Screening for Infectious Diseases Among Substance Abusers
Treatment Improvement Protocol (TIP) Series 6

Overview of the Program Models

The three program models presented in this section add a variety of services to an existing drug treatment program. The models assume a case management approach and 150 treatment slots per program. The tables present the following information for each program model:

• Functional tasks
• Staff needed to perform each task
• Time needed to complete each task
• Total number of direct and indirect service hours needed for 150 patient slots

The staffing levels presented in the tables allocate time for each task on a formula of 75 percent for direct service and 25 percent for indirect service. Indirect service time is computed as part of the total time needed to complete all tasks appropriately. For example, for each hour of staff work, 45 minutes is devoted to direct client service and 15 minutes is allotted for tasks such as charting and telephone calls. The staffing levels presented in the tables do not take into account tasks performed by administrative, managerial, and support personnel, such as a receptionist who answers the telephone and schedules appointments.

It is expected that there will be patient attrition for a variety of reasons. Staffing, patient scheduling, and screening will vary throughout the year due to the nature of the population and because of the need to screen or test for diseases more than once a year.

Overview of the Sample Budgets

The costs associated with the operation of each program model are presented in the sample budgets. Patients will be entering and leaving the program at different points in the treatment continuum; however, the sample budgets are based on a static patient population of 150 patient slots.

The sample budgets are based on these assumptions:

• The costs reflect fully operational programs at 150 patient slots.
• The tables identify a choice of professionals who could perform each task. For example, physicians and registered nurses are selected to provide the medical services. An intake worker and counselor are allotted to provide evaluation, counseling, and treatment planning services. In addition, salary ranges for social workers are used for the case manager positions.
• The wage rates are based on a limited survey. Actual salaries should be adjusted to prevailing wage rates for the geographic area.
• One full-time equivalent (FTE) position provides for 1,880 hours of service plus 80 hours of vacation and 40 hours of sick leave.
• The physician and nursing positions are paid on an hourly basis.
• The intake counselor and case manager positions are salaried.
• Laboratory costs per treatment slot are as follows:
  • Infectious disease screenings/tests - $1,355
  • HIV-antibody testing - $101
  • Combined HIV-antibody testing and infectious disease screenings/tests - $1,456
• Laboratory charges are based on a limited national survey and on single-unit prices. Actual costs will vary by geographic area, particularly if volume discounts are available.
• Phlebotomy services are obtained from an outside laboratory rather than performed by a staff member. Costs are calculated at $20 per hour.
• Clinical supplies are computed at $20 per patient slot per year.
• A transportation allowance of $20 per patient slot is included in the budgets to cover the cost of bus tokens or cab vouchers.
• Training and conference allowance costs are:
  • HIV counseling and testing program - $500 per staff member
  • Infectious diseases screening program - $250 per staff member
• The fringe benefit rate is calculated at 30 percent.
• An administrative overhead charge of 20 percent of total wages and fringe benefits is included in the budgets to provide for the costs of administrative supervision and support.
• The budgets do not include indirect costs necessary for the operation of a facility. Examples of indirect costs that should be considered part of an operating budget include:
  • space rental
  • utilities
  • telephone
  • cleaning
  • insurance
  • equipment purchase/rental and maintenance/ repairs
  • office supplies
  • depreciation
  • security services
• The budgets do not consider reimbursement issues. Before deciding to implement these guidelines, it may be advantageous to study Federal, State, local, and third-party reimbursement programs. Reimbursements from these sources may pay for part or all of the services offered by the program models.

Summary

The program models and sample budgets in this section provide examples of how to design and implement three different approaches to screening for infectious diseases in a drug treatment program. This information permits comparison between the costs of delivering separate or combined HIV/AIDS counseling and testing and infectious diseases screening programs. The economies of scale clearly indicate a cost advantage to a combined program. The HIV/< AIDS counseling and testing operation is a labor-driven program, while the infectious diseases screening program mainly involves costs for laboratory procedures. The combining of both HIV/AIDS counseling and testing and infectious diseases screening would allow for the greatest amount of programmatic and fiscal flexibility.

The number of patients in drug treatment programs with HIV/AIDS and infectious diseases continues to grow. At the present time, there is no reason to believe that this population will be decreasing in size. Given the strong correlation between HIV, infectious diseases, and chemical dependency, there is a need for drug treatment programs to consider enhancing their efforts by including counseling, testing, and screening services. The information provided in the guidelines, along with suggestions in this section for service design and implementation, staffing, and costing, are intended to guide States and local treatment programs in their efforts to provide services to this population.