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It is also important to reiterate, however, Gerstein et al.’s (1997) assertion that differences in the provision of ancillary and medical services and counseling intensity are largely a function of treatment modality.  They suggest that space, staffing, and licensing constraints, for example, may limit the ability of SDUs to expand services or increase the intensity with which they are delivered. We already showed in Table 4 that average revenues per client vary substantially across treatment modality.  Thus, a question for managers endeavoring to improve services is whether an injection of additional revenues can overcome some of the constraints to more effective service provision associated with different modalities of treatment.  This was an important issue motivating the NTIES research project.  Interestingly, Gerstein et al.(1997) find in some early analyses that SDUs that already had higher expenditures per client and more comprehensive and intensive services were more likely to expand or improve service quality with the CSAT grants.  This suggests that the ability of program administrators to effectively manage their financial resources in ways that enhance service quality might in fact be an important causal factor influencing treatment outcomes (in any given treatment modality).

In investigating the relationships between staffing (human resources) and financial resources, we found, as one might expect, that revenues per client were also significantly related to the number of staff-persons per patient in the SDUs: to total staff per patient (r=.314, p < 0.0001), contract staff per patient (r=.168, p=0.0006), staff medical doctors and registered nurses per patient (r=.405, p < 0.0001), and to contract MDs and RNs per patient (r=.301, p < 0.0001).  Short-term residential programs clearly have higher total staff and MD/RN per patient ratios than other treatment modalities (see Table 7), and outpatient drug-free programs have the lowest staff/patient ratio.  It is also noteworthy, however, that residential programs have a significantly

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