This project will provide fundamental knowledge on how clinic-level organizational characteristics affect drug abuse outcomes. Drug abuse treatment organizations have highly diverse organizational characteristics. While pressure from managed care may have reduced the services provided and managerial resources available, clinics have responded to reimbursement pressures in a variety of different ways. There is, however, little rigorous, empirical information about how varied characteristics and procedures actually affect long-term clinical outcomes. We feel there are compelling reasons to believe that how clinics are run can have important effects on outcome, and therefore a need to achieve a scientific understanding of what aspects make the most difference. The project has the following specific aims: (1) To conduct a multi-site longitudinal study to test predictions about how organizational factors affect clinical outcome, and (2) to test hypotheses about the processes by which organizational variables affect clinical outcomes. We propose to recruit 500 clients from 20 diverse outpatient drug treatment programs. Participants will receive a thorough baseline assessment and follow-up interviews at 6 and 12 months after intake. At the same time, we will conduct assessments of the clinical settings that will include clinical and structural aspects. In the data analysis, we will study the effects of organizational-level predictors in a multilevel statistical outcome model, jointly with baseline individual client characteristics expected to affect outcome. This statistical model will allow us to test for the impact of organizational characteristics controlling for patient characteristics (case mix). We will also test a model of how the effects of organizational variables are mediated by client customization/responsiveness, the capacity of an organization to detect and adapt to the strengths and needs of its clients. There are many reasons, beyond managed care, why it is important to run drug clinics effectively. We feel there is a critical need for rigorous, theoretically driven empirical research to provide guidance on the best ways to deliver drug treatment services to produce the best possible outcomes.
