Examining the pathways for young people with drug and alcohol dependence following residential treatment: a data linkage study

Background

Residential treatment has been shown to improve health and related outcomes for young people in the short term. However, there is little robust research showing longer term outcomes or benefits. Linking administrative data enables examination of outcomes data on large numbers of people spanning many years with little loss to follow-up. This data linkage study examined the outcomes of young people referred to a residential treatment program in Australia designed to address alcohol and drug issues. The study is the first among adolescents linking treatment program data to justice, and health data sets that goes beyond basic demographic correlates to including a range of psychosocial measures, including drug and alcohol use collected at referral for more than a decade.

Methods

The 3,639 person records of clients 13-18 years referred to the program (2001-2016) in the most populous state (NSW) and nearby territory (the ACT) in Australia were linked to administrative data from health and criminal justice data from these two jurisdictions, including Admitted Patients, Death and Cause of Death, Emergency Department presentations, Mental Health Ambulatory data, Notifiable Conditions and criminal justice system data for juveniles and adults to the year 2016. A third-party data linkage service was used following ethical approvals and agreements with data custodians. The client dataset includes referral source, date of admission and discharge, and reason for departure, and for all referrals including those not admitted: socio-demographics, past and current drug and alcohol use, psychological wellbeing, suicide and self-harm attempts, social and family functioning and past criminal activity. Mortality, emergency department and hospitalisation data has been merged and analysed with comparisons between young people who are referred and a) stay 30 days or more in the program (including those who go on to continuing care and those who do not); b) start, but stay fewer than 30 days in the program; c) are assessed, but do not start the program. Propensity scoring methods are used to reduce confounding when conducting comparisons.

Results

The records of 3,308 persons from the cohort of 3,639 persons were matched to at least one dataset with 72.1% linking to the NSW Admitted Patient records, and 79.4% to the NSW Emergency Department records. Links to the NSW Notifiable Conditions Registry and NSW Mental Health Ambulatory Data were 27.9% and 68.2% respectively, and 58.4% records were linked to the NSW criminal justice dataset. There were 64 deaths recorded with a standard mortality ratio of 5.32 (95% CI: 4.08-6.82) which is significantly higher than the general population of the same age and sex. The process, challenges in undertaking data linkage and further key results from the health datasets will be presented.

Conclusion

Data linkage studies can provide critical new understandings of how young people with drug and alcohol issues fare in the longer term. This particular study also examines the contribution of a residential treatment program with continuing care to young people’s pathways and trajectories informing policy and service design relating to treatment, early intervention and harm reduction.