James M Herrell

HIV outreach for hard-to-reach populations: a cross-site perspective.

This article examines the effectiveness of outreach as a vehicle for moving hard-to-reach substance abusing clients into substance abuse treatment. These clients were recruited by and participated in one of twelve HIV Outreach Demonstration Projects funded by the Center for Substance Abuse Treatment (CSAT). The analysis combines data across projects to provide a cross-site perspective. Data from 1675 clients were analyzed in this study. In addition, a comparison group of 3704 subjects was generated from the National Treatment Improvement Evaluation Study (NTIES) data. The results supported the hypothesis that clients representing traditional hard-to-reach populations would be more likely to enter treatment for substance abuse through participation in HIV Outreach programs than would clients exposed to treatment-specific recruiting methods (e.g. NTIES). The findings from this cross-site study support the view that HIV Outreach, as an integrated approach to several behavioral constellations, is more effective in recruiting clients to substance abuse treatment than are approaches that focus exclusively on substance abusing behavior. The HIV Outreach model is especially effective in reaching substance abusers earlier in the cycle of abuse. This has importance clinically for developing and focusing more effective methods for treatment for younger substance abusers with shorter histories of abuse. It also has implications for policy to guide the effective use of scarce treatment resources. Targeting specific populations and affiliation with substance abuse treatment providers were also influential in facilitating access to substance abuse treatment for groups at increased risk for HIV.

Performance measurement for co-occurring mental health and substance use disorders

BackgroundCo-occurring mental health and substance use disorders (COD) are the norm rather than the exception. It is therefore critical that performance measures are developed to assess the quality of care for individuals with COD irrespective of whether they seek care in mental health systems or substance abuse systems or both.MethodsWe convened an expert panel and asked them to rate a series of structure, process, and outcomes measures for COD using a structured evaluation tool with domains for importance, usefulness, validity, and practicality.ResultsWe chose twelve measures that demonstrated promise for future pilot testing and refinement. The criteria that we applied to select these measures included: balance across structure, process, and outcome measures, quantitative ratings from the panelists, narrative comments from the panelists, and evidence the measure had been tested in a similar form elsewhere.ConclusionTo be successful performance measures need to be developed in such a way that they align with needs of administrators and providers. Policymakers need to work with all stakeholders to establish a concrete agenda for developing, piloting and implementing performance measures that include COD. Future research could begin to consider strategies that increase our ability to use administrative coding in mental health and substance use disorder systems to efficiently capture quality relevant clinical data.