The IDAT Program, established under the Drug and Alcohol Treatment Act 2007 of New South Wales, aims to “provide short-term care, with an involuntary supervised withdrawal component, to protect the health and safety of people with severe substance dependence who have experienced, or are at risk of, serious harm and whose decision making capacity is considered to be compromised due to their substance use”. The IDAT evaluation aims to evaluate 1) the process; 2) the outcome; and 3) the costs of the IDAT Program.
The process evaluation aims to provide descriptive information about the program operations, its reach, patient progression through the defined model of care, and the feasibility and appropriateness of the model of care. The outcome evaluation aims to assess the impact of the IDAT program on a range of patient outcomes including drug and alcohol use and health service utilization, in comparison with a comparison group. The cost evaluation will determine the costs of the IDAT program.
Dr Mark Montebello
Drug and Alcohol Service
Professor Wayne Hall
University of Queensland
Under the new legislation (the Drug and Alcohol Treatment Act 2007), the IDAT program in New South Wales has been implemented for two years and has provided treatment for approximately 200 patients. Internationally, methodologically sound studies on the effectiveness of involuntary treatment are limited (Broadstock et al., 2008). Recent studies conducted in Thailand (Johnson et al., 2012) and Vietnam (Vuong et al., 2015) showed limited effectiveness of involuntary treatment among people who are dependent on heroin and amphetamine-type stimulants. However, the legislative frameworks, the treatment principles and the model of care under which involuntary treatment in Thailand and Vietnam are being implemented are substantially different from those of the IDAT program in New South Wales. Therefore, evidence of effectiveness (or ineffectiveness) of involuntary treatment in other countries should not be generalised to the context in which it is being implemented in New South Wales. For this reason, an evaluation study to determine the feasibility, appropriateness, effectiveness and the costs of the IDAT program is critical to assist NSW policy makers in their decision making on the prospects of the IDAT program.
The primary aim of the evaluation is to:
- Determine the effect of the IDAT program on patient outcomes for IDAT patients and in comparison to a control group.
The secondary aims of the evaluation are to:
- Determine the feasibility and appropriateness of the IDAT program in terms of:
- meeting demand, and reaching, the appropriate target group
- any unintended consequences of the program
- whether practice is consistent with the Model of Care, and where there are variations or possible refinements
- patient and practitioner experience
- whether the brokerage model is effective.
- Determine the costs of the IDAT program and inform cost-benefit analysis
For the process evaluation: A combination of quantitative and qualitative methods and multiple datasets will be used, including a quantitative analysis of the IDAT program database, interviews with patients and their carers, and in-depth interviews with stakeholders.
The outcome evaluation employs a prospective, repeated measures design. Structured interviews will be conducted with the IDAT patients at admission to the program, at discharge from inpatient treatment (default inpatient treatment is 28 days) and 6 months after discharge. The comparison group will be matched comparison sample using linked data only.
The cost evaluation will determine the costs of the IDAT program inclusive of the inpatient stay, the community care component and costs associated with the entry and assessment processes.
The following three components of the IDAT evaluation have been completed with final reports submitted to the NSW Ministry of Health:
- Process Evaluation: The final report was completed in April 2017.
- Cost Evaluation: The final report was completed in March 2018.
- Outcome Evaluation (using interview data of only one group- IDAT patients): The final report was completed in July 2019.
One component of the IDAT evaluations (which was originally one part of the Outcome Evaluation) is the data linkage component (comparing health service utilisations between IDAT and a control group). It is planned that this data linkage component will be completed by the end of 2019.