California Agency Develops a Treatment Model for Women with Complex Needs
From 1995 to 1996, staff at the Santa Barbara Regional Health Authority developed a long-term intervention model for treating Medicaid-eligible women diagnosed with both mental health and substance abuse problems.
The project was part of the Robert Wood Johnson Foundation (RWJF) Chronic Care Initiatives in HMOs national program.
- Project staff proposed a comprehensive treatment model based on long-term, intensive case management.
- Project staff identified strengths and gaps in service through a project survey.
- Project staff recommended a cost-effectiveness evaluation plan to help managed care organizations determine if savings from this model, which could be expected to lower use of services over time, would justify the cost of such an intervention.
RWJF supported this project through a grant of $47,231.
Women receiving Aid to Families with Dependent Children (AFDC, which became Temporary Assistance for Needy Families or TANF on July 1, 1997) who are dually diagnosed with drug abuse and mental health problems consume a disproportionate share of the total health care resources available to AFDC recipients. Health and social services provided to these women are isolated and fragmented, addressing their substance abuse and mental health problems as separate, unrelated issues.
Under the auspices of SBRHA, this six-month planning project developed a long-term intervention model for treating dually diagnosed Medicaid-eligible women in a managed care setting. SBRHA, a county-organized health system, has administered Santa Barbara's Medicaid system since 1983 and serves 41,000 recipients.
The project developed a comprehensive model program for dually diagnosed women to bring together social, health, parenting, and occupational resources. The model included a targeted case management program, a community-based support network, educational and vocational supports, and mental health and drug abuse treatment. In the model, the project's targeted case manager would work closely with local agencies to assess a family's needs and develop a long-term treatment plan. The treatment plan could include services such as detoxification, drug treatment, psychological therapy, parenting skills, respite child care, legal assistance, literacy building, vocational skill development, and transportation assistance.
- Proposed a comprehensive treatment model based on long-term, intensive case management. To develop this model the project met with three separate focus groups of women eligible for the program. The project coordinator also met with representatives from key agencies serving these women. The result of these meetings helped the project form the components of the treatment model.
- Identified strengths and gaps in service through a project survey. A survey of available resources was shared with service providers. As a result of that sharing and the project director's outreach to mental health and drug treatment agencies, the project was able to identify strengths and gaps in services. The survey found that the majority of service providers were not comfortable with and did not have the knowledge or experience to serve women with co-existing diagnoses of mental disorder and substance abuse.
- Recommended a cost-effectiveness evaluation plan to help managed care organizations determine if savings from this model, which could be expected to lower use of services over time, would justify the cost of such an intervention.
AFTER THE GRANT
The program model was not implemented after the project's completion, but SBRHA has continued its work to combine resources across departments in a number of areas, including community health and mental health.
GRANT DETAILS & CONTACT INFORMATION
Development of a Long-Term Intervention for AFDC Women with Special Needs
Santa Barbara Regional Health Authority (Santa Barbara, CA)
Dates: October 1995 to April 1996
David Bearman, M.D.
Report prepared by: Robert Mahon
Reviewed by: Marian Bass
Reviewed by: Molly McKaughan
Program Officer: Rosemary Gibson