Drug Abuse Treatment on Demand in San Francisco: Preliminary Findings

Abstract

This article reports on a process and capacity evaluation of San Francisco's Treatment on Demand Initiative, which was launched in 1997 to increase availability of publicly-funded substance abuse treatment. For the process evaluation, data from public documents, interviews with community key informants, and newspaper articles were analyzed. For the capacity evaluation, budget documents and admissions data for publicly-funded substance abuse treatment in San Francisco for fiscal years 1995-1998 were analyzed. Results from the process evaluation document the development of the community-oriented Treatment on Demand Planning Council, and its efforts to not only expand treatment, but to create a continuum of services to address the needs of San Francisco's richly diverse communities, to provide service enhancements, and to prioritize service needs. Process evaluation results also highlight the complexities of implementing treatment on demand, including the difficulty of opening new programs. Results from the capacity evaluation indicate that the San Francisco budget supporting publicly-funded treatment increased from $32 million to $45.2 million over four years. During the same period, the number of persons entering the system in a single year increased by 18%, and the number of admissions in a single year increased by 15%. Implications of these findings are discussed.

Access to Drug Abuse Treatment Under Treatment On Demand Policy in San Francisco

“…Earlier our group documented that admissions increased when TOD was implemented (6,22). The finding of increased waiting time to enter treatment among TOD-funded facilities was unexpected.…”

“…Implementation of TOD was gradual: San Francisco increased its drug treatment budget from $31.9 million in FY 1995-1996 to $45.2 million in FY 1999-2000. Admissions to drug treatment programs increased 15% during that time (6), and TOD was associated with an increase in the utilization of comprehensive treatments, particularly day treatment, with a decrease in the utilization of front-end treatments, such as drop-in services (7).…”

Drug treatment utilization before, during and after pregnancy

“…There are approximately 8200 births per year in the County; 10% African American, 30% White, 32% Asian, 23% Hispanic, and 5% other race/ethnicities (statistics compiled from vital statistics by San Francisco Department of Public Health staff). There are approximately 24,000 treatment admissions each year in the County drug treatment system (Guydish, Moore, Gleghorn, Davis, Sears, & Harcourt, 2000). Drug use during pregnancy is not reportable to any legal authority in San Francisco and, at birth, drug use, by itself, is not sufficient cause for reporting to child protective services.…”

Investigating the Effects of San Francisco's Treatment on Demand Initiative on a Publicly-Funded Substance Abuse Treatment System: A Time Series Analysis

“…A previous report found that increased treatment on demand funding was associated with a 15% increase in the annual number of treatment admissions and with a change in the way admissions were distributed across types of treatment (Guydish et al 2000). However, that report did not assess whether changes resulted from the Treatment on Demand Initiative or from preexisting time trends.…”