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Aleksanyan J, Choi S, Lincourt P, Burke C, Ramsey KS, Hussain S, Jordan AE, Morris M, D’Aunno T, Glied S, McNeely J, Elbel B, Mijanovich T, Adhikari S, Neighbors CJ. Lost in transition: A protocol for a retrospective, longitudinal cohort study for addressing challenges in opioid treatment for transition-age adults. PLoS One 2024; 19:e0297567. [PMID: 39141672 PMCID: PMC11324150 DOI: 10.1371/journal.pone.0297567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/21/2023] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND In the United States, there has been a concerning rise in the prevalence of opioid use disorders (OUD) among transition-age (TA) adults, 18 to 25-years old, with a disproportionate impact on individuals and families covered by Medicaid. Of equal concern, the treatment system continues to underperform for many young people, emphasizing the need to address the treatment challenges faced by this vulnerable population at a pivotal juncture in their life course. Pharmacotherapy is the most effective treatment for OUD, yet notably, observational studies reveal gaps in the receipt of and retention in medications for opioid use disorder (MOUD), resulting in poor outcomes for many TA adults in treatment. Few current studies on OUD treatment quality explicitly consider the influence of individual, organizational, and contextual factors, especially for young people whose social roles and institutional ties remain in flux. METHODS We introduce a retrospective, longitudinal cohort design to study treatment quality practices and outcomes among approximately 65,000 TA adults entering treatment for OUD between 2012 and 2025 in New York. We propose to combine data from multiple sources, including Medicaid claims and encounter data and a state registry of substance use disorder (SUD) treatment episodes, to examine three aspects of OUD treatment quality: 1) MOUD use, including MOUD option (e.g., buprenorphine, methadone, or extended-release [XR] naltrexone); 2) adherence to pharmacotherapy and retention in treatment; and 3) adverse events (e.g., overdoses). Using rigorous analytical methods, we will provide insights into how variation in treatment practices and outcomes are structured more broadly by multilevel processes related to communities, treatment programs, and characteristics of the patient, as well as their complex interplay. DISCUSSION Our findings will inform clinical decision making by patients and providers as well as public health responses to the rising number of young adults seeking treatment for OUD amidst the opioid and polysubstance overdose crisis in the U.S.
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Affiliation(s)
- Josh Aleksanyan
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Sugy Choi
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Patricia Lincourt
- New York State Office of Addiction Services and Supports (OASAS), Albany, New York, United States of America
| | - Constance Burke
- New York State Office of Addiction Services and Supports (OASAS), Albany, New York, United States of America
| | - Kelly S. Ramsey
- New York State Office of Addiction Services and Supports (OASAS), Albany, New York, United States of America
| | - Shazia Hussain
- New York State Office of Addiction Services and Supports (OASAS), Albany, New York, United States of America
| | - Ashly E. Jordan
- New York State Office of Addiction Services and Supports (OASAS), Albany, New York, United States of America
| | - Maria Morris
- New York State Office of Addiction Services and Supports (OASAS), Albany, New York, United States of America
| | - Thomas D’Aunno
- New York University Wagner School of Public Policy, New York, New York, United States of America
| | - Sherry Glied
- New York University Wagner School of Public Policy, New York, New York, United States of America
| | - Jennifer McNeely
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Brian Elbel
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
- New York University Wagner School of Public Policy, New York, New York, United States of America
| | - Tod Mijanovich
- Department of Applied Statistics, Social Science, and Humanities, New York University Steinhardt School of Culture, Education, and Human Development, New York, New York, United States of America
| | - Samrachana Adhikari
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Charles J. Neighbors
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
- New York University Wagner School of Public Policy, New York, New York, United States of America
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Kropp FB, Smid MC, Lofwall MR, Wachman EM, Martin PR, Murphy SM, Wilder CM, Winhusen TJ. Collaborative care programs for pregnant and postpartum individuals with opioid use disorder: Organizational characteristics of sites participating in the NIDA CTN0080 MOMs study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 149:209030. [PMID: 37023858 DOI: 10.1016/j.josat.2023.209030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/17/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
INTRODUCTION Pregnant individuals with substance use disorders face complex issues that may serve as barriers to treatment entry and retention. Several professional organizations have established recommendations on comprehensive, collaborative approaches to treatment to meet the needs of this population, but information on real-world application is lacking. Sites participating in the NIDA CTN0080 "Medication treatment for Opioid use disorder in expectant Mothers (MOMs)"-a randomized clinical trial of extended release compared to sublingual buprenorphine among pregnant and postpartum individuals (PPI)-were selected, in part, because they have a collaborative approach to treating PPI with opioid use disorder (OUD). However, organizational differences among sites and how they implement expert recommendations for collaborative care could impact study outcomes. METHODS Prior to study launch at each of the 13 MOMs sites, investigators used the Pregnancy and Addiction Services Assessment (PAASA) to collect information about organizational factors. Input from a team of addiction, perinatal, and economic evaluation experts guided the development of the PAASA. Investigators programmed the PAASA into a web-based data system and summarized the resultant site data using descriptive statistics. RESULTS Study sites represented four US census regions. Most sites were specialty obstetrics & gynecology (OB/GYN) programs providing OUD services (n = 9, 69.2 %), were affiliated with an academic institution (n = 11, 84.6 %), and prescribed buprenorphine in an ambulatory/outpatient setting (n = 11, 84.6 %); all sites offered access to naloxone. Sites reported that their population was primarily White, utilized public insurance, and faced numerous psychosocial barriers to treatment. Although all sites offered many services recommended by expert consensus groups, they varied in how they coordinated these services. CONCLUSIONS By providing the organizational characteristics of sites participating in the MOMs study, this report assists in filling the current gap in knowledge regarding similar programs providing services to PPI with OUD. Collaborative care programs such as those participating in MOMs are uniquely positioned to participate in research to determine the most effective models of care and to determine how research can be integrated into those clinical care settings.
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Affiliation(s)
- Frankie B Kropp
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA.
| | - Marcela C Smid
- University of Utah, 50 N. Medical Drive, Salt Lake City, UT 84132, USA.
| | - Michelle R Lofwall
- Departments of Behavioral Science and Psychiatry, University of Kentucky College of Medicine, 845 Angliana Avenue, Lexington, KY 40508, USA.
| | - Elisha M Wachman
- Boston Medical Center, 801 Albany Street, Boston, MA 02119, USA.
| | - Peter R Martin
- Vanderbilt Psychiatric Hospital, Vanderbilt University Medical Center, 1601 23rd Avenue South, Suite 3035, Nashville, TN 372124, USA.
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
| | - Christine M Wilder
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA.
| | - T John Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA.
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Akosile W, Bor W, Tilse A, Hunt G, Rushton A, McDermott B, Lee E, McBride M. Predictors of completion of an adolescent residential alcohol and other drug withdrawal program. JOURNAL OF SUBSTANCE USE 2023. [DOI: 10.1080/14659891.2023.2166608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Wole Akosile
- New Farm Clinic, School of Medicine, University of Queensland, Brisbane, Australia
| | - William Bor
- Consultant Psychiatrist Queensland Children's Hospital, Children’s Health Queensland, Brisbane, Australia
- Centre for Children’s Health Research, South Brisbane, Australia
| | - Amanda Tilse
- Mater Young Adult Health Centre, South Brisbane, Australia
| | - Georgia Hunt
- Mater Young Adult Health Centre, South Brisbane, Australia
| | - Ann Rushton
- Former Residential Co-ordinator: Mater Alcohol and other Drugs Withdrawal Service, Former Residential Co-ordinator, Mater Alcohol and other Drugs Withdrawal Service, South Brisbane, Australia
| | - Brett McDermott
- Professor of Psychiatry, James Cook University, Townsville, Australia
| | - Erica Lee
- Mater Child and Youth Mental Health Service, South Brisbane, Australia
| | - Michelle McBride
- Psychologist Ahead Psychology, Former Manager Mater Alcohol and other Drugs Withdrawal Service, South Brisbane, Australia
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Factors associated with the adoption of evidence-based innovations by substance use disorder treatment organizations: A study of HIV testing. J Subst Abuse Treat 2023; 144:108929. [PMID: 36402124 DOI: 10.1016/j.jsat.2022.108929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 09/12/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Though prior research shows that a range of important regulatory, market, community, and organizational factors influence the adoption of evidence-based practices (EBPs) among health care organizations, we have little understanding of how these factors relate to each other. To address this gap, we test a conceptual model that emphasizes indirect, mediated effects among key factors related to HIV testing in substance use disorder treatment organizations (SUTs), a critical EBP during the US opioid epidemic. METHODS We draw on nationally representative data from the 2014 (n = 697) and 2017 (n = 657) National Drug Abuse Treatment System Survey (NDATSS) to measure the adoption of HIV testing among the nation's SUTs and their key organizational characteristics; we also draw on data from the US Census Bureau; Centers for Disease Control; and legislative sources to measure regulatory and community environments. We estimate cross-sectional and longitudinal structural equation models (SEM) to test the proposed model. RESULTS Our longitudinal model of the adoption of HIV testing by SUTs in the United States identifies a pathway by which community and market characteristics (rurality and the number of other SUTs in the area) are related to key sociotechnical characteristics of these organizations (alignment of clients, staff, and harm-reduction culture) that, in turn, are related to the adoption of this EBP. CONCLUSIONS Results also show the importance of developing conceptual models that include indirect effects to account for organizational adoption of EBPs.
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Miles J, Mericle A, Ritter G, Reif S. Association of facility characteristics and substance use disorder outcomes at discharge from residential treatment. J Subst Abuse Treat 2022; 136:108664. [PMID: 34840041 PMCID: PMC8940653 DOI: 10.1016/j.jsat.2021.108664] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/03/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Individuals with substance use disorder (SUD) may benefit from services and supports delivered in residential settings. Prior research in this area has primarily focused on individual-level factors that affect outcomes, with little focus on the relationship between facility-level characteristics and treatment outcomes. METHODS Administrative data from 2713 individuals with an index enrollment in publicly funded residential treatment in Massachusetts during 2015 were linked with facility-level survey data from 33 treatment providers. This study conducted multilevel linear and logisitc regression analysis, adjusting for resident demographic, socioeconomic, and substance use history and severity, to examine relationships between facility-level characteristics, treatment duration and completion, and housing and employment status at discharge. RESULTS Residents stayed longer when they made and enforced rules (β = 30.22, p = 0.006). Residents were less likely to complete treatment as the number of non-clinical services increased (aOR = 0.918, p = 0.029), or in facilities where residents ate together family style (aOR = 0.485, p = 0.039). Being employed at discharge was more likely when house meetings were held less than once per week (aOR = 3.37, p = 0.005) and less likely when held more than once per week (aOR = 0.385, p = 0.038). CONCLUSION Overall, increased resident governance and fewer contingencies for successful treatment participation were associated with positive treatment outcomes. Future research should examine the internal processes of residential settings, including peer-to-peer interactions, to better understand how within-residence features affect outcomes.
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Affiliation(s)
- Jennifer Miles
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02453, USA.
| | - Amy Mericle
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA
| | - Grant Ritter
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02453, USA
| | - Sharon Reif
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02453, USA
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Burns J, Yates R. An examination of the reliability and validity of the recovery capital questionnaire (RCQ). Drug Alcohol Depend 2022; 232:109329. [PMID: 35101817 DOI: 10.1016/j.drugalcdep.2022.109329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/03/2022]
Abstract
AIMS AND BACKGROUND Recovery capital refers to the resources people can call upon to initiate and sustain alcohol and drug problem resolution. Measuring this phenomenon could help an individual better understand their strengths as well as gauge the impact of any interventions designed to improve recovery capital and / or reduce addiction severity. This study aimed to test the internal consistency, stability reliability, criterion-related concurrent validity and content validity of the Recovery Capital Questionnaire (RCQ). SETTING AND PARTICIPANTS Participants (n = 173) accessing community based addiction treatment (n = 108) and residential treatment (n = 65) in England and Scotland completed the RCQ at two time-points one week apart (n = 102) to test stability reliability, and also completed the RCQ alongside measures of quality of life and resilience (n = 152). Content validity was assessed by seven subject matter experts with content validity ratio and index calculated. FINDINGS Cronbach's Alpha values (internal consistency) included: social α = 0.52 (0.40-62); physical α = 0.73 (0.66-0.78); human α = 0.85 (0.82-0.88); community α = 0.85 (0.82-0.88); RCQ Total α = 0.88 (0.85-90). RCQ stability reliability (r = 0.89) and ICC (0.88) were calculated. Content Validity Index statistic of 0.91 was calculated. Correlations between relevant domains within the RCQ and WHOQOL Bref were found to include: r = 0.44, 0.59, 0.66 and 0.40. Correlations between RCQ and CD-RISC scores were calculated (r = 0.65). CONCLUSION The Recovery Capital Questionnaire was found to possess good overall internal consistency and stability reliability. Content validity was found to be strong and the RCQ demonstrated good concurrent validity with a measure of quality of life and a measure of resilience.
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Affiliation(s)
- John Burns
- Faculty of Social Sciences, University of Stirling, Stirling, Scotland FK94LA, UK.
| | - Rowdy Yates
- Faculty of Social Sciences, University of Stirling, Stirling, Scotland FK94LA, UK
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Park SE, Pinto RM. Factors that Influence Co-production among Student Interns, Consumers, and Providers of Social and Public Health Services: Implications for Interprofessional Collaboration and Training. SOCIAL WORK IN PUBLIC HEALTH 2022; 37:71-83. [PMID: 34488568 PMCID: PMC8665028 DOI: 10.1080/19371918.2021.1974638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Providers of public health and social services ("providers") develop and deliver services by engaging in interprofessional collaboration (IPC), from seeking external advice to making referrals and linkages to various social and public health services. Providers collaborate with consumers of social and public health services ("consumers") and student interns (e.g., social work, public health) to explore, determine, and deliver relevant services through a process referred to as co-production. Both IPC and co-production are widespread strategies with the potential to improve service accessibility and quality. However, the intersection of co-production and IPC remains understudied. This study examines factors that influence co-production in IPC among service providers, consumers, and student interns. We used cross-sectional survey data from an NIMH-funded study, including 379 providers in 36 HIV-service organizations in New York City. We examined the relationships between providers' perspectives on co-production in IPC and multiple provider- and organization-level variables using random-effects logistic regression. Most respondents said that consumers and students in their agency participate in IPC on the issues that concern them. Providers who perceive greater flexibility in the IPC process were more likely to agree that their organizations' providers co-produced IPC. Organizational service offerings (i.e., multilingual services, a comprehensive range of services), job positions, and full-time employment status were strong predictors of co-production. Our findings indicate that intentional and inclusive models of flexible IPC are needed. Fostering co-production in the HIV service field requires more institutional support and incentives for organizations, providers, and student interns. Implications for research and practice are discussed.
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Advancing theory on the multilevel role of leadership in the implementation of evidence-based health care practices. Health Care Manage Rev 2021; 45:151-161. [PMID: 29944489 PMCID: PMC6309767 DOI: 10.1097/hmr.0000000000000213] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Top managers’ transformational leadership is associated with significant influence on subordinates. Yet little is known about the extent to which top managers’ transformational leadership influences middle managers’ implementation leadership and, ultimately, frontline staff delivery of evidence-based health care practices. Purpose: To test a multilevel leadership model examining the extent to which top managers’ transformational leadership, as mediated by implementation leadership of middle managers (i.e., those who supervise direct clinical services), affects staff attitudes toward evidence-based practices (EBPs) and their implementation. Methodology/Approach: We used data collected in 2013 from 427 employees in 112 addiction health services programs in Los Angeles County, California. We relied on hierarchical linear models with robust standard errors to analyze multilevel data, individuals nested in programs. We conducted two path models to estimate multilevel relationships with two EBPs: contingency management and medication-assisted treatment. Results: Findings partially supported our theory-driven multilevel leadership model. Specifically, results demonstrated that middle managers’ implementation leadership mediated the relationship between top managers’ transformational leadership and attitudes toward EBPs. At the same time, they showed the mediated relationship for delivery of contingency management treatment was only marginally significant (standardized indirect effect = .006, bootstrap p = .091). We did not find a mediation effect for medication-assisted treatment. Discussion: Findings advance leadership theory in health care, highlighting the importance of middle managers’ implementation leadership in transmitting the influence of top managers’ transformational leadership on staff attitudes toward EBPs. The full path model shows the extent to which transformational leadership may influence staff implementation of innovative practices as mediated through staff attitudes toward EBPs and middle managers’ implementation leadership. Practice Implications: Our findings have implications for developing a multilevel leadership approach to implementation in health care. Leadership development should build on different competencies based on managers' level but align managers' priorities on the same implementation goals.
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Park S(E. Representative Bureaucracy Through Staff With Lived Experience: Peer Coproduction in the Field of Substance Use Disorder Treatment. AMERICAN REVIEW OF PUBLIC ADMINISTRATION 2020; 50:880-897. [PMID: 38836005 PMCID: PMC11149910 DOI: 10.1177/0275074020930414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
This study extends the representative bureaucracy literature by theorizing and empirically testing how staff sharing lived experience with service users can serve as user representatives in service provision processes (i.e., the peer coproduction mechanism). Using survey data from a representative sample of substance use disorder treatment clinics in the United States, we explore factors associated with descriptive representation (the presence of staff with firsthand experience of a substance use disorder in both frontline treatment and senior positions) and directors' perceptions of recovering staff's potential to serve as user representatives in individual care and organizational decision-making processes. Recovering staff accounted for a third of the field's workforce, but the majority of the clinics did not employ them in senior staff positions. Regression results suggest that organizational leaders' recognition of recovering staff's unique representation capacities may facilitate greater descriptive representation and grant meaningful organizational decision-making authority to recovering staff. Multiple research and practice implications are discussed.
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Park SE, Mosley JE, Grogan CM, Pollack HA, Humphreys K, D'Aunno T, Friedmann PD. Patient-centered care's relationship with substance use disorder treatment utilization. J Subst Abuse Treat 2020; 118:108125. [PMID: 32972650 PMCID: PMC7528396 DOI: 10.1016/j.jsat.2020.108125] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/29/2020] [Accepted: 08/25/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Calls for more patient-centered care are growing in the substance use disorder (SUD) treatment field. However, evidence is sparse regarding whether patient-centered care improves access to, or utilization of, effective treatment services. METHODS Using nationally representative survey data from SUD treatment clinics in the United States, we examine the association between patient-centered clinical care and the utilization of six services: methadone, buprenorphine, behavioral treatment, routine medical care, HIV testing, and suicide prevention counseling. We measured clinics' practice of and emphasis on patient-centered care with two variables: (1) whether the clinic regularly invites patients into clinical decision-making processes, and (2) whether supervisors believe in patient-centered healthcare and shared decision-making practices within their clinics. RESULTS In 2017, only 23% of SUD treatment clinics regularly invited patients into care decision-making meetings when their cases were discussed. A composite variable captured clinical supervisors' own experience with and expectations for patient-clinician interaction within their clinics (Cronbach's alpha = 0.79). Results from regression models that controlled for several organizational and environmental factors show that patient-centered care was independently associated with greater utilization of four of six evidence-based services. CONCLUSIONS A minority of SUD clinics practice patient-centered healthcare in the United States. Given the connection to evidence-based services, increasing participatory mechanisms in SUD treatment service provision can facilitate patients' access to appropriate and evidence-based services.
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Affiliation(s)
| | | | | | | | - Keith Humphreys
- Veterans Affairs and Stanford University Medical Centers, USA
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Guerrero EG, Alibrahim A, Howard DL, Wu S, D'Aunno T. Stability in a large drug treatment system: Examining the role of program size and performance on service discontinuation. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 86:102948. [PMID: 32977185 PMCID: PMC7508010 DOI: 10.1016/j.drugpo.2020.102948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/02/2022]
Abstract
Background Little is known about the stability of public drug treatment in the United States to deliver services in an era of expansion of public insurance. Guided by organizational theories, we examined the role of program size, and performance (i.e., rates of treatment initiation and engagement) on discontinuing services in one of the largest treatment systems in the United States. Methods This study relied on multi-year (2006–2014) administrative data of 249,029 treatment admission episodes from 482 treatment programs in Los Angeles County, CA. We relied on survival regression analysis to identify associations between program size, treatment initiation (wait time) and engagement (retention and completion rates) and discontinuing services in any given year. We examined program differences between discontinued versus sustained services in pre- and post-expansion periods. Results Sixty-two percent of programs discontinued services at some point between 2006 and 2014. Program size and rates of treatment retention were negatively associated with risk of discontinuing services. Proportion of female clients was also negatively associated with risk of discontinuing services. Compared to residential programs, methadone programs were associated with reduced likelihood of discontinuing services. Two interactions were significant; program size and retention rates, as well as program size and completion rates were negatively associated with risk of discontinuing services. Conclusions Program size (large), type (methadone), performance (retention) and client population (women) were associated with stability in this drug treatment system. Because more than 70% of programs in this system are small, it is critical to support their capacity to sustain services to reduce existing disparities in access to care. We discuss the implications of these findings for system evaluation and for responding to public health crises.
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Affiliation(s)
- Erick G Guerrero
- I-LEAD Institute, Research to End Healthcare Disparities Corp, United States.
| | | | - Daniel L Howard
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, United States.
| | - Shinyi Wu
- Suzanne Dworak-Peck, School of Social Work, University of Southern California, United States.
| | - Thomas D'Aunno
- Wagner School of Public Policy, New York University, United States.
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Park SE. Coproduction in the Treatment of Substance Use Disorder and Its Relationship to Clinics' Service Output Patterns. THE SOCIAL SERVICE REVIEW 2020; 94:607-645. [PMID: 38827019 PMCID: PMC11142637 DOI: 10.1086/710706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Health, social, and human service providers seek diverse ways to engage service users in the service production process. This approach to engagement with users is known as "coproduction." In addition to conventional user-provider coproduction (i.e., patient-centered care), providers attending to stigmatized and marginalized groups may hire staff who share life experiences with user groups. These providers are known as "user representatives," and their service provision is known as "peer coproduction." Using nationally representative data from substance use disorder treatment clinics in the United States, I investigate how clinics' use of patient-centered care and peer coproduction mechanisms is associated with organizational service availability and utilization patterns. Results demonstrate the potential and limitations of the two coproduction mechanisms in substance use disorder treatment. This study is a critical examination of working conditions and the impact of user-engagement mechanisms and calls for a more empowered work environment in human service organizations.
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Correlates of subjective hepatitis C knowledge among clinical staff in US drug treatment programs. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-019-01032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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O'Grady MA, Lincourt P, Gilmer E, Kwan M, Burke C, Lisio C, Neighbors CJ. How are Substance Use Disorder Treatment Programs Adjusting to Value-Based Payment? A Statewide Qualitative Study. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2020; 14:1178221820924026. [PMID: 32518481 PMCID: PMC7252360 DOI: 10.1177/1178221820924026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/08/2020] [Indexed: 11/16/2022]
Abstract
Healthcare systems are implementing value-based payment (VBP) arrangements in efforts to incentivize cost-effective, high quality of care. These arrangements represent a major shift for substance use disorder (SUD) treatment providers who may need to make changes to their clinical and business operations to meet new demands for quality under value-based contracts. This qualitative study was conducted in the context of New York State's efforts to implement VBP among SUD treatment providers to understand their experiences, challenges, and needs. Five focus groups were conducted across the State with a total of 68 treatment professionals. Content analysis was conducted and five themes emerged. First, competing demands, limited workforce and technology infrastructure, and perceived lack of information were leading to overwhelmed administrators. Second, confusion and financial fear was being driven by the need for new clinical roles, business practices, and external partnerships. Third, providers were undertaking a number of measures to address workforce needs. Fourth, providers were building new business models and clinical practices. Fifth, providers desired more support and information. As VBP models are being adopted, healthcare systems should identify ways to mitigate challenges and support SUD treatment providers that may have limited resources to address complex workforce, client, and infrastructure needs.
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Affiliation(s)
- Megan A O'Grady
- Center on Addiction, Division of Health Services Research, NY, USA
| | - Patricia Lincourt
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Evan Gilmer
- Center on Addiction, Division of Health Services Research, NY, USA
| | - Michael Kwan
- Center on Addiction, Division of Health Services Research, NY, USA
| | - Constance Burke
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Carla Lisio
- Center on Addiction, Division of Health Services Research, NY, USA
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Park SE, Grogan CM, Mosley JE, Humphreys K, Pollack HA, Friedmann PD. Correlates of Patient-Centered Care Practices at U.S. Substance Use Disorder Clinics. Psychiatr Serv 2020; 71:35-42. [PMID: 31500544 PMCID: PMC6939146 DOI: 10.1176/appi.ps.201900121] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Substance use disorder treatment professionals are paying increased attention to implementing patient-centered care. Understanding environmental and organizational factors associated with clinicians' efforts to engage patients in clinical decision-making processes is essential for bringing patient-centered care to the addictions field. This study examined factors associated with patient-centered care practices in substance use disorder treatment. METHODS Data were from the 2017 National Drug Abuse Treatment System Survey, a nationally representative survey of U.S substance use disorder treatment clinics (outpatient nonopioid treatment programs, outpatient opioid treatment programs, inpatient clinics, and residential clinics). Multivariate regression analyses examined whether clinics invited patients into clinical decision-making processes and whether clinical supervisors supported and believed in patient-centered care practices. RESULTS Of the 657 substance use disorder clinics included in the analysis, about 23% invited patients to participate in clinical decision-making processes. Clinicians were more likely to engage patients in decision-making processes when working in residential clinics (compared with outpatient nonopioid treatment programs) or in clinics serving a smaller proportion of patients with alcohol or opioid use disorder. Clinical supervisors were more likely to value patient-centered care practices if the organization's administrative director perceived less regional competition or relied on professional information sources to understand developments in the substance use disorder treatment field. Clinicians' tendency to engage patients in decision-making processes was positively associated with clinical supervisors' emphasis on patient-centered care. CONCLUSIONS A minority of U.S. substance use disorder clinics invited patients into clinical decision-making processes. Therefore, patient-centered care may be unavailable to certain vulnerable patient groups.
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Affiliation(s)
- Sunggeun Ethan Park
- School of Social Work, University of Michigan, Ann Arbor (Park); School of Social Service Administration, University of Chicago, Chicago (Grogan, Mosley, Pollack); Health Services Research & Development, U.S. Department of Veterans Affairs Medical Center, Palo Alto, California, and Department of Psychiatry, Stanford University Medical Center, Stanford, California (Humphreys); Department of Medicine, University of Massachusetts--Baystate, and Office of Research, Baystate Health, Springfield, Massachusetts (Friedmann)
| | - Colleen M Grogan
- School of Social Work, University of Michigan, Ann Arbor (Park); School of Social Service Administration, University of Chicago, Chicago (Grogan, Mosley, Pollack); Health Services Research & Development, U.S. Department of Veterans Affairs Medical Center, Palo Alto, California, and Department of Psychiatry, Stanford University Medical Center, Stanford, California (Humphreys); Department of Medicine, University of Massachusetts--Baystate, and Office of Research, Baystate Health, Springfield, Massachusetts (Friedmann)
| | - Jennifer E Mosley
- School of Social Work, University of Michigan, Ann Arbor (Park); School of Social Service Administration, University of Chicago, Chicago (Grogan, Mosley, Pollack); Health Services Research & Development, U.S. Department of Veterans Affairs Medical Center, Palo Alto, California, and Department of Psychiatry, Stanford University Medical Center, Stanford, California (Humphreys); Department of Medicine, University of Massachusetts--Baystate, and Office of Research, Baystate Health, Springfield, Massachusetts (Friedmann)
| | - Keith Humphreys
- School of Social Work, University of Michigan, Ann Arbor (Park); School of Social Service Administration, University of Chicago, Chicago (Grogan, Mosley, Pollack); Health Services Research & Development, U.S. Department of Veterans Affairs Medical Center, Palo Alto, California, and Department of Psychiatry, Stanford University Medical Center, Stanford, California (Humphreys); Department of Medicine, University of Massachusetts--Baystate, and Office of Research, Baystate Health, Springfield, Massachusetts (Friedmann)
| | - Harold A Pollack
- School of Social Work, University of Michigan, Ann Arbor (Park); School of Social Service Administration, University of Chicago, Chicago (Grogan, Mosley, Pollack); Health Services Research & Development, U.S. Department of Veterans Affairs Medical Center, Palo Alto, California, and Department of Psychiatry, Stanford University Medical Center, Stanford, California (Humphreys); Department of Medicine, University of Massachusetts--Baystate, and Office of Research, Baystate Health, Springfield, Massachusetts (Friedmann)
| | - Peter D Friedmann
- School of Social Work, University of Michigan, Ann Arbor (Park); School of Social Service Administration, University of Chicago, Chicago (Grogan, Mosley, Pollack); Health Services Research & Development, U.S. Department of Veterans Affairs Medical Center, Palo Alto, California, and Department of Psychiatry, Stanford University Medical Center, Stanford, California (Humphreys); Department of Medicine, University of Massachusetts--Baystate, and Office of Research, Baystate Health, Springfield, Massachusetts (Friedmann)
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16
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Abstract
OBJECTIVES The demand for substance use disorder treatment is increasing, fueled by the opioid epidemic and the Affordable Care Act mandate to treat substance use disorders. The increased demand for treatment, however, is not being met by a corresponding increase in access to or availability of treatment. This report focuses specifically on the treatment referral process, which we have identified as 1 of the key barriers to timely and effective treatment. Difficulties in referral to substance use disorder treatment are examined through the lens of providers who make referrals (ie, referral source) and individuals who work in substance use disorder facilities (ie, referral recipient). METHODS Administrative officials, emergency department physicians, addiction physicians, government officials, providers, insurance officials, and mental health advocates (n = 59) were interviewed on the referral process protocol, challenges for providers and others making referrals, and issues with substance use treatment facility intake procedures. RESULTS Several main themes were identified as barriers in the process: difficulties in determining patient eligibility, lack of transparency regarding treatment capacity, referral source knowledge/understanding of options, and issues with communication between referral source and recipient. We then proposed several solutions to address specific barriers. CONCLUSIONS Current gaps in the referral process cause delays to care. Improving systems would involve addressing these themes and expanding the use of appropriate treatments for the many patients in need.
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Guerrero EG, Khachikian T, Frimpong JA, Kong Y, Howard DL, Hunter S. Drivers of continued implementation of cultural competence in substance use disorder treatment. J Subst Abuse Treat 2019; 105:5-11. [PMID: 31443891 PMCID: PMC7532800 DOI: 10.1016/j.jsat.2019.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 07/19/2019] [Accepted: 07/19/2019] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to examine whether the key characteristics of organizational decision makers predicted continued implementation of five different practices that represent organizational cultural competence in one of the largest and most diverse substance use disorder (SUD) treatment systems in the United States. We analyzed data collected from SUD treatment programs at four-time points: 2011 (N = 115), 2013 (N = 111), 2015 (N = 106), and 2017 (N = 94). We conducted five mixed-effect linear regression models, one per each outcome to examine the extent to which program director's transformational leadership and ethnic background (Latino) predicted (1) knowledge of minority community needs; (2) development of resources and linkages to serve minorities; (3) reaching out to minority communities; (4) hiring and retention of staff members from minority backgrounds; and (5) development of policies and procedures to effectively respond to the service needs of minority patients. Results show that two of the five practices continued implementation at same degree (resources and linkages and policies and procedures), one practice increased degree of implementation (knowledge), while two practices reduced degree of implementation (staffing and outreach to communities) over the six-year period. Directorial leadership was positively associated with the continued implementation of all five practices. Latino directors were associated with an increase in knowledge of minority communities, but a decrease in resources and linkages and policies and procedures to serve minorities. On the other hand, interactions showed that leadership among Latino directors increased staffing over time and led to increases in resources and linkages and policies and procedures overtime. Overall, continued implementation of culturally responsive practices was uneven in the SUD treatment system studied. But program directors' transformational leadership and ethnic background played a critical role in increasing the implementation of key practices over time. Findings have implications for developing and testing culturally grounded leadership interventions for program directors to ensure the continued and increased implementation of practices that are necessary to improve standards of care in minority health.
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Affiliation(s)
- Erick G Guerrero
- I-Lead Institute, Research to End Healthcare Disparities Corp, 150 Ocean Park Blvd, 418, Santa Monica, CA 90405, United States of America.
| | - Tenie Khachikian
- Psychological Science, University of California, 5200 North Lake Road Merced, CA 95343, United States of America.
| | - Jemima A Frimpong
- Johns Hopkins University, Carey Business School, 100 International Dr., Baltimore, MD 21202, United States of America.
| | - Yinfei Kong
- Mihaylo College of Business and Economics, California State University, Fullerton, CA 90089, United States of America
| | - Daniel L Howard
- Texas A&M University, Public Policy Research Institute, 4476 TAMU College Station, TX 77843-4476, United States of America.
| | - Sarah Hunter
- Rand Corporation, 1776 Main Street, Santa Monica, CA 90401, United States of America.
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Program Capacity to Deliver Prevention Services to Children of Adult Clients Receiving Substance Use Disorder Treatment. J Prim Prev 2019; 40:343-355. [PMID: 31093817 DOI: 10.1007/s10935-019-00551-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Children whose parents have a history of substance use are at elevated risk of developing substance use disorders (SUDs) and related debilitating behaviors. Although specialty treatment programs are uniquely positioned to deliver prevention care to children of adult clients, these programs may have limited capacity to implement prevention and early intervention care services, particularly in racial and ethnic minority communities. We merged data from program surveys and client records collected in 2015 to examine the extent to which program capacity factors are associated with the odds of delivering prevention and early intervention services for children of adult clients attending outpatient SUD treatment in low-income minority communities in Los Angeles County, California. Our analytic sample consisted of 16,712 clients embedded in 82 programs. Our results show that 85% of these programs reported delivering prevention care services, while 71% of programs delivered early intervention services. Programs with organizational climates supporting change and those that served a high number of clients annually were more likely to implement both prevention and early intervention practices. Programs accepting Medicaid payments and serving clients whose primary drug was marijuana were more than three times as likely to implement prevention services. Overall, our findings suggest both program- and client-level characteristics are associated with delivering preventive care offered to children of adult clients receiving SUD treatment in communities of color. As Medicaid has become a major payor of SUD treatment services and marijuana use has been legalized in California, findings identify capacity factors to deliver public health prevention interventions in one of the nation's largest public SUD treatment systems.
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Mericle AA, Mahoney E, Korcha R, Delucchi K, Polcin DL. Sober living house characteristics: A multilevel analyses of factors associated with improved outcomes. J Subst Abuse Treat 2019; 98:28-38. [PMID: 30665601 PMCID: PMC6605057 DOI: 10.1016/j.jsat.2018.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/06/2018] [Accepted: 12/13/2018] [Indexed: 12/14/2022]
Abstract
Safe and stable housing is integral to addiction recovery. Across numerous studies, recovery housing has been found to be associated with improvements in a variety of domains. Although procedures for operating some types of recovery housing have been manualized and national standards established, there are few empirical findings identifying which recovery residence characteristics may lead to improved outcomes. Using data from 330 newly admitted residents recruited from 49 sober living houses in California and re-contacted for 6- and 12-month follow-up interviews, this study examines the effects of organizational, operational, and programming characteristics on substance use, criminal justice, and employment outcomes. Results from multilevel analyses adjusting for resident demographics and length of stay indicate that organizational characteristics were associated with outcomes. Residents recruited from houses that were part of a larger organization or group of houses had increased odds of total abstinence (aOR = 3.98, p < 0.001) and drug abstinence (aOR = 3.19, p < 0.001). Residents recruited from houses that were affiliated with a treatment program had increased odds of employment (aOR = 2.92, p = 0.003). Operational characteristics such as where the house was located and whether the house required incoming residents to be sober for at least 30 days prior to entry were also related to improved outcomes, but additional work is needed to develop tools to assess and measure recovery housing characteristics and to better understand how these factors contribute to improved outcomes.
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Affiliation(s)
- Amy A Mericle
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA.
| | - Elizabeth Mahoney
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA
| | - Rachael Korcha
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA
| | - Kevin Delucchi
- University of California San Francisco, San Francisco, CA 94143, USA
| | - Douglas L Polcin
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA
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20
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Fenwick KM, Brimhall KC, Hurlburt M, Aarons G. Who Wants Feedback? Effects of Transformational Leadership and Leader-Member Exchange on Mental Health Practitioners' Attitudes Toward Feedback. Psychiatr Serv 2019; 70:11-18. [PMID: 30373496 PMCID: PMC6408302 DOI: 10.1176/appi.ps.201800164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to identify the mechanisms through which different aspects of leadership affect mental health practitioners' attitudes toward supervisory feedback. METHODS Data were collected from 363 practitioners nested in 68 treatment teams in public-sector mental health organizations. A multilevel path analysis was conducted to examine the associations of transformational leadership (supervisor's ability to inspire others to follow a course of action) and leader-member exchange (quality of the supervisor-practitioner relationship) with practitioner attitudes toward feedback. RESULTS Transformational leadership and leader-member exchange were directly and positively associated with practitioners' attitudes toward feedback. Transformational leadership was also indirectly associated with practitioners' attitudes toward feedback through the quality of supervisor-practitioner relationships. CONCLUSIONS Study results contribute to the growing body of evidence suggesting that leaders play a key role in shaping mental health service delivery. Both leadership behavior and high-quality supervisor-practitioner relationships are important in supporting practitioners in delivering evidence-based mental health care. Policymakers, administrators, and researchers should consider an integrative approach when developing leadership training interventions.
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Affiliation(s)
- Karissa M Fenwick
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Fenwick, Hurlburt); Child and Adolescent Services Research Center (Hurlburt, Aarons) and Department of Psychiatry (Aarons), University of California, San Diego; Department of Social Work, Binghamton University, State University of New York, Binghamton (Brimhall)
| | - Kim C Brimhall
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Fenwick, Hurlburt); Child and Adolescent Services Research Center (Hurlburt, Aarons) and Department of Psychiatry (Aarons), University of California, San Diego; Department of Social Work, Binghamton University, State University of New York, Binghamton (Brimhall)
| | - Michael Hurlburt
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Fenwick, Hurlburt); Child and Adolescent Services Research Center (Hurlburt, Aarons) and Department of Psychiatry (Aarons), University of California, San Diego; Department of Social Work, Binghamton University, State University of New York, Binghamton (Brimhall)
| | - Gregory Aarons
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Fenwick, Hurlburt); Child and Adolescent Services Research Center (Hurlburt, Aarons) and Department of Psychiatry (Aarons), University of California, San Diego; Department of Social Work, Binghamton University, State University of New York, Binghamton (Brimhall)
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21
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Cummings JR, Wen H, Ko M. Decline In Public Substance Use Disorder Treatment Centers Most Serious In Counties With High Shares Of Black Residents. Health Aff (Millwood) 2018; 35:1036-44. [PMID: 27269020 DOI: 10.1377/hlthaff.2015.1630] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Previous research has associated declines in health care resources such as hospitals and trauma centers with communities' racial composition. However, little is known about changes in the substance use disorder treatment infrastructure in recent years and the implications for black communities. We used data for the period 2002-10 from the National Survey of Substance Abuse Treatment Services to describe changes in the supply of public and private outpatient facilities for substance use disorder treatment, and to determine whether these trends had implications for the geographical availability of these facilities in counties with high percentages of black residents. During the study period the number of publicly owned facilities declined 17.2 percent, whereas the number of private for-profit facilities grew 19.1 percent. At baseline, counties with very high percentages of black residents (that is, more than one standard deviation above the mean) were more likely than counties with less than the mean percentage of black residents to be served by public facilities and were thus disproportionately affected by the overall decline in public facilities. Future research should examine the effect of expanding eligibility for Medicaid on the supply of substance use disorder treatment facilities across diverse communities.
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Affiliation(s)
- Janet R Cummings
- Janet R. Cummings is an associate professor in the Department of Health Policy and Management, Rollins School of Public Health, at Emory University, in Atlanta, Georgia
| | - Hefei Wen
- Hefei Wen is an assistant professor of health management and policy at the University of Kentucky, in Lexington
| | - Michelle Ko
- Michelle Ko is a research scientist at the Center for Health Policy Research, at the University of California, Los Angeles
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22
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Do benefits restrictions limit Medicaid acceptance in addiction treatment? Results from a national study. J Subst Abuse Treat 2018; 87:50-55. [PMID: 29471926 DOI: 10.1016/j.jsat.2018.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the relationship of restrictions on Medicaid benefits for addiction treatment to Medicaid acceptance among addiction treatment programs. DATA SOURCES We collected primary data from the 2013-2014 wave of the National Drug Abuse Treatment System Survey. STUDY DESIGN We created two measures of benefits restrictiveness. In the first, we calculated the number of addiction treatment services covered by each state Medicaid program. In the second, we calculated the total number of utilization controls imposed on each service. Using a mixed-effects logistic regression model, we estimated the relationship between state Medicaid benefit restrictiveness for addiction treatment and adjusted odds of Medicaid acceptance among addiction treatment programs. DATA COLLECTION Study data come from a nationally-representative sample of 695 addiction treatment programs (85.5% response rate), representatives from Medicaid programs in forty-seven states and the District of Columbia (response rate 92%), and data collected by the American Society for Addiction Medicine. PRINCIPAL FINDINGS Addiction treatment programs in states with more restrictive Medicaid benefits for addiction treatment had lower odds of accepting Medicaid enrollees (AOR = 0.65; CI = 0.43, 0.97). The predicted probability of Medicaid acceptance was 35.4% in highly restrictive states, 48.3% in moderately restrictive states, and 61.2% in the least restrictive states. CONCLUSIONS Addiction treatment programs are more likely to accept Medicaid in states with less restrictive benefits for addiction treatment. Program ownership and technological infrastructure also play an important role in increasing Medicaid acceptance.
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23
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Guerrero EG, Fenwick K, Kong Y. Advancing theory development: exploring the leadership-climate relationship as a mechanism of the implementation of cultural competence. Implement Sci 2017; 12:133. [PMID: 29137668 PMCID: PMC5686798 DOI: 10.1186/s13012-017-0666-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 11/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leadership style and specific organizational climates have emerged as critical mechanisms to implement targeted practices in organizations. Drawing from relevant theories, we propose that climate for implementation of cultural competence reflects how transformational leadership may enhance the organizational implementation of culturally responsive practices in health care organizations. METHODS Using multilevel data from 427 employees embedded in 112 addiction treatment programs collected in 2013, confirmatory factor analysis showed adequate fit statistics for our measure of climate for implementation of cultural competence (Cronbach's alpha = .88) and three outcomes: knowledge (Cronbach's alpha = .88), services (Cronbach's alpha = .86), and personnel (Cronbach's alpha = .86) practices. RESULTS Results from multilevel path analyses indicate a positive relationship between employee perceptions of transformational leadership and climate for implementation of cultural competence (standardized indirect effect = .057, bootstrap p < .001). We also found a positive indirect effect between transformational leadership and each of the culturally competent practices: knowledge (standardized indirect effect = .006, bootstrap p = .004), services (standardized indirect effect = .019, bootstrap p < .001), and personnel (standardized indirect effect = .014, bootstrap p = .005). CONCLUSIONS Findings contribute to implementation science. They build on leadership theory and offer evidence of the mediating role of climate in the implementation of cultural competence in addiction health service organizations.
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Affiliation(s)
- Erick G. Guerrero
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089 USA
- Marshall School of Business, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089 USA
| | - Karissa Fenwick
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089 USA
| | - Yinfei Kong
- Mihaylo College of Business and Economics, California State University, Fullerton, Fullerton, CA 90089 USA
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24
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Frimpong JA, Shiu‐Yee K, D'Aunno T. The Role of Program Directors in Treatment Practices: The Case of Methadone Dose Patterns in U.S. Outpatient Opioid Agonist Treatment Programs. Health Serv Res 2017; 52:1881-1907. [PMID: 27618580 PMCID: PMC5583309 DOI: 10.1111/1475-6773.12558] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To describe changes in characteristics of directors of outpatient opioid agonist treatment (OAT) programs, and to examine the association between directors' characteristics and low methadone dosage. DATA SOURCE Repeated cross-sectional surveys of OAT programs in the United States from 1995 to 2011. STUDY DESIGN We used generalized linear regression models to examine associations between directors' characteristics and methadone dose, adjusting for program and patient factors. DATA COLLECTION Data were collected through telephone surveys of program directors. PRINCIPAL FINDINGS The proportion of OAT programs with an African American director declined over time, from 29 percent in 1995 to 16 percent in 2011. The median percentage of patients in each program receiving <60 mg/day declined significantly, from 48.5 percent in 1995 to 29 percent in 2005 and 23 percent in 2011. Programs with an African American director were significantly more likely to provide low methadone doses than other programs. This association was even stronger in programs with an African American director who served populations with higher percentages of African American patients. CONCLUSIONS Demographic characteristics of OAT program directors (e.g., their race) may play a key role in explaining variations in methadone dosage across programs and patients. Further research should investigate the causal pathways through which directors' characteristics affect treatment practices. This may lead to new, multifaceted managerial interventions to improve patient outcomes.
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Affiliation(s)
- Jemima A. Frimpong
- The Johns Hopkins Carey Business SchoolJohns Hopkins UniversityBaltimoreMD
| | - Karen Shiu‐Yee
- Department of Sociomedical SciencesMailman School of Public HealthColumbia UniversityNew YorkNY
| | - Thomas D'Aunno
- Robert F. Wagner Graduate School of Public ServiceNew York UniversityNew YorkNY
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25
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Hunt P, Hunter SB, Levan D. Continuous quality improvement in substance abuse treatment facilities: How much does it cost? J Subst Abuse Treat 2017; 77:133-140. [PMID: 28189289 PMCID: PMC8664292 DOI: 10.1016/j.jsat.2017.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
Abstract
Continuous quality improvement (CQI) has grown in the U.S. since the 1970s, yet little is known about the costs to implement CQI in substance abuse treatment facilities. This paper is part of a larger group randomized control trial in a large urban county evaluating the impact of Plan-Study-Do-Act (PDSA)-CQI designed for community service organizations (Hunter, Ober, Paddock, Hunt, & Levan, 2014). Operated by one umbrella organization, each of the eight facilities of the study, four residential and four outpatient substance abuse treatment facilities, selected their own CQI Actions, including administrative- and clinical care-related Actions. Using an activity-based costing approach, we collected labor and supplies and equipment costs directly attributable to CQI Actions over a 12-month trial period. Our study finds implementation of CQI and meeting costs of this trial per facility were approximately $2000 to $10,500 per year ($4500 on average), or $10 to $60 per admitted client. We provide a description of the sources of variation in these costs, including differing intensity of the CQI Actions selected, which should help decision makers plan use of PDSA-CQI.
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Affiliation(s)
- Priscillia Hunt
- RAND Corporation, Santa Monica, CA, USA; Institute for the Study of Labor (IZA), Bonn, Germany.
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26
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Guerrero EG, Garner BR, Cook B, Kong Y, Vega WA, Gelberg L. Identifying and reducing disparities in successful addiction treatment completion: testing the role of Medicaid payment acceptance. Subst Abuse Treat Prev Policy 2017; 12:27. [PMID: 28545551 PMCID: PMC5445402 DOI: 10.1186/s13011-017-0113-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/19/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Medicaid has become the largest payer of substance use disorder treatment and may enhance access to quality care and reduce disparities. We tested whether treatment programs' acceptance of Medicaid payments was associated with reduced disparities between Mexican Americans and non-Latino Whites. METHODS We analyzed client and program data from 122 publicly funded treatment programs in 2010 and 112 programs in 2013. These data were merged with information regarding 15,412 adult clients from both periods, of whom we selected only Mexican Americans (n = 7130, 46.3%) and non-Latino Whites (n = 8282, 53.7%). We used multilevel logistic regression and variance decomposition to examine associations and underlying factors associated with Mexican American and White differences in treatment completion. Variables of interest included client demographics; drug use severity and mental health issues; and program license, accreditation, and acceptance of Medicaid payments. RESULTS Mexican Americans had lower odds of treatment completion (OR = 0.677; 95% CI = 0.534, 0.859) compared to non-Latino Whites. This disparity was explained in part by primary drug used, greater drug use severity, history of mental health disorders, and program acceptance of Medicaid payments. The interaction between Mexican Americans and acceptance of Medicaid was statistically significant (OR = 1.284; 95% CI = 1.008, 1.637). CONCLUSIONS Findings highlighted key program and client drivers of this disparity and the promising role of program acceptance of Medicaid payment to eliminate disparities in treatment completion among Mexican Americans. Implications for health policy during the Trump Administration are discussed.
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Affiliation(s)
- Erick G. Guerrero
- Suzanne Dworak-Peck School of Social Work and Marshall School of Business, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089 USA
| | | | - Benjamin Cook
- Department of Psychiatry, Harvard Medical School, 2 West Room 305, 401 Park Drive, Boston, MA 02215 USA
| | - Yinfei Kong
- Mihaylo College of Business and Economics, California State University, Fullerton, Fullerton, CA 90089 USA
| | - William A. Vega
- Department of Preventive Medicine, Keck School of Medicine, and Suzanne Dworak-Peck School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089 USA
| | - Lillian Gelberg
- Department of General Medicine, University of California, Los Angeles, Los Angeles, CA 90025 USA
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27
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Aletraris L, Edmond MB, Roman PM. Insurance Receipt and Readiness for Opportunities under the Affordable Care Act: A National Survey of Treatment Providers for Substance Use Disorders. J Psychoactive Drugs 2017; 49:141-150. [DOI: 10.1080/02791072.2017.1306661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lydia Aletraris
- Assistant Director, Center for Research on Behavioral Health and Human Services Delivery, Owens Institute for Behavioral Research, University of Georgia, Athens, GA, USA
| | - Mary Bond Edmond
- Assistant Research Scientist, Center for Research on Behavioral Health and Human Services Delivery, Owens Institute for Behavioral Research, University of Georgia, Athens, GA, USA
| | - Paul M. Roman
- Director and Regents Professor of Sociology, Center for Research on Behavioral Health and Human Services Delivery, Owens Institute for Behavioral Research, University of Georgia, Athens, GA, USA
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Program Capacity to Eliminate Outcome Disparities in Addiction Health Services. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 43:23-35. [PMID: 25450596 DOI: 10.1007/s10488-014-0617-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We evaluated program capacity factors associated with client outcomes in publicly funded substance abuse treatment organizations in one of the most populous and diverse regions of the United States. Using multilevel cross-sectional analyses of program data (n = 97) merged with client data from 2010 to 2011 for adults (n = 8,599), we examined the relationships between program capacity (leadership, readiness for change, and Medi-Cal payment acceptance) and client wait time and treatment duration. Acceptance of Medi-Cal was associated with shorter wait times, whereas organizational readiness for change was positively related to treatment duration. Staff attributes were negatively related to treatment duration. Overall, compared to low program capacity, high program capacity was negatively associated with wait time and positively related to treatment duration. In conclusion, program capacity, an organizational indicator of performance, plays a significant role in access to and duration of treatment. Implications for health care reform implementation in relation to expansion of public health insurance and capacity building to promote health equities are discussed.
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Padwa H, Urada D, Gauthier P, Rieckmann T, Hurley B, Crèvecouer-MacPhail D, Rawson RA. Organizing Publicly Funded Substance Use Disorder Treatment in the United States: Moving Toward a Service System Approach. J Subst Abuse Treat 2016; 69:9-18. [DOI: 10.1016/j.jsat.2016.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/29/2016] [Accepted: 06/27/2016] [Indexed: 11/29/2022]
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Frimpong JA, Guerrero EG, Kong Y, Kim T. Abstinence at Successful Discharge in Publicly Funded Addiction Health Services. J Behav Health Serv Res 2016; 43:661-675. [PMID: 26882909 PMCID: PMC4987262 DOI: 10.1007/s11414-016-9497-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstinence at successful discharge in substance use disorder treatment is important to reducing relapse rates and increasing long-term recovery from substance use disorders. However, few studies have examined abstinence as an essential component of successful discharge. This study examined rates and correlates of reported abstinence (nonuse of drugs 30 days prior to successful discharge) among clients attending publicly funded treatment in Los Angeles County, California. Finding show that only 36% of clients who were successfully discharged reported abstinence. Black clients were less likely than non-Hispanic Whites to report abstinence at successful discharge. Clients in methadone treatment programs were less likely than outpatient clients to report abstinence, whereas clients referred to treatment through the legal system (Proposition 36) were more likely to report abstinence compared to self-referred clients. Findings underscore the importance of systematic assessment of abstinence in determining successful discharge and provide a basis for further examination of strategies to improve abstinence and reduce relapse.
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Affiliation(s)
- Jemima A Frimpong
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA.
| | - Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA, 90089, USA
| | - Yinfei Kong
- Department of Information Systems and Decision Sciences, Mihaylo College of Business and Economics, California State University at Fullerton, 2250 Nutwood Avenue, Fullerton, 2831, USA
| | - Tina Kim
- Los Angeles County Department of Public Health, Substance Abuse Prevention and Control, 1000 South Fremont Avenue, Building A-9 East, Alhambra, CA, 91803, USA
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Guerrero EG, He A, Kim A, Aarons GA. Organizational implementation of evidence-based substance abuse treatment in racial and ethnic minority communities. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 41:737-49. [PMID: 24046236 DOI: 10.1007/s10488-013-0515-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We evaluated organizational factors associated with the implementation of contingency management treatment (CMT) and medication-assisted treatment (MAT) in substance abuse treatment (SAT) programs serving racial and ethnic minority communities. Analysis of cross-sectional data collected in 2010-2011 from a random sample of 148 publicly funded SAT programs showed that accepting private insurance was positively associated with CMT and MAT implementation, whereas larger programs were associated with greater implementation of MAT. Supervisorial openness to and expectations about implementing evidence-based practices (EBPs) and attributes for change were strongly associated with CMT, whereas the interactions between openness to EBPs and programs that accept private insurance and that are governed by parent organizations were positively associated with MAT. These external expectations and managerial attitudes supported the implementation of psychosocial and pharmacotherapy treatments in SAT. Implications for improving standards of care in minority communities are discussed.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA, 90089-041, USA,
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Linkages Between Patient-centered Medical Homes and Addiction Treatment Organizations: Results From a National Survey. Med Care 2016; 55:379-383. [PMID: 27635601 DOI: 10.1097/mlr.0000000000000645] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To meet their aims of providing comprehensive and coordinated care, patient-centered medical homes (PCMHs) need to coordinate services for individuals with substance use disorders. Yet, the 14,000 addiction treatment (AT) organizations across the United States that provide services for more than 1 million individuals daily are generally ill-prepared to work with PCMHs (eg, AT organizations often lack electronic health records). OBJECTIVES To examine the extent to which AT organizations have formal linkages through contracts with PCMHs; to identify key dimensions of linkages between PCMHs and AT organizations (eg, shared use of electronic health records); to identify characteristics of AT organizations and their environments associated with these linkages. MATERIALS AND METHODS We draw on data from a 2014 nationally representative survey of directors and clinical supervisors from 695 AT organizations (n=1390 survey respondents). RESULTS Thirty-eight percent of patients across the nation are receiving treatment in AT organizations linked by contracts to PCMHs. This number increases to 51% in states that expanded Medicaid (vs. only 6.2% of patients in non-Medicaid expansion states). Yet, the great majority of linkages are relatively weak; they do not include the exchange of patient information. Results from multivariable analyses show that larger, nonprofit and publicly owned AT organizations, as well as those located in the northeast and in states that expanded Medicaid coverage, are more likely to have contracts with PCMHs. CONCLUSIONS Without stronger linkages between AT organizations and PCMHs or the development of other models that integrate services, individuals with substance abuse disorders may continue to receive uncoordinated care.
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Frimpong JA, D'Aunno T, Helleringer S, Metsch LR. Spillover effects of HIV testing policies: changes in HIV testing guidelines and HCV testing practices in drug treatment programs in the United States. BMC Public Health 2016; 16:666. [PMID: 27473519 PMCID: PMC4966765 DOI: 10.1186/s12889-016-3322-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 07/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine the extent to which state adoption of the Centers for Disease Control and Prevention (CDC) 2006 revisions to adult and adolescent HIV testing guidelines is associated with availability of other important prevention and medical services. We hypothesized that in states where the pretest counseling requirement for HIV testing was dropped from state legislation, substance use disorder treatment programs would have higher availability of HCV testing services than in states that had maintained this requirement. METHODS We analyzed a nationally representative sample of 383 opioid treatment programs from the 2005 and 2011 National Drug Abuse Treatment System Survey (NDATSS). Data were collected from program directors and clinical supervisors through telephone surveys. Multivariate logistic regression models were used to measure associations between state adoption of CDC recommended guidelines for HIV pretest counseling and availability of HCV testing services. RESULTS The effects of HIV testing legislative changes on HCV testing practices varied by type of opioid treatment program. In states that had removed the requirement for HIV pretest counseling, buprenorphine-only programs were more likely to offer HCV testing to their patients. The positive spillover effect of HIV pretest counseling policies, however, did not extend to methadone programs and did not translate into increased availability of on-site HCV testing in either program type. CONCLUSIONS Our findings highlight potential positive spillover effects of HIV testing policies on HCV testing practices. They also suggest that maximizing the benefits of HIV policies may require other initiatives, including resources and programmatic efforts that support systematic integration with other services and effective implementation.
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Affiliation(s)
- Jemima A Frimpong
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, 600 West 168th Street, New York, NY, 10032, USA.
| | - Thomas D'Aunno
- Robert F. Wagner Graduate School of Public Service, New York University, 295 Lafayette Street, New York, NY, 10012, USA
| | - Stéphane Helleringer
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
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Guerrero EG, Padwa H, Fenwick K, Harris LM, Aarons GA. Identifying and ranking implicit leadership strategies to promote evidence-based practice implementation in addiction health services. Implement Sci 2016; 11:69. [PMID: 27180231 PMCID: PMC4894378 DOI: 10.1186/s13012-016-0438-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/06/2016] [Indexed: 11/16/2022] Open
Abstract
Background Despite a solid research base supporting evidence-based practices (EBPs) for addiction treatment such as contingency management and medication-assisted treatment, these services are rarely implemented and delivered in community-based addiction treatment programs in the USA. As a result, many clients do not benefit from the most current and efficacious treatments, resulting in reduced quality of care and compromised treatment outcomes. Previous research indicates that addiction program leaders play a key role in supporting EBP adoption and use. The present study expanded on this previous work to identify strategies that addiction treatment program leaders report using to implement new practices. Methods We relied on a staged and iterative mixed-methods approach to achieve the following four goals: (a) collect data using focus groups and semistructured interviews and conduct analyses to identify implicit managerial strategies for implementation, (b) use surveys to quantitatively rank strategy effectiveness, (c) determine how strategies fit with existing theories of organizational management and change, and (d) use a consensus group to corroborate and expand on the results of the previous three stages. Each goal corresponded to a methodological phase, which included data collection and analytic approaches to identify and evaluate leadership interventions that facilitate EBP implementation in community-based addiction treatment programs. Results Findings show that the top-ranked strategies involved the recruitment and selection of staff members receptive to change, offering support and requesting feedback during the implementation process, and offering in vivo and hands-on training. Most strategies corresponded to emergent implementation leadership approaches that also utilize principles of transformational and transactional leadership styles. Leadership behaviors represented orientations such as being proactive to respond to implementation needs, supportive to assist staff members during the uptake of new practices, knowledgeable to properly guide the implementation process, and perseverant to address ongoing barriers that are likely to stall implementation efforts. Conclusions These findings emphasize how leadership approaches are leveraged to facilitate the implementation and delivery of EBPs in publicly funded addiction treatment programs. Findings have implications for the content and structure of leadership interventions needed in community-based addiction treatment programs and the development of leadership interventions in these and other service settings.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089, USA.
| | - Howard Padwa
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA
| | - Karissa Fenwick
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089, USA
| | - Lesley M Harris
- Kent School of Social Work, University of Louisville, Louisville, KY 40292, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, 9500 Gilman Dr. (0812), San Diego, La Jolla, CA 92093-0812, USA
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Frimpong JA, D’Aunno T. Hepatitis C testing in substance use disorder treatment: the role of program managers in adoption of testing services. Subst Abuse Treat Prev Policy 2016; 11:13. [PMID: 27036115 PMCID: PMC4818491 DOI: 10.1186/s13011-016-0057-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 03/17/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Health care organizations do not adopt best practices as often or quickly as they merit. This gap in the integration of best practices into routine practice remains a significant public health concern. The role of program managers in the adoption of best practices has seldom been investigated. METHODS We investigated the association between characteristics of program managers and the adoption of hepatitis C virus (HCV) testing services in opioid treatment programs (OTPs). Data came from the 2005 (n = 187) and 2011 (n = 196) National Drug Abuse Treatment System Survey (NDATSS). We used multivariate regression models to examine correlates of the adoption of HCV testing. We included covariates describing program manager characteristics, such as their race/ethnicity, education, and their sources of information about developments in the field of substance use disorder treatment. We also controlled for characteristics of OTPs and the client populations they serve. RESULTS Program managers were predominantly white and female. A large proportion of program managers had post-graduate education. Program managers expressed strong support for preventive services, but they reported making limited use of available sources of information about developments in the field of substance use disorder (SUD) treatment. The provision of any HCV testing (either on-site or off-site) in OTPs was positively associated with the extent to which a program manager was supportive of preventive services. Among OTPs offering any HCV testing to their clients, on-site HCV testing was more common among programs with an African American manager. It was also more common when program managers relied on a variety of information sources about developments in SUD treatment. CONCLUSIONS Various characteristics of program managers are associated with the adoption of HCV testing in OTPs. Promoting diversity among program managers, and increasing managers' access to information about developments in SUD treatment, may help foster the adoption of best practices.
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Affiliation(s)
- Jemima A. Frimpong
- />Department of Health Policy and Management, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032 USA
| | - Thomas D’Aunno
- />Robert F. Wagner Graduate School of Public Service, New York University, 295 Lafayette St., #3062, New York, NY 10012 USA
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Guerrero EG, Andrews C, Harris L, Padwa H, Kong Y, M S W KF. Improving Coordination of Addiction Health Services Organizations with Mental Health and Public Health Services. J Subst Abuse Treat 2016; 60:45-53. [PMID: 26350114 PMCID: PMC4679570 DOI: 10.1016/j.jsat.2015.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 07/30/2015] [Accepted: 08/03/2015] [Indexed: 11/24/2022]
Abstract
In this mixed-method study, we examined coordination of mental health and public health services in addiction health services (AHS) in low-income racial and ethnic minority communities in 2011 and 2013. Data from surveys and semistructured interviews were used to evaluate the extent to which environmental and organizational characteristics influenced the likelihood of high coordination with mental health and public health providers among outpatient AHS programs. Coordination was defined and measured as the frequency of interorganizational contact among AHS programs and mental health and public health providers. The analytic sample consisted of 112 programs at time 1 (T1) and 122 programs at time 2 (T2), with 61 programs included in both periods of data collection. Forty-three percent of AHS programs reported high frequency of coordination with mental health providers at T1 compared to 66% at T2. Thirty-one percent of programs reported high frequency of coordination with public health services at T1 compared with 54% at T2. Programs with culturally responsive resources and community linkages were more likely to report high coordination with both services. Qualitative analysis highlighted the role of leadership in leveraging funding and developing creative solutions to deliver coordinated care. Overall, our findings suggest that AHS program funding, leadership, and cultural competence may be important drivers of program capacity to improve coordination with health service providers to serve minorities in an era of health care reform.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089.
| | | | - Lesley Harris
- Kent School of Social Work, University of Louisville, KY, 40292.
| | - Howard Padwa
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Box 71579, 760 Westwood Plaza, Los Angeles, CA 90024.
| | - Yinfei Kong
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089.
| | - Karissa Fenwick M S W
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089.
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Low Rates of Adoption and Implementation of Rapid HIV Testing in Substance Use Disorder Treatment Programs. J Subst Abuse Treat 2015; 63:46-53. [PMID: 26810130 DOI: 10.1016/j.jsat.2015.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/30/2015] [Accepted: 12/03/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Rapid HIV testing (RHT) greatly increases the proportion of clients who learn their test results. However, existing studies have not examined the adoption and implementation of RHT in programs treating persons with substance use disorders, one of the population groups at higher risk for HIV infection. METHODS We examined 196 opioid treatment programs (OTPs) using data from the 2011 National Drug Abuse Treatment System Survey (NDATSS). We used logistic regressions to identify client and organizational characteristics of OTPs associated with availability of on-site RHT. We then used zero-inflated negative binomial regressions to measure the association between the availability of RHT on-site and the number of clients tested for HIV. RESULTS Only 31.6% of OTPs offered on-site rapid HIV testing to their clients. Rapid HIV testing was more commonly available on-site in larger, publicly owned and better-staffed OTPs. On the other hand, on-site rapid HIV testing was less common in OTPs that prescribed only buprenorphine as a method of opioid dependence treatment. The availability of rapid HIV testing on-site reduced the likelihood that an OTP did not test any of its clients during the prior year. But on-site availability rapid HIV testing was not otherwise associated with an increased number of clients tested for HIV at an OTP. CONCLUSIONS New strategies are needed to a) promote the adoption of rapid HIV testing on-site in substance use disorder treatment programs and b) encourage substance use disorder treatment providers to offer rapid HIV testing to their clients when it is available.
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Timko C, Valenstein H, Stuart GL, Moos RH. Substance abuse and batterer programmes in California, USA: factors associated with treatment outcomes. HEALTH & SOCIAL CARE IN THE COMMUNITY 2015; 23:642-53. [PMID: 25470658 PMCID: PMC4573371 DOI: 10.1111/hsc.12178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 06/04/2023]
Abstract
The association between substance abuse and intimate partner violence is quite robust. A promising area to improve treatment for the dual problems of substance abuse and violence perpetration is the identification of client characteristics and organisational and programme factors as predictors of health outcomes. Therefore, we examined associations of client, organisational and programme factors with outcomes in community health settings. Directors of 241 substance use disorder programmes (SUDPs) and 235 batterer intervention programmes (BIPs) reported outcomes of programme completion and substance use and violence perpetration rates at discharge; data collection and processing were completed in 2012. SUDPs having more female, non-white, younger, uneducated, unemployed and lower income clients reported lower completion rates. In SUDPs, private, for-profit programmes reported higher completion rates than public or private, non-profit programmes. SUDPs with lower proportions of their budgets from government sources, and higher proportions from client fees, reported better outcomes. Larger SUDPs had poorer programme completion and higher substance use rates. Completion rates in SUDPs were higher when clients could obtain substance- and violence-related help at one location, and programmes integrated violence-prevention contracting into care. In BIPs, few client, organisational and programme factors were associated with outcomes, but the significant factors associated with programme completion were consistent with those for SUDPs. Publicly owned and larger programmes, and SUDPs lacking staff to integrate violence-related treatment, may be at risk of poorer client outcomes, but could learn from programmes that perform well to yield better outcomes.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System and Stanford University Medical Center, Palo Alto, California, USA
| | - Helen Valenstein
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Gregory L. Stuart
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, Tennessee, USA
| | - Rudolf H. Moos
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System and Stanford University Medical Center, Palo Alto, California, USA
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The relationship of state Medicaid coverage to Medicaid acceptance among substance abuse providers in the United States. J Behav Health Serv Res 2015; 41:460-72. [PMID: 24407938 DOI: 10.1007/s11414-013-9387-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Affordable Care Act will dramatically increase the number of Americans with Medicaid coverage for substance abuse treatment (SAT). Currently, few SAT providers accept Medicaid, and consequently, there is concern that newly-eligible Medicaid enrollees will have difficulty finding SAT providers willing to serve them. However, little is known about why few SAT providers accept Medicaid. In response, this study examines how features of state Medicaid coverage for SAT, including benefits, eligibility, and oversight, are associated with Medicaid acceptance among SAT providers. Medicaid acceptance was positively associated with the number of SAT services covered, and the number of optional categorical expansions implemented by the state. Requirements for physician involvement were associated with lower odds of acceptance. The results suggest that more generous Medicaid coverage may encourage SAT providers to accept Medicaid, but regulatory policies may inhibit their ability to do so.
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Shelley D, VanDevanter N, Cleland CC, Nguyen L, Nguyen N. Implementing tobacco use treatment guidelines in community health centers in Vietnam. Implement Sci 2015; 10:142. [PMID: 26453554 PMCID: PMC4600252 DOI: 10.1186/s13012-015-0328-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/18/2015] [Indexed: 11/29/2022] Open
Abstract
Background Vietnam has a smoking prevalence that is the second highest among Southeast Asian countries (SEACs). According to the World Health Organization (WHO), most reductions in mortality from tobacco use in the near future will be achieved through helping current users quit. Yet, largely due to a lack of research on strategies for implementing WHO-endorsed treatment guidelines in primary care settings, services to treat tobacco dependence are not readily available to smokers in low middle-income countries (LMICs) like Vietnam. The objective of this study is to conduct a cluster randomized controlled trial that compares the effectiveness of two system-level strategies for implementing evidence-based guidelines for the treatment of tobacco use in 26 public community health centers (CHCs) in Vietnam. Methods/Design The current study will use a cluster-randomized design and multiple data sources (patient exit interviews, provider and village health worker (VHW) surveys, and semi-structured provider/VHW interviews) to study the process of adapting and implementing clinical practice guidelines in Vietnam and theory-driven mechanisms hypothesized to explain the comparative effectiveness of the two strategies for implementation. CHCs will be randomly assigned to either of the following: (1) training plus clinical reminder system (TC) or (2) TC + referral to a VHW (TCR) for three in person counseling sessions. The primary outcome is provider adherence to tobacco use treatment guidelines. The secondary outcome is 6-month biochemically verified smoking abstinence. Discussion The proposed implementation strategies draw on evidence-based approaches and a growing literature that supports the effectiveness of integrating community health workers as members of the health care team to improve access to preventive services. We hypothesize that the value of these implementation strategies is additive and that incorporating a referral resource that allows providers to delegate the task of offering counseling (TCR) will be superior to TC alone in improving delivery of cessation assistance to smokers. The findings of this research have potential to guide large-scale adoption of promising strategies for implementing and disseminating tobacco use treatment guidelines throughout the public health system in Vietnam and will serve as a model for similar action in other LMICs. Trial registration NCT01967654 Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0328-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Donna Shelley
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, 7th floor, New York, NY, 10016, USA.
| | - Nancy VanDevanter
- New York University College of Nursing, 433 First Ave, New York, NY, 10010, USA.
| | - Charles C Cleland
- Center for Drug Use and HIV Research, New York University College of Nursing, 433 First Ave, New York, NY, 10010, USA.
| | - Linh Nguyen
- Institute of Social Medical Studies, No. 18, Lot 12B, Trung Yen 10, Trung Hoa, Cau Giay District, Hanoi, Vietnam.
| | - Nam Nguyen
- Institute of Social Medical Studies, No. 18, Lot 12B, Trung Yen 10, Trung Hoa, Cau Giay District, Hanoi, Vietnam.
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D'Aunno T, Friedmann PD, Chen Q, Wilson DM. Integration of Substance Abuse Treatment Organizations into Accountable Care Organizations: Results from a National Survey. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2015; 40:797-819. [PMID: 26124307 PMCID: PMC4704856 DOI: 10.1215/03616878-3150062] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
To meet their aims of managing population health to improve the quality and cost of health care in the United States, accountable care organizations (ACOs) will need to focus on coordinating care for individuals with substance abuse disorders. The prevalence of these disorders is high, and these individuals often suffer from comorbid chronic medical and social conditions. This article examines the extent to which the nation's fourteen thousand specialty substance abuse treatment (SAT) organizations, which have a daily census of more than 1 million patients, are contracting with ACOs across the country; we also examine factors associated with SAT organization involvement with ACOs. We draw on data from a recent (2014) nationally representative survey of executive directors and clinical supervisors from 635 SAT organizations. Results show that only 15 percent of these organizations had signed contracts with ACOs. Results from multivariate analyses show that directors' perceptions of market competition, organizational ownership, and geographic location are significantly related to SAT involvement with ACOs. We discuss implications for integrating the SAT specialty system with the mainstream health care system.
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Leadership and Licensure for Drug Treatment and the Implementation of Co-Occurring Disorder Treatment in Community Mental Health Centers. Community Ment Health J 2015; 51:554-66. [PMID: 25982830 PMCID: PMC4476917 DOI: 10.1007/s10597-015-9886-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 05/06/2015] [Indexed: 10/23/2022]
Abstract
Using a random sample of 48 outpatient mental health programs in low-income and racial and ethnic minority communities, this study examined directorial leadership, drug treatment licensure, and implementation of evidence-based protocols and practices to address co-occurring mental health and substance abuse disorders (COD). Understanding of findings was enhanced with focus groups at six clinics. Most programs (81 %) offered COD treatment. Directorial leadership was positively associated with COD treatment (β = 0.253, p = 0.047, 95 % CI 0.003, 0.502) and COD supervision and training (β = 0.358, p = 0.002, 95 % CI 0.142, 0.575). Licensure was negatively associated with COD treatment (β = -0.235, p = 0.041, 95 % CI -0.460, -0.010) and COD supervision and training (β = -0.195, p = 0.049, 95 % CI -0.389, -0.001). Although lack of financial integration may limit the effect of licensing on COD treatment implementation, the response of leaders to regulation, funding, and human resources issues may encourage COD treatment practices. Implications for leadership interventions and policy are discussed in the context of health care reform.
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Dick AW, Pacula RL, Gordon AJ, Sorbero M, Burns RM, Leslie D, Stein BD. Growth In Buprenorphine Waivers For Physicians Increased Potential Access To Opioid Agonist Treatment, 2002-11. Health Aff (Millwood) 2015; 34:1028-34. [PMID: 26056209 PMCID: PMC4743254 DOI: 10.1377/hlthaff.2014.1205] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Opioid use disorders are a significant public health problem, affecting two million people in the United States. Treatment with buprenorphine, methadone, or both is predominantly offered in methadone clinics, yet many people do not receive the treatment they need. In 2002 the Food and Drug Administration approved buprenorphine for prescription by physicians who completed a course and received a waiver from the Drug Enforcement Administration, exempting them from requirements in the Controlled Substances Act. To determine the waiver program's impact on the availability of opioid agonist treatment, we analyzed data for the period 2002-11 to identify counties with opioid treatment shortages. We found that the percentage of counties with a shortage of waivered physicians fell sharply, from 98.9 percent in 2002 to 46.8 percent in 2011. As a result, the percentage of the US population residing in what we classified as opioid treatment shortage counties declined from 48.6 percent in 2002 to 10.4 percent in 2011. These findings suggest that the increase in waivered physicians has dramatically increased potential access to opioid agonist treatment. Policy makers should focus their efforts on further increasing the number and geographical distribution of physicians, particularly in more rural counties, where prescription opioid misuse is rapidly growing.
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Affiliation(s)
- Andrew W Dick
- Andrew W. Dick is a senior economist at the RAND Corporation in Boston, Massachusetts
| | - Rosalie L Pacula
- Rosalie L. Pacula is a senior economist at RAND in Santa Monica, California
| | - Adam J Gordon
- Adam J. Gordon is an associate professor of medicine at the University of Pittsburgh School of Medicine and a staff physician in the Veterans Affairs Pittsburgh Healthcare System
| | - Mark Sorbero
- Mark Sorbero is a project associate at RAND in Pittsburgh
| | - Rachel M Burns
- Rachel M. Burns is a project associate at RAND in Pittsburgh
| | - Douglas Leslie
- Douglas Leslie is a professor of public health sciences and psychiatry at the Penn State College of Medicine
| | - Bradley D Stein
- Bradley D. Stein is a senior natural scientist at RAND in Pittsburgh and an adjunct professor of psychiatry at the University of Pittsburgh School of Medicine
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Fields D, Blum TC, Roman PM. Dissemination activities: a critical new role for substance abuse treatment organizations. J Behav Health Serv Res 2014; 41:473-87. [PMID: 24722825 PMCID: PMC4162753 DOI: 10.1007/s11414-014-9405-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Affordable Care Act calls for integration of substance abuse treatment into medical care via medical homes and continuing specialty care. For this integration to occur in the substance abuse treatment field, substantial sharing and dissemination of information by treatment providers is required. This study explored the determinants of organizational activities directed at disseminating evidence-based practices (EBPs) undertaken by 193 community treatment programs who are members of the National Institute on Drug Abuse (NIDA) Clinical Trials Network. Using factor analysis, the research identified two generic categories reflecting different motivations for dissemination activities and explored both treatment center leadership and organizational characteristics as determinants of these different types of dissemination activities. Organizational characteristics predicting treatment center dissemination activities included size, previous involvement in research protocols, linkages with other providers, and having non-profit status. The treatment center leader's membership in professional organizations was also a significant determinant. Organization variables account for a larger portion of the variance in treatment center dissemination activities. The results suggest that the willingness of treatment providers to help disseminate EBPs within the industry may be heavily influenced through shared network connections with other treatment organizations.
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Affiliation(s)
- Dail Fields
- Center for Research on Behavioral Health and Human Services Delivery, Institute for Behavioral Research, University of Georgia, Phone: 706-542-6054
| | - Terry C. Blum
- Institute for Leadership and Entrepreneurship, Scheller College of Business, Georgia Institute of Technology, Atlanta, GA 30332, 404-894-4924
| | - Paul M. Roman
- Center for Research on Behavioral Health and Human Services Delivery, Institute for Behavioral Research and Department of Sociology, University of Georgia, Phone: 706-542-6090
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Frimpong JA, D'Aunno T, Jiang L. Determinants of the availability of hepatitis C testing services in opioid treatment programs: results from a national study. Am J Public Health 2014; 104:e75-82. [PMID: 24825236 DOI: 10.2105/ajph.2013.301827] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We examined trends and organizational-level correlates of the availability of HCV testing in opioid treatment programs. METHODS We used generalized ordered logit models to examine associations between organizational characteristics of 383 opioid treatment programs from the 2005 and 2011 National Drug Abuse Treatment System Survey and HCV testing availability. RESULTS Between 2005 and 2011, the proportion of opioid treatment programs offering HCV testing increased but largely because of increases in off-site referrals rather than on-site testing. HCV testing availability was higher in opioid treatment programs affiliated with a hospital and those receiving federal funds. Opioid treatment programs providing both methadone and buprenorphine were more likely to offer any HCV testing, whereas opioid treatment programs providing only buprenorphine treatment were less likely to offer on-site testing. HCV testing availability was associated with more favorable staff-to-client ratios. CONCLUSIONS The increasing use of off-site referrals for HCV testing in opioid treatment programs likely limits opportunities for case finding, prevention, and treatment. Declines in federal funding for opioid treatment programs may be a key determinant of the availability of HCV testing in opioid treatment programs.
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Affiliation(s)
- Jemima A Frimpong
- Jemima A. Frimpong and Thomas D'Aunno are with the Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY. Lan Jiang is with the Providence Veterans Affairs Medical Center, Providence, RI
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Ostroff JS, Li Y, Shelley DR. Dentists United to Extinguish Tobacco (DUET): a study protocol for a cluster randomized, controlled trial for enhancing implementation of clinical practice guidelines for treating tobacco dependence in dental care settings. Implement Sci 2014; 9:25. [PMID: 24559178 PMCID: PMC3936874 DOI: 10.1186/1748-5908-9-25] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although dental care settings provide an exceptional opportunity to reach smokers and provide brief cessation advice and treatment to reduce oral and other tobacco-related health conditions, dental care providers demonstrate limited adherence to evidence-based guidelines for treatment of tobacco use and dependence. METHODS/DESIGN Guided by a multi-level, conceptual framework that emphasizes changes in provider beliefs and organizational characteristics as drivers of improvement in tobacco treatment delivery, the current protocol will use a cluster, randomized design and multiple data sources (patient exit interviews, provider surveys, site observations, chart audits, and semi-structured provider interviews) to study the process of implementing clinical practice guidelines for treating tobacco dependence in 18 public dental care clinics in New York City. The specific aims of this comparative-effectiveness research trial are to: compare the effectiveness of three promising strategies for implementation of tobacco use treatment guidelines-staff training and current best practices (CBP), CBP + provider performance feedback (PF), and CBP + PF + provider reimbursement for delivery of tobacco cessation treatment (pay-for-performance, or P4P); examine potential theory-driven mechanisms hypothesized to explain the comparative effectiveness of three strategies for implementation; and identify baseline organizational factors that influence the implementation of evidence-based tobacco use treatment practices in dental clinics. The primary outcome is change in providers' tobacco treatment practices and the secondary outcomes are cost per quit, use of tobacco cessation treatments, quit attempts, and smoking abstinence. DISCUSSION We hypothesize that the value of these promising implementation strategies is additive and that incorporating all three strategies (CBP, PF, and P4P) will be superior to CBP alone and CBP + PF in improving delivery of cessation assistance to smokers. The findings will improve knowledge pertinent to the implementation, dissemination, and sustained utilization of evidence-based tobacco use treatment in dental practices. TRIAL REGISTRATION NCT01615237.
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Affiliation(s)
- Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10022, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10022, USA
| | - Donna R Shelley
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, 7th floor, New York, NY 10016, USA
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Guerrero EG, Aarons GA, Palinkas LA. Organizational capacity for service integration in community-based addiction health services. Am J Public Health 2014; 104:e40-7. [PMID: 24524525 DOI: 10.2105/ajph.2013.301842] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined factors associated with readiness to coordinate mental health, public health, and HIV testing among community-based addiction health services programs. METHODS We analyzed client and program data collected in 2011 from publicly funded addiction health services treatment programs in Los Angeles County, California. We analyzed a sample of 14 379 clients nested in 104 programs by using logistic regressions examining odds of service coordination with mental health and public health providers. We conducted a separate analysis to examine the percentage of clients receiving HIV testing in each program. RESULTS Motivational readiness and organizational climate for change were associated with higher odds of coordination with mental health and public health services. Programs with professional accreditation had higher odds of coordinating with mental health services, whereas programs receiving public funding and methadone and residential programs (compared with outpatient) had a higher percentage of clients receiving coordinated HIV testing. CONCLUSIONS These findings provide an evidentiary base for the role of motivational readiness, organizational climate, and external regulation and funding in improving the capacity of addiction health services programs to develop integrated care.
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Affiliation(s)
- Erick G Guerrero
- Erick G. Guerrero and Lawrence A. Palinkas are with the School of Social Work, University of Southern California, Los Angeles. Gregory A. Aarons is with the Department of Psychiatry, University of California, San Diego
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Smith BD, Liu J. Latent practice profiles of substance abuse treatment counselors: do evidence-based techniques displace traditional techniques? J Subst Abuse Treat 2013; 46:439-46. [PMID: 24462243 DOI: 10.1016/j.jsat.2013.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/25/2013] [Accepted: 12/10/2013] [Indexed: 10/25/2022]
Abstract
As more substance abuse treatment counselors begin to use evidence-based treatment techniques, questions arise regarding the continued use of traditional techniques. This study aims to (1) assess whether there are meaningful practice profiles among practitioners reflecting distinct combinations of cognitive-behavioral and traditional treatment techniques; and (2) if so, identify practitioner characteristics associated with the distinct practice profiles. Survey data from 278 frontline counselors working in community substance abuse treatment organizations were used to conduct latent profile analysis. The emergent practice profiles illustrate that practitioners vary most in the use of traditional techniques. Multinomial regression models suggest that practitioners with less experience, more education, and less traditional beliefs about treatment and substance abuse are least likely to mix traditional techniques with cognitive-behavioral techniques. Findings add to the understanding of how evidence-based practices are implemented in routine settings and have implications for training and support of substance abuse treatment counselors.
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Affiliation(s)
- Brenda D Smith
- School of Social Work, University of Alabama, Tuscaloosa, Alabama 35487, United States.
| | - Junqing Liu
- National Committee for Quality Assurance, 1100 13th St., NW Suite 1000, Washington, D.C. 20005.
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Csete J, Catania H. Methadone treatment providers' views of drug court policy and practice: a case study of New York State. Harm Reduct J 2013; 10:35. [PMID: 24308548 PMCID: PMC4176483 DOI: 10.1186/1477-7517-10-35] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 12/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Specialized drug treatment courts are a central part of drug-related policy and programs in the United States and increasingly outside the U.S. While in theory they offer treatment as a humane and pragmatic alternative to arrest and incarceration for certain categories of drug offenses, they may exclude some forms of treatment-notably methadone maintenance treatment (MMT). We sought to understand from the perspective of treatment providers whether this exclusion existed and was of public health importance in New York State as a case example of a state heavily committed to drug courts and with varying court-level policies on MMT. Drug courts have been extensively evaluated but not with respect to exclusion of MMT and not from the perspective of treatment providers. METHODS Qualitative structured interviews of 15 providers of MMT and 4 NGO advocates in counties with diverse court policies on MMT, with content analysis. RESULTS Courts in some counties require MMT patients to "taper off" methadone in an arbitrary period or require that methadone be a "bridge to abstinence". Treatment providers repeatedly noted that methadone treatment is stigmatized and poorly understood by some drug court personnel. Some MMT providers feared court practices were fueling non-medical use of prescription opiates. CONCLUSIONS Drug court practices in some jurisdictions are a barrier to access to MMT and may constitute discrimination against persons in need of MMT. These practices should be changed, and drug courts should give high priority to ensuring that treatment decisions are made by or in close consultation with qualified health professionals.
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Affiliation(s)
| | - Holly Catania
- Open Society Foundation, 21-24 Millbank, SW1P 4QP London, UK.
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Guerrero EG, Kim A. Organizational structure, leadership and readiness for change and the implementation of organizational cultural competence in addiction health services. EVALUATION AND PROGRAM PLANNING 2013; 40:74-81. [PMID: 23816502 DOI: 10.1016/j.evalprogplan.2013.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 05/18/2013] [Accepted: 05/27/2013] [Indexed: 06/02/2023]
Abstract
Increasing representation of racial and ethnic minorities in the health care system and on-going concerns about existing health disparities have pressured addiction health services programs to enhance their cultural competence. This study examines the extent to which organizational factors, such as structure, leadership and readiness for change contribute to the implementation of community, policy and staffing domains representing organizational cultural competence. Analysis of a randomly selected sample of 122 organizations located in primarily Latino and African American communities showed that programs with public funding and Medicaid reimbursement were positively associated with implementing policies and procedures, while leadership was associated with staff having greater knowledge of minority communities and developing a diverse workforce. Moreover, program climate was positively associated with staff knowledge of communities and having supportive policies and procedures, while programs with graduate staff and parent organizations were negatively associated with knowledge of and involvement in these communities. By investing in funding, leadership skills and a strategic climate, addiction health services programs may develop greater understanding and responsiveness of the service needs of minority communities. Implications for future research and program planning in an era of health care reform in the United States are discussed.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, Los Angeles, CA 90089, USA.
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