New Directions Evaluation

OBJECTIVES: There is a great need for dual diagnosis (both substance abuse and psychiatric disorders) services in the Los Angeles area. For example, the VA identified 2,500 veterans with dual diagnosis who received medical treatment from 10/1/99 to 9/30/00 in Los Angeles. The New Directions program, located on the VA's West Los Angeles campus, is ideally suited to meet this need, providing dual diagnosis services in their 43-bed North facility. Supported by a SAMHSA grant, this project is an evaluation of this program, measuring progress against the following objectives:

o At least 75% residents who complete the program will move into permanent housing after discharge
o 50% will remain drug free for twelve months following entry into the program.
o 50% will remain medication compliant for twelve months following entry into the program
o 25% will obtain employment, full or part-time, by twelve months following entry into the program.
o 80% response rate on the outcome measures at all follow-up data points.

METHODOLOGY: The evaluation of this program uses both qualitative and quantitative techniques and follows a "pre-post" design in which the intervention residents serve as their own controls. After admission, evaluation staff administered the baseline resident survey consisting of measures of symptoms, medication compliance, substance use, quality of life, and functioning. At 6 and 12 months after their baseline resident survey, residents receive an interview that consists of the baseline questionnaire minus items that are required only once, such as demographics. Also, all service delivery staff are responsible for tracking their own residents' services. Each week, staff record the number of resident service contacts on a Service Tracking Form and this information is entered into a resident database. To assess program context, residents and staff completed the Community-Oriented Programs Environment and Program Environment Scales, six months after the start of the evaluation and six months before the end of the evaluation. Two focus groups of a random sample of residents and all providers were conducted on the same timeline to elicit feedback about the New Directions approach.

FINDINGS/RESULTS: We have currently concluded baseline enrollment into the evaluation (N= 147) and six-month follow-up (N= 108). We will conclude twelve-month follow-up in June 2006. Preliminary results from the structured interviews indicate that 90.6% of respondents report being housed at the time of their twelve-month follow-up interview, with about half of respondents (54.2%) still housed in some form of residential treatment, while 34.3% of respondents report living on their own in an apartment or house. Respondents show significant improvements in mental health symptoms and functioning at 12-month as compared to baseline but are still more impaired than the general population. In addition, respondents demonstrate significant decreases in overall use of alcohol and illegal drugs from baseline to 12-month, while also showing significant improvements in adherence to psychiatric medication prescriptions--74% took all or most of prescribed psychiatric medication at 12-month, up from 50% at baseline. Regarding employment, while none of the respondents were employed at the time of the baseline interview, 24.2% of respondents were employed at the twelve-month follow-up and 5.2% were enrolled in school or job training. The assessment of program treatment context is also close to completion. The first implementation of the program environment survey and focus groups found considerable discrepancies between residents' and providers' perceptions of the program environment, resulting in a series of recommendations to program administration for organizational changes. The second implementation of the program survey and the focus groups for both staff and residents has been completed and is currently being analyzed to assess what changes have occurred.

STATUS: Data collection is nearing completion. Analyses are ongoing.