Deborah W. Garnick, Constance M. Horgan, Margaret T. Lee, Lee Panas, Grant A. Ritter, Steve Davis, Tracy Leeper, Rebecca Moore, Mark Reynolds

This study examines the association between adherence to during-treatment process measures of quality (defined as initiation and engagement in treatment as developed by the Washington Circle) and outcome measures (defined as arrests and incarcerations) in the following year. The data come from the Oklahoma Department of Mental Health and Substance Abuse Services administrative data system linked to data from state criminal justice agencies. Clients who initiated a new episode of outpatient treatment and who engaged in treatment were significantly less likely to be arrested or incarcerated in the following year. Initiation of substance abuse treatment alone, without engagement in treatment, was not significantly associated with arrests or incarcerations. These findings validate the clinical importance of the Washington Circle performance measures of initiation and engagement. Applying the "process-of-care" measures can make a difference when they are used as a target for quality improvement in treatment facilities.