for program improvement. Brief face-to-face interviews were conducted with 92 participants at the time of their admission to CLARE who were sampled across five modalities (Primary Care, Long-term Rehabilitation, Outpatient, Sober Living, and Drug Court). Follow-up interviews were conducted at 3, 6, and 12 months; 89% of the study sample completed at least one follow-up interview.
Overall, close to two thirds of the study sample completed treatment and less than one third discharged prior to completion. Over half (60%) of Primary Care participants transferred to Long-term Rehabilitation; these participants were more likely to be male, older, have more prior drug treatment episodes, have lower levels of alcohol and drug use severity, and have fewer psychological problems. About 40% of participants in Long-term Treatment successfully transferred to CLARE Sober Living.
Key outcome findings include:
- There is an initial reduction in alcohol and drug use from the baseline to the 3-month follow-up, after which there is a rebound in drug use at subsequent follow-ups. This is not unexpected given that more individuals have moved out of treatment and back to the community by the time of follow-up.
- Drug use severity scores are significantly lower for individuals in Sober Living as compared with those in Primary Care, indicating that individuals who continue along the continuum of services at CLARE sustain their recovery over time.
- Overall health status and psychological status are also improved at follow-up, with greater improvements generally among those who completed treatment compared with those who did not.
- Substance use at the time of follow-up is also generally associated with poorer functioning in several areas, particularly regarding psychological problems.
- The rate of employment increases from 13% at baseline to approximately 58% at the 6-month follow-up, with the largest increases among participants in Primary Care and Long-term Rehabilitation. Overall, the odds of working increase by approximately 40% over time, after controlling for modality.
- Individuals who are more involved in AA/12-step participation (both during and after treatment) have lower levels of drug use, depressive symptoms, and severity of psychological problems over time.
- There are significant gender differences in the areas of social/family functioning and psychological problems, with women reporting more anxiety, overall psychological problems, and problems in social/family functioning at all time points.
Overall, these studies provide support for CLARE’s continuum of services and for its leadership in building community partnerships that aim to provide comprehensive services for individuals who have chronic histories of addiction, mental health problems, and homelessness. Further, these studies have the added benefit of exposing staff to current research and evidence-based treatments within the addiction field, leveraging new resources for staff training, and identifying areas that can be targeted for program improvement. As the field of substance abuse treatment is transitioning into the new realm of the Affordable Care Act (i.e., health care reform), involvement in evaluation research will further help to position CLARE with data that can be used for ongoing program development and for developing new collaborative partnerships to better serve its participants and the community.