Competency-based training approaches are being used more in healthcare to guide curriculum content and ensure accountability and outcomes in the educational process. This article provides an overview of the state of competency development in the field of behavioral health. Specifically, it identifies the groups and organizations that have conducted and supported this work, summarizes their progress in defining and assessing competencies, and discusses both the obstacles and future directions for such initiatives. A major purpose of this article is to provide a compendium of current competency efforts so that these might inform and enhance ongoing competency development in the varied behavioral health disciplines and specialties. These varied resources may also be useful in identifying the core competencies that are common to the multiple disciplines and specialties.
Data from SADAP indicate that total alcohol and other drug treatment monies expended during FY 1988 in programs that receive at least some State funds were more than $1.6 billion. Also, data from NDATUS for the fiscal year encompassing October 30, 1987, demonstrate that total monies from all sources for drug abuse treatment (excluding alcohol, but including non-State-funded programs) exceeded $1.3 billion. Total other drug client treatment admissions as reported in SADAP for FY 1988 were 518,851; the number of other drug abuse clients in treatment as reported in NDATUS as of October 30, 1987, was 260,151. From a meeting of experts convened by NASADAD on September 2, 1987, the annual estimated cost of drug treatment (excluding detoxification) for needle users at that time ranged from $2,300 for outpatient drug-free, to $3,000 for outpatient methadone maintenance, to $14,600 for adult nonhospital residential drug-free, to $18,000 for adolescent nonhospital residential drug-free. The above data and lack of data point to the need for more extensive well-designed data collection studies on the cost, capacity, and utilization of drug treatment services. Today, significant information gaps exist. Such data are required for the administration, Congress, and States to better plan for the availability, accessibility, and support of expanded alcohol and other drug dependency treatment services for persons in need of such treatment services.
Study was made of the relationship between methadone dosage policy and retention in drug abuse treatment. Responses were obtained from administrators of 113 methadone maintenance programs representing the 11 states with the largest number of maintenance programs. It was found that program policies involving the use of flexible dosages, i.e., where no single dosage policy predominated, were associated with greater retention in treatment. Programs making use of flexible strategies retained clients an average of almost 9 months longer than those programs making use of any other dosage policy. In contrast, no differences in retention were found between high, mid, and low dose programs when effort was made to control for relevant client variables. Study is suggested to explore the relationship of service delivery elements to dosage policy within methadone maintenance programs.
