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St Vil NM, Haley DF, Montgomery B, Williams M, Watson L, Zhang S, Wingood GM. An Exploration of Geographic Access to Substance Use Treatment Programs and Violence Against Women. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241246000. [PMID: 38605583 DOI: 10.1177/08862605241246000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Violence against women (VAW) is a significant public health and human rights issue, with an estimated 736 million women globally experiencing VAW. Consistent evidence demonstrates that substance use is associated with VAW and that participation in substance use treatment programs is associated with reduction in substance use-related violence. While evidence demonstrates the ability to address VAW through substance use treatment programs, less attention has been paid to geographic access to substance use programs. If these programs are geographically inaccessible, particularly to marginalized populations, many people will not get the help they need. This study seeks to explore the relationship between geographic access to substance use treatment programs on VAW. Using data from the HIV Prevention Trials Network (HPTN) 064 study, longitudinal multilevel models were used to assess the relationship between neighborhood-level social determinants, with a specific focus on geographic access to Substance Abuse and Mental Health Services Administration (SAMHSA) certified drug and alcohol treatment programs and VAW. The study included 1910 women, ages 18 to 44, living in select geographic areas with high-ranked prevalence of HIV and poverty. The findings of this study indicate that among women who reside in census tracts with high prevalence rates of HIV: (1) substance use increases VAW; (2) VAW decreases as geographic access to SAMHSA-certified drug and alcohol treatment facilities increases; and (3) when looking at specific types of VAW, emotional and physical abuse decreases as geographic access to substance use treatment increases. Policies and programs to increase access to substance use treatment should be explored and evaluated, and more programs are needed that address the intersectionality of substance use and VAW.
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Affiliation(s)
| | | | | | | | | | - Shuaiqi Zhang
- Statistical Center for HIV/AIDS Research and Prevention, Seattle, WA, USA
| | - Gina M Wingood
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
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Congia P, Carta E. Spatial and Environmental Correlates of Prevalence of Treatment for Substance Use Disorders, Retention, and SUD Services Utilization in South Sardinia. Psychiatr Q 2024; 95:121-135. [PMID: 38153599 DOI: 10.1007/s11126-023-10065-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 12/29/2023]
Abstract
This study explored the economic, social, and spatial correlates of treatment prevalence, retention, and service utilization for substance use disorder (SUD) in South Sardinia. Data from 1,667 patients with an ICD-10 diagnosis of SUD were extracted from the medical records of individuals assisted by three public addiction services in 2019. We used a spatial autoregressive model, a parametric proportional hazard model, and Poisson regression to examine the associations of spatial factors and residents' socioeconomic status with the prevalence of treatment at the census block level, treatment retention, and SUD service utilization at the individual level. The prevalence was higher among residents of areas closer to competent treatment centers, with the worst building conservation status, a lower percentage of high school and university graduates, and a higher percentage of unemployed, divorced, separated, or widowed residents. Men who were older at the time of their first treatment access; primary users of cocaine, cannabis, and alcohol; had higher education level; and who lived far from competent treatment centers and closer to drug trafficking centers interrupted their treatment earlier. Primary heroin users experienced more SUD treatment encounters. Living in economically and socially disadvantaged areas and near treatment facilities was associated with a higher prevalence, whereas living near drug-dealing centers and far from competent treatment centers was associated with a decrease in treatment retention.
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Affiliation(s)
- Pierpaolo Congia
- Department of Mental Health and Addiction, SER.D.2, ASSL Cagliari, Via Liguria, Cagliari, Italy.
| | - Eleonora Carta
- Department of Mental Health and Addiction, SER.D.2, ASSL Cagliari, Via Liguria, Cagliari, Italy
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Adams DR. Availability and Accessibility of Mental Health Services for Youth: A Descriptive Survey of Safety-Net Health Centers During the COVID-19 Pandemic. Community Ment Health J 2024; 60:88-97. [PMID: 37097491 PMCID: PMC10127985 DOI: 10.1007/s10597-023-01127-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/05/2023] [Indexed: 04/26/2023]
Abstract
Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) are critical access points for families with adolescents needing mental health care, especially those enrolled in Medicaid. However, barriers exist which may reduce their accessibility. This study aims to describe the availability and accessibility of outpatient mental health services for children and adolescents at safety-net health centers in a large metropolitan county. Approximately one year after the COVID-19 pandemic began in the U.S., a comprehensive sample of 117 CMHCs and 117 FQHCs were called and administered a 5-minute survey. Approximately 10% of health centers were closed, and 20% (28.2% of FQHCs and 7.7% of CMHCs) reported not offering outpatient mental health services. Despite CMHCs having 5.4 more clinicians on staff on average, reported wait times were longer at CMHCs than FQHCs. These findings indicate that online directories intended to be a comprehensive and accessible resource, such as the SAMHSA Treatment Locator, are often inaccurate or out-of-date.
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Affiliation(s)
- Danielle R Adams
- Center for Mental Health Services Research, Brown School of Social Work and Public Health, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, USA.
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Hooley C, Salvo D, Brown DS, Brookman-Frazee L, Lau AS, Brownson RC, Fowler PJ, Innes-Gomberg D, Proctor EK. Scaling-up Child and Youth Mental Health Services: Assessing Coverage of a County-Wide Prevention and Early Intervention Initiative During One Fiscal Year. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:17-32. [PMID: 36289142 PMCID: PMC9977707 DOI: 10.1007/s10488-022-01220-3] [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: 08/23/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE In the U.S., the percentage of youth in need of evidence-based mental health practices (EBPs) who receive them (i.e., coverage rate) is low. We know little about what influences coverage rates. In 2010, the Los Angeles County Department of Mental Health (LACDMH) launched a reimbursement-driven implementation of multiple EBPs in youth mental health care. This study examines two questions: (1) What was the coverage rate of EBPs delivered three years following initial implementation? (2) What factors are associated with the coverage rates? METHODS To assess coverage rates of publicly insured youth, we used LACDMH administrative claims data from July 1, 2013 to June 30, 2014 and estimates of the size of the targeted eligible youth population from the 2014 American Community Survey (ACS). The unit of analysis was clinic service areas (n = 254). We used Geographic Information Systems and an OLS regression to assess community and clinic characteristics related to coverage. RESULTS The county coverage rate was estimated at 17%, much higher than national estimates. The proportion of ethnic minorities, individuals who are foreign-born, adults with a college degree within a geographic area were negatively associated with clinic service area coverage rates. Having more therapists who speak a language other than English, providing care outside of clinics, and higher proportion of households without a car were associated with higher coverage rates. CONCLUSION Heterogeneity in municipal mental health record type and availability makes it difficult to compare the LACDMH coverage rate with other efforts. However, the LACDMH initiative has higher coverage than published national rates. Having bilingual therapists and providing services outside the clinic was associated with higher coverage. Even with higher coverage, inequities persisted.
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Affiliation(s)
- Cole Hooley
- Brigham Young University, 84602, Provo, UT, USA.
| | - Deborah Salvo
- Department of Kinesiology and Health Education, The University of Texas at Austin, Bellmont Hall 822J, 2109 San Jacinto Blvd, Stp D3700, 78712, Austin, TX, United States
| | - Derek S Brown
- Brown School, Washington University in St. Louis, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive #0812, 92093, La Jolla, CA, USA
| | - Anna S Lau
- UCLA Department of Psychology, 502 Portola Plaza, 90095, Los Angeles, CA, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School, Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University in St. Louis, Washington University School of Medicine, Washington University in St. Louis CDC U48DP006395, the Foundation for Barnes-Jewish Hospital, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Patrick J Fowler
- Brown School, Washington University in St. Louis, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Debbie Innes-Gomberg
- Los Angeles County Department of Mental Health, 510 S. Vermont Avenue, 17th Floor, 90020, Los Angeles, CA, USA
| | - Enola K Proctor
- Brown School, Washington University in St. Louis, 1 Brookings Drive, 63130, St. Louis, MO, 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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Mowbray O, Purser G, Tennant E, Paseda O. Substance use related violent deaths among racial/ethnic groups in the United States. Addict Behav 2022; 133:107384. [PMID: 35671554 DOI: 10.1016/j.addbeh.2022.107384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/17/2022] [Accepted: 05/30/2022] [Indexed: 11/17/2022]
Abstract
While prior research highlights the overlap of substance use and violent death, few examine this overlap among different racial/ethnic groups or how patterns change over time. This study examines how substance use related deaths differ by racial/ethnic groups in the United States. We use data from the National Violent Death Reporting System (NVDRS), which includes violent deaths from 43 states in the U.S., collected for the decade between 2009 and 2019 (N = 226,459). Fixed-effects multivariate models examined whether race/ethnicity was associated with substance use-related death over time, controlling for additional demographic and clinical factors. Results showed a significantly larger rate of increase over time for African American and Hispanic (any race) persons compared to White non-Hispanic persons for most types of substance use-related deaths. While current rates of substance use may show little variability between African American, Hispanic, and White non-Hispanic individuals, this research suggests that the consequences for substance use, including death, may be disproportional.
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Affiliation(s)
- Orion Mowbray
- University of Georgia, School of Social Work, 279 Williams St, Athens, GA 30602, USA.
| | - Greg Purser
- Louisiana State University, Department of Social Work, Huey P Long Field House, APT 311, Baton Rouge, LA 70802, USA
| | - Elena Tennant
- Louisiana State University, Department of Social Work, Huey P Long Field House, APT 311, Baton Rouge, LA 70802, USA
| | - Oluwayomi Paseda
- University of Georgia, School of Social Work, 279 Williams St, Athens, GA 30602, USA
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Abell-Hart K, Rashidian S, Teng D, Rosenthal RN, Wang F. Where Opioid Overdose Patients Live Far From Treatment: Geospatial Analysis of Underserved Populations in New York State. JMIR Public Health Surveill 2022; 8:e32133. [PMID: 35412467 PMCID: PMC9044159 DOI: 10.2196/32133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/08/2021] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Opioid addiction and overdose have a large burden of disease and mortality in New York State (NYS). The medication naloxone can reverse an overdose, and buprenorphine can treat opioid use disorder. Efforts to increase the accessibility of both medications include a naloxone standing order and a waiver program for prescribing buprenorphine outside a licensed drug treatment program. However, only a slim majority of NYS pharmacies are listed as participating in the naloxone standing order, and less than 7% of prescribers in NYS have a buprenorphine waiver. Therefore, there is a significant opportunity to increase access. OBJECTIVE Identifying the geographic regions of NYS that are farthest from resources can help target interventions to improve access to naloxone and buprenorphine. To maximize the efficiency of such efforts, we also sought to determine where these underserved regions overlap with the largest numbers of actual patients who have experienced opioid overdose. METHODS We used address data to assess the spatial distribution of naloxone pharmacies and buprenorphine prescribers. Using the home addresses of patients who had an opioid overdose, we identified geographic locations of resource deficits. We report findings at the high spatial granularity of census tracts, with some neighboring census tracts merged to preserve privacy. RESULTS We identified several hot spots, where many patients live far from the nearest resource of each type. The highest density of patients in areas far from naloxone pharmacies was found in eastern Broome county. For areas far from buprenorphine prescribers, we identified subregions of Oswego county and Wayne county as having a high number of potentially underserved patients. CONCLUSIONS Although NYS is home to thousands of naloxone pharmacies and potential buprenorphine prescribers, access is not uniform. Spatial analysis revealed census tract areas that are far from resources, yet contain the residences of many patients who have experienced opioid overdose. Our findings have implications for public health decision support in NYS. Our methods for privacy can also be applied to other spatial supply-demand problems involving sensitive data.
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Affiliation(s)
- Kayley Abell-Hart
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, United States
| | - Sina Rashidian
- Department of Computer Science, School of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY, United States
| | - Dejun Teng
- Department of Computer Science, School of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY, United States
| | - Richard N Rosenthal
- Department of Psychiatry, Stony Brook Medicine, Stony Brook, NY, United States
| | - Fusheng Wang
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, United States
- Department of Computer Science, School of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY, United States
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Hyder A, Lee J, Dundon A, Southerland LT, All D, Hammond G, Miller HJ. Opioid Treatment Deserts: Concept development and application in a US Midwestern urban county. PLoS One 2021; 16:e0250324. [PMID: 33979342 PMCID: PMC8115812 DOI: 10.1371/journal.pone.0250324] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/05/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives An Opioid Treatment Desert is an area with limited accessibility to medication-assisted treatment and recovery facilities for Opioid Use Disorder. We explored the concept of Opioid Treatment Deserts including racial differences in potential spatial accessibility and applied it to one Midwestern urban county using high resolution spatiotemporal data. Methods We obtained individual-level data from one Emergency Medical Services (EMS) agency (Columbus Fire Department) in Franklin County, Ohio. Opioid overdose events were based on EMS runs where naloxone was administered from 1/1/2013 to 12/31/2017. Potential spatial accessibility was measured as the time (in minutes) it would take an individual, who may decide to seek treatment after an opioid overdose, to travel from where they had the overdose event, which was a proxy measure of their residential location, to the nearest opioid use disorder (OUD) treatment provider that provided medically-assisted treatment (MAT). We estimated accessibility measures overall, by race and by four types of treatment providers (any type of MAT for OUD, Buprenorphine, Methadone, or Naltrexone). Areas were classified as an Opioid Treatment Desert if the estimate travel time to treatment provider (any type of MAT for OUD) was greater than a given threshold. We performed sensitivity analysis using a range of threshold values based on multiple modes of transportation (car and public transit) and using only EMS runs to home/residential location types. Results A total of 6,929 geocoded opioid overdose events based on data from EMS agencies were used in the final analysis. Most events occurred among 26–35 years old (34%), identified as White adults (56%) and male (62%). Median travel times and interquartile range (IQR) to closest treatment provider by car and public transit was 2 minutes (IQR: 3 minutes) and 17 minutes (IQR: 17 minutes), respectively. Several neighborhoods in the study area had limited accessibility to OUD treatment facilities and were classified as Opioid Treatment Deserts. Travel time by public transit for most treatment provider types and by car for Methadone-based treatment was significantly different between individuals who were identified as Black adults and White adults based on their race. Conclusions Disparities in access to opioid treatment exist at the sub-county level in specific neighborhoods and across racial groups in Columbus, Ohio and can be quantified and visualized using local public safety data (e.g., EMS runs). Identification of Opioid Treatment Deserts can aid multiple stakeholders better plan and allocate resources for more equitable access to MAT for OUD and, therefore, reduce the burden of the opioid epidemic while making better use of real-time public safety data to address a public health epidemic that has turned into a public safety crisis.
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Affiliation(s)
- Ayaz Hyder
- Division of Environmental Health, College of Public Health, The Ohio State University, Columbus, OH, United States of America
- Translational Data Analytics Institute, The Ohio State University, Columbus, OH, United States of America
- * E-mail:
| | - Jinhyung Lee
- Department of Geography and Environment, Faculty of Social Science, Western University, Social Science Centre, London, ON, Canada
| | - Ashley Dundon
- Division of Environmental Health, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Lauren T. Southerland
- Department of Emergency Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - David All
- Founder and CEO, Mount Ethos, Seattle, WA, United States of America
| | - Gretchen Hammond
- College of Social Work, The Ohio State University, Columbus, OH, United States of America
| | - Harvey J. Miller
- Center for Urban Regional Analysis, The Ohio State University, Columbus, OH, United States of America
- Department of Geography, The Ohio State University, Columbus, OH, United States of America
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Rosales R, Calvo R. The Affordable Care Act: policy predictors of integrated care between Hispanic-serving and mainstream mental health organizations. BMC Health Serv Res 2021; 21:186. [PMID: 33639952 PMCID: PMC7916277 DOI: 10.1186/s12913-021-06198-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 02/21/2021] [Indexed: 12/02/2022] Open
Abstract
Background The Patient Protection and Affordable Care Act increased funding for integrated care to improve access to quality health care among underserved populations. There is evidence that integrated care decreases inequities in access and quality of mental health care among Hispanic clients. Increasing integrated care at Hispanic-Serving Organizations may help to eliminate mental health service disparities among Hispanic clients. Method Using organizational responses from the 2014 and 2016 waves of the National Mental Health Service survey, this study conducted multivariate logistic analyses to assess whether the ACA policies related to integrated care increased the provision of integrated addictions treatment and primary care at mental health Hispanic-Serving Organizations, relative to Mainstream Organizations. Results Findings showed that Hispanic-Serving Organizations (54.4%) were less likely to provide integrated health services than Mainstream Organizations (59.1%) after the ACA. However, federal funding to help organizations transition into integrated care services (AOR = 1.74, p = 0.01) and accepting Medicaid payments (AOR = 1.59, p = 0.01) increased the provision of integrated care services at Hispanic-Serving Organizations over time. Conclusions Health care policies that increase funding to adopt integrated health services at community Hispanic-Serving Organizations may help decrease inequities in mental health access for Hispanics in the United States.
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Affiliation(s)
- Robert Rosales
- Department of Behavioral & Social Sciences, Center for Alcohol and Addictions Studies, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI, 02903, USA.
| | - Rocío Calvo
- Boston College, School of Social Work, McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
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Daly M, Gargano LM. Factors Associated with Substance Use Disorder Treatment Completion, Rhode Island, USA, 2018. Subst Use Misuse 2021; 56:793-800. [PMID: 33729105 DOI: 10.1080/10826084.2021.1899222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The successful retention of individuals with substance use disorders in treatment remains a challenge but is an important indicator of positive post-treatment outcomes. The aim of this study is to advance understanding of pre-admission factors associated with substance use treatment completion in Rhode Island. METHODS Data for this longitudinal analysis are from the RI Behavioral Health On-Line Database (RI-BHOLD). The primary outcome of interest was substance use treatment completion defined as any planned discharge from treatment, including transfers to other facilities. Associations were assessed using generalized estimating equations (GEE) to account for the potential of repeated measures for the same individuals. RESULTS Among the 7,351 clients discharged from a substance use treatment program in RI in 2018, the treatment completion rate was 58.1%. There was a positive relationship between the frequency of attendance of voluntary self-help groups and odds of treatment completion. Treatment completion rates were lower among those who reported use of opioids (AOR: 0.59; 95% CI: 0.52-0.66) and other drugs (AOR: 0.52; 95% CI: 0.44-0.62), compared to alcohol and for those with co-occurring mental health conditions (AOR: 0.85; 95% CI: 0.76-0.94). CONCLUSIONS This study highlights the importance of social connectedness in substance use disorder treatment completion. Future research is needed to identify the characteristics of persons who are most likely to benefit from self-help groups and the optimal combination of treatment participation and attendance of self-help groups across a spectrum of disorder severity and community resources.
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Affiliation(s)
- Mackenzie Daly
- Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, Cranston, Rhode Island, USA
| | - Lisa M Gargano
- Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, Cranston, Rhode Island, USA
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Smith-East M, Neff DF. Mental Health Care Access Using Geographic Information Systems: An Integrative Review. Issues Ment Health Nurs 2020; 41:113-121. [PMID: 31661647 DOI: 10.1080/01612840.2019.1646363] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A decade after the Mental Health Parity and Addiction Equity Act was implemented to ensure access to mental health and substance abuse services for U.S. citizens, accessing mental health care still is problematic for many needing services. More than 123 million Americans reside in federally-designated Mental Health Professional Shortage Areas (MHPSA) compared to 84 million living in similarly-designated primary care shortage areas and 62 million in dental health shortage areas. Health professional shortage areas are geographic areas that have a shortage of primary medical, dental, or mental health providers. Geographic Information Systems (GIS) with spatial analysis approaches provide tools to understand the ever-changing distribution of health care, outcomes, and delivery to improve care. The aim of this integrative review is to describe and synthesize the literature on GIS approaches to improve access to mental health care services. GIS Bibliography, PubMed, CINAHL, PsycINFO, Academic Search Premier, Social Sciences Citation Index, and Oalster were searched for articles between January 1, 1998 and January 1, 2018 that met established inclusion/exclusion criteria. Among the 138 articles reviewed, 18 met criteria and were included in the review. GIS approaches to improve access to mental health care can be categorized as (1) type of care (integrated, community), (2) contributions to access (distance, time, cost, perception of traveling, inequalities), and (3) the utilization of services. Results from the literature suggest closer examination of measures used to assess geographic variations in accessibility is needed for ultimately improving quality of care for people in MHPSA.
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Affiliation(s)
- Marie Smith-East
- College of Nursing, University of Central Florida, Orlando, Florida, USA
| | - Donna Felber Neff
- College of Nursing, University of Central Florida, Orlando, Florida, USA
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Chung Y, Bagheri N, Salinas-Perez JA, Smurthwaite K, Walsh E, Furst M, Rosenberg S, Salvador-Carulla L. Role of visual analytics in supporting mental healthcare systems research and policy: A systematic scoping review. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT 2020. [DOI: 10.1016/j.ijinfomgt.2019.04.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Van Keer RL, Fernandez SM, Bilsen J. Intercultural mediators in Belgian hospitals: Demographic and professional characteristics and work experiences. PATIENT EDUCATION AND COUNSELING 2020; 103:165-172. [PMID: 31349964 DOI: 10.1016/j.pec.2019.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the 1) socio-demographic characteristics, 2) working environment, 3) tasks and responsibilities and 4) work experiences of intercultural mediators (IMs) working in Belgian hospitals. METHODS Cross-sectional quantitative survey among all IMs working in Flemish and Brussels hospitals (n = 66). Data were descriptively analyzed. Meaningful associations between variables were also studied. RESULTS Most IMs are young women from first- and second-generation migrant groups with different levels of education. They work under different superiors and most IMs are not employed full-time. They work mainly with patients from their own ethnic group. Mostly they intervene directly in daily intercultural communication, as per their official task description, but they also perform other tasks, such as offering support to patients/families/staff/management. IMs would prefer more of the tasks they perform to be formalized. Furthermore, they want to have policy-making responsibilities. IMs have positive and negative work experiences, e.g. working overtime. CONCLUSIONS IMs' socio-demographic characteristics (ethnic origin - sex - education) and official task description is only adapted to needs in the workplace to a limited extent. Furthermore, intercultural mediation is poorly integrated into hospitals' organizational structure. PRACTICE IMPLICATIONS Different measures are needed, including tailored education and offering IMs enough organizational support and policy responsibilities.
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Affiliation(s)
- Rose-Lima Van Keer
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103 1090 Brussel, Brussels, Belgium.
| | - Sarah Machado Fernandez
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103 1090 Brussel, Brussels, Belgium.
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103 1090 Brussel, Brussels, Belgium.
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Cyr ME, Etchin AG, Guthrie BJ, Benneyan JC. Access to specialty healthcare in urban versus rural US populations: a systematic literature review. BMC Health Serv Res 2019; 19:974. [PMID: 31852493 PMCID: PMC6921587 DOI: 10.1186/s12913-019-4815-5] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 12/05/2019] [Indexed: 11/25/2022] Open
Abstract
Background Access to healthcare is a poorly defined construct, with insufficient understanding of differences in facilitators and barriers between US urban versus rural specialty care. We summarize recent literature and expand upon a prior conceptual access framework, adapted here specifically to urban and rural specialty care. Methods A systematic review was conducted of literature within the CINAHL, Medline, PubMed, PsycInfo, and ProQuest Social Sciences databases published between January 2013 and August 2018. Search terms targeted peer-reviewed academic publications pertinent to access to US urban or rural specialty healthcare. Exclusion criteria produced 67 articles. Findings were organized into an existing ten-dimension care access conceptual framework where possible, with additional topics grouped thematically into supplemental dimensions. Results Despite geographic and demographic differences, many access facilitators and barriers were common to both populations; only three dimensions did not contain literature addressing both urban and rural populations. The most commonly represented dimensions were availability and accommodation, appropriateness, and ability to perceive. Four new identified dimensions were: government and insurance policy, health organization and operations influence, stigma, and primary care and specialist influence. Conclusions While findings generally align with a preexisting framework, they also suggest several additional themes important to urban versus rural specialty care access.
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Affiliation(s)
- Melissa E Cyr
- School of Nursing, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - Anna G Etchin
- VA Boston Healthcare System, 150 South Huntington Avenue, Jamaica Plain, MA, 02130, USA
| | - Barbara J Guthrie
- Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - James C Benneyan
- Healthcare Systems Engineering Institute, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA.
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Cultural competence and derivatives in substance use treatment for migrants and ethnic minorities: what’s the problem represented to be? SOCIAL THEORY & HEALTH 2019. [DOI: 10.1057/s41285-019-00113-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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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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Ralston AL, Andrews AR, Hope DA. Fulfilling the promise of mental health technology to reduce public health disparities: Review and research agenda. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/cpsp.12277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abraham AJ, Adams GB, Bradford AC, Bradford WD. County-level access to opioid use disorder medications in medicare Part D (2010-2015). Health Serv Res 2019; 54:390-398. [PMID: 30665272 DOI: 10.1111/1475-6773.13113] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To identify geographic disparities in access to opioid use disorder (OUD) treatment medications and county demographic and economic characteristics associated with access to buprenorphine and oral naltrexone prescribers in Medicare Part D. DATA SOURCES/STUDY SETTING We utilized data from the Medicare Part D Prescription Drug Event Standard Analytic File (2010-2015). STUDY DESIGN/DATA COLLECTION We used logistic regression to examine county-level access to OUD medication prescribers. PRINCIPAL FINDINGS There was a 5.6 percentage point increase in counties with access to an OUD prescriber over the study period. However, in 2015, 60 percent of US counties lacked access to a Medicare Part D buprenorphine prescriber and over 75 percent lacked access to an oral naltrexone prescriber. Increased access to OUD prescribers was largely concentrated in urban counties. Results of logistic regression indicate regional differences and potential racial disparities in access to OUD prescribers. CONCLUSIONS To improve access to buprenorphine and naltrexone treatment for Medicare Part D enrollees, CMS may consider implementing educational and training initiatives focused on OUD treatment, offering training to obtain a buprenorphine waiver at no cost to providers, and sending targeted information to providers in low OUD treatment capacity areas.
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Affiliation(s)
- Amanda J Abraham
- Department of Public Administration and Policy, School of Public and International Affairs, University of Georgia, Athens, Georgia
| | - Grace Bagwell Adams
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
| | - Ashley C Bradford
- School of Public and Environmental Affairs, Indiana University, Bloomington, Indiana
| | - William D Bradford
- Department of Public Administration and Policy, School of Public and International Affairs, University of Georgia, Athens, Georgia
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Jabour SM, Page A, Hall SF, Rodriguez L, Shields WC, Alvanzo AA. Information and Communication Technologies Interest, Access, and Use: Cross-Sectional Survey of a Community Sample of Urban, Predominantly Black Women. J Med Internet Res 2018; 20:e248. [PMID: 30108036 PMCID: PMC6113594 DOI: 10.2196/jmir.9962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/25/2018] [Accepted: 06/18/2018] [Indexed: 11/23/2022] Open
Abstract
Background Information and communication technologies (ICT) offer the potential for delivering health care interventions to low socioeconomic populations who often face barriers in accessing health care. However, most studies on ICT for health education and interventions have been conducted in clinical settings. Objective The aim of this study was to examine access to and use of mobile phones and computers, as well as interest in, using ICT for receipt of behavioral health information among a community sample of urban, predominately black, women with low socioeconomic status. Methods Participants (N=220) were recruited from hair salons and social service centers and completed audio-computer assisted self-interviews. Results The majority of the participants (212/220, 96.3%) reported use of a cell phone at least weekly, of which 89.1% (189/212) used smartphones and 62.3% (137/220) reported computer use at least weekly. Of the women included in the study, 51.9% (107/206) reported using a cell phone and 39.4% (74/188) reported using a computer to access health and/or safety information at least weekly. Approximately half of the women expressed an interest in receiving information about stress management (51%-56%) or alcohol and health (45%-46%) via ICT. Smartphone ownership was associated with younger age (odds ratio [OR] 0.92, 95% CI 0.87-0.97) and employment (OR 5.12, 95% CI 1.05-24.95). Accessing health and safety information weekly by phone was associated with younger age (OR 0.96, 95% CI 0.94-0.99) and inversely associated with higher income (OR 0.42, 95% CI 0.20-0.92). Conclusions Our findings suggest that ICT use, particularly smartphone use, is pervasive among predominantly black women with low socioeconomic status in urban, nonclinical settings. These results show that ICT is a promising modality for delivering health information to this population. Further exploration of the acceptability, feasibility, and effectiveness of using ICT to disseminate behavioral health education and intervention is warranted.
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Affiliation(s)
- Sarah M Jabour
- Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Alexis Page
- Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Seventy F Hall
- School of Social Work, University of Buffalo, Buffalo, NY, United States
| | - Lycinda Rodriguez
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX, United States
| | - Wendy C Shields
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Anika Ah Alvanzo
- Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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Zemore SE, Karriker-Jaffe KJ, Mulia N, Kerr WC, Ehlers CL, Cook WK, Martinez P, Lui C, Greenfield TK. The Future of Research on Alcohol-Related Disparities Across U.S. Racial/Ethnic Groups: A Plan of Attack. J Stud Alcohol Drugs 2018; 79:7-21. [PMID: 29227222 DOI: 10.15288/jsad.2018.79.7] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Research suggests striking disparities in alcohol use, problems, and treatment across racial/ethnic groups in the United States. However, research on alcohol-related disparities affecting racial/ethnic minorities remains in its developmental stages. The current article aims to support future research in this growing field by highlighting some of the most important findings, questions, and approaches, focusing on psychosocial research. METHOD This article advances seven research needs (i.e., questions and topics meriting attention) that we believe are of crucial importance to the field. We draw on the existing literature to illuminate under-explored areas that are highly relevant to health intervention and that complement the field's existing focus. RESULTS Identified research needs include research that (a) better describes disparities in alcohol-related health conditions and their drivers, (b) identifies appropriate screening and brief intervention methods for racial/ethnic minorities, (c) investigates disparities in access to and use of alcohol treatment and support services, (d) examines the comparative efficacy of existing alcohol interventions and develops tailored interventions, (e) explores the impacts of specific alcohol policies across and within racial/ethnic groups, and (f) describes the full spectrum of alcohol-related harms and how and why these may vary across racial/ethnic groups. We also call for (g) continuing research to monitor disparities over time. CONCLUSIONS This article points to specific strategies for describing, explaining, intervening on, and monitoring some of the most substantial alcohol-related disparities. Conclusions outline methods and processes that may be advantageous in addressing these priorities, including the use of longitudinal designs; consideration of life course changes; attention to nontraditional intervention settings; and inclusion of disadvantaged populations in all aspects of research.
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Affiliation(s)
| | | | - Nina Mulia
- Alcohol Research Group, Emeryville, California
| | | | - Cindy L Ehlers
- Department of Neuroscience, The Scripps Research Institute, La Jolla, California
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Abraham AJ, Andrews CM, Yingling ME, Shannon J. Geographic Disparities in Availability of Opioid Use Disorder Treatment for Medicaid Enrollees. Health Serv Res 2017; 53:389-404. [PMID: 28345210 DOI: 10.1111/1475-6773.12686] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine county-level geographic variation in treatment admissions among opioid treatment programs (OTPs) that accept Medicaid in the continental United States. DATA SOURCES/STUDY SETTING Data come from the 2012 National Survey of Substance Abuse Treatment Services. STUDY DESIGN/DATA COLLECTION We used local measures of spatial autocorrelation (LISA) analysis to identify (1) clusters of counties with higher and lower than average rates of opioid use disorders and (2) clusters of counties with higher and lower than average treatment admissions among OTPs that accept Medicaid, adjusting for county population size. PRINCIPAL FINDINGS Our results reveal several clusters of counties with higher than average rates of opioid use disorder (OUD) and lower than average treatment admissions among OTPs that accept Medicaid. These clusters are highly concentrated in the Southeast region of the country and include Arkansas, Kentucky, Louisiana, Mississippi, and Tennessee. CONCLUSIONS Medicaid enrollees in areas in the Southeast have the largest gaps between county-level OUD rates and estimated county-level capacity for treatment, as measured by county-level total treatment admissions among OTPs that accept Medicaid. Policy makers should consider strategies to increase the availability of OTPs with the capacity to serve Medicaid enrollees.
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Affiliation(s)
- Amanda J Abraham
- Department of Public Administration and Policy, School of Public and International Affairs, University of Georgia, Athens, GA
| | - Christina M Andrews
- College of Social Work, University of South Carolina, Hamilton College, Columbia, SC
| | - Marissa E Yingling
- Department of Sociology and Anthropology, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC
| | - Jerry Shannon
- Department of Geography, University of Georgia, Athens, GA
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Wielen LM, Gilchrist EC, Nowels MA, Petterson SM, Rust G, Miller BF. Not Near Enough: Racial and Ethnic Disparities in Access to Nearby Behavioral Health Care and Primary Care. J Health Care Poor Underserved 2017; 26:1032-47. [PMID: 26320931 DOI: 10.1353/hpu.2015.0083] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Racial, ethnic, and geographical health disparities have been widely documented in the United States. However, little attention has been directed towards disparities associated with integrated behavioral health and primary care services. METHODS Access to behavioral health professionals among primary care physicians was examined using multinomial logistic regression analyses with 2010 National Plan and Provider Enumeration System, American Medical Association Physician Masterfile, and American Community Survey data. RESULTS Primary care providers practicing in neighborhoods with higher percentages of African Americans and Hispanics were less likely to have geographically proximate behavioral health professionals. Primary care providers in rural areas were less likely to have geographically proximate behavioral health professionals. CONCLUSION Neighborhood-level factors are associated with access to nearby behavioral health and primary care. Additional behavioral health professionals are needed in racial/ethnic minority neighborhoods and rural areas to provide access to behavioral health services, and to progress toward more integrated primary care.
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Linton SL, Cooper HLF, Kelley ME, Karnes CC, Ross Z, Wolfe ME, Chen YT, Friedman SR, Des Jarlais D, Semaan S, Tempalski B, Sionean C, DiNenno E, Wejnert C, Paz-Bailey G. Associations of place characteristics with HIV and HCV risk behaviors among racial/ethnic groups of people who inject drugs in the United States. Ann Epidemiol 2016; 26:619-630.e2. [PMID: 27576908 DOI: 10.1016/j.annepidem.2016.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 07/18/2016] [Accepted: 07/26/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE Investigate whether characteristics of geographic areas are associated with condomless sex and injection-related risk behavior among racial/ethnic groups of people who inject drugs (PWID) in the United States. METHODS PWID were recruited from 19 metropolitan statistical areas for 2009 National HIV Behavioral Surveillance. Administrative data described ZIP codes, counties, and metropolitan statistical areas where PWID lived. Multilevel models, stratified by racial/ethnic groups, were used to assess relationships of place-based characteristics to condomless sex and injection-related risk behavior (sharing injection equipment). RESULTS Among black PWID, living in the South (vs. Northeast) was associated with injection-related risk behavior (adjusted odds ratio [AOR] = 2.24, 95% confidence interval [CI] = 1.21-4.17; P = .011), and living in counties with higher percentages of unaffordable rental housing was associated with condomless sex (AOR = 1.02, 95% CI = 1.00-1.04; P = .046). Among white PWID, living in ZIP codes with greater access to drug treatment was negatively associated with condomless sex (AOR = 0.93, 95% CI = 0.88-1.00; P = .038). CONCLUSIONS Policies that increase access to affordable housing and drug treatment may make environments more conducive to safe sexual behaviors among black and white PWID. Future research designed to longitudinally explore the association between residence in the south and injection-related risk behavior might identify specific place-based features that sustain patterns of injection-related risk behavior.
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Affiliation(s)
- Sabriya L Linton
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA.
| | - Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Mary E Kelley
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Conny C Karnes
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Zev Ross
- ZevRoss Spatial Analysis, Ithaca, NY
| | - Mary E Wolfe
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Yen-Tyng Chen
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Samuel R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY
| | - Don Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, NY
| | - Salaam Semaan
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Barbara Tempalski
- Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY
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Mauro PM, Furr-Holden CD, Strain EC, Crum RM, Mojtabai R. Classifying substance use disorder treatment facilities with co-located mental health services: A latent class analysis approach. Drug Alcohol Depend 2016; 163:108-15. [PMID: 27106113 PMCID: PMC4880516 DOI: 10.1016/j.drugalcdep.2016.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 03/29/2016] [Accepted: 04/03/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Affordable Care Act calls for increased integration and coordination of behavioral health services, as people with co-occurring disorders (CODs), meeting criteria for both substance use and psychiatric disorders, are overrepresented in treatment samples. Nationwide estimates of mental health (MH) service co-location in substance use disorder (SUD) treatment facilities are needed. We empirically derived a multiple-indicator categorization of services for CODs in SUD treatment facilities. METHODS We used latent class analysis to categorize 14,037 SUD treatment facilities in the United States and territories included in the 2012 National Survey of Substance Abuse Treatment Services. Latent class indicators included MH screening and diagnosis, MH support services, psychiatric medications, groups for CODs, and psychosocial approaches. Multinomial logistic regression compared facility-identified primary focus (i.e., SUD, MH, mix of SUD-MH, and general/other) and other facility characteristics across classes. RESULTS A four-class solution was chosen with the following classes: Comprehensive MH/COD Services (25%), MH without COD Services (25%), MH Screening Services (21%), and Limited MH Services (29%). The former two classes with co-located MH services were less likely to report a SUD-primary focus than the latter classes reporting only MH screening or Limited MH Services. Only the Comprehensive MH/COD Services class also had a high probability of providing special groups for CODs. CONCLUSIONS Approximately half of SUD treatment facilities were in classes with co-located mental health services, but only a quarter provided comprehensive COD services. Future studies should assess differences in patient experiences and treatment outcomes across facilities with and without COD services.
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Affiliation(s)
- Pia M. Mauro
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore MD 21205 USA; Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168 Street, New York NY 10032 USA,Address correspondence to Pia M. Mauro: Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168 Street #R228D, New York NY 10032
| | - C. Debra Furr-Holden
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore MD 21205 USA
| | - Eric C. Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 733 N. Broadway, Baltimore MD 21205 USA
| | - Rosa M. Crum
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore MD 21205 USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore MD 21205 USA
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA.
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Mennis J, Stahler GJ. Racial and Ethnic Disparities in Outpatient Substance Use Disorder Treatment Episode Completion for Different Substances. J Subst Abuse Treat 2016; 63:25-33. [DOI: 10.1016/j.jsat.2015.12.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/30/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022]
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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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Bauer SR, Monuteaux MC, Fleegler EW. Geographic Disparities in Access to Agencies Providing Income-Related Social Services. J Urban Health 2015; 92:853-63. [PMID: 26264235 PMCID: PMC4608945 DOI: 10.1007/s11524-015-9971-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Geographic location is an important factor in understanding disparities in access to health-care and social services. The objective of this cross-sectional study is to evaluate disparities in the geographic distribution of income-related social service agencies relative to populations in need within Boston. Agency locations were obtained from a comprehensive database of social services in Boston. Geographic information systems mapped the spatial relationship of the agencies to the population using point density estimation and was compared to census population data. A multivariate logistic regression was conducted to evaluate factors associated with categories of income-related agency density. Median agency density within census block groups ranged from 0 to 8 agencies per square mile per 100 population below the federal poverty level (FPL). Thirty percent (n = 31,810) of persons living below the FPL have no access to income-related social services within 0.5 miles, and 77 % of persons living below FPL (n = 83,022) have access to 2 or fewer agencies. 27.0 % of Blacks, 30.1 % of Hispanics, and 41.0 % of non-Hispanic Whites with incomes below FPL have zero access. In conclusion, some neighborhoods in Boston with a high concentration of low-income populations have limited access to income-related social service agencies.
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Affiliation(s)
- Scott R Bauer
- University of California School of Medicine, 505 Parnassus Avenue, San Francisco, CA, 94103, USA
| | - Michael C Monuteaux
- Division of Clinical Research, Boston Children's Hospital, Boston, USA
- Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
- Department of Pediatrics, Harvard Medical School, Boston, USA.
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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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