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

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example, several studies report that “lack of transportation” is a barrier to substanceabuse treatment entry (Hser et al., 1998), especially for low-income groups who have lessaccess to private transportation and who may not be able to afford public transport(Allard, Tolman, & Rosen, 2003). Although research indicates that providing clients withtransport increases substance abusers’ use of treatment services (Booth et al., 2000;Friedmann, Lemon, & Stein, 2001; Hser et al., 1998), only12.5% of facilitiesparticipating in this study routinely provide clients with transport to their treatmentfacility. Similarly, 12.5% of facilities routinely provide clients’ families with transport totheir facilities. This lack of transportation may limit the extent to which poorer familiesare able to participate in the treatment process. This is cause for concern as familyparticipation in treatment is an essential ingredient of effective treatment, particularly foradolescent clients (NIDA, 2006) and because a lack of participation may limit theirknowledge of how to provide a supportive social environment to their family member – akey ingredient for positive treatment outcomes (Joe et al., 2002).Affordability factors have also been identified as significant obstacles to substance abusetreatment entry (Hser et al., 1998; Myers, 2007; Tucker, Vuchinich, & Rippens, 2004).These factors include the direct costs of treatment as well as indirect costs associated withtransport to treatment facilities, replacement of wages, and child care (Myers, 2007;Tucker, Vuchinich, & Rippens, 2004). Cost barriers seem highest for substance userswithout health insurance (Sturm & Sherbourne, 2001), which in South Africa consistslargely of Black/African persons (Goosen, et al., 2003). Findings from this study showthat few treatment facilities address the cost barriers that restrict poorer clients fromentering treatment. Although more than half of facilities report routinely offering indigentclients reduced fees, often these reduced fees are still unaffordable to indigent clients.Three quarter of the facilities routinely have free treatment slots available for clients whocannot afford to pay for treatment. In terms of the indirect costs of entering treatment,less than half of the facilities have child care services available to clients participating intheir treatment programmes. As affordability considerations are one of the mostimportant predictors of treatment entry among South African substance abusers (Myers,2007), it is vital that facilities consider innovative ways in which the costs associated withtreatment can be reduced for clients from underserved groups; particularly as addressing72
these barriers appears to significantly improve entry into substance abuse treatment(Friedmann, Lemon, & Stein, 2001).Cultural and linguistic barriers to treatment entryHistorically, one of the major barriers to entering substance abuse treatment forBlack/African persons has been the lack of cultural and linguistically appropriateservices, with most treatment services being provided in English or Afrikaans and byWhite or Coloured treatment staff (Myers, 2004; Myers et al., 2005). Although researchindicates that providing clients with treatment services in their home language andmatching clients and counsellors on ethnicity and gender dimensions increases substanceabusers’ use of treatment services (Appel et al., 2004; Tucker, Vuchinich, & Rippens,2004), only a small proportion of facilities actively address these cultural and linguisticbarriers to treatment entry for Black/African clients.Although all facilities report employing multilingual staff and staff from ethnicallydiverse backgrounds, further questioning revealed that only 81.3% of facilities employAfrican language-speaking counsellors. This potentially inhibits Black/African personsfrom seeking treatment, with Black/African clients being more likely to seek treatment atfacilities that actively address the cultural/linguistic barriers they experience. Forexample, facilities that employ African language-speaking counsellors treat asignificantly greater proportion of Black/African clients, than facilities without thesecounsellors. Although treatment facilities may serve a higher proportion of Black/Africanclients because they actively target linguistic barriers to treatment entry, it is also possiblethat certain facilities employ African language-speaking counsellors because a highproportion of their clientele are Black/African. To fully understand these findings,further investigation into the relationships among demographic profile, treatment needs,and factors facilitating treatment entry for recipients of substance abuse treatment isrequired.In summary, it seems that treatment facilities in Free State, Limpopo, Mpumalanga,North West and Northern Cape have not adequately addressed key affordability,logistical and linguistic barriers to treatment entry for substance abusers fromunderserved communities. These findings mirror those found in previous audits of73
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Alcohol & Drug Abuse Research UnitM
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3.1.2 Treatment facility profile by
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4.3 Targeting barriers to treatment
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EXECUTIVE SUMMARYA cross-sectional
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services to historically underserve
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use, reductions in criminal activit
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Despite high levels of substance ab
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Despite the apparent availability o
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treatment services provided. At pre
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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: high levels of substance use among
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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