Defacto client-treatment matching: how clinicians make referrals to outpatient treatments for substance use

Despite the fact that there is no clear consensus from clinical trials on client-treatment matching guidelines for substance use problems, qualitative research with clinicians has begun to identify the factors that influence treatment placement decisions. The purpose of the present study was to use ethnographic decision tree modeling to describe and predict decisions to refer clients to either a brief or a longer substance use program. Eleven clinicians who complete intakes at an addiction treatment agency engaged in two semi-structured interviews regarding actual referral decisions; one interview was to develop a decision tree model and the other was to test the accuracy of the model. The setting for the referrals was an addiction treatment facility with both a brief and a longer outpatient program. Results showed that the decision tree was accurate in predicting 85% of new referral decisions. The decision tree indicated that clinicians tended to use the longer outpatient treatment as the default, with a series of constraints being put on referral to the briefer treatment program. The decision tree also suggested that there are a number of contextual factors that arise in decisions that present a challenge for simple implementation strategies of general clinical guidelines in substance use treatment. (C) 2000 Elsevier Science Ltd. AII rights reserved.