ACCESS TO RECOVERY (ATR)
Mady Chalk, Ph.D.
Director, Division of Services Improvement
Center for Substance Abuse Treatment
SAMHSA
What is the Access to
Recovery Program?

ATR is an innovative program that
provides both a new source of funding
for substance abuse treatment and
recovery support services and, by using
a voucher mechanism, supports client
choice of service provider.
What Are the Goals of ATR?

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To insure genuine and independent
client choice of treatment and
recovery support services at the
appropriate level of care.
To increase the array of communityand faith-based programs that
provide clinical treatment and
recovery support services.
What Are the Goals of ATR?

To provide an additional source
of funding for services
(vouchers) and, thereby,
increase access to clinical
treatment and recovery support
services.
ATR Funding
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The ATR grants were funded in August, 2004.
There are 14 States and 1 Tribal grantee.
The sites have only just begin to fully
implement the ATR program.
Significant ramp up time was needed to
develop the infrastructure needed to support
the program, e.g., clinical assessment
systems, voucher tracking and monitoring,
eligibility standards, and reimbursement
rates.
What is Expected of Grantees?

Grantees are expected to:
 Conduct significant outreach to a wide
range of new service providers, including
faith-based providers.
 Develop an eligibility system for new
providers who have never before received
Federal funds, provide technical assistance
as needed, and maintain up-to-date lists of
all eligible providers.
What Is Expected of Grantees
(con’t)?
Develop assessment, level of care
determination, and referral processes
for clients that include choice of
service providers.
 Be accountable for service outcomes.

What Are The Service
Outcomes?
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Abstinence from Substance Use
Employment/Education
Criminal or Juvenile Justice Involvement
Family and Living Conditions
Social Support of Recovery
Access/Capacity
Retention
How Are ATR Voucher Funds
Used?
Grantees have chosen a variety of
ways to use voucher funds:
For
 For
 For
 For
 For

specific substances of abuse
a defined population
specific geographic areas
a defined modality of treatment
identified recovery services
What Services Can Be Paid for
Using ATR Vouchers?
Grantees have determined what services they
will cover using vouchers, e.g.,
 Employment coaching
 Recovery management
 Life skills training
 Family services
 Sober housing
 Group counseling
What Do Grantees Need to Do to
Track Individuals and Vouchers?

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Grantees must assign voucher recipients
unique identifiers that are maintained
throughout what may be multiple treatment
and/or recovery support episodes.
These episodes may occur at different points
in time and with different providers. They
may also involve multiple services, which may
be included in a single voucher.
Research and Evaluation
Issues

Program Evaluation Questions:

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Has the program led to an increase in the
numbers of treatment and recovery support
providers, especially those new to Federal funding,
including faith-based programs;
Do client’s have great choice of providers;
Are States able to tracking clients and vouchers,
including vouchers that contain multiple treatment
and recovery-support services?
Research and Evaluation
Issues

Research Questions:
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How do outcomes differ given when appropriate
recovery support services are provided: before, in
parallel with, or post acute treatment or any
combination of the above?
How do the episode costs differ, given differences
in the timing of recovery support services?
What are the differences in the client’s perception
of care given choice?
Research and Evaluation
Issues

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What are the systemic changes at the State
and provider level that result from
implementation of the voucher method of
payment?
How does adding an additional source of
funding for purchase of services affect the
organization and costs of services in the State
or Tribe as a whole?