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

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psychological treatments. Using this definition, self-help groups and facilities thatprovide only information, education, crisis intervention, aftercare and/or preventionservices are not classified as substance abuse treatment facilities. In addition, solopractitioners and facilities that provide general health and social services, includingsubstance abuse-related services (e.g. psychologists, social workers, and generalhospitals) are not included in the sample. As the Treatment Services Audit Questionnaire(TSA) is designed to collect data from each physical location where treatment servicesare provided, a “facility” is defined as the point of delivery of substance abuse treatmentservices (i.e. the physical location).The sample frame was constructed from the list of known treatment facilities madeavailable by the Central Drug Authority (CDA) resource directory on alcohol and drugrelated services (CDA, 2003) and the SACENDU database of treatment facilities.Snowball sampling was used to expand upon these databases. In other words, thesefacilities were contacted telephonically and asked to identify other specialist substanceabuse treatment facilities in Free State, Limpopo, Mpumalanga, North West and NorthernCape that were not in the CDA’s resource directory. At the time of the audit, there were6 facilities in Free State, 2 in Limpopo, 4 in Mpumalanga, 1 in North West and 4facilities in Northern Cape that satisfied the criteria used by this study for the definitionof “substance abuse treatment facility”.2.5. TREATMENT SERVICES AUDIT (TSA) QUESTIONNAIREThe Treatment Services Audit (TSA) Questionnaire (revised version) was used to collectself-report information from substance abuse treatment facilities in Free State, Limpopo,Mpumalanga, North West and Northern Cape. The TSA was designed for the purposesof auditing substance abuse treatment facilities in South Africa. The construction of theoriginal TSA was based loosely on the Unified Facility Data Set Questionnaire (UFDS)(Carise, McLellan, & Gifford, 2000) that has been used to collect one-day censusinformation on the population of substance abuse treatment facilities in the USA. Thequestions contained in the original version of the TSA were discussed in focus groups ofsubstance abuse treatment experts to ensure applicability to the South African context. Apilot version of the original TSA was then used at two treatment facilities in Cape Townand necessary changes were made to problematic items. The original TSA was used to22
audit substance abuse treatment facilities in Cape Town in 2002 (Myers & Parry, 2003).Subsequent to this, the TSA was revised to reflect South African minimum norms andstandards for inpatient treatment centres. This revised version was used to audittreatment facilities in Gauteng in 2003 as well as Gauteng and KwaZulu-Natal in2006/2007.In order to minimise non-response and to include areas of emerging interest (such asquestions about service delivery); several adjustments have been made to the revisedversion of the TSA. These changes included additional questions about the organisationand work environment that relate to human resources and governing body procedures,additional questions about the types of treatment services offered (especially substanceabuse counselling, medical and family services).The TSA (revised version) is a six-page questionnaire with 41 questions, many of whichrequire multiple responses. Information is collected from a number of domains includingtreatment facility characteristics, service delivery characteristics, types of treatmentservices offered, services to improve access to and retention in treatment, characteristicsof clients served, staffing characteristics, organisational environment, and monitoring andevaluation activities. The TSA is directed at key informants from treatment programmes,such as clinical/treatment programme managers or treatment directors. The TSA collectsself-report information in English and takes approximately 30 minutes to complete.2.6. DATA COLLECTIONThe field period ran from October 2007 to February 2008. Treatment programmemanagers and/or facility directors of all the treatment facilities in the sampling framewere contacted telephonically, informed about the study, and asked to participate. Datacollection packets, including the TSA, a two-page guideline for completion of the TSA,and a covering letter explaining the purpose of the audit, were sent via post, fax, or emailto the identified key informants at participating facilities in October 2007. Questionnairepacks were mailed with self-addressed, stamped return envelopes. During the datacollection phase, the principal investigator was available to answer facilities’ questionsabout the audit. Telephone calls were made to all facilities to check whether they hadreceived the TSA. Thereafter, reminder and follow-up telephone calls were made to all23
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 and 16: Despite the apparent availability o
Page 17 and 18: treatment services provided. At pre
Page 19 and 20: use disorders whose physical and em
Page 21: delivery, treatment retention, and
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
Page 77 and 78:
clients progress post-treatment, an
Page 79 and 80:
• The number of state facilities
Page 81 and 82:
• Another way of ensuring (indire
Page 83 and 84:
• The age appropriateness of serv
Page 85 and 86:
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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