# Presentation: 530372

## Using Vouchers to Deliver Substance Abuse Treatment and Recovery Services: The Access to Recovery Program 				(ATR)

- Andrea Kopstein, Ph.D., M.P.H.
- June 4, 2007
- ACF 10th Annual Welfare Research and Evaluation Conference

## Press Release

- John Walters “Addiction is not a one-size-fits-all disease. This program represents the next step in our ability to treat this disease, opening the door to a full range of treatment providers, and offering treatment access to thousands of Americans who would otherwise remain trapped in the maze of addiction”

- Many people who seek help are unable to find care.  This ATR program was planned to provide grants to States/Tribes to support provision of vouchers to pay for the addiction treatment care people need at a level consistent with the severity of the disease, or, the level of support needed to sustain sobriety.

## What Are the Goals of ATR (three main objectives)? 

- 1) Allowing recovery to be pursued through many different and personal pathways.  Grantees must insure genuine and independent client choice of treatment and recovery support services at the appropriate level of care.

## What Are the Goals of ATR?

- (2) Grantees are required to manage performance, based on outcomes that demonstrate patient successes

## What Are the Goals of ATR?

- (3) expanding capacity by increasing the number and types of providers who deliver clinical treatment and/or recovery support services

## Who Was Eligible to Apply and What Was the Review Process?

- States, Territories, Tribal Organizations, and DC were eligible to apply for an ATR grant.
- Sixty-six grants were reviewed face-to-face by three committees: forty-four States, DC, and twenty-one tribal organizations.

## Voucher Functions

- Referral to Program of Client’s Choice
- Eligibility Confirmation
- Assessment Results Enforcement
- Obligating Instrument
- Initiate an Invoice
- Set up an Audit Trail

## What’s on a Voucher?

- Client Identification
- Service Type
- Provider Identification?
- Not To Exceed (NTE) Amount
- Date Voucher Issued
- Date Voucher Expires

## What’s on a Redeemed Voucher

- Provider (if not on New Voucher)
- Actual Services
- Actual Dates of Service
- Actual Reimbursement Claim
- Signatures (physical or electronic)

## What is Required of Grantees?

- Grantees are required to:
- Conduct significant outreach to a wide range of new service providers.
- Develop an eligibility system for new providers and maintain up-to-date lists of all eligible providers.

## What is Required of Grantees?(continued)

- Grantees are required to:
- Develop assessment, level of care determination, and referral processes.
- Be accountable for service outcomes

## How Are ATR Voucher Funds Being Used?

-   Grantees have chosen a variety of ways to use voucher funds:
- For a specific substance of abuse
- For a defined population
- For an identified modality of treatment
- For identified recovery services

## Are All Service Providers Licensed or Certified? 

- All clinical treatment and recovery support services providers are required to adhere to standards established by the grantee (State, Territory, Tribe, District of Columbia).

## What Services Can Be Paid for Using ATR Vouchers?

- Detoxification
- Brief intervention
- Group counseling
- Case management
- Family services
- Sober housing

- Employment coaching
- 12-step groups
- Recovery coaching
- Other

- Grantees may determine what services they cover using vouchers – examples:

## Do Grantees Need to Track Individuals and Vouchers?

- Grantees must assign unique identifiers to voucher recipients that are maintained throughout what may be multiple treatment and/or recovery support episodes.
- These episodes may occur at different points in time and with different providers.

## What Data Are Grantees Expected to Submit?

- Grantees are required to submit the same GPRA data as are all discretionary grant program grantees. These data include financial as well as performance and outcome data in the seven domains.

## What Are The Seven Domains?

- Abstinence from Substance Use
- Employment/Education
- Criminal or Juvenile Justice Involvement
- Family and Living Conditions
- Social Support of Recovery
- Access/Capacity
- Retention

## Who Are the ATR Grantees?

| Missouri | Florida | Idaho |
| --- | --- | --- |
| Illinois | CA Rural Indian Health Bd. | Texas |
| State of California | Washington | Connecticut |
| Wyoming | Louisiana | Tennessee |
| New Jersey | New Mexico | Wisconsin |

## Lessons Learned

**There is a tremendous need for the services accessed through ATR**
**Recovery support services make a big difference**
**Increased trainings for non-traditional providers is usually necessary **

## Lessons Learned

**Partnerships to build referral sources**
**Communications with SAMHSA, providers, & clients**
**Voucher tracking and analyses**
**Financial management**
**FWA**
_**  **__**Meeting your project goals**_

***SAIS: March 31, 2007***

***SAIS: December 31, 2006***

***SAIS: December 31, 2006***

## What is the Focus of Each of the ATR Grants?

- California – Regional, four target cities, youth between 12 and 20 years of age
- Large unmet need for residential youth treatment
- Plan to involve the families
- CA Urban Indian Health Bd. – Statewide, American Indian, adults and adolescents

## What is the Focus of Each of the ATR Grants?

- Connecticut – Statewide, payer of last resort, nondependent adults, populations with significant barriers in access to care
- Florida – Regional, 18 and older, criminal justice, families, co-occurring disorders, prescription drug abuse

## What is the Focus of Each of the ATR Grants?

- Idaho – Statewide, adolescents and adults
- Illinois – Statewide, probationers referred by circuit courts
- Louisiana –

## What is the Focus of Each of the ATR Grants?

- New Jersey – Statewide with initial focus on Newark, payer of last resort, individuals who are medically indigent and have a DSM-IV diagnosis, aging out adolescents, adults aged 16-34, heroin users
- New Mexico –

## What is the Focus of Each of the ATR Grants?

- Tennessee – Methamphetamine users, adults, low or below median income who otherwise cannot afford treatment
- Texas – Statewide, drug court participants
- Washington State – Regional, six counties, families with children in protective services, residents in supported housing, detoxification, low-income clients using migrant health clinics

## What is the Focus of Each of the ATR Grants?

- Wisconsin – Regional, initial focus on Milwaukee County residents, emphasis on families with children, criminal justice population
- Wyoming – Statewide, adolescents in the criminal justice system and their families

## In summary.....

- States are responsible for reporting on common performance measures to illustrate effectiveness and these performance measures will be used to measure treatment success and the ultimate success of the voucher program itself.

## Where are we now?

- The 2004 cohort of ATR grants is in their third and final grant year
- We are accepting applications for a new cohort of ATR grantees  - awards will be made in August or September of 2007

## In summary.....

- There is a external cross site evaluation of the 2004 cohort of ATR grantees funded to begin in 2008

- QUESTIONS?