This project is providing information on current efforts to transfer mental health care away from hospitals and to match patients to different types of community care. Its ultimate goal is to improve the quality of care and reduce treatment costs for veterans with substance abuse and psychiatric problems. This project is evaluating a patient-treatment matching strategy to improve hospital- and community-based residential treatment for substance abuse patients with psychiatric disorders. Its immediate objective is to examine whether the matching strategy results in more effective and cost-effective treatment in VA programs. We hypothesize that patients with severe clinical and functional problems will have better outcomes when they are matched to service-intensive programs; patients with moderate problems will have better outcomes when they are matched to programs having a lower intensity of services. For both patient groups, community-based treatment should prove to be more cost-effective than hospital-based treatment. The project is utilizing a stratified randomized design. We have paired each of three VA hospital-based programs that treat dual diagnosis patients and are high on intensity with a nearby high-intensity community residential facility (CRF) that contracts with the VA. We have also paired four VA hospital and four community programs that are low on intensity. Veterans who apply for substance abuse treatment at VA facilities are randomly assigned to either the VA hospital or community program. Patient assessments are conducted at intake (to date, N=224), discharge, and 4- and 12-month follow-ups. Primary outcomes are patients? severity of substance abuse and psychiatric problems. Secondary outcomes are patients? functional status and their VA and non-VA health care utilization and its costs.

Genders Eligible for Study:  Both

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