dualdiagnosis

Executive Summary of Foundations Evaluation Project 1998-2002

Evaluation Design

The overall research plan was to assess each consumer entering integrated services in several key clinical, functional, and life domains, and closely follow each consumer over the year following treatment at Foundations, to permit evaluation of change over time.  Within this framework, all consumers entering Foundations were offered an opportunity to participate in the research model that repeats administration of specific protocols at admission and again both six and twelve months following completion of the treatment program. Assessment included a comprehensive evaluation of major life domains and placement/service needs based upon the American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Substance-Related Disorders (ASAM PPC-IIR) standards, evaluation of the individual's preparedness for services, and use of multiple sources of information to assess each outcome domain. Each primary outcome domain comprised multiple measures based upon client self-report, evaluator observations, and objective indicators. This approach had significant benefit because it minimized bias resulting from relying too heavily upon any single source of information, and it provides multiple indicators for use in latent variable analysis (a method which relies on multiple measures to eliminate measurement error). The overall interview length was minimized by eliminating items redundant with other measures.  Evaluators also meet periodically with program staff and consumers to allow for informal qualitative feedback regarding program process and outcome. At a global level, domains and associated measures include:

Summary Of Baseline Findings

Substance Use:

q    ASI Alcohol Use Composite Score was slightly lower than ASI normative data (34^th percentile)

q    ASI Drug Use Composite Score was slightly higher than ASI normative data (75^th percentile)

q    Predominant drugs-of-choice included alcohol, cocaine (crack), and cannabis

q    70% reported polysubstance abuse of 5 or more years (51% report 10 or more years)

Mental Health Disorders:

q    ASI Psychiatric Composite Scores were substantially higher than ASI norms (99^th percentile)

q    BSI General Psychiatric Severity Ratings were in the 79^th percentile relative to psychiatric inpatient normative data.

q    52% had been treated 3 or more times in inpatient psychiatric settings

q    60% reported a serious thought disorder accompanied by hallucinations, such as schizophrenia, schizoaffective, bipolar with psychotic features, etc.

q    The average number of DSM-IV Axis I Diagnoses was 2.52.

q    The average Global Assessment of Functioning (GAF) Score was 46.

Associated Problems:

q    ASI Medical Composite Score was slightly higher than ASI normative data (63^rd percentile)

q    51% of Foundations' consumers reported chronic medical problems

q    ASI Legal Composite Scores were higher than ASI normative data (80^th percentile)

q    51% had been incarcerated for one month or more in their lifetimes

q    ASI Family/Social Composite Scores were higher than ASI normative data (79^th percentile)

q    Rates of homelessness or unstable housing were substantial (37%)

q    Rates of abuse were substantial, including emotional (82%), physical (66%), and sexual (45%)

Summary Of Followup Findings

Foundations Associates completed a 3-year longitudinal research investigation, conducting intake interviews on 210 consumers entering Foundations' residential program with at least one followup interview completed on 88% of study participants.  Results follow: