OBJECTIVE: State governments are exploring the potential of various
forms of case management to control the costs of substance abuse treatment
programs. This report describes an experimental program in one Iowa county
in which clients are assessed and referred elsewhere if treatment is
needed. Outcomes of clients in that county are compared with those of
clients served elsewhere in the state. METHODS: All claims submitted by
provider agencies to the Iowa Department of Public Health for substance
abuse treatment of eligible clients in 1994 were analyzed to test the
effect of the experimental intake-and-referral program on clients'
utilization of outpatient treatment, rate of treatment completion, and rate
of abstention at discharge from treatment. RESULTS: In the county with the
experimental program, 27 percent of clients recommended for treatment
actually attended, compared with 48 percent in other counties. Clients who
used the experimental program were also less likely to complete treatment.
These differences persisted after adjusting for baseline differences in
client characteristics. CONCLUSIONS: Lower utilization arising from failure
to attend recommended treatment may reduce treatment costs but is not the
intended outcome of the intake-and-referral program. Failure to complete
treatment also is an adverse outcome. Outcomes of various types of case
management programs should be carefully evaluated before statewide
implementation is considered.