Access to Recovery: Enhancing Consumer Choice—Part 2
A Closer Look: Louisiana
The experience of Louisiana, a two-time ATR grantee, parallels the national trends.
"Whenever we do our needs assessment each year, it shows that we're meeting less than 10 percent of the need for substance abuse treatment in our state," said Charlene M. Gradney, M.S.W., L.C.S.W., ATR Project Director in the Office for Addictive Disorders in the Louisiana Department of Health and Hospitals. "ATR was an opportunity to expand services."
When it came to women and adolescents, said Ms. Gradney, the situation was even more dire. The state couldn't fund case management, aftercare, education, and other recovery support services women needed.
That's why the state jumped at the opportunity to participate in ATR, said Ms. Gradney, and why it decided to focus its first round of funding on women and adolescents across the state.
No matter who the target population is, the process is the same: After a referral from a court, school, or some other source, the client undergoes an assessment to determine whether she has an alcohol or drug problem and whether she meets the financial criteria for participation in ATR. If the answer to both questions is "yes," she then undergoes a thorough clinical assessment.
"We look at all aspects of their lives-their family, work and employment history, educational background, and psychiatric issues as well as their substance abuse history," said Ms. Gradney.
Once the client and clinician decide on a treatment plan, the client receives a list of ATR-approved providers for the level of treatment or recovery support she needs. She then selects the provider she wants and uses a voucher to pay for the care. Each voucher is good for 6 months and for whatever level of care a client needs.
Like other grantees, Louisiana has a Web-based voucher system that tracks how vouchers are used. The system also contains clients' clinical records. When a client chooses a particular provider, that provider gets access to an electronic version of the client's clinical records.
"Our Web-based system also allows for good continuity of services," said Ms. Gradney. "Clients can easily transition to the next level of care, because the progress notes in their electronic records can easily be transferred."
Like the program overall, Louisiana has served more clients than expected. As of June 2007, the program had served 17,113 clients-115 percent more than targeted.
Part of the explanation for that success is the heavy involvement of faith-based organizations, said Ms. Gradney. "Faith-based organizations have been able to reach out to clients that our traditional providers may not have been able to engage," she explained. "They've been a big help."
Faith-based organizations represent 28 percent of providers in the state's program and received 56 percent of all ATR reimbursements in the state.
Good Results
The percentage of clients reporting no alcohol or drug use in the past 30 days jumped from 37 percent at intake to 87 percent at discharge. Those who were employed or enrolled in school jumped from 36 percent to 59 percent. And the percentage who had no involvement with the criminal justice system went from 89 percent to almost 97 percent.
Louisiana's state legislature was so impressed with those results that it decided to provide $9 million a year for the next 3 years.
In the meantime, the state won another ATR grant and is now starting its second initiative. The focus this time will be another underserved population: juvenile and adult criminal offenders who are re-entering the community.
"The emphasis on client choice starts clients in the process of making positive decisions in their lives," said Ms. Gradney. "We're empowering them to make better decisions."
For more information about ATR, visit www.atr.samhsa.gov. 
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