An interview with H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM, noted author and Director of the Center for Substance Abuse Treatment (CSAT). Each month, “Ask the Expert” features an interview with a leading expert on homelessness or co-occurring mental health and substance use disorders.
Site visitors are welcome to propose ideas for people to interview or send us questions they would like answered.
Dr. Clark, CHAB has a unique mandate to coordinate within the Substance Abuse and Mental Health Services Administration (SAMHSA) and even beyond the Department of Health and Human Services (HHS) to foster effective systems of care for persons who are experiencing co-occurring disorders (CODs) and are homeless. Why is coordination so important in addressing these particular problems?
We know that many people who are homeless and have addiction problems need a variety of services to help them recover. The population we serve is diverse, and the services they need are usually diverse as well. To understand these needs we require data from a variety of sources, including our own Office of Applied Studies (OAS), as well as numerous others. Mayors, tribal leaders, governors, advocacy groups, foundations, professional groups, and other Federal agencies all bring to the table data necessary for making decisions. We need to understand special populations, including how best to serve different age groups, different cultural and ethnic groups, and people in a variety of situations (for example, in and outside of supportive housing, or in rural vs. urban areas). For example, we know that youth in transition from foster care are vulnerable to homelessness, so we work with the Administration for Children and Families (ACF) to understand how we can help meet their continuing needs for treatment. A wide range of partners helps us stay informed on key issues and current data.
We also know that addressing the often-complex needs of these populations requires coordination at every level—Federal, State, and local. For example, some people in these populations suffer from physical health problems, such as diabetes, obesity, or infectious diseases as well as behavioral health issues, so we need to coordinate with the Centers for Disease Control and Prevention (CDC) to understand how best to coordinate care; some have been involved with the criminal justice system, so we need to work with the Department of Justice (DOJ); many lack housing, so we need to work with the Department of Housing and Urban Development (HUD); and we know that employment often helps in recovery, so we also work closely with the Department of Labor (DOL). The diverse needs and populations mean that we have to remain connected with the agencies and providers most familiar with those populations so that we use our resources wisely.
What do you see as CSAT’s specific role in addressing the overlapping problems of homelessness and co-occurring disorders? How are you working with your partners to advance the field?
CSAT is one conduit for resources that community providers can use to deliver services. However, no one agency has all the resources needed to advance the field significantly in these tough times. That means we need to avoid duplication of services and leverage what we have at every level. We try to use our Request for Applications (RFAs) to promote evidence-based, effective services, such as routine screening for co-occurring disorders. To cite another example, we are increasingly aware of the need for housing in at least half the populations we serve, and we believe that the impact of drug and alcohol use on the ability to maintain housing has been underestimated. Consequently, we now emphasize the development of supportive housing programs. Some of our Treatment for the Homeless grants are specifically targeted to facilitate access to services for people in supportive housing.
Although we are not a research organization, we do monitor our grants and collect information on the outcomes we’re achieving. We reflect on what we are doing and try to glean all the “lessons learned” we can from each project and grant so that we can share cutting-edge information with the field and with our partners.
What do you see as CSAT’s major accomplishments in the last few years in providing treatment for persons who are homeless and those who have co-occurring disorders?
A major area of progress has been in accountability, including the use of data to drive program decisions and enable providers to steadily improve quality. Grantee reports now enable us to determine how many people have been seen and what outcomes have been achieved through the interventions tried. We have real-time information on the services delivered. By aggregating and sharing these data, we help inform the field about what works best and what outcomes providers can expect to achieve.
What directions do you envision for CSAT in the near future?
I will be more comfortable answering that question several months into the new administration. CSAT will have the opportunity to compile and present information in support of recommended policies and programs, but ultimately, the new decisionmakers will either agree or disagree, and we will proceed accordingly. We hope we will receive strong support to continue to provide education on the critical need for suitable treatment, combined with effective supportive services, to help people recover and reclaim productive lives. We would also like to see rigorous evaluation of supportive housing so we have a better understanding of how to make these evidence-based practices as effective as possible in producing positive outcomes.
In the immediate future, because of the economic climate, resources will be even more limited than usual. We need to pay attention to changes in funding that will affect services in many agencies and make adjustments in our own programs as needed—for example, by adjusting the size of our grants to suit the resources available.