Communique — Documents — Home

— Camille T. Barry, Ph.D., R.N.

Many of the recent challenges to the field of substance abuse treatment have originated with State-level reform efforts aimed at controlling or reducing the costs of publicly funded health care. State substance abuse agencies and treatment providers across the Nation have responded to the incremental progression of health care reform with innovations and the determination to ensure treatment services for all those in need. The implementation of Federal-level welfare reform has created the newest challenge to the field. CSAT actively supports the Federal welfare reform initiatives and is poised to help States plan the transition, implement the initiatives, and continue efforts to provide a full continuum of substance abuse treatment services, as well as a complete complement of wraparound services for individuals and their families.

For many current welfare recipients, substance abuse may pose the largest single obstacle in their ability to secure and keep jobs. These individuals will be unlikely to succeed in their welfare-to-work transition without effective treatment services. The expansion of treatment service capacity could be one of the positive impacts of welfare reform. But to assume that such capacity expansion will, in fact, occur would be naïve.

Like many of today's other health care issues, the impact of welfare reform on substance abuse treatment services is a "work in progress," and it is difficult to predict the full impact at this time. Sharing information and collaboration are two important elements of the reform process, not only among the various agencies within States, but across States.

The purpose of this special issue of the TIE Communiqué is to help States identify the issues concerning welfare reform and to disseminate that information to the field. CSAT's role will be:

• To collaborate with the other Federal entities that are involved in implementing welfare reform

• To "speak" for the issues that revolve around substance abuse treatment under welfare reform 

• To work with other elements within the Substance Abuse and Mental Health Services Administration (e.g., the Center for Substance Abuse Prevention).

CSAT will share information with the States and communities and will facilitate information sharing among them. For example, the development of infrastructures for data systems is a critical State need. Because there are differences among the States and Terri-

tories in their capabilities to collect, analyze, and use data, CSAT will help them develop the tools to build effective infrastructure and management information systems. Such systems will lend credence to State- and Federal-level data and will give States and Territories the power to generate and use their own data in more meaningful ways.

Another of CSAT's specific initiatives is to help States and communities in their efforts to identify, develop, and monitor outcome measures. Outcome-related service delivery and accountability have assumed importance in the substance abuse field. As an extension of this movement, outcome measures will be used at agency and program levels to assess the impact of welfare reform. The assessments will help determine the best aspects of welfare reform and will allow States and communities to track the changes over the next 5 to 10 years. With community-level outcomes in hand, policymakers can understand and follow what is happening under welfare reform. As the issues become apparent, outcome measures will help States and communities determine their priorities.

The U.S. Department of Health and Human Services (HHS) found that 15.5 percent of women on AFDC would need treatment services: 4.9 percent were "significantly" impaired, and another 10.6 percent were "somewhat impaired" by substance abuse. AFDC women have higher rates of "significant impairment" (5.2 percent) than non-AFDC women (2.6 percent). Reference U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, National Institute on Drug Abuse, and Substance Abuse and Mental Health Services Administration. Patterns of Substance Use and Substance-Related Impairment Among Participants in the Aid to Families with Dependent Children Program (AFDC); 1994.

Table of Contents

Last Updated