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Hall RL, Willging CE, Aarons GA, Reeder K. Site-level evidence-based practice accreditation: A qualitative exploration using institutional theory. HUMAN SERVICE ORGANIZATIONS, MANAGEMENT, LEADERSHIP & GOVERNANCE 2023; 47:157-175. [PMID: 38681745 PMCID: PMC11052582 DOI: 10.1080/23303131.2023.2194940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Accreditation is gaining ground in human services as leaders find ways to demonstrate the quality and legitimacy of services. This study examined site-level accreditation for SafeCare®, an evidence-based practice designed to prevent and reduce child maltreatment. We leveraged two waves of qualitative data to explore the perspectives of trainers, organizational and system leaders, and program developers who participated in an initial rollout of a site-level accreditation process for SafeCare. Institutional theory was used to frame accreditation's potential benefits, burden, and impact. Findings highlight specific considerations for the human service environment, including the inherent resource scarcity, interdependence among organizations, and the impact of cost and slow-moving bureaucratic processes.
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Affiliation(s)
| | | | - Gregory A. Aarons
- Department of Psychiatry, University of California, San Diego, California, USA
- University of California San Diego Dissemination and Implementation Science Center, La Jolla, California, USA
| | - Kendal Reeder
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
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Guerrero EG, Kong Y, Frimpong JA, Khachikian T, Wang S, D’Aunno T, Howard DL. Workforce Diversity and disparities in wait time and retention among opioid treatment programs. Subst Abuse Treat Prev Policy 2022; 17:74. [PMID: 36384761 PMCID: PMC9670430 DOI: 10.1186/s13011-022-00500-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Workforce diversity is a key strategy to improve treatment engagement among members of racial and ethnic minority groups. In this study, we seek to determine whether workforce diversity plays a role in reducing racial and ethnic differences in wait time to treatment entry and retention in different types of opioid use disorder treatment programs. METHODS We conducted comparative and predictive analysis in a subsample of outpatient opioid treatment programs (OTPs), who completed access and retention survey questions in four waves of the National Drug Abuse Treatment System Survey (162 OTPs in 2000, 173 OTPs in 2005, 282 OTPs in 2014, and 300 OTPs in 2017). We sought to assess the associations between workforce diversity on wait time and retention, accounting for the role of Medicaid expansion and the moderating role of program ownership type (i.e., public, non-profit, for-profit) among OTPs located across the United States. RESULTS We found significant differences in wait time to treatment entry and retention in treatment across waves. Average number of waiting days decreased in 2014 and 2017; post Medicaid expansion per the Affordable Care Act, while retention rates varied across years. Key findings show that programs with high diversity, measured by higher percent of African American staff and a higher percent of African American clients, were associated with longer wait times to enter treatment, compared to low diversity programs. Programs with higher percent of Latino staff and a higher percent of Latino clients were associated with lower retention in treatment compared with low diversity programs. However, program ownership type (public, non-profit and for-profit) played a moderating role. Public programs with higher percent of African American staff were associated with lower wait time, while non-profit programs with higher percent of Latino staff were related to higher retention. CONCLUSIONS Findings show decreases in wait time over the years with significant variation in retention during the same period. Concordance in high workforce and client diversity was associated with higher wait time and lower retention. But these relations inverted (low wait time and high retention) in public and non-profit programs with high staff diversity. Findings have implications for building resources and service capacity among OTPs that serve a higher proportion of minority clients.
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Affiliation(s)
- Erick G. Guerrero
- Research to End Healthcare Disparities Corp, I-Lead Institute, Los Angeles, CA USA
| | - Yinfei Kong
- Mihaylo College of Business and Economics, California State University, Fullerton, CA USA
| | - Jemima A. Frimpong
- Business, Organizations and Society, New York University, Abu Dhabi, United Arab Emirates
| | | | - Suojin Wang
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX USA
| | - Thomas D’Aunno
- Wagner Graduate School of Public Service, New York University, New York City, New York USA
| | - Daniel L. Howard
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX 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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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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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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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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Fields D, Riesenmy K, Roman PM. Exploring Diversification as A Management Strategy in Substance Use Disorder Treatment Organizations. J Subst Abuse Treat 2015; 57:63-9. [PMID: 26021404 DOI: 10.1016/j.jsat.2015.05.003] [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: 12/17/2014] [Revised: 04/25/2015] [Accepted: 05/03/2015] [Indexed: 11/28/2022]
Abstract
Implementation of the Affordable Care Act (ACA) creates both environmental uncertainties and opportunities for substance use disorder (SUD) treatment providers. One managerial response to uncertainties and emergent opportunities is strategic diversification of various dimensions of organizational activity. This paper explored organizational outcomes related to diversification of funding sources, services offered, and referral sources in a national sample of 590 SUD treatment organizations. Funding diversification was related to higher average levels of census, organization size, and recent expansion of operations. Service diversification was related to higher average levels of use of medication-assisted treatment (MAT), organization size, and expansion. Referral source diversification was related only to greater average use of MAT. Overall, strategic diversification in the three areas explored was related to positive organizational outcomes. Considering alternative strategies of diversification may help position SUD treatment centers to deliver more innovative treatments such as MAT as well as enhance capacity to satisfy current unmet treatment needs of individuals with behavioral health coverage provided under the ACA.
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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.
| | | | - Paul M Roman
- Center for Research on Behavioral Health and Human Services Delivery, Institute for Behavioral Research and, Department of Sociology, University of Georgia.
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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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Chuang E, Wells R, Alexander J, Green S. How outpatient substance abuse treatment unit director activities may affect provision of community outreach services. DRUGS-EDUCATION PREVENTION AND POLICY 2012; 20:149-159. [PMID: 29170607 DOI: 10.3109/09687637.2012.703261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aims Community outreach services play an important role in infectious disease prevention and engaging drug users not currently in treatment. However, fewer than half of US substance abuse treatment units provide these services and many have little financial incentive to do so. Unit directors generally have latitude about scope of services, including the level of outreach provided to the community. The current study examines how directors' interactions with external stakeholders affect substance abuse treatment units' provision of community outreach services. Methods Cross-sectional logistic and Poisson regression analyses were conducted on a national sample of US outpatient substance abuse treatment units (N = 547). Results Findings suggest that the amount of time directors spent with licensing and monitoring associations was associated with provision of a greater number of community outreach services, while time spent with professional and occupational associations was associated with provision of off-site human immunodeficiency virus and hepatitis C testing. Several other director attributes and organizational characteristics also emerged as significant. Conclusions External stakeholders with whom substance abuse treatment directors interact may influence community outreach through their effects on treatment directors' strategic priorities. Implications for policy and prevention efforts are discussed.
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Affiliation(s)
- Emmeline Chuang
- Division of Health Management and Policy, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Rebecca Wells
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeffrey Alexander
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Sherri Green
- Department of Maternal and Child Health, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Currie G, Dingwall R, Kitchener M, Waring J. Let's dance: Organization studies, medical sociology and health policy. Soc Sci Med 2011; 74:273-280. [PMID: 22218227 DOI: 10.1016/j.socscimed.2011.11.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 11/07/2011] [Indexed: 10/14/2022]
Abstract
This Special Issue of Social Science & Medicine investigates the potential for positive inter-disciplinary interaction, a 'generative dance', between organization studies (OS), and two of the journal's traditional disciplinary foundations: health policy and medical sociology. This is both necessary and timely because of the extent to which organizations have become a neglected topic within medical sociology and health policy analysis. We argue there is need for further and more sustained theoretical and conceptual synergy between OS, medical sociology and health policy, which provides, on the one-hand a cutting-edge and thought-provoking basis for the analysis of contemporary health reforms, and on the other hand, enables the development and elaboration of theory. We emphasize that sociologists and policy analysts in healthcare have been leading contributors to our understanding of organizations in modern society, that OS enhances our understanding of medical settings, and that organizations remain one of the most influential actors of our time. As a starting point to discussion, we outline the genealogy of OS and its application to healthcare settings. We then consider how medical sociology and health policy converge or diverge with the concerns of OS in the study of healthcare settings. Following this, we focus upon the material environment, specifically the position of business schools, which frames the generative dance between OS, medical sociology and health policy. This sets the context for introducing the thirteen articles that constitute the Special Issue of Social Science & Medicine.
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Affiliation(s)
- Graeme Currie
- Warwick Business School, University of Warwick, Coventry CV47AL, UK.
| | - Robert Dingwall
- Warwick Business School, University of Warwick, Coventry CV47AL, UK; School of Social Sciences, Nottingham Trent University, UK
| | - Martin Kitchener
- School of Social Sciences, Nottingham Trent University, UK; Cardiff Business School, Cardiff University, UK
| | - Justin Waring
- Warwick Business School, University of Warwick, Coventry CV47AL, UK
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Knudsen HK, Abraham AJ, Roman PM, Studts JL. Nurse turnover in substance abuse treatment programs affiliated with the National Drug Abuse Treatment Clinical Trials Network. J Subst Abuse Treat 2010; 40:307-12. [PMID: 21177062 DOI: 10.1016/j.jsat.2010.11.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 11/13/2010] [Accepted: 11/22/2010] [Indexed: 11/27/2022]
Abstract
Voluntary nurse turnover, which is costly and disrupts patient care, has not been studied as an organizational phenomenon within substance abuse treatment organizations. In this exploratory study, we examined the frequency and correlates of nurse turnover within treatment programs affiliated with the National Drug Abuse Treatment Clinical Trials Network. During face-to-face interviews conducted in 2005-2006, 215 program administrators reported the number of nurses currently employed. Leaders of programs with nursing staff then described the number of nurses who had voluntarily quit in the past year, the degree to which filling vacant nursing positions was difficult, and the average number of days to fill a vacant position. About two thirds of these programs had at least one nurse on staff. In programs with nurses, the average rate of voluntary turnover was 15.0%. Turnover was significantly lower in hospital-based programs and programs offering adolescent treatment but higher in facilities offering residential treatment. Most of the administrators indicated that filling vacant nurse positions was difficult and took more than 2 months to complete. These findings suggest that nurse turnover is a significant issue facing many substance abuse treatment facilities. Efforts to improve retention of the addiction treatment workforce should be expanded to include nursing professionals.
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Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science, University of Kentucky, Lexington, KY 40536-0086, USA.
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12
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Edwards JR, Knight DK, Broome KM, Flynn PM. The development and validation of a transformational leadership survey for substance use treatment programs. Subst Use Misuse 2010; 45:1279-302. [PMID: 20509734 PMCID: PMC4006131 DOI: 10.3109/10826081003682834] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Directors in substance use treatment programs are increasingly required to respond to external economic and socio-political pressures. Leadership practices that promote innovation can help offset these challenges. Using focus groups, factor analysis, and validation instruments, the current study developed and established psychometrics for the Survey of Transformational Leadership. In 2008, clinical directors were evaluated on leadership practices by 214 counselors within 57 programs in four U.S. regions. Nine themes emerged: integrity, sensible risk, demonstrates innovation, encourages innovation, inspirational motivation, supports others, develops others, delegates tasks, and expects excellence. Study implications, limitations, and suggested future directions are discussed.
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Affiliation(s)
- Jennifer R Edwards
- Institute of Behavioral Research, Psychology, Texas Christian University, Fort Worth, Texas 76129, USA.
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13
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Friedmann PD, Jiang L, Alexander JA. Top manager effects on buprenorphine adoption in outpatient substance abuse treatment programs. J Behav Health Serv Res 2009; 37:322-37. [PMID: 19296223 DOI: 10.1007/s11414-009-9169-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 02/07/2009] [Indexed: 11/25/2022]
Abstract
To examine the influence of top managers' characteristics on the adoption of buprenorphine for opioid dependence among U.S. outpatient substance abuse treatment units, this investigation analyzed a cross-sectional national study of 547 such units in the 2004-2005 wave of the Drug Abuse Treatment System Survey. Administrators reported their demographics, training, and treatment orientation, as well as features of the unit and its pattern of use of buprenorphine. Nationally, 15.8% of programs offered any buprenorphine services. Greater adoption of buprenorphine correlated with directors' younger age, longer tenure, male gender, and weaker endorsement of abstinence as the most important treatment goal. Availability of naltrexone and medical services also correlated positively with buprenorphine adoption. The authors conclude that leaders' characteristics are related to the adoption of innovative practices in addiction treatment programs. Future work should examine whether leadership development for community addiction programs might speed up the diffusion of buprenorphine and other innovative, evidence-based practices.
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Affiliation(s)
- Peter D Friedmann
- Center on Systems, Outcomes & Quality in Chronic Disease & Rehabilitation (SOQCR), Research Service, Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI, USA.
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14
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Friedmann PD, Jiang L, Richter KP. Cigarette smoking cessation services in outpatient substance abuse treatment programs in the United States. J Subst Abuse Treat 2007; 34:165-72. [PMID: 17509809 PMCID: PMC3689419 DOI: 10.1016/j.jsat.2007.02.006] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Revised: 01/17/2007] [Accepted: 02/16/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this study was to estimate the prevalence and determinants of cigarette smoking cessation treatment in U.S. outpatient substance abuse treatment (OSAT) units. METHODS Program directors and clinical supervisors from a national sample of 550 OSAT units in the United States were surveyed in 2004-2005. Supervisors reported the availability of cigarette smoking assessment, and individual or group counseling and pharmacotherapy for smoking cessation. This analysis examines whether institutional and resource factors influence the delivery of these services. RESULTS Of OSAT programs in the United States, 41% offer smoking cessation counseling or pharmacotherapy, 38% offer individual/group counseling, and 17% provide quit-smoking medication. In multivariate models, hospital affiliation, service breadth, the priority given to physical health, the availability of medication to treat addictive problems, assessment of cigarette smoking, and a greater perception of the proportion of patients who smoke were associated with the delivery of smoking cessation services. Program size and medical staffing also influenced the availability of quit-smoking medication. CONCLUSIONS Of U.S. OSAT programs, two in five offer behavioral treatment for smoking cessation, but fewer than one in five provide access to pharmacotherapy. Substance abuse treatment programs that are medically oriented, provide more comprehensive services, and recognize the burden of tobacco smoking among their patients are more likely to deliver evidence-based smoking cessation services.
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Affiliation(s)
- Peter D Friedmann
- Program to Integrate Psychosocial and Health Services, Research Service, Providence Veterans Affairs Medical Center, Providence, RI, USA.
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15
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D'Aunno T. The role of organization and management in substance abuse treatment: Review and roadmap. J Subst Abuse Treat 2006; 31:221-33. [PMID: 16996385 DOI: 10.1016/j.jsat.2006.06.016] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Accepted: 06/15/2006] [Indexed: 11/20/2022]
Abstract
To develop an understanding as to why there exists a seemingly wide gap between research and practice in the field of substance abuse treatment and, more important, to understand how this gap can be closed, researchers have focused their attention on the role of organizational and management factors in the delivery of treatment services. This article's overarching goal is to stimulate research and interventions that focus on these factors so as to improve the standards and outcomes of care in substance abuse treatment. Part 1 introduces the key assumptions and perspectives that guide organization and management research. Part 2 selectively reviews empirical studies that examine relationships between treatment programs' use of research-based treatment practices and organization and management factors. The article concludes with a discussion of the next important steps for research and policy.
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Affiliation(s)
- Thomas D'Aunno
- INSEAD, Boulevard de Constance, 77305 Fontainebleau Cedex, France.
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Wells R, Lemak CH, D'Aunno TA. Insights from a national survey into why substance abuse treatment units add prevention and outreach services. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2006; 1:21. [PMID: 16887037 PMCID: PMC1562404 DOI: 10.1186/1747-597x-1-21] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 08/03/2006] [Indexed: 11/11/2022]
Abstract
Background Previous studies have found that even limited prevention-related interventions can affect health behaviors such as substance use and risky sex. Substance abuse treatment providers are ideal candidates to provide these services, but typically have little or no financial incentive to do so. The purpose of this study was therefore to explore why some substance abuse treatment units have added new prevention and outreach services. Based on an ecological framework of organizational strategy, three categories of predictors were tested: (1) environmental, (2) unit-level, and (3) unit leadership. Results A lagged cross-sectional logistic model of 450 outpatient substance abuse treatment units revealed that local per capita income, mental health center affiliation, and clinical supervisors' graduate degrees were positively associated with likelihood of adding prevention-related education and outreach services. Managed care contracts and methadone treatment were negatively associated with addition of these services. No hospital-affiliated agencies added prevention and outreach services during the study period. Conclusion Findings supported the study's ecological perspective on organizational strategy, with factors at environmental, unit, and unit leadership levels associated with additions of prevention and outreach services. Among the significant predictors, ties to managed care payers and unit leadership graduate education emerge as potential leverage points for public policy. In the current sample, units with managed care contracts were less likely to add prevention and outreach services. This is not surprising, given managed care's emphasis on cost control. However, the association with this payment source suggests that public managed care programs might affects prevention and outreach differently through revised incentives. Specifically, government payers could explicitly compensate substance abuse treatment units in managed care contracts for prevention and outreach. The effects of supervisor graduate education on likelihood of adding new prevention and outreach programs suggests that leaders' education can affect organizational strategy. Foundation and government officials may encourage prevention and outreach by funding curricular enhancements to graduate degree programs demonstrating the importance of public goods. Overall, these findings suggest that both money and professional education affect substance abuse treatment unit additions of prevention and outreach services, as well as other factors less amenable to policy intervention.
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Affiliation(s)
- Rebecca Wells
- Department of Health Policy and Administration, School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christy Harris Lemak
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
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