Prop36 - TSI Frequently Asked Questions

FAQs (Frequently Asked Questions)

(Note: To see FAQs For Providers in the Treatment Outcome Component, please click here).

1. Who supports the Proposition 36 Treatment System Impact Study?

In addition to NIDA and UCLA oversight, the study will be guided by a Steering Committee consisting of representatives from the participating counties. Two independent experts (Drs. Thomas McLellan and Nancy Young) in the substance abuse field will facilitate the annual Steering Committee meetings. The research team will regularly inform California Department of Alcohol and Drug Programs (ADP) and the County Alcohol and Drug Program Administrators Association of California (CADPAAC) of the study’s progress.

ADP is the Single State Agency responsible for the state’s block grants and provides funding to California’s 58 counties in administrating substance abuse services programs. ADP is also the lead state agency for the implementation of Proposition 36. CADPAAC is comprised of the designated county alcohol and drug program administrators representing the 58 counties within California.

2. What are the potential benefits of participating in this study?

The research conducted in this study is expected to result in benefits to drug treatment clients, drug treatment providers, policymakers, researchers, and others by assessing the impact of Proposition 36 implementation/operation on the treatment system and treatment outcomes, which is crucial to improving strategies for treating drug-abusing offenders. Significant benefits to society may accrue because research findings may improve the design of treatment strategies and allocation of treatment resources.

For counties: Counties will receive assistance from UCLA ISAP in their local evaluation efforts. In addition, county-specific reports can be provided upon request.

For programs: Programs will receive provider-specific feedback from the data collected and information on client outcomes upon request. Treatment staff will also receive training on the state-of-the-art assessment tools in the substance abuse treatment field.

3. How does this study differ from the statewide Proposition 36 Evaluation Study and other research projects currently underway or being proposed?

The data collected in the federally-funded TSI study will complement the Statewide Proposition 36 Evaluation Study. The two studies have distinctive focuses, and together, provide a more comprehensive assessment of the impact of the new legislation. The statewide evaluation focuses on analyses of cost-offsets, SACPA's effects on public health and public safety via reductions in crime, drug use, and other outcomes, and how the criminal justice and treatment systems respond to SACPA. The TSI study describes five distinct and diverse counties’ plans and strategies for implementing Proposition 36 in their drug treatment systems as well as the characteristics of drug offenders diverted to treatment. The TSI study has a treatment outcome component that aims to assess treatment outcomes via follow-up interviews and cross-system data linkage. Investigators of both studies will work closely to avoid duplication of data collection efforts by counties and treatment providers. In addition, the TSI study investigators are open to working collaboratively with investigators of other current or planned research efforts to maximize efficiency and minimize county and provider burden.

4. How were the counties in the study selected?

The counties were scientifically selected to address factors that may influence the impact of Proposition 36 on the drug abuse treatment system.

We first selected the 13 counties that participated in the California Treatment Outcome Project (CalTOP), as they have already provided baseline data (one year prior to Proposition 36 implementation) in program, service, cost, and client outcomes data, with which the present study results can be compared to assess changes.
The second criterion applied in the county selection process was sufficient Proposition 36 cases (e.g., more than 100 Proposition 36 clients in the first year of implementation) to allow for the use of measures of significant system impact.
The third criterion used was the variation across the selected counties in Proposition 36 implementation strategies or policies along dimensions (e.g., treatment approach, testing policy, strategy for co-occurring disorders) that may have important implications for the county’s alcohol and drug (AOD) treatment system and client outcomes.

5. How will study subjects be recruited?

Participation in the study interviews, focus groups and surveys is voluntary.

System Impact Study

County administrators will be invited, via phone or email, to participate in in-person interviews.
Treatment program administrators will be invited, via mail, to complete the program survey.
Treatment staff and clients will be invited, via flyers, to participate in separate focus groups. Representatives of other key stakeholder groups will be invited, via phone or mail, to participate in a focus group.

Treatment Outcome Study

Client assessment at admission. All eligible subjects in the selected programs will be assessed as part of the regular treatment admission process. They will also be asked to voluntarily participate in the treatment outcome follow-up study.
3-month and 12-month post-admission follow-ups. A randomly selected sample among those who agree to participate will be interviewed, via phone, by UCLA research staff. A small number of these clients will be interviewed in person as well.

6. What is being asked of the participants, how much time will be involved, and how will participants be compensated?

We understand that our study will require time from all study participants. Our goal is to avoid disrupting normal program activities, and we will work with each program and county to ensure this. We plan to compensate counties, programs and individuals for their time.

County “lead agency” administrators will facilitate the conduct of the study in their respective counties. Along with representatives of key stakeholder groups, the county administrators will also be asked to complete a two-hour administrator interview and a self-administered survey questionnaire in years 1 and 3 of the study. Each participating administrator will be compensated for his or her time with $100 for completing each interview.
Treatment program directors will facilitate the conduct of the study in their respective programs and complete the treatment program survey questionnaire that takes approximately one hour during project years 1 and 3. Each participating program will be compensated with $100 for completing each questionnaire.
Individuals from key stakeholder groups (treatment staff, clients, and members of other stakeholder groups) will participate in a focus group that lasts approximately two hours. Each participant will receive $100 as compensation.
Counties or participating treatment programs will be compensated for client assessments and subject recruitment. Up to $50 per complete assessment has been budgeted in each of the participating counties. The assessments will take approximately 1-1/2 to 2 hours to complete. Data will be sent to UCLA electronically if feasible, or by secured mail.
Clients who provide UCLA-ISAP with contact information will receive $10. Clients who complete the 3-month follow-up phone interviews, which take approximately 30 minutes, will each be compensated for their time with $10. Clients who complete the 12-month follow-up phone interview, which takes approximately 45 minutes, will each be compensated with $15. Those clients completing the in-person interview conducted at 12-month follow-up will each be compensated with $40 for the interview and $10 for providing a urine specimen.

7. What types of questions will be asked of participants?

System Impact Study

Interviews with county administrators will involve questions inquiring about the delivery of services to Proposition 36 clients in their respective counties.
Treatment program surveys will include questions about changes they have experienced and strategies they have developed in response to the implementation of Proposition 36.
Focus groups with key stakeholder groups will cover the impact of Proposition 36 on the delivery of treatment services.

Treatment Outcome Study

Client assessment at admission. We will collect information using the Addiction Severity Index (ASI) that includes alcohol and drug use, employment, family and social relationships, legal, psychological and medical status. We will also collect information on clients’ perception of their physical health and functioning, motivation for treatment, and perceived level of coercion to enter treatment.
Client assessment at follow-up. At the 3-month follow-up we will collect information using the Treatment Services Review (TSR) and the motivation and perceived coercion scales, while at the 12-month follow-up, we will collect information similar to that collected at the assessment conducted at treatment admission.

8. What confidentiality assurances are provided to county and individual participants?

UCLA ISAP has extensive experience collecting information from client records, personal interviews, mailed surveys, and focus groups. We have developed procedures to ensure that the information collected remains completely confidential.

These procedures include the following:

All data will be collected by well-trained interviewers and focus group moderators/assistants who have signed confidentiality certificates.
Training on assessment tools and the research protocol will be provided for program staff.
All data collection materials will be identified by code numbers only.
Interviews with county administrators and focus group discussions will be audiotape recorded and transcribed verbatim. Only aliases will be used in the focus groups; no actual names will be used.
All data will be stripped of personally identifying information, and any publications or reports will use data in aggregate form, meaning no individuals or programs will be identified.
Data (including audiotapes, compact disks, magnetic tapes, and paper printouts) will be kept in locked files at the research office.
Data and code keys with subjects’ names will be accessible only to the Principal Investigator and senior research staff.
The data are also covered by a Certificate of Confidentiality from the Department of Health and Human Services. This Certificate will protect the researchers from being forced to release research data in which patient participants are identified, even under a court order or subpoena.
Approval of the research by the UCLA Institutional Review Board provides additional protection against disclosure of information provided by participants in the study.

9. What informed consent procedures are used?

County administrator interviews, treatment program surveys, focus groups, and client interviews include formal informed consent procedures reviewed and approved by the UCLA Institutional Review Board. Each participant will be given an informed consent information packet that describes the participant selection criteria, purpose and nature of the research activity (e.g., interview, focus group, survey), and the measures taken to protect the confidentiality of the responses. The participant is invited to voluntarily participate in the study. Once the interviewer or focus group moderator has covered the form, the participant is asked to give written or verbal consent if he or she wishes to participate in the study. (Program administrators are not asked to sign the informed consent form. The return of their questionnaires serves as an indication of the administrators’ agreement to participate in the study.)

10. Are interviewers and focus group moderators trained to have the skills and sensitivity to protect confidentiality?

The focus group moderators and interviewers for the follow-up study are well trained on the research protocol, informed consent procedures, and confidentiality, are experienced in these data collection methods, and have worked on similar studies at UCLA ISAP.

11. How will follow-up tracking be conducted to ensure confidentiality?

The 3- and 12-month follow-up interviews will require that study staff track and locate participants. UCLA ISAP has developed procedures that result in high percentages of participants being located, as described in the Staying in Touch manual available at: http://www.uclaisap.org/trackingmanual/index.html.

Tracking information will be gathered voluntarily from the participants during the initial interview. TSI study staff and county/treatment staff will ask participants to provide full names and aliases; date of birth; place of birth; residence address and phone; best mailing address and phone number; work address and phone number; name, address, and phone numbers of all immediate family and friends, case worker, clinic, doctor, or other regular contact/agency. This information will be the primary source of the tracking and locating conducted.

Follow-up interview tracking will begin with a letter mailed to the last known address, requesting that the person contact study staff regarding a “health study.” No details of the project, why the person was recruited, or the nature of the follow-up will be included in the letter, in case it is opened by persons other than the participant. Any follow-up phone calls to persons other than the participant will discuss the study vaguely in terms of a “health study.” No other information will be given to persons other than the participant.

If the information provided by the client does not lead to contact, study staff will search publicly available records for additional follow-up leads. UCLA may ask county staff or treatment providers to assist with tracking and locating.

12. How will information about research findings be disseminated?

We will provide periodic reports on aggregate-level data across counties and programs. We plan to periodically brief the treatment communities and policymakers at the local, state, and national levels on the study findings. Information about the study will also be available on the Proposition 36 Treatment System Impact (TSI) Study web site: www.uclaisap.org/Prop36/TSI. Initial results are published in Evaluation Review and are available at: http://www.uclaisap.org/Prop36/TSI/publications.html.