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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. 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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Hernández D, Feaster DJ, Gooden L, Douaihy A, Mandler R, Erickson SJ, Kyle T, Haynes L, Schwartz R, Das M, Metsch L. Self-Reported HIV and HCV Screening Rates and Serostatus Among Substance Abuse Treatment Patients. AIDS Behav 2016; 20:204-14. [PMID: 25952768 PMCID: PMC4637257 DOI: 10.1007/s10461-015-1074-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Substance users are at increased risk for HIV and HCV infection. Still, many substance use treatment programs (SUTP) fail to offer HIV/HCV testing. The present secondary analysis of screening data from a multi-site randomized trial of rapid HIV testing examines self-reported HIV/HCV testing patterns and serostatus of 2473 SUTP patients in 12 community-based sites that had not previously offered on-site testing. Results indicate that most respondents screened for the randomized trial tested more than a year prior to intake for HIV (52 %) and HCV (38 %). Prevalence rates were 3.6 and 30 % for HIV and HCV, respectively. The majority of participants that were HIV (52.2 %) and HCV-positive (40.5 %) reported having been diagnosed within the last 1-5 years. Multivariable logistic regression showed that members of high-risk groups were more likely to have tested. Bundled HIV/HCV testing and linkage to care issues are recommended for expanding testing in community-based SUTP settings.
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Affiliation(s)
- Diana Hernández
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th St, Rm 934, New York, NY, 10032, USA.
| | | | - Lauren Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th St, Rm 934, New York, NY, 10032, USA
| | - Antoine Douaihy
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Raul Mandler
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - Sarah J Erickson
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Tiffany Kyle
- The Center for Drug Free Living, Orlando, FL, USA
| | - Louise Haynes
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Moupali Das
- School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Lisa Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th St, Rm 934, New York, NY, 10032, USA
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Implementing HIV Testing in Substance Use Treatment Programs: A Systematic Review. J Assoc Nurses AIDS Care 2015; 28:199-215. [PMID: 26825458 DOI: 10.1016/j.jana.2015.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/16/2015] [Indexed: 11/22/2022]
Abstract
People who use drugs are at increased risk for HIV acquisition, poor engagement in health care, and late screening for HIV with advanced HIV at diagnosis and increased HIV-related morbidity, mortality, and health care costs. This systematic review evaluates current evidence about the effectiveness and feasibility of implementing HIV testing in U.S. substance use treatment programs. The literature search identified 535 articles. Full text review was limited to articles that explicitly addressed strategies to implement HIV testing in substance use programs: 17 met criteria and were included in the review; nine used quantitative, qualitative, or mixed-method designs to describe or quantify HIV testing rates, acceptance by clients and staff, and cost-effectiveness; eight organization surveys described barriers and facilitators to testing implementation. The evidence supported the effectiveness and feasibility of rapid, routine, and streamlined HIV testing in substance use treatment programs. Primary challenges included organizational support and sustainable funding.
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Sloboda Z. "Read My Lips"--Empty Words: The Semantics of Institutionalized Flawing. Subst Use Misuse 2015; 50:981-6. [PMID: 25774782 DOI: 10.3109/10826084.2015.1007690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Zili Sloboda
- a Applied Prevention Science, Inc. , Ontario , Ohio , USA
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Bachhuber MA, Southern WN, Cunningham CO. Profiting and providing less care: comprehensive services at for-profit, nonprofit, and public opioid treatment programs in the United States. Med Care 2014; 52:428-34. [PMID: 24638120 PMCID: PMC4277871 DOI: 10.1097/mlr.0000000000000121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Opioid use disorders are frequently associated with medical and psychiatric comorbidities (eg, HIV infection and depression), as well as social problems (eg, lack of health insurance). Comprehensive services addressing these conditions improve outcomes. OBJECTIVE To compare the proportion of for-profit, nonprofit, and public opioid treatment programs offering comprehensive services, which are not mandated by government regulations. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis of opioid treatment programs offering outpatient care in the United States (n=1036). MAIN OUTCOME MEASURE Self-reported offering of communicable disease (HIV, sexually transmitted infections, and viral hepatitis) testing, psychiatric services (screening, assessment and diagnostic evaluation, and pharmacotherapy), and social services support (assistance in applying for programs such as Medicaid). Mixed-effects logistic regression models were developed to adjust for several county-level factors. RESULTS Of opioid treatment programs, 58.0% were for profit, 33.5% were nonprofit, and 8.5% were public. Nonprofit programs were more likely than for-profit programs to offer testing for all communicable diseases [adjusted odds ratios (AOR), 1.7; 95% confidence interval (CI), 1.2, 2.5], all psychiatric services (AOR, 8.0; 95% CI, 4.9, 13.1), and social services support (AOR, 3.3; 95% CI, 2.3, 4.8). Public programs were also more likely than for-profit programs to offer communicable disease testing (AOR, 6.4; 95% CI, 3.5, 11.7), all psychiatric services (AOR, 25.8; 95% CI, 12.6, 52.5), and social services support (AOR, 2.4; 95% CI, 1.4, 4.3). CONCLUSIONS For-profit programs were significantly less likely than nonprofit and public programs to offer comprehensive services. Interventions to increase the offering of comprehensive services are needed, particularly among for-profit programs.
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Affiliation(s)
- Marcus A. Bachhuber
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
- Robert Wood Johnson Foundation Clinical Scholars Program at the University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - William N. Southern
- Division of Hospital Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Chinazo O. Cunningham
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, 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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Factors Associated With Use of ASAM Criteria and Service Provision in a National Sample of Outpatient Substance Abuse Treatment Units. J Addict Med 2013; 3:139-50. [PMID: 21769010 DOI: 10.1097/adm.0b013e31818ebb6f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Standardized patient placement criteria such as those developed by the American Society of Addiction Medicine are increasingly common in substance abuse treatment, but it is unclear what factors are associated with their use or with treatment units' provision of related services. This study examined these issues in the context of a national survey of outpatient substance abuse treatment units. Regressions using 2005 data revealed that both public and private managed care were associated with a greater likelihood of using American Society of Addiction Medicine criteria to develop client treatment plans. However, only public managed care was associated with a greater likelihood of offering more resource-intensive services. Associations between client population severity and resource-intensive service provision were sparse but positive.
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Lindley LC, Mark BA, Daniel Lee SY, Domino M, Song MK, Jacobson Vann J. Factors associated with the provision of hospice care for children. J Pain Symptom Manage 2013; 45:701-11. [PMID: 22921174 PMCID: PMC4019999 DOI: 10.1016/j.jpainsymman.2012.03.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 03/13/2012] [Accepted: 03/22/2012] [Indexed: 11/19/2022]
Abstract
CONTEXT Children at the end of life often lack access to hospice care at home or in a dedicated facility. The factors that may influence whether or not hospices provide pediatric care are relatively unknown. OBJECTIVES The purpose of this study was to understand the institutional and resource factors associated with provision of pediatric hospice care. METHODS This study used a retrospective, longitudinal design. The main data source was the 2002 to 2008 California State Hospice Utilization Data Files. The sample size was 311 hospices or 1368 hospice observations over seven years. Drawing on institutional and resource dependence theory, this study used generalized estimating equations to examine the institutional and resource factors associated with provision of pediatric hospice care. Interaction terms were included to assess the moderating effect of resource factors on the relationship between institutional factors and provision of care. RESULTS Membership in professional groups increased the probability (19%) of offering hospice services for children. Small- (-22%) and medium-sized (-11%) hospices were less likely to provide care for children. The probability of providing pediatric hospice care diminished (-23%) when competition increased in the prior year. Additionally, small size attenuated the accreditation-provision relationship and medium size magnified the membership-provision relationship. CONCLUSION Professional membership may promote conformity to industry standards of pediatric care and remove the unknowns of providing hospice care for children. Hospices, especially medium-sized hospices, interested in developing or expanding care for children may benefit by identifying a pediatric champion to join a professional group.
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Affiliation(s)
- Lisa C Lindley
- College of Nursing, University of Tennessee, Knoxville, TN 37996, USA.
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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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Guerrero EG. Organizational characteristics that foster early adoption of cultural and linguistic competence in outpatient substance abuse treatment in the United States. EVALUATION AND PROGRAM PLANNING 2012; 35:9-15. [PMID: 21949458 PMCID: PMC3176458 DOI: 10.1016/j.evalprogplan.2011.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Recent years have seen an increased interest in developing culturally and linguistically responsive systems of care in substance abuse treatment in the United States. This study examines the extent to which external and internal organizational pressures contributed to the degree of adoption of culturally and linguistically responsive practices in the nation's outpatient substance abuse treatment system early in the period of development of this system of care. Findings show that a higher degree of adoption of culturally competent practices was most likely in treatment programs with high dependence on external funding and regulation. Internally, programs with a larger number of professionals were associated with the lowest degree of adoption, while managers' cultural sensitivity contributed significantly to a high degree of adoption of these responsive practices. Considering the passage of recent legislation enforcing the use of cultural and linguistic competence in health care, implications of these baseline findings on early adoption patterns are discussed for future research and health care policy evaluation.
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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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12
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Holder HD. Substance Abuse Treatment as Part of a Total System of Community Response. NORDIC STUDIES ON ALCOHOL AND DRUGS 2010. [DOI: 10.1177/145507251002700601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Treatment of substance abuse in many communities throughout the world is often separated from other social and health responses to alcohol and other drug harms. Current responses exist like silos within the community. In addition, there are population-level policy approaches concerning the distribution and sales of alcohol and the restrictions on and enforcement of illegal drugs which also exist only loosely connected to treatment (or prevention for that matter). A systems approach to substance abuse and related problems is described in which evaluation addresses both clinical patient needs as well as overall performance demonstration. Effectiveness can be measured both by population level reductions in use and associated problems, a second level of accountability, i.e., documented reductions in problems of at risk groups or clients whose drinking or drug use patterns place them at risk for future problems, and a third level of response for individuals with clearly identified substance-related problems, which requires intervention at the person level (typically called treatment). Thus within such a comprehensive system, treatment and prevention would lose their separate identities and would be employed according to local needs and the potential to achieve desired effects where the overall system is required to select the mix of strategies which maximizes effectiveness at each level.
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Affiliation(s)
- Harold D. Holder
- Prevention Research Center Pacific Institute for Research and Evaluation Berkeley, California, USA
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Guerrero EG, Cederbaum JA. Adoption and utilization of sexually transmitted infections testing in outpatient substance abuse treatment facilities serving high risk populations in the U.S. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 22:41-8. [PMID: 20970314 DOI: 10.1016/j.drugpo.2010.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 07/29/2010] [Accepted: 09/09/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although adoption and utilization of sexually transmitted infection (STI) testing is a cost effective public health intervention, it is inconsistently offered or referred out for by outpatient substance abuse treatment (OSAT) programs where at-risk racial/ethnic and sexual minorities receive services. METHODS We explored the organizational adoption and client utilization of STI testing using a nationally representative sample of OSAT facilities in the U.S. in 2005 (N=566). Data missing at random was imputed and the resulting database was analysed using multivariate Tobit and logistic regressions. RESULTS The analyses suggest that private non-profit facilities, which are the largest providers of OSAT treatment are less likely than public facilities to offer STI testing or to report adequate client utilization rates. Higher utilization was instead associated with professionally accredited facilities, and with facilities whose majority of clients were Latino/a, reported a history of treatment, stayed in treatment longer, or received case management. CONCLUSION While OSAT facilities are poised to be primary intervention points for diagnosis and treatment of STIs, only a segment of these facilities provide this preventive practice or manage to refer clients out. As such, U.S. health care policy should ensure the adoption and comprehensive utilization, particularly among high risk clients, of this cost-effective prevention strategy in OSAT admission protocols.
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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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Guerrero EG. Managerial capacity and adoption of culturally competent practices in outpatient substance abuse treatment organizations. J Subst Abuse Treat 2010; 39:329-39. [PMID: 20727703 DOI: 10.1016/j.jsat.2010.07.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 07/05/2010] [Accepted: 07/13/2010] [Indexed: 10/19/2022]
Abstract
The field of cultural competence is shifting its primary emphasis from enhancement of counselors' skills to management, organizational policy, and processes of care. This study examined managers' characteristics associated with adoption of culturally competent practices in the nation's outpatient substance abuse treatment field. Findings indicate that in 1995, supervisors' cultural sensitivity played the most significant role in adopting practices, such as matching counselors and clients based on race and offering bilingual services. Staff's exposure to cross-cultural training increased from 1995 to 2005. In this period, positive associations were found between managers' cultural sensitivity and connection with the community and staff receiving cross-cultural training and the number of training hours completed. However, exposure to and investment in this training were negatively correlated with managers' formal education. Health administration policy should consider the extent to which the decision makers' education, community involvement, and cultural sensitivity contribute to building culturally responsive systems of care.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, Social Work Center, Los Angeles, CA 90089-0411, USA.
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15
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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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Alexander JA, Wells R, Jiang L, Pollack H. Organizational determinants of boundary spanning activity in outpatient substance abuse treatment programmes. Health Serv Manage Res 2008; 21:168-77. [PMID: 18647945 DOI: 10.1258/hsmr.2007.007028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Substance abuse treatment programmes depend on boundary spanning to identify opportunities and threats, and represent their interests to stakeholders such as licensing entities and regulators. This study sought to identify director, client, unit and market factors associated with active director boundary spanning. METHODS Using data from the 1995, 1999-2000 and 2005 waves of a national survey of outpatient substance abuse treatment units, generalized estimating equation regression models tested associations between predictors and five aspects of directors' self-reported boundary spanning. RESULTS Directors licensed as substance abuse treatment counsellors spent more time than average consulting with other treatment providers and making presentations in the community. Older directors spent less time consulting with other treatment providers, making community presentations and liaisoning with monitoring organizations. The few associations between client unemployment and director boundary spanning were positive; the two associations between the percentage of clients who were African-American and boundary spanning were negative. Private ownership and being based in larger organizations were negatively associated with some types of boundary spanning. Perceived competition for public support was positively associated with all measures of boundary spanning. CONCLUSION Directors of treatment organizations may improve treatment practices and political leverage by directly, but selectively, interacting with key external stakeholders.
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Affiliation(s)
- Jeffrey A Alexander
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA.
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Chriqui JF, Terry-McElrath Y, McBride DC, Eidson SS. State policies matter: the case of outpatient drug treatment program practices. J Subst Abuse Treat 2007; 35:13-21. [PMID: 17936550 DOI: 10.1016/j.jsat.2007.08.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 07/02/2007] [Accepted: 08/08/2007] [Indexed: 11/27/2022]
Abstract
This study examined relationships between state policy requirements governing outpatient substance abuse treatment services and reported outpatient treatment program practices. State policies effective as of February 1, 2003, and February 1, 2004, were collected and analyzed via primary legal research; data were validated by state officials (88% response rate; >90% validation rate). Treatment practice data were obtained from the National Survey of Substance Abuse Treatment Services for the years 2003 and 2004. Multivariate analyses clustered by state were conducted, controlling for state, program, and state-aggregated client admission characteristics. Results indicated that treatment programs located in states with requirements for comprehensive substance abuse assessment, family counseling, substance abuse and infectious disease/sexually transmitted disease testing services, HIV/AIDS education, and aftercare services had significantly higher odds of offering such services (p values ranging from < .05 to < .001). This study presents new information regarding the potential role that state policy context may play in understanding treatment program practices.
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Affiliation(s)
- Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL 60608, USA.
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