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

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Age appropriate servicesAccess to age and developmentally appropriate services is a key ingredient of effectivetreatment for young people (NIDA, 2006). Findings show that a relatively largeproportion of facilities report using age appropriate assessment tools, provide counsellingservices that are age and developmentally appropriate, conduct family-focusedinterventions, and employ staff trained to work with adolescents and young people. Incomparison, just over half of the facilities provide family reunification services foradolescents as well as adapt their facility environment to ensure the safety of youngpeople. However, a very small proportion of facilities provide adolescentfocused/adolescent-onlytreatment services. The latter finding is surprising in relation tothe reported staff capacity trained to work with adolescents and young people.In addition, this factor potentially inhibits young people from being retained in treatment,with young clients being more likely to remain in facilities that provide age appropriateservices. For example, facilities which provide family-focused interventions and whichadapt facility environments to make them suitable for young people treat a significantlygreater proportion of clients younger than 20 years of age than facilities without theseservices. Although treatment facilities may serve a higher proportion of adolescent clientsbecause they provide age appropriate services, it is also possible that certain facilitiesexamine the appropriateness of their services because a high proportion of their clientsare adolescents. To fully understand these findings, further investigation into therelationships among demographic profile, treatment needs, and factors facilitatingtreatment retention for recipients of substance abuse treatment is needed.4.4. MONITORING AND EVALUATION IN SUBSTANCE ABUSETREATMENT FACILITIESResearch has emphasised the importance of monitoring and evaluating (M & E) theprocess and outcomes of substance abuse treatment, not only because M & E helpsidentify areas in which treatment programmes and service delivery can be improved, butalso because evidence of treatment effectiveness can be used to inform decision-makingabout the rational distribution of human and financial resources to substance abusetreatment services (Cole, 1999). This study examined M & E activities that facilitate (i)the monitoring of clients’ progress during the course of treatment, (ii) the monitoring of76
clients progress post-treatment, and (iii) the evaluation of substance abuse treatmentprogrammes.This study examined administrative and procedural structures and activities that facilitatethe monitoring of client progress during the course of treatment. Findings show that mosttreatment facilities report having good administrative systems and structures thatfacilitate the monitoring of clients within-treatment and more than half of the facilitiesreport monitoring clients post-treatment. While all treatment facilities report developingindividualised treatment plans for each client and keep notes of clients’ progress duringtreatment; a smaller percentage of facilities obtain collateral information from varioussources; have formal discharge plans for each client and maintain a formal managementinformation system; and only 62.5% of facilities track clients’ progress once theycomplete treatment. These findings are similar to findings from previous audits oftreatment facilities in Gauteng and KwaZulu-Natal (Myers & Fakier, 2007), Gauteng(Myers, 2004) and Cape Town (Myers & Parry, 2003).Findings suggest a discrepancy between the proportion of facilities that systematicallymonitor clients’ progress post-treatment and the (large) proportion of facilities that reportmonitoring clients’ progress post-treatment via telephone and during follow-upcounselling sessions. A possible explanation for this apparent discrepancy may lie in thefact that telephonic monitoring and monitoring during follow-up counselling sessions arerelatively informal and unstructured ways of tracking clients’ progress; whereas postdischargemonitoring refers to a more formalised system of monitoring where self-reportquestionnaires and/or blood and urine tests are used to establish the extent to whichclients have achieved and maintained treatment goals. This explanation seems to besupported by the findings that only 43.8% of facilities report the use of blood tests and/orurinalysis to monitor clients’ substance use and only 18.8% of facilities use structuredfollow-up questionnaires to track clients’ progress post-treatment. In addition, just overhalf of the facilities monitor clients on an ad hoc basis or on request of family members.These findings mirror findings from audits of substance abuse treatment facilities in CapeTown (Myers & Parry, 2003), Gauteng (Myers, 2004) as well as Gauteng and KwaZulu-Natal (Myers & Fakier, 2007).77
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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
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delivery, treatment retention, and
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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: appropriate services for Black/Afri
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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