TABLE 5-2 A Delivery System Approach Based on the Center for Substance Abuse Treatment’s (CSAT’s) Treatment Improvement Protocol No. 47

CSAT Principle Delivery System Approach

1. Having the ability to make effective connections and treatment readily available

  • Crisis assessments available 24/7
  • Screening, brief intervention, and referral to treatment (SBIRT) approaches adopted in various medical settings; use of peers

2. Enabling easy treatment entry

  • Crisis assessments 24/7
  • Wide geographic coverage
  • Access standards and time frames from assessment to start of treatment

3. Building on existing motivation (i.e., treatment system is able to handle and manage unwilling patients’ entry into treatment)

  • Manualized readiness for treatment interviews and rating scales
  • Legal system, job jeopardy or support systems mandates
  • Staff competencies in behavioral techniques for working through treatment resistance (e.g., motivational interviewing)
  • Policies and program philosophy that promote a safe harbor that reduces stigma and maintains necessary confidentiality

4. Building an enhanced therapeutic alliance

  • Staff trained in engagement techniques
  • Measurement of the therapeutic alliance by accountable provider/program
  • Use of recovered peers

5. Offering appropriate treatment that is patient specific and not a singular provider approach

  • Move away from set program protocols and time frames
  • Individualized treatment plans and treatments
  • Adjunctive services to match the specific needs of special populations (e.g., pregnant or newly delivered mothers—skill building in parenting)

6.Providing ongoing care through a continuum and extending into the long-term sobriety period

  • Multiple levels of the care system (inpatient, residential, partial hospitalization, intensive outpatient, outpatient sessions, community support systems such as Alcoholics Anonymous
    [AA], long-term case management, primary care physician monitoring, alumni groups)
  • System that facilitates interconnectivity and collaboration necessary to create seamless care

7.Having the ability to address the multiple needs of the patient, not just the substance use disorder

  • Psychiatric services (high psychiatric comorbidity)
  • Linkage to employee assistance programs (EAPs) and employment, financial, child care services

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