Treatment Costs and Organizational Monitoring

TEXT Box--TCOM Proj Info (4-8-14)

This project focused on developing an assessment and information system for treatment providers that monitors organizational attributes and program resources, and links these factors to client performance and program changes over time. It uses the TCU Program Change Model as a conceptual framework for this technology transfer process. The sample consists of 115 outpatient drug-free (i.e., non-methadone), community-based, treatment providers—by far the most common and diverse setting for addiction treatment in the United States. This work extended our thematic program of research designed to better understand treatment and research diffusion. It also expanded applications of our client-level Treatment Process Model (i.e., a framework for integrating interventions with client assessments of needs and measures of performance changes over time).

A primary goal was to develop reliable instruments that can measure and provide feedback on program resources and organizational dynamics (along with aggregated client data) for the purpose of clinical management in real world outpatient community settings. While the ability to effectively use information technology is increasing at most agencies, integrated data systems that meet these crucial clinical management needs have not been developed and tested, and are not yet available for routine use. The specific aims were to: (1) develop a set of field instruments and procedures that treatment programs will use in assessing their organization and its resources, (2) demonstrate the feasibility and utility of these assessments in a sample of 100 or more outpatient drug-free treatment providers from different regions in the U.S., (3) monitor organizational changes over time and relate them to client-level indicators of program effectiveness, (4) plan and evaluate a training protocol for program directors on how to use assessment information for improving program management and functioning, and (5) study the process of program change and the long-range implementation of this new technology.

The conceptual approach, assessment strategy, and sampling design build on previous work and experience in conducting organizational and client functioning assessments. Integrated into this plan for collecting and interpreting information about program resources was work by colleagues from the Heller School for Social Policy and Management at Brandeis University. The domains addressed by the comprehensive assessment battery include program structure, organizational factors, staff, clients, and program resources. In addition to improving scientific understanding of these issues (communicated through journal publications, conferences, newsletters, and our website), several “application” products have resulted from this project, including the development of a comprehensive system for assessing and reporting organizational and client functioning.

Computer-Assisted Cost Analysis Interview

A new methodology for collecting drug abuse treatment cost data was developed. It adapts computer-assisted data collection and Web-based technology to support community-based outpatient drug treatment providers in their efforts to conduct routine economic evaluations of services. This supplement transforms the parent project’s economic assessment tool from accounting-style spreadsheets into an interactive, computer-assisted interview. This costing tool, and a prototype of a Web-based version, was developed by a multidisciplinary research team from IBR and the Heller School for Social Policy and Management at Brandeis University.

Training Activities

The TCOM Project provided collaborative training for 129 staff from 102 selected programs affiliated with the Southern Coast, Northwest Frontier, Great Lakes, and Gulf Coast Addiction Technology Transfer Centers. Participants were taught how to use a practical, self-guided tool for determining the actual service delivery costs of different treatment components. The TCOM tools assist programs in pricing their services competitively and maintaining fingertip access to financial information that can be used for grant writing and negotiating reimbursement rates. In addition, these tools allow agencies to compare their costs and organizational performance with national and regional data.

Feedback Reports

An important aim of the TCOM Project was to provide information to participants about program improvement through individualized reports. Reports detailed how each program changed over time and compared with regional means on organizational and client data. Several participating programs used these findings as a basis for discussion and training among staff and as a rationale for proposed changes designed to address “weak” areas of organizational functioning. Their response confirms the utility of the TCOM assessment system.


Brandeis University:
Heller School for Social Policy and Management
Schneider Institute for Health Policy
Donald S. Shephard, Ph.D.
Constance M. Horgan, Sc.D.

Family Health International:
Aaron Beaston-Blaakman, Ph.D.

Selected Publications

Edwards, J. R., Knight, D. K., & Flynn, P. M. (2011). Organizational correlates of service availability in outpatient substance abuse treatment programs. Journal of Behavioral Health Services & Research, 38(4), 432-443.  [Abstract]

Knight, D. K., Broome, K. M., Edwards, J. R., & Flynn, P. M. (2011). Supervisory turnover in outpatient substance abuse treatment. Journal of Behavioral Health Services & Research, 38(1), 80-90.  PMCID: PMC2888979  [Abstract]

Edwards, J. R., Knight, D. K., Broome, K. M., & Flynn, P. M. (2010). The development and validation of a transformational leadership survey for substance use treatment programs. Substance Use & Misuse, 45, 1279-1302.  [Abstract]

Knight, D. K., Edwards, J. R., & Flynn, P. M. (2010). Predictors of change in the provision of services within outpatient substance abuse treatment programs. Journal of Public Health Management & Practice, 16(6), 553-563.  PMCID: PMC2978524  [Abstract]

Broome, K. M., Knight, D. K., Edwards, J. R., & Flynn, P. M. (2009). Leadership, burnout, and job satisfaction in outpatient drug-free treatment programs. Journal of Substance Abuse Treatment, 37(2), 160-170.  PMCID: PMC2752305  [Abstract]

Flynn, P. M., Broome, K. M., Beaston-Blaakman, A., Knight, D. K., Horgan, C. M., & Shepard,
D. S. (2009). Treatment Cost Analysis Tool (TCAT) for estimating costs of outpatient treatment services. Drug and Alcohol Dependence, 100(1), 47-53.  PMCID: PMC2647776  [Abstract]

Flynn, P. M., & Simpson, D. D. (2009). Adoption and implementation of evidence-based treatment. In P. M. Miller (Ed.), Evidence-based addiction treatment (pp. 419-437). San Diego, CA: Elsevier.

Flynn, P. M., & Brown, B. S. (2008). Co-Occurring disorders in substance abuse treatment: Issues and prospects. Journal of Substance Abuse Treatment, 34(1), 36-47. PMCID: PMC2200799  [Abstract]

Knight, D. K., Broome, K. M., Simpson, D. D., & Flynn, P. M. (2008). Program structure and counselor-client contact in outpatient substance abuse treatment. Health Services Research, 43(2), 616-634.  PMCID: PMC2442366  [Abstract]

Broome, K. M., Flynn, P. M., Knight, D. K., & Simpson, D. D. (2007). Program structure, staff perceptions, and client engagement in treatment. Journal of Substance Abuse Treatment, 33(2), 149-158.  PMCID: PMC2140244  [Abstract]