Audit of Substance Abuse Treatment Facilities in ... - SA HealthInfo

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disadvantaged communities, and for being located in suburban areas and thus beinginaccessible to the majority of the population (Myers & Parry, 2005).There has also been a proliferation of private, non-profit treatment facilities. Althoughmany of these are professionally run accredited facilities with solid treatmentprogrammes, in recent years several facilities have been started by well-meaningcommunity members with little knowledge of how to treat substance abuse and fewresources. Often these community-based facilities operate illegally and are unregulatedby the state. Although private non-profit facilities are relatively more accessible to BlackSouth Africans than for-profit services, the quality of services provided by these facilitiesis often variable and waiting lists at the better-resourced facilities are lengthy. Inaddition, many of the accredited non-profit facilities require clients to make some form offinancial contribution towards their treatment (Myers, 2004). Quality of services, waitinglists, and co-payment fees all restrict access to treatment for poor substance users.1.4. SUBSTANCE ABUSE TREATMENT IN SOUTH AFRICA: PRIORRESEARCH AND THE WAY FORWARDIn South Africa, national, provincial, and local governments control the allocation ofresources for substance abuse services. For the state to plan and deliver substance abusetreatment services that ensure appropriate and adequate provision of services to thecommunity (through addressing current and projected treatment needs, targeting high-riskgroups, and improving accessibility for all sectors of the population), access to qualityinformation about local treatment needs, existing treatment services, patterns of serviceutilisation, and service performance are required. This necessitates the development of asystem for monitoring substance abuse treatment services (Grant & Petrie, 2001).Yet, treatment service planning is hampered in South Africa by the lack of a monitoringsystem that routinely collects information on substance abuse treatment services. Whilethe South African Community Epidemiology Network on Drug Use (SACENDU) projectdoes collect descriptive information about the profile of clients served at treatmentcentres in all nine provinces in the country on a six-monthly basis and although thissystem provides essential information that should be collected as part of a nationalmonitoring system; it does not collect information on the type, intensity or quality of16
treatment services provided. At present, only limited information is collected on thefacilities that provide substance abuse treatment services. This information, typicallycontained in resource directories, generally consists of a brief description of the types ofclients served and services provided.Exceptions to this include two local-level audits of specialist substance abuse treatmentfacilities in Cape Town and Gauteng, conducted in 2002 and 2004, respectively (Myers &Parry, 2003; Myers, 2004). These audits reported on treatment facility characteristics, theprofile of clients served, the type and range of treatment services provided, theaccessibility of treatment services to clients from historically underserved groups, andtreatment service monitoring and evaluation processes. In addition, these auditsrecommended that a national audit of substance abuse treatment facilities occur on aregular basis to facilitate the collection of quality information on substance abusetreatment services (Myers & Parry, 2003; Myers, 2004). In 2007, an attempt was made toaddress this gap by auditing all known substance abuse treatment facilities in Gautengand KwaZulu-Natal provinces (Myers & Fakier, 2007). This report represents anotherattempt to provide missing information on current treatment services in the followingprovinces: Free State, Limpopo, Mpumalanga, North West and the Northern Cape. Assuch, the current project represents a partial response to earlier recommendations andgoes some way towards developing a national monitoring system of substance abusetreatment services.In a context where there is an increasing demand for scarce health and social welfareresources due to the burden caused by poverty, TB, HIV/AIDS and other infectiousdiseases (Freeman, 2000), a study that describes the structure of the substance abusetreatment system, describes the extent to which this system adheres to norms andstandards for treatment, and provides evidence as to whether barriers to accessingexisting services exist within this system is useful. Through identifying gaps in currentservice delivery, this study could help guide the design of policies to improve servicedelivery and could also assist planning and decision-making around substance abusetreatment services by suggesting ways in which treatment service delivery can beimproved (Thind & Andersen, 2003).17
Page 1 and 2: Alcohol & Drug Abuse Research UnitM
Page 3 and 4: 3.1.2 Treatment facility profile by
Page 5 and 6: 4.3 Targeting barriers to treatment
Page 7 and 8: EXECUTIVE SUMMARYA cross-sectional
Page 9 and 10: services to historically underserve
Page 11 and 12: use, reductions in criminal activit
Page 13 and 14: Despite high levels of substance ab
Page 15: Despite the apparent availability o
Page 19 and 20: use disorders whose physical and em
Page 21 and 22: delivery, treatment retention, and
Page 23 and 24: audit substance abuse treatment fac
Page 25 and 26: 2.8.3. Further data considerations
Page 27 and 28: Figure 1. Inpatient intensity of ca
Page 29 and 30: Since there is a large overlap betw
Page 31 and 32: the total client population (χ = 4
Page 33 and 34: Figure 7.Comparison of race profile
Page 35 and 36: services per month ranges from 13 t
Page 37 and 38: 3.4.1. Characteristics of staff at
Page 39 and 40: supervision. In contrast, a much sm
Page 41 and 42: In terms of client record-keeping,
Page 43 and 44: Core findings:• Compared to the p
Page 45 and 46: using 12-step approaches, 75.0% rep
Page 47 and 48: Figure 16. Proportion of treatment
Page 49 and 50: 3.7. ADDRESSING BARRIERS TO TREATME
Page 51 and 52: Table 11. Proportion of facilities
Page 55 and 56: Figure 20.Proportion of substance a
Page 61 and 62: 3.9.2. Monitoring of clients’ pro
Page 65 and 66: PART 4: DISCUSSION OF KEY FINDINGSW
Page 67 and 68:
previous audits of specialist subst
Page 69 and 70:
small proportion of South African d
Page 71 and 72:
high levels of substance use among
Page 73 and 74:
these barriers appears to significa
Page 75 and 76:
appropriate services for Black/Afri
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clients progress post-treatment, an
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• The number of state facilities
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• Another way of ensuring (indire
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• The age appropriateness of serv
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REFERENCESAllard, S.W., Tolman, R.M
Page 87 and 88:
Myers, B., & Fakier, N. (2007). Rep
Page 89:
Zule, W.A., Lam, W.K., & Wechsberg,
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