Partnerships for improved service delivery: the Newark Target Cities Project.

Abstract

Despite the many efforts at improving treatment for chemically dependent individuals, people undergoing treatment still relapse. The tendency to relapse is exacerbated by fragmentation of services, lack of coordination among treatment providers and social service agencies, duplication of services, insufficient access to primary health care, long waiting periods for treatment, inconsistent case follow-up, and inadequate case management. This situation is magnified in the inner city. Problems in service delivery reduce client access, diminish program quality, increase costs, and impair efficiency. Many professionals believe that recovery rates and treatment outcomes would improve if these many problems with service delivery were eliminated (Couch, 1991; Gillies, Shortell, Anderson, Mitchell, & Morgan, 1993; Halvorson, Pike, Reed, McClatchey, & Gosselink, 1993; Shortell, Gillies, Anderson, Mitchell, & Morgan, 1993; Shortell & Morrison, 1990). Many communities have been experimenting with models of substance abuse treatment service delivery that address these threats to treatment effectiveness. Some of the experiments with alternative designs for health care delivery have found that creative and cooperative models can remove obstacles to service delivery and can promote high-quality, accessible care (Adelman, 1993; Crowson & Boyd, 1993; Fennel & Alexander, 1993; Gaines, Rice, & Carmon, 1993). In addition, many funding sources are requiring applicants to develop consortium models of service delivery to avoid duplication of services and to maximize resources. This article describes the Newark Target Cities Project (NTCP), which was developed to address service delivery problems and to improve the outcomes of people admitted to substance abuse treatment programs by creating a seamless treatment network. This article describes the NTCP, the problems it addressed, and the issues that arose in implementing the program. The article discusses implications for other communities seeking to create a coordinated system of care. PROBLEMS WITH SERVICE DELIVERY IN NEWARK Newark, the largest city in New Jersey, is located in one of the largest metropolitan regions (between New York and Philadelphia) in the United States. The majority of Newark's 275,221 residents are people of color, and the city has high rates of poverty, unemployment, illiteracy, and substance abuse. In 1993 Newark's substance abuse treatment programs served over 4,000 Newark residents (New Jersey Department of Health, 1993). The majority (51 percent) of individuals in treatment reported using heroin as their drug of choice. Newark's citizens suffer disproportionately from health care risks. New Jersey is fifth in the nation for reported AIDS cases and has a tuberculosis rate five times higher than New York City, and more individuals with these health problems reside in Newark. Sixty-six percent of the AIDS cases in Newark are among intravenous drug users (New Jersey Department of Health, 1993), and the rate of drug abuse - related hospital emergency room visits is second only to San Francisco (National Institute on Drug Abuse, 1991). In 1993 substance abuse treatment services in Newark were fragmented, duplicated services, and used resources inefficiently. Ten independent agencies provided substance abuse treatment services. Individuals had to contact directly any one of these agencies to obtain treatment. Each program had its own unique intake protocol and assessment instruments. Admission criteria were independently determined by each service provider. There was no uniform policy for dealing with clients who did not meet an agency's admissions criteria and no guarantee that an individual applying for treatment would be referred to the most appropriate service. In addition, clients receiving substance abuse treatment were routinely served by other health and human services programs. Large caseloads and severe personnel shortages made it difficult for these agencies to communicate with each other about shared clients. …