Consumers, purchasers, service providers and policymakers want quality and accountability in alcohol and other drug (AOD) treatment services for adolescents. In contrast to mainstream healthcare services, quality of care indicators with which to measure provider performance and drive quality improvements are underdeveloped for AOD treatment services generally, and adolescent services in particular. In the absence of quality indicators, we propose to develop tools, methods and theories that will support use of outcomes-based performance measurement systems to construct provider benchmarks, or standardized scores of providers' effectiveness. Outcomes data on treated adolescents are already collected by state and federal outcomes monitoring systems. Three new Center for Substance Abuse Treatment (CSAT) initiatives may dramatically increase the quantity of such data collected. Although outcomes monitoring systems are designed to ensure accountability and quality improvement, without improved understanding of the role of pretreatment characteristics in determining treatment outcomes, and reliable case-mix adjustment methods, these systems cannot support strong conclusions on provider effectiveness. Building on our recent case-mix adjustment innovations we propose to use outcomes data collected by CSAT and NIDA on nearly four thousand treated youths to develop risk adjusted outcomes models for adolescent AOD services in three levels of care (short term residential, long term residential and outpatient drug-free treatment), and for a range of outcomes including drug use problem severity, criminal behavior, psychological functioning, social functioning, and educational/vocational functioning.
Our aims are to: 1) model the effects of adolescents' pretreatment characteristics on their AOD treatment service outcomes, 2) evaluate use of these models as a prototype performance benchmarking system for adolescent treatment service providers, and 3) develop and disseminate versions of the benchmarking tool for use in examining adolescent AOD treatment effectiveness by service providers, CSAT, program evaluators, and treatment researchers. We expect the results from this study to offer important contributions to efforts to develop quality of care indicators that will help to drive improvements in adolescent AOD treatment services.
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