title: ASAM Patient Placement Criteria treatment levels: do they correspond to care actually received by homeless substance abusing adults?
abstract: We report findings from a community-based two-city survey of homeless adults comparing the level of substance abuse treatment assigned to them using the ASAM Patient Placement Criteria with care actually received during the previous 12 months. Overall 531 adults were surveyed with 382 meeting DSM-IIIR criteria of being in need of treatment or having a demand for treatment. Of those with a treatment need, 1.5% met criteria for outpatient care, 40.3% intensive outpatient/partial hospitalization care, 29.8% medically monitored care and 28.8% managed care levels. In contrast, of those receiving treatment (50.5%, 162 persons), almost all care received by this cohort was either inpatient or residential based (83.6%). Unsheltered homeless persons and those without insurance were significantly more likely to report not receiving needed treatment. Lack of treatment availability or capacity, expense, and changing one's mind while on a wait list were the most commonly cited reasons for no treatment.
authors.affiliation: The Johns Hopkins University, Welch Center for Epidemiology, Prevention, and Clinical Research, Baltimore, MD 21205-2223, USA. totoole@jhmi.edu
authors.forename: Thomas P
authors.initials: TP
authors.lastname: O'Toole
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Freyder
authors.forename: Jeanette L
authors.initials: JL
authors.lastname: Gibbon
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Hanusa
authors.forename: Debora
authors.initials: D
authors.lastname: Seltzer
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000706:statistics & numerical data / Q000600:supply & distribution*; D003430:Cross-Sectional Studies; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006703:Ill-Housed Persons / Q000145:classification / Q000523:psychology* / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010414:Pennsylvania / Q000453:epidemiology; D015143:Philadelphia / Q000453:epidemiology; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000628:therapy*; D011795:Surveys and Questionnaires; D019037:Urban Health Services