Tennessee’s Publicly-Funded Treatment System
for Youth with Substance Abuse Problems
Article prepared by Craig Anne Heflinger Ph.D.- Principal Investigator
with Andrea Flowers - Data Disseminator

Four studies in the state of Tennessee indicated that twenty-one to thirty-one percent of Tennessee’s youth were using or dependent on substances and potentially in need of treatment, or at a minimum, screening. The Alcohol and Drug Administrative Service (ADAS) estimated that 60,297 (26%) male and 46,552 (21%) female adolescents were in need of treatment in the state of Tennessee.

This article is based on a sub-study of the IMPACT Study¹ that examined how adolescents with substance abuse problems accessed and used publicly-funded services in Tennessee. The IMPACT Study found that 24,000⁺ youth on TennCare were in need of a substance abuse assessment. However, according to TennCare data from 1999, only 1,227 youth received treatment. At least 26% of youth admitted to a publicly-funded substance abuse treatment program had a co-occurring disorder. The IMPACT Study found that the publicly-funded substance abuse treatment system in Tennessee falls short in providing care to adolescents with substance abuse problems, and modifications are needed.

Tennessee’s publicly-funded substance abuse treatment system is supported by both state and federal funds. Federal funding includes the Substance Abuse Prevention & Treatment Block Grant (SAPT) from SAMHSA; Medicaid dollars for TennCare; the Children’s Health Insurance Plan (CHIP), a Medicaid expansion plan; and Title IV-E funds to the Department of Children’s Services (DCS) for services to children in state custody. The State of Tennessee provides matching funds to TennCare and CHIP, and additional dollars to DCS.

Two major strengths were found in Tennessee’s publicly-funded substance abuse treatment system. The system in Tennessee could be improved by building upon these strengths. These included:

· Dedicated alcohol and drug abuse treatment centers were available for adolescents. In interviews, treatment providers portrayed a sincere concern for the overall well-being of the youth in treatment.
· The SAPT block grant allowed flexibility in the way the dollars could be spent on the youth’s treatment plan that allowed services for youth to be expanded.

In every system there are challenges that can be addressed and improved over time. Within the substance abuse treatment system for youth in Tennessee, some of the challenges were:

· Access to substance abuse treatment through TennCare appeared to decrease over time.
· There was little monitoring of treatment and outcomes for youth who received treatment.
· There was no single agency responsible to oversee the substance abuse treatment program in Tennessee.
· There was a lack of coordination among agencies and services provided to youth.
· There was a lack of aftercare and family support services for adolescents.
· The continuum of services after initial treatment was limited.

The IMPACT Study found that the publicly-funded substance abuse treatment system in Tennessee did not work as the program was intended and designed. Providers expressed concern that not all youth had access to treatment. Because youth in state custody were given priority due to the DCS fee-for-service contracts with most residential treatment providers, many youth were placed into state custody in order to receive the services they needed. This study also found that the "placement" process did not always lead to the best treatment for the youth’s needs. For example, many youth were sent to residential treatment centers because more appropriate less restrictive options were not available or not funded. Once a youth was placed inappropriately, the removal and replacement process was long and tedious. For youth with a dual mental health and substance abuse problem, the treatment programs available typically only addressed one of the youth’s issues.

One of the biggest concerns was that aftercare services, such as individual counseling, group therapy, and support groups, were few and far between. These needed services were not available in all areas of the state. Rural areas, especially, lacked these services. The majority of the aftercare services that were available were for adults, not youth. One reason that aftercare services were so scarce was that the number of community mental health centers (CMHCs) that provided alcohol and drug abuse services had decreased from previous years. With the implementation of TennCare, many CMHCs had changed their focus from substance abuse services to services for youth with serious emotional disturbance (SED) due to TennCare’s behavioral health organization (BHO) contracts. Aftercare monitoring services were also limited; therefore, youth were placed back into their communities with little assistance with the transition. With no monitoring of aftercare services for youth coming out of intensive treatment, there was a greater likelihood that these youth would resume using substances.

The IMPACT Study findings emphasize that adolescents with substance abuse problems need appropriate long-term and short-term services and a well-coordinated system of care that also includes both mental and physical health services. Findings suggest that the success of youth coming out of substance abuse treatment not only depends on the service system, but also on other factors including the youth’s environment, and the support the youth receives from family, friends, and providers. The system must consider all aspects of the youth’s life in order to develop the most appropriate treatment plan. Modifications are needed in order to design and implement a coordinated service system for youth needing substance abuse treatment. By strengthening the foundation of the current system, treatment for Tennessee’s youth with substance abuse problems can be improved.

¹ This article is based on one of several reports from the IMPACT Study, conducted by Vanderbilt University's Center for Mental Health Policy in conjunction with Tennessee Voices for Children, the Tennessee Commission on Children and Youth, and Mississippi Families as Allies.  The IMPACT Study focused on mental health and substance abuse issues of school-aged Medicaid children and adolescents in Tennessee and Mississippi, and was funded by the United States Department of Health & Human Services (USDHHS) Substance Abuse and Mental Health Services Administration (SAMHSA) as part of a national study to examine the impact of Medicaid managed care on vulnerable populations. 

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