By GARRY RAYNO, InDepthNH.org

CONCORD - An initiative designed to act as the main entry point for people dealing with substance abuse to reach services and treatment did not collect enough information to judge its results, a performance audit determined.

Reviewed Friday before the Joint Legislative Fiscal Committee, the performance audit by the Legislative Budget Assistant concluded the Doorway Program must make several adjustments to strengthen its oversight and better track how well it helps individuals secure treatment for substance use disorders.

The effort receives most of its support from federal grants along with limited state funds from the Governor's Commission on Addiction, Treatment, and Prevention.

The Department of Health and Human Services works with nine hospitals across the state to function as entry points for treatment and related services.

The nine hospitals handle screening, assessment, referrals, and client coordination, yet the department did not create full policies and procedures for oversight or a uniform care model, which led to variations in practice, the audit stated.

On the administrative side, the program faced weak management controls, underused client information, and a slow reimbursement system, the auditors reported.

They added that DHHS staffing shortages and staff changes limited the department's capacity to run the program properly and supervise the doorway contractors effectively.

During fiscal years 2022 to 2024 the program used more than $27 million and assisted an average of 1,805 clients each year.

John Clinch, LBA Senior Audit Manager, informed the committee that no standard success rate exists for addiction recovery efforts, so the program results could not be measured against accepted benchmarks.

He pointed out that while addiction is viewed as a long-term condition, one useful indicator is improvement in a person's overall quality of life.

Based on federal data submitted by the program, auditors found that 45.5 percent of clients showed better quality of life after six months, and the rate of successful completion stood at 16.5 percent.

Clinch cautioned that these figures came from a non-random group with available data and should not be applied to all participants.

The auditors offered 12 recommendations for program improvements and urged the department and the governor's commission to create detailed formal policies and procedures for managing and reviewing the effort.

The auditors noted that the governor's commission, which provided state money when federal funds fell short for some clients, did not submit required reports on its finances, allocations, or activities.

Without those reports, the Governor, the Legislature, and other interested parties may have lacked key details for sound decision making, the auditors wrote.

The auditors also discovered that monthly statistical reports from the program contained inaccuracies and were frequently incomplete.

Nearly all monthly reports issued during the review period had mistakes or left out important program information.

The auditors further determined that the program did not meet federal reporting standards.

The program failed to follow federal Government Performance and Results Act data collection rules because of low response rates on client interviews and incomplete monthly statistical reports from the nine doorway sites, the audit stated.

They recommended that the department adopt a new interview survey created by the federal Substance Abuse and Mental Health Services Administration along with planned follow-up interviews at the six-month mark.

The auditors also found that the department delayed payments to its contractors.

The agency agreed fully with 10 of the 12 recommendations and agreed in part with the remaining two.

Senate President Sharon Carson, R-Londonderry, highlighted a portion of the audit that compared the Doorway Program with other efforts offering similar services, including certified community behavioral health clinics and regional public health networks.

She expressed interest in additional details to explore whether some of these programs could be combined.

The legislature routinely seeks cost-saving measures, she noted, and merging services might offer one option.

Katja Fox, Director of the Division of Behavioral Health at DHHS, explained that both the doorway and certified community health programs focus on substance use disorders. She added that combining substance abuse treatment with mental health support is a newer approach in New Hampshire and reflects efforts to improve service integration.

More developments are expected as the doorway program evolves, she said, recalling that it started during the state's opioid crisis.

As progress continues, the focus will shift toward integrating all related services so individuals can receive comprehensive support in one setting rather than visiting multiple locations, Fox said.

Carson also proposed collecting data to show how many doorway users return after a period of recovery due to relapse.

She asked how many clients are repeat users.

Clinch responded that such details are part of protected medical records under HIPAA rules.

He noted the auditors did not have access to that information.

The Doorway Program began in January 2019 to provide substance use disorder screening, evaluation, referrals, and care coordination. It created a statewide system of regional centers for opioid use disorder treatment and recovery support through federal grants.

The model drew from earlier efforts in Manchester and Nashua that used fire stations as starting points for treatment and services. Individuals seeking help could visit those locations and receive direction to appropriate programs.

Many supporters identify the shortage of treatment beds as the state's primary barrier when someone seeks assistance.

The committee plans to revisit the program at its October meeting.

Garry Rayno may be reached at garry.rayno@yahoo.com.