Preliminary
Data Analyses and Results
Below
are some of the results from preliminary analyses of the data
that were conducted and reported to each site during the summer
of calendar year 2000.
Study Site A: Preliminary Outcome, Service & Cost Profile
for Adults with Serious Problems With Drugs/Alcohol, Mental Health
& Daily Living (Note: As Site A was just beginning
to implement its pilot-test, these data represented the pre-pilot
baseline data).
• Slightly over 400 outcome ratings were completed for members
of this cluster over the course of five rating periods beginning
in February 1995 and ending in February 1999. The ethnic make-up
of the group is about 2/3 Caucasian, ¼ African American
and 1/10 Hispanic. About 2/3 of the 400 ratings relate to males;
the remaining 1/3 deal with female cluster members. However, data
indicate that in recent years, the ratio of males to females in
this cluster is approaching one-to-one.
• This is a high cost cluster! Data from FY 1999 indicate
that the average cost of care was higher for this cluster than
for any other at Site A. High hospital costs account for a large
part of this. In fact, hospital costs represent nearly one-half
of the estimated one million dollars that was spent on 118 members
of this cluster in FY 1999. Further, during the 1-year period
between February 1998 and February 1999, over ½ of the
members of this cluster for whom outcome ratings were available
were hospitalized at least once. The average hospital cost for
these 62 people approached $9,400.00/year.
• Agency-wide snapshots of functioning of cluster members
taken at each rating period indicate that during that time period
they were functioning "moderately well" to "well"
on many targeted treatment goals. These included their ability
to complete basic living skills, get their regular health needs
addressed, and to avoid getting into trouble with the criminal
justice system. Their psychiatric symptoms continued to interfere
in their lives at a moderate level, however they were beginning
to overcome their denial of their addiction. They were consistently
getting the public benefits to which they were entitled. On the
other hand, they continued to have problems developing social
connections to the drug-free community. Overall, even though changes
were seen in performance on some outcomes between some rating
periods, no pattern of improvement or decline was evident.
• Some gender and ethnic differences also were observed within
this cluster. Hispanics were found to be doing better than African
Americans and Caucasians on two outcomes (interference from psychiatric
symptoms and being connected to a drug free community). Females
were doing significantly better than males on six outcomes (e.g.,
overcoming denial, connecting to a drug free community, maintaining
health).
• Community support program staff felt many more members
of this cluster could be working (n = 273) than were presently
working (n = 80). Overcoming denial appeared to be a key factor
considered by staff in discriminating between cluster members
who could and who could not work. Also, people who were presently
working looked very similar on many outcomes to those who "could
be working".
• Finally, data support the notion that overcoming denial
is a particularly important outcome for members of this cluster.
Overcoming denial was significantly related to four other outcomes.
It was most strongly linked to attending substance abuse treatment
in the community, followed by controlling addictive behavior,
maintaining one's health, and avoiding involvement with the criminal
justice system. The direction of causality is unknown, however,
regardless of which outcomes are "causes" and which
outcomes are "effects," the findings suggest that these
outcomes are linked in meaningful ways.
Study
Site B: Preliminary Test Of The Goodness Of Fit Hypothesis For
Adults Who Are Severely Disabled In Many Life Areas (SAM
GROUPS ONLY)
• The analyses shown in Table 1 the on the next page are
based on 86 consumers who were consistently judged "fit"
and 40 consumers consistently judged "not fit" to receive
SAM Group services. Remember that the SAM groups began at the
beginning of FY2000. Sample sizes for comparison groups are quite
small so findings should be interpreted cautiously (but with optimism!)
at this point.
• Preliminary analyses provide some support for the goodness
of fit hypothesis. Cluster members who were judged fit for SAM
and who received SAM (n = about 10), were doing better in three
out of 4 outcome domains as of the second half of FY 2000, than
Cluster members who were judged 'fit" but who were not receiving
SAM services (n = 40). The domains in which SAM participants were
reported as doing better than those judged "fit" but,
not getting SAM (based on an 11-point rating scale) were: community
living (7.4 vs 6.5, p <. 05); independence (8.0, p < .05);
and, involvement in treatment (7.8 vs 6.5, p < .05). This finding
was supported by both parametric and non-parametric tests. No
difference was found between these groups in the symptom management
domain (6.9 vs 6.4).
• Finally, with regard to the outcome data gathered during
the second half of FY 2000, members of both groups judged to be
'fit' for SAM (getting SAM/not getting SAM) were doing better
in all four outcome domains than those judged "not fit".
However, this is may be a function of a selection bias that assumes
that people need to be functioning at a certain level in order
to be seen as "fit" for SAM.
Research
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