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08 Ethnography and Street Studies

·        The Middleman/Woman Revisited: An Excursion into Illegal Drug Market Analysis. (presentation)  R. Terry Furst, Ph.D.  Terryfurst@oasas.state.ny.us

Drug researchers have long recognized the significance of supply and demand dynamics in illegal drug markets and have used this as a conceptual starting point for market analysis of drug abuse patterns.  In recent empirical research, with the help of others, the author has studied changes in illegal drug market for crack as a starting point for the analysis of exogenous and endogenous factors leading to changes in drug abuse patterns.  Drug abuse patterns are defined as activities and behavior that are both cause and effect of illegal drug distribution and consumption practices.  The crack epidemic of the late 1980s and the recent upsurge in the intranasal use of heroin are cases in point.  

This study involves a reexamination of data collected from twenty in-depth ethnographic interviews conducted in Bushwick, Brooklyn, with drug seeking customers, middlemen/women, street dealers, and “crew managers.” The ages of the respondents ranged from 18 to 48. Field notes and extensive observations complement these interviews. The methodology seeks to identify elements of drug consumption and distribution that have market implications for changes in drug markets.

The response to questions by respondents, about the strategies, the nuances, and the mechanics of how business is conducted on the street in times of police-induced stress were candid. The aggregate of vantage points offered by respondents provide a better understanding of how actions of consumers and sellers of illegal drugs are interrelated and how illegal street drug markets function in Bushwick. The pressures applied by law enforcement, rising HIV among IDUs, subsequent changes in the route of administration of heroin, and the coalescing of the distribution of powder cocaine and heroin by individual street sellers and the emergence of different kinds of heroin cuts have contributed to changes in drug markets and drug abuse patterns.

·        Current Drug Use Trends and Drug Paraphernalia. (presentation)  John Galea, M.A.  Johngalea@oasas.state.ny.us

The OASAS Ethnography Section (known as the Street Studies Unit) works undercover to study the culture of individuals involved in the illicit sale and use of drugs.  Up to date information on the drug subculture is critical for both agencies and individual clinicians in understanding the physical and psychological effects of clients’ drug abuse and developing relevant treatment modalities.  The goals of the Unit are to identify types and amounts of drugs being sold, offered and/or used, and the various costs; identify locations of sales and shifts in drug scenes; define labels and other identifying marks of illicitly sold drugs; define general characteristics of dealers/sellers/users; and identify drug paraphernalia.  This presentation will summarize some recent findings and display and discuss drug paraphernalia.

·        Current Drug Paraphernalia. (poster)  John Galea, M.A.  (Johngalea@oasas.state.ny.us)

The Street Studies Unit works undercover to study the culture of individuals involved in the illicit sale and use of drugs.  Up to date information on the drug subculture is critical for both agencies and individual clinicians in order to understand the physical and psychological effects of clients' drug abuse and to develop relevant treatment modalities.  The display will identify an array of drug paraphernalia.

09 Criminal Justice System and Highway Safety

·        Working with the Criminal Justice System and the AOD Abusing Client. (presentation)  Eugene Cooperman, Dale Sturkey, and Storm Jorgensen  (Eugenecooperman@oasas.state.ny.us)

This presentation will discuss points of convergence between the criminal justice system and the AOD treatment system including initiatives of the OASAS Bureau of Criminal Justice Services.  The use of AOD assessment instruments in the criminal justice system will be featured.

·        Differences in Predicting Motivation for Treatment for Court Mandated and Non-mandated Adolescents in Substance Abuse Treatment. (presentation)  Patricia Perry, Ph.D., John Yu, Ph.D., Robert Gallati, M.A., and Dayna Stark, B.S.  (Patriciaperry@oasas.state.ny.us)

Adolescents who are mandated into treatment through the criminal justice system may be more severely involved with substances and have prior experiences that distinguish them from the non-mandated counterparts.  This paper examines the hypothesis that mandated youth will have less motivation for treatment because they have greater substance use history, experience less family cohesion, and have greater criminal justice involvement than their non-mandated counterparts.  Self-report data were examined from 110 adolescents in NYC who were admitted to substance abuse treatment and who participated in the study conducted under the CSAT-sponsored study to examine the Effects of Medicaid Managed Care on Vulnerable Populations.  Preliminary findings from this sample showed that lifetime cocaine use was most predictive of motivation for treatment and other factors such as criminal justice status and family conflict did not predict motivation.  Implications for practice and policy will be discussed.

·        Drinking in College, Zero Tolerance, and Public Opinion on Highway Safety: Highlights of Three Recent Studies. (poster)  John Yu, Ph.D. and Elena Rizzo, MA  (Johnyu@oasas.state.ny.us)

This poster presents the highlights of three recent research projects conducted by the Criminal Justice Studies Section of the Evaluation Unit. 

“Alcohol Use and Safety Risks Among College Students in New York State” is a recently completed study that aims to examine the extent to which college drinkers are exposed to alcohol-related risks, especially traffic safety risks. Telephone interviews were conducted among 813 students randomly selected from five New York State four-year colleges. Results from preliminary analyses indicate that 42 percent of the students meet the criteria for alcohol abuse, as adapted from the Diagnostic and Statistical Manual of Mental Disorders – fourth Edition (DSM-IV) and 18 percent meet the DSM-IV criteria for alcohol dependence. Binge drinkers are two times more likely than non-binge drinkers to be involved in drinking driving and almost five times more likely to report riding with impaired drivers.

“Alcohol/Substance Use and Traffic Safety Awareness Survey” is an ongoing OASAS study in cooperation with the New York State Police. The 1999 survey marks the 10^th anniversary of this survey series. For the past decade, OASAS and the State Police examined and reported patterns and trends of public opinions on DWI enforcement, drinking age laws, alcoholism/substance abuse, neighborhood crimes and traffic safety, and perceived safety risks. Surveys conducted in 1998 and 1999 suggest serious public concerns of aggressive driving; close to 80 percent of the respondents indicated that they saw an aggressive driver within 30 days prior to the survey.

“Zero Tolerance and Young Drivers” aims to assess the possible deterrent effect of the zero tolerance law and establish a database which will allow the evaluation of the long-term impact of the law. The results of the project will inform the design of education/prevention strategies that encourage compliance with the zero tolerance law and the 21 drinking age law through incorporation of efforts from parents, schools, student organizations, and law enforcement agencies. A telephone survey was conducted on a random statewide sample of 600 pairs of youth between 15 and 18 years of age and one of their parents. Preliminary data analysis examines youths’ alcohol use and compliance with the zero tolerance law affected by such family processes as alcohol use in the family, interaction between parent and child, and deterrence through informal sanction by parents.

10 Managed Care

·        Access to Alcohol and Other Drug Treatment Services for Adolescents in Medicaid Managed Care in New York State. (poster)  Melissa Wyman Paquin, Ph.D., Dawn Lambert-Wacey, M.A., D. Scott Momrow, M.P.H., Erica Eaton, M.P.A., and Patricia Perry, Ph.D. (Melissawymanpaquin@oasas.state.ny.us)

To examine the extent to which the constellation of recent system changes (e.g., Medicaid managed care, Welfare Reform) has impacted adolescents' access to and continuity of alcohol or drug (AOD) treatment, we conducted a qualitative study and examined trends in the Client Data System.  In particular, in the qualitative study, we interviewed AOD providers and key state & local stakeholders in the AOD system to assess their perceptions of the effects of the system changes.  The results from the Client Data system indicated the complexity of the system that many adolescents navigate; many adolescents are simultaneously involved in the AOD, criminal justice, and social service systems.  In addition, the qualitative results indicated that although the full effects of Medicaid managed care are yet to be felt, there are numerous challenges to be overcome to obtain adolescent AOD treatment.

·        Preliminary Results from a Qualitative Analysis of the Impact of Medicaid Managed Care and Welfare Reform on AOD Treatment in New York State. (poster)  Melissa Wyman Paquin, Ph.D., Patricia Perry, Ph.D., Andrew Ferraro, Erica Eaton, M.P.A., and Robert J. Gallati, M.A.  (Melissawymanpaquin@oasas.state.ny.us)

In 1997 New York State implemented two major policy initiatives, mandatory Medicaid managed care (MMC) and welfare reform.  To assess the potential effects of these policies on adults' and adolescents' alcohol or drug (AOD) treatment in New York, we conducted two qualitative studies in which we interviewed local and state stakeholders (including AOD providers, local and state policy makers, and consumer groups) who were involved in or affected by the implementation of these policies.  The results of these studies revealed discrepancies between the intentions and outcomes of the policies.  Taken together the findings suggest that Medicaid managed care and welfare reform have begun to affect AOD treatment in New York; however, the full impact of Medicaid managed care will be felt only as the policies become fully implemented.

·        Effects of Medicaid Managed Care on Adults and Adolescents with Chemical Dependence: A Cooperative Agreement. (poster)  Patricia Perry, Ph.D., and Robert Gallati, M.A.  (Patriciaperry@oasas.state.ny.us)

NYS-OASAS is participating in two studies that are part of a 21 site cooperative agreement funded by the Center for Substance Abuse Treatment to respond to the general question, “What is the effect of Medicaid managed care on cost and utilization of services, and client outcomes for vulnerable populations?”.  This poster will highlight the progress to-date for these two studies which consist of (1) a prospective study of clients in treatment with 6 & 12 month follow-up interviews, (2) an administrative data and cost study, (3) an alcohol and drug treatment provider study, and (4) an alcohol and drug treatment provider study.  Preliminary findings from client interviews, the alcohol and drug treatment provider study, the implementation study, and a review of the administrative data will be displayed.

11 Cost and Efficiency of Services

·        What Does it Cost to Provide Outpatient Alcohol and Substance Abuse Treatment in NY State? (poster)  Diane Dewar, Ph. D., School of Public Health,  Anusuya Roy, M.A., Department of Economics, SUNY, Albany., Robert. J. Gallati, M.A., and Joseph  Maloney, B.B.A.  (Ddewar@cnsvax.albany.edu)

The purpose of this analysis is to develop an econometric model specifying the factors affecting the cost of delivering outpatient services and estimating the costs for those outpatient units for which detailed cost reports are unavailable. This analysis supports a parent study of Medicaid managed care and chemical dependency treatment services.

This analysis utilizes data bases of the New York State Office of Alcoholism and Substance Abuse Services. Based on the 1997 Consolidated Fiscal Reports (CFR) for 204 outpatient treatment units for annual costs, variables representing theoretical explanatory factors are merged into the CFR from the following sources: scale and scope (volume of services and multi-unit provider), organizational structure (hospital or freestanding), and resource market (urban or rural) from the Provider Directory System and service intensity (staff to client ratio,  day services, and hours per admission)  from the Monthly Service Delivery Report; and case mix (substance abuse severity, social support, vocational/educational functioning, criminal justice involvement,  and medical/mental health comorbidities) from the Client Data System.   Profiles of the clients treated at each provider unit are used to construct clinical and social risk adjustment scores for the case mix dimensions above. Simple correlations are performed to test the hypothesized associations between variables.  Based on the theoretical development and descriptive analysis, two regression models (one for alcohol clinics and the other for Medically supervised Drugs and Drug-free outpatient/day-service combined) are estimated to predict the independent impacts of the explanatory variables on the three cost measures.

The scale (or volume of services provided) is the most important factor. Volume is positively related to cost for alcohol clinics whereas it has opposite signs for the Drug group. Besides, for all these programs, more intensive services reduces cost and high volume hospitals tends to raise cost, although hospitals, in general, results in lower costs. For the alcohol program, staff to patient ratio and factorial scores for Comorbiditiy and education tend to lower cost. For the drug programs, factorial score for severity of illness is positively related to total cost.

12 Tobacco

·        Who Quits Smoking? Evidence from the first waves of the Health and Retirement Study. (presentation)  Kajal Lahiri, Professor of Economics, University at Albany, SUNY (518-442-4735)

Economists have traditionally studied the role of cigarette prices on quitting decisions without considering the feedback effect of smoking on health. This paper examines the role of health conditions on the cessation behavior of smokers by using the first four waves of the Health and Retirement Study (HRS). We distinguish between curative and preventative reasons for quitting. We found that current and foreseeable health conditions significantly influence the late-age quitting decisions, whereas those having higher socioeconomic status and education tend to quit at younger ages.

·        Tobacco Outlet Random Inspection Survey: The OASAS Response to Synar Amendment Requirements. (poster)  Claire Dalton,  MSW,  Eric Habel, MS (Clairedalton@oasas.state.ny.us)

Based on a 1994 amendment (the “Synar Amendment”) to the legislation that governs the Substance Abuse Prevention and Treatment Block Grant, state agencies that receive those monies must comply with federal Synar requirements or risk losing a sizable portion of their allocations.  OASAS is that agency in New York State; since 1996, OASAS has conducted an annual survey designed to measure the prevalence of illegal tobacco sales to underage (under 18) youth and to demonstrate compliance with the Synar Amendment.

This poster describes the current status of the annual Tobacco Outlet Random Inspection Survey (T.O.R.I.S.) in New York State.  Various aspects of the project will be presented, including the legislative history; a chronology of key events and milestones; the protocol of Synar cooperation in New York State, including OASAS’ liaisons with other state agencies; the complex sampling design and methodology; and, highlights of data collection and analyses from the first four years of the survey.

METHODOLOGY AND RESOURCES

13 Research/Evaluation Methodology

·        Tracking Clients for Follow-up While Maintaining Client Confidentiality in a Multi-User Network Environment. (poster)  Gary M. Dollard and Cecilia Aybar  (Garydollard@oasas.state.ny.us)

Multi-wave surveys require high retention rates.  To achieve the highest possible retention rates it is essential to maintain contact with participants throughout the duration of the data-gathering phase. Particular challenges are posed in tracking adolescent alcohol and other drug treatment recipients.  Relational Database systems are effective means of gathering and manipulating inter-related data concerning study participants.  This information enables study administrators to identify, contact, re-establish contact and track previously interviewed participants, while complying with Human Subject confidentiality regulations. The Locator database is a cost effective relational database created and maintained using Microsoft Access that provides a significant level of protection coupled with network security and user protocols.  The locator system can be administered from remote sites and multiple users at multiple sites can perform data entry. The system is constructed from several basic elements that are customizable and that perform primary functions based on core information for each of the participants.  The data are obtained during initial interviews and subsequent contacts and updated by the database administrator. In addition to tracking and scheduling functions, information and reports for administrative purposes are easily created and modified. For example, Locator provides real time ad hoc reporting to determine the current demographic profile of the study population or to assist with research data management that can be exported in numerous standard formats.  Locator has been developed and refined through a number of multi-wave studies.  Locator’s development and design have built on previous findings and have improved retention rates as the studies have progressed.

·        Analyzing Complicated Data Sets:  Suggestions from Statistical Consultants. (poster)  Patricia Perry, Ph.D., Howard Stratton, Ph.D., and Robert Pruzek, Ph.D. (Patriciaperry@oasas.state.ny.us) 

This poster illustrates two statistical techniques which were used on the self-report data obtained in the Adult Medicaid managed care study.  The data collected for this study are complicated due to the number of variables, the context of the study (e.g., the AOD treatment system which consists of in-plan, out-of-plan, and non-Medicaid services), and the nature of the information (e.g., self-report which is inevitably fallible).  Traditional statistical methods may be inadequate to describe fully the structure within the data given these limitations.  Shown first are conditional plots which can display distributions for multiple subsets of the data.  This is followed by a regression tree which examines the structure of the data without specifying a model.  While it is too early to state the effects of Medicaid managed care on outcomes, these and other more specialized inferential techniques will assist in providing a comprehensive understanding of the nuances of results for Medicaid managed care and fee-for-service clients.

·        Concordance Between Self-Report and State Administrative Data for Alcohol and Substance Abuse Clients. (poster)  Dayna Stark, B.S., Patricia Perry, Ph.D., and Robert Gallati, M.A. (Daynastark@oasas.state.ny.us)

As part of  SAMHSA’s Cooperative Agreement to study the effects of Medicaid managed care on vulnerable populations, 672 adults completed a structured interview when they were admitted to alcohol and substance abuse services. The structured interview asked clients to identify their primary drug of abuse, whether they ever injected drugs, and whether they received services for mental health reasons. These data were linked with OASAS Client Data System records using an anonymous tracking ID. Findings substantiate a high level of congruence for criminal justice, mental health and other constructs.  Future analyses will examine the congruence of these two instruments in other content areas. Efforts to improve data collection and reporting can be targeted at those areas with substantial incongruity.

·        Data Resources and Analysis Opportunities in Services Research. (poster)  Dawn Lambert-Wacey, M.A., Dayna Maniccia Stark, Gary Dollard, and Pen Che-Ho (Dawnlambert-wacey@oasas.state.ny.us)

Working with administrative sources and multi-wave panel studies often involve the handling of large amounts of data. The Medicaid Managed Care Studies (MMCS) data collection within Services Research consist of multi-year, multi-wave interrelated data from the following sources: Interview Data from two prospective studies for adults and adolescents that include baseline and 6 and 12 month follow-ups,  OASAS client, program and cost data, and DOH Medicaid data, including adjudicated claims records, eligibility status and enrollment information.

An overview of the MMCS data collection is presented. These diverse data sources provide rich insights when combined. These data matrices are often structured very differently.  Administrative data files primarily contain many records with relatively little detail and may range in size from thousands to millions of records, whereas panel studies or prospective data typically contain much more detail on relatively few cases.  Merging and combining such databases have presented many challenges including the standardization of data transport methods, development of matching strategies, and standardization and transformation of data definitions. A description of the merges of the prospective, CDS and DOH Medicaid data will also be presented.

Preparing such data resources for research purposes and analysis is also complex.  Methodologies and processes developed for the gathering, storing, managing, accessing, merging and analyzing of such diverse and complex data collections are presented. The infrastructure to handle such data (including the computer resources to extract, transport, store and manage the data repositories, the software to transform, cleanse and analyze the data, and the standardization of such processes) is also discussed. The acquisition and merging of such rich and diverse data sources produces combined data sets that allow researchers to address many important research and policy questions.

·        A Model for Collecting and Analyzing Data on Federal, State and Local Polices Affecting Access to Alcohol and Other Drug Treatment by Adolescents in New York State. (Poster)  Dawn A. Lambert-Wacey, M.A., D. Scott Momrow, M.P.H., and Patricia Perry, Ph. D.  (Dawnlambert-wacey@oasas.state.ny.us) 

The advent of Medicaid Managed Care and its effects on access to, and financing of, alcohol and other drug (AOD) treatment services is of increasing concern.  Existing qualitative and quantitative techniques do not provide adequate methods for understanding the potential impact of policy changes on an existing complex system that includes other health care and welfare reforms.  An analytic model was developed to adequately represent these complex systems by situating quantifiable data within their qualitative contexts.  This model was then operationalized as a relational database that provides a flexible mechanism for both collecting and analyzing policy-related data.  The model constructed captures three major elements “Players,” e.g., governmental entities, MCO’s, providers, “Policies,” e.g., contracts and regulations; and “Products,” e.g., fiscal resources and populations served. Relationships were built to describe the connections among the elements; then, reports were generated to describe the attributes of the system.  The principal players, policies, and products affecting access to AOD services for Adolescents in New York State have been entered to test the model.  The model/database is a useful tool for identifying gaps in information, specifying relationships among complex systems, describing the context from within which multiple changes occur and identifying critical factors and potential impacts of changes.

14 Information Resources

·        The OASAS Geographic Information System (GEOASAS). (poster)  Jean Audet  (Jeanaudet@oasas.state.ny.us)

Geographic Information Systems (GIS) enable spatial analyses to be performed on a wide variety of geographic data and to be presented graphically on a map.  This technology is becoming increasingly more valuable in planning, needs assessment, and research activities.  While GIS has been used on a limited basis for a number of years by planning and research staff, the current OASAS GIS system, also known as GEOASAS, was developed in 1998 to expand the use of GIS to more agency staff.

GEOASAS is housed on a Server located within, and administered by, the Health and Planning Services Division.  Included in GEOASAS are all the resources needed to perform GIS-related activities, including mapping software, boundary files, data files, graphic overlay files, and standard map templates to display data on.  Access to GEOASAS is available to OASAS staff via the intra-net or from a computer workstation located in the Bureau of Planning and Evaluation in Albany.

This poster contains a brief introduction to GIS technology, diagrams the components of GEOASAS and how they are accessed, and shows several examples of the application of GIS in planning and needs assessment activities.

·        Community Health Indicators Group. (poster)  Kathy Dixon and Dawne E. Amsler  (Kathydixon@oasas.state.ny.us)

The Community Health Indicators (CHI) Group is responsible for the collection and analysis of NYS indicator data and dissemination of technical reports and information products to support alcohol and substance abuse prevention and treatment planning at the community level.  Prevention information products include PRISMS County Risk Profiles and NYC Risk Profiles, trend analyses, prevention planning technical assistance, and County Resource Book support.  Treatment information products include community-level treatment need estimates, social area analyses, special population studies, and need estimates for the SAPT Block Grant application.  The CHI group is also responsible for the Research Guide for Alcoholism and Substance Abuse, and the GEOASAS Data Mart.  The Data Mart provides OASAS staff with access to community-level indicator data, including geographic and demographic identifiers, from over 60 NYS data sets to support planning and prevention research and analysis.

·        Health and Planning Services Research Library and LIB-CAT. (poster)  Douglas Carl  (Douglascarl@oasas.state.ny.us)

The Health & Planning Services Division established a special collections library containing books, journals, government publications, and other materials related to alcohol and substance abuse issues.  As the library expanded, the need for a system to maintain the collection, as well as to allow users to search for and locate materials, became apparent. A Library Catalogue System (LIB-CAT) was created specifically for this purpose.  Using LIB-CAT, library users can browse all of the materials located within the library and search for materials by author, title, keywords, and search for words in journal abstracts.  A description of the Health & Planning Services, Services Research library and LIB-CAT are illustrated in this poster.  

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