This study examines the association between adherence to during-treatment process measures of quality (defined as initiation and engagement in treatment as developed by the Washington Circle) and outcome measures (defined as arrests and incarcerations) in the following year. The data come from the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) administrative data system linked to data from state agencies involved in criminal justice. Clients who initiated a new episode of outpatient treatment and who engaged in treatment were significantly less likely to be arrested or incarcerated during the following year. Initiation of substance abuse treatment alone, without engagement in treatment, was not significantly associated with arrests or incarcerations. These findings validate the clinical importance of the Washington Circle performance measures of initiation and engagement. These "process of care" measures can make a difference when used as a target for quality improvement at treatment facilities.

This study examined variations by race/ethnicity in initiation and engagement, two performance measures of treatment for substance use disorders, which focus on the timely receipt of services during the early stage of treatment. Administrative data from the Oklahoma Department of Mental Health and Substance Abuse Services were linked with facility-level information from the National Survey of Substance Abuse Treatment Services. We found that Black clients were less likely to initiate treatment, but we found no differences in treatment engagement by race/ethnicity. Most client and facility characteristics’ association with initiation or engagement did not differ across racial/ethnic groups. Increased attention is needed to understand what may contribute to the differences found and how to address them. This study also offers an approach that state agencies may implement for monitoring treatment quality and examining racial/ethnic disparities in substance abuse treatment services.

The relationship between engagement in outpatient treatment facilities in the public sector and subsequent arrest is examined for clients in Connecticut, New York, Oklahoma and Washington. Engagement is defined as receiving another treatment service within 14 days of beginning a new episode of specialty treatment and at least two additional services within the next 30 days. Data are from 2008 and survival analysis modeling is used. Survival analyses express the effects of model covariates in terms of “hazard ratios,” which reflect a change in the likelihood of outcome because of the covariate. Engaged clients had a significantly lower hazard of any arrest than non-engaged in all four states. In NY and OK, engaged clients also had a lower hazard of arrest for substance-related crimes. In CT, NY, and OK engaged clients had a lower hazard of arrest for violent crime. Clients in facilities with higher engagement rates had a lower hazard of any arrest in NY and OK. Engaging clients in outpatient treatment is a promising approach to decrease their subsequent criminal justice involvement.

Administrative data from five states were used to examine whether continuity of specialty substance abuse treatment after detoxification predicts outcomes. We examined the influence of a 14-day continuity of care process measure on readmissions. Across multiple states, there was support that clients who received treatment for substance use disorders within 14-days after discharge from detoxification were less likely to be readmitted to detoxification. This was particularly true for reducing readmissions to another detoxification that was not followed with treatment and when continuity of care was in residential treatment. Continuity of care in outpatient treatment was related to a reduction in readmissions in some states, but not as often as when continuity of care occurred in residential treatment. A performance measure for continuity of care after detoxification is a useful tool to help providers monitor quality of care delivered and to alert them when improvement is needed.

ABSTRACT. Objective: A limited literature on racial/ethnic disparities in the treatment of substance use disorders suggests that quality of treatment may differ based on client's race/ethnicity. This study examined whether (a) disparities exist in the probability of treatment engagement, a performance measure for substance use disorders, and (b) treatment engagement is associated with similar reductions in likelihood of arrest for Whites, Blacks, Latinos, and American Indians. Method: Adult clients who began an outpatient treatment episode in 2008 in public sector specialty treatment facilities in Connecticut, New York, Oklahoma, and Washington made up the sample (N = 108,654). Administrative treatment data were linked to criminal justice data. The criminal justice outcome was defi ned as an arrest within a year after beginning treatment. Engagement is defi ned as receiving a treatment service within 14 days of beginning a new outpatient treatment episode and at least two additional services within the next 30 days. Two-step Heckman probit models and hierarchical time-to-event models were used in the analyses. Results: Black clients in New York and American Indian clients in Washington had signifi cantly lower likelihood of engagement than White clients. As moderators of engagement, race/ethnicity had inconsistent effects across states on the hazard of arrest. Conclusions: Racial/ethnic minority groups may benefi t from additional treatment support to reduce criminal justice involvement. States should examine whether disparities exist within their treatment system and incorporate disparities reduction in their quality improvement initiatives. (J. Stud. Alcohol Drugs, 76, 57-67, 2015)