Impact of centralized intake on drug and alcohol treatment placement decisions

The American Society of Addiction Medicine (ASAM) and others have asserted that matching persons to an appropriate level of care will result in more positive and cost-effective treatment outcomes. The Center for Substance Abuse Treatment, through its Target Cities demonstration project, proposed the implementation of centralized intake and the use of comprehensive standardized assessment procedures as mechanisms for improving the treatment process. As part of Chicago Target Cities, it was decided to implement ASAM criteria at the central intake units (CIU). A comprehensive assessment instrument was developed, assessors were trained, and decision protocols were designed to facilitate the implementation. This article examines the impact of these interventions on the placement decision process. The placement decisions of the assessors employed by individual treatment agencies before implementation of the CIU were compared to the placement decision process of the CIU assessors. The role of patient preferences, the information assessors used to make placement decisions, and the willingness of assessors to make the clinical judgments indicated by ASAM PPC-2 were examined. Results indicate that the CIU assessors' final treatment recommendations were more similar to what they thought was best for the patient, and less related to patient preference than those made by assessors at the individual treatment agencies. The CIU assessors also used a wider range of information when making their placement decisions than did the Pre-CIU assessors. Finally, the CIU assessors were more willing to rate patients on ASAM criteria than were the Pre-CIU assessors. Implementation of the ASAM PPC-2 at the CIUs produced the expected differences in the placement decision processes at the CIU from those observed at the treatment agencies. The results indicate that the implementation of ASAM PPC-2 is both feasible and produces expected changes in the placement decision process.