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Guerrero EG, Amaro H, Kong Y, Khachikian T, Marsh JC. Understanding the role of financial capacity in the delivery of opioid use disorder treatment. BMC Health Serv Res 2023; 23:166. [PMID: 36797752 PMCID: PMC9933309 DOI: 10.1186/s12913-023-09179-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Opioid treatment programs must have adequate financial capacity to sustain operations and deliver a high standard of care for individuals suffering from opioid use disorder. However, there is limited consistency in the health services literature about the concept and relationship of organizational financial capacity and key outcome measures (wait time and retention). In this study, we explored five common measures of financial capacity that can be applied to opioid treatment programs: (a) reserve ratio, (b) equity ratio, (c) markup, (d) revenue growth, and (e) earned revenue. We used these measures to compare financial capacity among 135 opioid treatment programs across four data collection points: 2011 (66 programs), 2013 (77 programs), 2015 (75 programs), and 2017 (69 programs). We examined the relationship between financial capacity and wait time and retention. Findings from the literature review show inconsistencies in the definition and application of concepts associated with financial capacity across business and social service delivery fields. The analysis shows significant differences in components of financial capacity across years. We observed an increase in average earned revenue and markup in 2017 compared to prior years. The interaction between minorities and markup was significantly associated with higher likelihood of waiting (IRR = 1.077, p < .05). Earned revenue (IRR = 0.225, p < .05) was related to shorter wait time in treatment. The interaction between minorities and equity ratio is also significantly associated with retention (IRR = 0.796, p < .05). Our study offers a baseline view of the role of financial capacity in opioid treatment and suggests a framework to determine its effect on client-centered outcomes.
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Affiliation(s)
- Erick G. Guerrero
- Research to End Health Disparities Corp, I-Lead Institute, 12300 Wilshire Blvd., Suite 210, Los Angeles, CA 90025 USA
| | - Hortensia Amaro
- grid.65456.340000 0001 2110 1845Herbert Werthein College of Medicine and Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8Th St., AHC4, Miami, FL 33199 USA
| | - Yinfei Kong
- grid.253559.d0000 0001 2292 8158College of Business and Economics, California State University Fullerton, 800 N. State College Blvd., Fullerton, CA 92831 USA
| | - Tenie Khachikian
- grid.170205.10000 0004 1936 7822Crown Family School of Social Work, Policy, and Practice, University of Chicago, 969 E. 60Th St., Chicago, IL 60637 USA
| | - Jeanne C. Marsh
- grid.170205.10000 0004 1936 7822Crown Family School of Social Work, Policy, and Practice, University of Chicago, 969 E. 60Th St., Chicago, IL 60637 USA
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Dir AL, Tillson M, Aalsma MC, Staton M, Staton M, Watson D. Impacts of COVID-19 at the intersection of substance use disorder treatment and criminal justice systems: findings from three states. HEALTH & JUSTICE 2022; 10:25. [PMID: 35922684 PMCID: PMC9351174 DOI: 10.1186/s40352-022-00184-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Individuals with substance use disorders (SUD), particularly opioid use disorder (OUD), who are criminal justice-involved are a particularly vulnerable population that has been adversely affected by COVID-19 due to impacts of the pandemic on both the criminal justice and treatment systems. The manuscript presents qualitative data and findings exploring issues related to SUD/OUD treatment among individuals involved in the justice system and the impacts of COVID-19 on these service systems. Qualitative data were collected separately by teams from three different research hubs/sites in Illinois, Indiana, and Kentucky; at each hub, data were collected from justice system personnel (n = 17) and community-level SUD/OUD providers (n = 21). Codes from two hubs were reviewed and merged to develop the cross-hub coding list. The combined codes were used deductively to analyze the third hub's data, and higher-level themes were then developed across all the hubs' data. RESULTS Themes reflected the justice and treatment systems' responses to COVID-19, the intersection of systems and COVID-19's impact on providing OUD treatment for such individuals, and the use of telehealth and telejustice. CONCLUSIONS Results highlight that despite rapid adaptations made by systems during the pandemic, additional work is needed to better support individuals with OUD who are involved in the justice system. Such work can inform longer-term public health crisis planning to improve community OUD treatment access and linkage for those who are criminal justice-involved.
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Affiliation(s)
- Allyson L. Dir
- Department of Psychiatry, Indiana University School of Medicine, 410 W 10th Street, Indianapolis, IN 46202 USA
- Adolescent Behavioral Health Research Program, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th Street, Indianapolis, IN 46202 USA
| | - Martha Tillson
- Center on Drug and Alcohol Research, University of Kentucky, 643 Maxwelton Ct., Lexington, KY 40508 USA
| | - Matthew C. Aalsma
- Adolescent Behavioral Health Research Program, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th Street, Indianapolis, IN 46202 USA
- Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, 410 W 10th Street, Indianapolis, IN 46202 USA
| | - Michele Staton
- Department of Behavioral Science, College of Medicine, University of Kentucky, 117 Medical Behavioral Science Building, Lexington, KY 40504 USA
| | - Monte Staton
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois College of Medicine at Chicago, 818 S Wolcott Ave, Chicago, IL 60613 USA
| | - Dennis Watson
- Chestnut Health Systems, 221 W. Walton St., Chicago, IL 60610 USA
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Searby A, Burr D, James R, Maude P. Service integration: The perspective of Australian alcohol and other drug (AOD) nurses. Int J Ment Health Nurs 2022; 31:908-919. [PMID: 35338569 PMCID: PMC9314025 DOI: 10.1111/inm.12998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
The recently released Victorian Mental Health Royal Commission report has recommended a shift to integrated treatment, defined as treatment for alcohol and substance use disorders and mental ill health occurring in parallel, rather than distinct systems catering to each need. However, little work has sought to determine the perceptions of nurses working in alcohol and other drug (AOD) treatment towards integrating with mental health services. In this study, we explore the perspectives of specialist AOD nurses towards the integration of mental health and AOD treatment services. Secondary analysis of semi-structured interviews with Australian specialist AOD nurses (n = 46) conducted as part of a wider workforce study in 2019. Data were analysed using thematic analysis and reported using the COREQ guidelines. Of the interviews analysed, six were AOD nurses working in an Australian state that had recently undergone service integration; however, many participants expressed perceptions of service integration. Two key themes are reported in this paper: (i) perceptions of service integration, where AOD nurses participating in our study were concerned that integration would result in the model of care they worked under being replaced by a mental health-based model that was felt to be highly risk averse, and (ii) experiences of service integration. Concerns about the focus of care as well as the complexity of care differing between the two services demonstrated a contrast in both philosophical approaches to work with consumers and legislative difference in voluntary versus compulsory care provision.
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Affiliation(s)
- Adam Searby
- Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Dianna Burr
- Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Russell James
- School of Nursing, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Phil Maude
- La Trobe Rural Health School, Violet Vines Marshman Centre for Rural Health Research, Latrobe University, Melbourne, Victoria, Australia
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Behrends CN, Kapadia SN, Schackman BR, Frimpong JA. Addressing Barriers to On-site HIV and HCV Testing Services in Methadone Maintenance Treatment Programs in the United States: Findings From a National Multisite Qualitative Study. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:393-402. [PMID: 33346582 PMCID: PMC8137509 DOI: 10.1097/phh.0000000000001262] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Few substance use disorder (SUD) treatment programs provide on-site human immunodeficiency virus (HIV) and/or hepatitis C virus (HCV) testing, despite evidence that these tests are cost-effective. OBJECTIVE To understand how methadone maintenance treatment (MMT) programs that offer on-site HIV/HCV testing have integrated testing services, and the challenges related to offering on-site HIV/HCV testing. DESIGN We used the 2014 National Drug Abuse Treatment System Survey to identify outpatient SUD treatment programs that reported offering on-site HIV/HCV testing to 75% or more of their clients. We stratified the sample to identify programs based on combinations of funding source, type of drug treatment offered, and Medicaid-managed care arrangements. We conducted semi-structured qualitative interviews with leadership and staff in 2017-2018 using a directed content analysis approach to identify dominant themes. SETTING Seven MMT programs located in 6 states in the United States. PARTICIPANTS Fifteen leadership and staff from 7 MMT programs with on-site HIV/HCV testing. MAIN OUTCOME MEASURE Themes related to integration of on-site HIV/HCV testing. RESULTS Methadone maintenance treatment programs identified 3 domains related to the integration of HIV/HCV testing on-site at MMT programs: (1) payment and billing, (2) internal and external stakeholders, and (3) medical and SUD treatment coordination. Programs identified the absence of state policies that facilitate medical billing and inconsistent grant funding as major barriers. Testing availability was limited by the frequency at which external organizations could provide services on-site, the reliability of those external relationships, and MMT staffing. Poor electronic health record systems and privacy policies that prevent medical information sharing between medical and SUD treatment providers also limited effective care coordination. CONCLUSION Effective and sustainable integration of on-site HIV/HCV testing by MMT programs in the United States will require more consistent funding, improved billing options, technical assistance, electronic health record system enhancement and coordination, and policy changes related to privacy.
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Affiliation(s)
- Czarina N Behrends
- Departments of Population Health Sciences (Drs Behrends, Schackman, and Kapadia) and Medicine (Dr Kapadia), Weill Cornell Medical College, New York, New York; and Carey Business School, John Hopkins University, Baltimore, Maryland (Dr Frimpong)
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Watkins KE, Hunter SB, Cohen CC, Leamon I, Hurley B, McCreary M, Ober AJ. Organizational Capacity and Readiness to Provide Medication for Individuals with Co-Occurring Alcohol Use Disorders in Public Mental Health Settings. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:707-717. [PMID: 33387128 PMCID: PMC8628547 DOI: 10.1007/s10488-020-01103-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
Alcohol use disorders (AUD) in individuals with mental illness are largely untreated. The purpose of this study was to identify gaps in organizational capacity and readiness to provide medications for AUD in outpatient public mental health clinics. We selected a purposive sample of eight publicly funded outpatient mental health clinics operated by the Los Angeles County Department of Mental Health; clinics were chosen to maximize heterogeneity. Guided by theories of organizational capacity and readiness and research on the adoption of pharmacotherapy for AUD in primary and specialty care treatment settings, we conducted semi-structured interviews and focus groups with administrators, providers and staff, and a qualitative analysis of the results. Respondents described significant organizational capacity and behavioral readiness constraints to providing medication treatment for AUD. Both groups articulated a perception that mental health clinics were not designed to provide co-occurring AUD treatment because of large caseloads, staffing configurations, and time constraints that did not support the delivery of appropriate treatment, and a lack of protocols and workflow procedures. We documented organizational capacity and readiness constraints which impede the delivery of medication treatment for AUD in a large mental helth system. While some constraints have straightforward solutions, others require structural changes to the way care is delivered, and state-level funding and policy changes.
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Affiliation(s)
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | | | - Isabel Leamon
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Brian Hurley
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Michael McCreary
- Health Services and Society, UCLA Semel Institute for Neuroscience & Human Behavior, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
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Viglione J, Labrecque RM. Core Correctional Practices in Community Supervision: An Evaluation of a Policy Mandate to Increase Probation Officer Use of Skills. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2021; 65:858-881. [PMID: 33292016 DOI: 10.1177/0306624x20981045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Community supervision officer training programs aim to translate core correctional practices into routine practice. These training programs emphasize skill-building designed to shift supervision strategies from law enforcement/compliance-oriented to a focus on promoting and supporting behavior change. Despite evidence of their effectiveness, research finds trained officers use newly learned skills infrequently. The current study examined the impact of a policy, implemented post-training, designed to encourage trained officers to use skills emphasized by the Staff Training Aimed at Reducing Rearrest (STARR) training program more frequently. The current study examined the effectiveness of this policy on the frequency and type of skills used by officers in their interactions with individuals on their caseload. Analyses suggested the policy mandate was effective in increasing skill use, however officers still used trained skills in less than half of their interactions. Implications and considerations for increasing the use of skills are discussed.
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Guerrero EG, Alibrahim A, Howard DL, Wu S, D'Aunno T. Stability in a large drug treatment system: Examining the role of program size and performance on service discontinuation. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 86:102948. [PMID: 32977185 PMCID: PMC7508010 DOI: 10.1016/j.drugpo.2020.102948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/02/2022]
Abstract
Background Little is known about the stability of public drug treatment in the United States to deliver services in an era of expansion of public insurance. Guided by organizational theories, we examined the role of program size, and performance (i.e., rates of treatment initiation and engagement) on discontinuing services in one of the largest treatment systems in the United States. Methods This study relied on multi-year (2006–2014) administrative data of 249,029 treatment admission episodes from 482 treatment programs in Los Angeles County, CA. We relied on survival regression analysis to identify associations between program size, treatment initiation (wait time) and engagement (retention and completion rates) and discontinuing services in any given year. We examined program differences between discontinued versus sustained services in pre- and post-expansion periods. Results Sixty-two percent of programs discontinued services at some point between 2006 and 2014. Program size and rates of treatment retention were negatively associated with risk of discontinuing services. Proportion of female clients was also negatively associated with risk of discontinuing services. Compared to residential programs, methadone programs were associated with reduced likelihood of discontinuing services. Two interactions were significant; program size and retention rates, as well as program size and completion rates were negatively associated with risk of discontinuing services. Conclusions Program size (large), type (methadone), performance (retention) and client population (women) were associated with stability in this drug treatment system. Because more than 70% of programs in this system are small, it is critical to support their capacity to sustain services to reduce existing disparities in access to care. We discuss the implications of these findings for system evaluation and for responding to public health crises.
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Affiliation(s)
- Erick G Guerrero
- I-LEAD Institute, Research to End Healthcare Disparities Corp, United States.
| | | | - Daniel L Howard
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, United States.
| | - Shinyi Wu
- Suzanne Dworak-Peck, School of Social Work, University of Southern California, United States.
| | - Thomas D'Aunno
- Wagner School of Public Policy, New York University, United States.
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Leadership in Integrated Care Networks: A Literature Review and Opportunities for Future Research. Int J Integr Care 2020; 20:6. [PMID: 32863804 PMCID: PMC7427680 DOI: 10.5334/ijic.5420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction In many countries, elderly patients with chronic conditions require a web of services delivered by several providers collaborating in inter-organisational networks. In view of their global importance, it is surprising how little we know how these networks are led. Like traditional organisations, networks require leadership to function effectively. This paper reviews central characteristics of leadership in integrated care networks and proposes opportunities for future research. Theory and methods Analysing 73 studies published in leading academic journals, this paper consolidates research on leadership media, practices, activities and outcomes, covering the network, policy and organisation levels of analysis. Results Findings indicate that the field has focused on leadership media and outcomes at the network level. They also suggest that leadership in integrated care networks faces multiple tensions. Future research could usefully provide a fuller picture by examining leadership practices, activities and outcomes at the policy and organisation level, integrating advances in the wider leadership literature. Discussion and conclusion These findings contribute to the debate on leadership in integrated care networks. They also inform practice, drawing attention to persistent tensions as a core leadership challenge and offering latest scholarly evidence practitioners can use to reflect on and advance their own leadership practice.
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Correlates of subjective hepatitis C knowledge among clinical staff in US drug treatment programs. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-019-01032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Torres EM, Seijo C, Ehrhart MG, Aarons GA. Validation of a pragmatic measure of implementation citizenship behavior in substance use disorder treatment agencies. J Subst Abuse Treat 2020; 111:47-53. [PMID: 32087838 DOI: 10.1016/j.jsat.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 11/15/2022]
Abstract
The organizational context in which substance use disorder treatment (SUDT) evidence-based practices (EBPs) are implemented plays a critical role in successful implementation. Employee behaviors that go above and beyond typical job requirements to support EBP implementation have been suggested to facilitate the likelihood of overall implementation success. The current study explored the psychometric properties of the Implementation Citizenship Behavior Scale (ICBS) within SUDT settings. Utilizing a sample of 322 direct service providers and 60 of their respective supervisors from three SUDT agencies, results from a confirmatory factor analysis and construct validity analysis support the use of the ICBS in the SUDT context. Validation of the ICBS provides a useful, pragmatic tool for both researchers and practitioners to assess employee citizenship behavior to support EBP implementation. The ICBS can provide critical insights into how providers respond to organizational context that may facilitate EBP implementation.
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Affiliation(s)
- Elisa M Torres
- University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA; Child and Adolescent Services Research Center, 3020 Children's Way, MC5033, San Diego, CA 92123, USA; George Mason University, 4400 University Drive, MSN 3F5, Fairfax, VA 22030, USA.
| | - Chariz Seijo
- University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA; Child and Adolescent Services Research Center, 3020 Children's Way, MC5033, San Diego, CA 92123, USA.
| | - Mark G Ehrhart
- University of Central Florida, 4000 Central Florida Blvd, Orlando, FL 32816, USA.
| | - Gregory A Aarons
- University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA; Child and Adolescent Services Research Center, 3020 Children's Way, MC5033, San Diego, CA 92123, USA.
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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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Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. Understanding new models of integrated care in developed countries: a systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06290] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BackgroundThe NHS has been challenged to adopt new integrated models of service delivery that are tailored to local populations. Evidence from the international literature is needed to support the development and implementation of these new models of care.ObjectivesThe study aimed to carry out a systematic review of international evidence to enhance understanding of the mechanisms whereby new models of service delivery have an impact on health-care outcomes.DesignThe study combined rigorous and systematic methods for identification of literature, together with innovative methods for synthesis and presentation of findings.SettingAny setting.ParticipantsPatients receiving a health-care service and/or staff delivering services.InterventionsChanges to service delivery that increase integration and co-ordination of health and health-related services.Main outcome measuresOutcomes related to the delivery of services, including the views and perceptions of patients/service users and staff.Study designEmpirical work of a quantitative or qualitative design.Data sourcesWe searched electronic databases (between October 2016 and March 2017) for research published from 2006 onwards in databases including MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Science Citation Index, Social Science Citation Index and The Cochrane Library. We also searched relevant websites, screened reference lists and citation searched on a previous review.Review methodsThe identified evidence was synthesised in three ways. First, data from included studies were used to develop an evidence-based logic model, and a narrative summary reports the elements of the pathway. Second, we examined the strength of evidence underpinning reported outcomes and impacts using a comparative four-item rating system. Third, we developed an applicability framework to further scrutinise and characterise the evidence.ResultsWe included 267 studies in the review. The findings detail the complex pathway from new models to impacts, with evidence regarding elements of new models of integrated care, targets for change, process change, influencing factors, service-level outcomes and system-wide impacts. A number of positive outcomes were reported in the literature, with stronger evidence of perceived increased patient satisfaction and improved quality of care and access to care. There was stronger UK-only evidence of reduced outpatient appointments and waiting times. Evidence was inconsistent regarding other outcomes and system-wide impacts such as levels of activity and costs. There was an indication that new models have particular potential with patients who have complex needs.LimitationsDefining new models of integrated care is challenging, and there is the potential that our study excluded potentially relevant literature. The review was extensive, with diverse study populations and interventions that precluded the statistical summary of effectiveness.ConclusionsThere is stronger evidence that new models of integrated care may enhance patient satisfaction and perceived quality and increase access; however, the evidence regarding other outcomes is unclear. The study recommends factors to be considered during the implementation of new models.Future workLinks between elements of new models and outcomes require further study, together with research in a wider variety of populations.Study registrationThis study is registered as PROSPERO CRD37725.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Susan Baxter
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Maxine Johnson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. The effects of integrated care: a systematic review of UK and international evidence. BMC Health Serv Res 2018; 18:350. [PMID: 29747651 PMCID: PMC5946491 DOI: 10.1186/s12913-018-3161-3] [Citation(s) in RCA: 293] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/29/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. METHODS The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. RESULTS One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. CONCLUSIONS Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. TRIAL REGISTRATION Prospero registration number: 42016037725 .
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Affiliation(s)
- Susan Baxter
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Maxine Johnson
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Duncan Chambers
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Anthea Sutton
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Elizabeth Goyder
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
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Leadership Training and the Problems of Competency Development. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:73-80. [PMID: 27598708 DOI: 10.1097/phh.0000000000000456] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT An important workforce development effort during the past 25 years has been developing competency sets. Several of the sets rely on the concepts of Senge's Learning Organization and Burns' Transformational Leadership. The authors' experiences and study in designing and implementing a curriculum for a public health leadership institute based on these concepts raised several important questions about competency development and application. OBJECTIVES To summarize the use of the Senge and Burns frameworks in several competency sets and the practice literature and to assess the status of competency development for those frameworks and for competency development generally. DESIGN The authors reviewed several commonly used competency sets and textbooks and searched 3 leading public health practice journals (Journal of Public Health Management and Practice, Public Health Reports, and American Journal of Public Health) for Senge and Burns framework terms. They also reviewed efforts to implement competency sets in public health education and practice. MAIN OUTCOME MEASURES (1) The extent to which the articles and texts demonstrated understanding of the frameworks and reported their implementation and (2) whether competency statements and their uses in the literature contained precise definitions of competencies (knowledge, skills, behaviors, and attitudes associated with them), the standards by which competence is to be measured, and the means for measuring their attainment. RESULTS "Learning Organization" and "Transformational Leadership" terms were used often and viewed favorably. However, the terms were rarely defined as Senge and Burns had, the uses generally did not indicate the complexity and difficulty of implementation, and there was only one report of even partial implementation. The review of competency development efforts found there is virtually no attention to the definitional and measurement issues in the literature. CONCLUSION Unless public health organizations recognize the need for a common understanding of competencies and how to measure their attainment and act on that understanding, it will be impossible to say with confidence that there is agreement on which individuals are competent, whether public health agencies have competent personnel, or that the public health workforce itself is competent.
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Kiberu VM, Scott RE, Mars M. Assessment of health provider readiness for telemedicine services in Uganda. Health Inf Manag 2018; 48:33-41. [PMID: 29359588 DOI: 10.1177/1833358317749369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: There are few telemedicine projects in Africa that have reached scale. One of the reasons proposed for this has been failure to assess health provider readiness for telemedicine prior to implementation. OBJECTIVE: To assess health provider readiness for implementation and integration of telemedicine services at three levels of Uganda's health facilities, namely, a national referral hospital (NRH), regional referral hospitals (RRHs) and level 4 health centres (HC-IVs) and to investigate factors associated with readiness for telemedicine. METHOD: A cross-sectional descriptive study was conducted at public healthcare facilities in Uganda. One RRH and HC-IV was identified from each of the Western, Eastern and Northern regions using a multistage random sampling technique. Mulago Hospital, which doubles as an RRH and HC-IV in the central region, was purposively identified for the study. After validation, a questionnaire was distributed for self-administration to senior administrators and doctors selected at the NRH, RRHs and HC-IVs. Data were analysed using bivariate associations between the outcome and the potential independent variables. RESULTS: In total, 114 healthcare workers completed the questionnaire. Of the respondents, 24 (21%) were from HC-IVs, 44 (39%) were from RRHs, and 46 (40%) from NRH. Doctors made up 45.8% (11) of respondents at HC-IVs, 59% (26) at RRHs, and 30.4% (14) at NRH. Administrators across all health facility levels were more likely to integrate telemedicine into the healthcare system than doctors (odd ratio = 1.39 [95% confidence interval = 0.38-4.95]). A significant association existed between the state of readiness and type of health facility, p < 0.001. The NRH and RRHs are more likely to integrate telemedicine into their systems than the HC-IVs. Among the factors investigated (job title, health facility, technology type, reason for referral and frequency of electronic communication), the level of health facility and title or role of healthcare worker were found to have a significant statistical association with being ready to integrate telemedicine into the healthcare system. CONCLUSION: Health provider readiness to integrate telemedicine services varies at the different levels of the health facility and job title or role. However, referral hospitals and administrators were more likely to integrate telemedicine than HC-IVs and doctors, respectively. While this study shows physicians and administrators are ready, other sectors (nurses, allied healthcare workers, public) will also need to be assessed.
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Affiliation(s)
| | - Richard E Scott
- 1 University of KwaZulu-Natal, South Africa.,2 University of Calgary, Canada
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Schmit MK, Watson JC, Fernandez MA. Examining the Effectiveness of Integrated Behavioral and Primary Health Care Treatment. JOURNAL OF COUNSELING AND DEVELOPMENT 2018. [DOI: 10.1002/jcad.12173] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michael K. Schmit
- Department of Counseling and Educational Psychology; Texas A&M University-Corpus Christi
- Now at Department of Counseling and Higher Education, University of North Texas
| | - Joshua C. Watson
- Department of Counseling and Educational Psychology; Texas A&M University-Corpus Christi
| | - Mary A. Fernandez
- Department of Counseling and Educational Psychology; Texas A&M University-Corpus Christi
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Saloner B, Akosa Antwi Y, Maclean JC, Cook B. Access to Health Insurance and Utilization of Substance Use Disorder Treatment: Evidence from the Affordable Care Act Dependent Coverage Provision. HEALTH ECONOMICS 2018; 27:50-75. [PMID: 28127822 DOI: 10.1002/hec.3482] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/03/2016] [Accepted: 12/15/2016] [Indexed: 05/26/2023]
Abstract
The relationship between insurance coverage and use of specialty substance use disorder (SUD) treatment is not well understood. In this study, we add to the literature by examining changes in admissions to SUD treatment following the implementation of a 2010 Affordable Care Act provision requiring health insurers to offer dependent coverage to young adult children of their beneficiaries under age 26. We use national administrative data on admissions to specialty SUD treatment and apply a difference-in-differences design to study effects of the expansion on the rate of treatment utilization among young adults and, among those in treatment, changes in insurance status and payment source. We find that admissions to treatment declined by 11% after the expansion. However, the share of young adults covered by private insurance increased by 5.4 percentage points and the share with private insurance as the payment source increased by 3.7 percentage points. This increase was largely offset by decreased payment from government sources. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | - Johanna Catherine Maclean
- Temple University, Department of Economics, Philadelphia, PA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
- Institute for the Study of Labor, Bonn, Germany
| | - Benjamin Cook
- Harvard Medical School, Department of Psychiatry, Cambridge, MA, USA
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Kelly P, Hegarty J, Barry J, Dyer KR, Horgan A. The relationship between staff perceptions of organizational readiness to change and client outcomes in substance misuse treatment programmes: A systematic review. JOURNAL OF SUBSTANCE USE 2017. [DOI: 10.1080/14659891.2017.1394385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Peter Kelly
- Department of Nursing and Healthcare, Waterford Institute of Technology, Waterford, Ireland
| | - Josephine Hegarty
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Joe Barry
- Department of Public Health and Primary Care, Trinity Centre for Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Kyle R. Dyer
- Institute of Psychiatry, Department of Psychology and Neuroscience, Kings College London, 4 Windsor Walk, Denmark Hill, London, SE58BB, United Kingdom
| | - Aine Horgan
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
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Guerrero EG, Fenwick K, Kong Y. Advancing theory development: exploring the leadership-climate relationship as a mechanism of the implementation of cultural competence. Implement Sci 2017; 12:133. [PMID: 29137668 PMCID: PMC5686798 DOI: 10.1186/s13012-017-0666-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 11/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leadership style and specific organizational climates have emerged as critical mechanisms to implement targeted practices in organizations. Drawing from relevant theories, we propose that climate for implementation of cultural competence reflects how transformational leadership may enhance the organizational implementation of culturally responsive practices in health care organizations. METHODS Using multilevel data from 427 employees embedded in 112 addiction treatment programs collected in 2013, confirmatory factor analysis showed adequate fit statistics for our measure of climate for implementation of cultural competence (Cronbach's alpha = .88) and three outcomes: knowledge (Cronbach's alpha = .88), services (Cronbach's alpha = .86), and personnel (Cronbach's alpha = .86) practices. RESULTS Results from multilevel path analyses indicate a positive relationship between employee perceptions of transformational leadership and climate for implementation of cultural competence (standardized indirect effect = .057, bootstrap p < .001). We also found a positive indirect effect between transformational leadership and each of the culturally competent practices: knowledge (standardized indirect effect = .006, bootstrap p = .004), services (standardized indirect effect = .019, bootstrap p < .001), and personnel (standardized indirect effect = .014, bootstrap p = .005). CONCLUSIONS Findings contribute to implementation science. They build on leadership theory and offer evidence of the mediating role of climate in the implementation of cultural competence in addiction health service organizations.
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Affiliation(s)
- Erick G. Guerrero
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089 USA
- Marshall School of Business, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089 USA
| | - Karissa Fenwick
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089 USA
| | - Yinfei Kong
- Mihaylo College of Business and Economics, California State University, Fullerton, Fullerton, CA 90089 USA
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Quinn AE, Hodgkin D, Perloff JN, Stewart MT, Brolin M, Lane N, Horgan CM. Design and impact of bundled payment for detox and follow-up care. J Subst Abuse Treat 2017; 82:113-121. [PMID: 29021109 DOI: 10.1016/j.jsat.2017.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Recent payment reforms promote movement from fee-for-service to alternative payment models that shift financial risk from payers to providers, incentivizing providers to manage patients' utilization. Bundled payment, an episode-based fixed payment that includes the prices of a group of services that would typically treat an episode of care, is expanding in the United States. Bundled payment has been recommended as a way to pay for comprehensive SUD treatment and has the potential to improve treatment engagement after detox, which could reduce detox readmissions, improve health outcomes, and reduce medical care costs. However, if moving to bundled payment creates large losses for some providers, it may not be sustainable. The objective of this study was to design the first bundled payment for detox and follow-up care and to estimate its impact on provider revenues. METHODS Massachusetts Medicaid beneficiaries' behavioral health, medical, and pharmacy claims from July 2010-April 2013 were used to build and test a detox bundled payment for continuously enrolled adults (N=5521). A risk adjustment model was developed using general linear modeling to predict beneficiaries' episode costs. The projected payments to each provider from the risk adjustment analysis were compared to the observed baseline costs to determine the potential impact of a detox bundled payment reform on organizational revenues. This was modeled in two ways: first assuming no change in behavior and then assuming a supply-side cost sharing behavioral response of a 10% reduction in detox readmissions and an increase of one individual counseling and one group counseling session. RESULTS The mean total 90-day detox episode cost was $3743. Nearly 70% of the total mean cost consists of the index detox, psychiatric inpatient care, and short-term residential care. Risk mitigation, including risk adjustment, substantially reduced the variation of the mean episode cost. There are opportunities for organizations to gain revenue under this bundled payment design, but many providers will lose money under a bundled payment designed using historic payment and costs. CONCLUSIONS Designing a bundled payment for detox and follow-up care is feasible, but low case volume and the adequacy of the payment are concerns. Thus, a detox episode-based payment will likely be more challenging for smaller, independent SUD treatment providers. These providers are experiencing many changes as financing shifts away from block grant funding toward Medicaid funding. A detox bundled payment in practice would need to consider different risk mitigation strategies, provider pooling, and costs based on episodes of care meeting quality standards, but could incentivize care coordination, which is important to reducing detox readmissions and engaging patients in care.
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Affiliation(s)
- Amity E Quinn
- The Heller School for Social Policy and Management, Brandeis University, MS035, 415 South Street, Waltham, MA 02453, USA.
| | - Dominic Hodgkin
- The Heller School for Social Policy and Management, Brandeis University, MS035, 415 South Street, Waltham, MA 02453, USA
| | - Jennifer N Perloff
- The Heller School for Social Policy and Management, Brandeis University, MS035, 415 South Street, Waltham, MA 02453, USA
| | - Maureen T Stewart
- The Heller School for Social Policy and Management, Brandeis University, MS035, 415 South Street, Waltham, MA 02453, USA
| | - Mary Brolin
- The Heller School for Social Policy and Management, Brandeis University, MS035, 415 South Street, Waltham, MA 02453, USA
| | - Nancy Lane
- Vanderbilt University Medical Center 1211 Medical Center Dr, Nashville, TN 37232, USA; Vanderbilt University School of Medicine, 1161 21st Ave S # D3300, Nashville, TN 37232, USA
| | - Constance M Horgan
- The Heller School for Social Policy and Management, Brandeis University, MS035, 415 South Street, Waltham, MA 02453, USA
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Nakanishi M, Endo K. National Suicide Prevention, Local Mental Health Resources, and Suicide Rates in Japan. CRISIS 2017; 38:384-392. [PMID: 28748710 DOI: 10.1027/0227-5910/a000469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suicide rates in Japan are relatively high in OECD countries. A national fund to help local authorities implement suicide prevention programs was launched in 2009. The national suicide prevention project was transferred from the Cabinet Office to the Ministry of Health, Labor, and Welfare on April 2016, with a greater focus on mental health promotion by local governments. AIMS The aim of the present study was to (a) identify local authorities' implementation of suicide prevention programs in terms of local health policies, and (b) examine the associations between local health resources and suicide rates in Japan. METHOD We investigated the types of programs implemented under the fund, and correlations with authorities' sociodemographic characteristics and mental health and welfare resources. RESULTS A majority of authorities implemented general suicide prevention programs. More focused programs addressing issues such as mental health in the workplace, alcohol problems, and attempted suicide were less frequently implemented. There were significantly fewer suicides in health regions with a higher ratio of psychiatrists to residents or a lower ratio of psychiatric beds. LIMITATIONS A causal relationship between suicide rates and characteristics of local authorities cannot be inferred from the data. CONCLUSION A community mental health system that operated in parallel to the current system may result in fewer inpatients and a reduction in Japan's suicide rate.
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Affiliation(s)
- Miharu Nakanishi
- 1 Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kaori Endo
- 2 Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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Guerrero EG, Harris L, Padwa H, Vega WA, Palinkas L. Expected Impact of Health Care Reform on the Organization and Service Delivery of Publicly Funded Addiction Health Services. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 44:463-469. [PMID: 26008902 PMCID: PMC4661135 DOI: 10.1007/s10488-015-0662-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Little is known about how the Affordable Care Act (ACA) will be implemented in publicly funded addiction health services (AHS) organizations. Guided by a conceptual model of implementation of new practices in health care systems, this study relied on qualitative data collected in 2013 from 30 AHS clinical supervisors in Los Angeles County, California. Interviews were transcribed, coded, and analyzed using a constructivist grounded theory approach with ATLAS.ti software. Supervisors expected several potential effects of ACA implementation, including increased use of AHS services, shifts in the duration and intensity of AHS services, and workforce professionalization. However, supervisors were not prepared for actions to align their programs' strategic change plans with policy expectations. Findings point to the need for health care policy interventions to help treatment providers effectively respond to ACA principles of improving standards of care and reducing disparities.
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Affiliation(s)
- Erick G Guerrero
- USC School of Social Work, University of Southern California, 1150 South Olive Street, Los Angeles, CA, 90015, USA.
| | - Lesley Harris
- Kent School of Social Work, University of Louisville, Louisville, KY, 40292, USA
| | - Howard Padwa
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Box 71579, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - William A Vega
- USC School of Social Work, University of Southern California, 1150 South Olive Street, Los Angeles, CA, 90015, USA
| | - Lawrence Palinkas
- USC School of Social Work, University of Southern California, 1150 South Olive Street, Los Angeles, CA, 90015, USA
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Aarons GA, Ehrhart MG, Torres EM, Finn NK, Beidas RS. The Humble Leader: Association of Discrepancies in Leader and Follower Ratings of Implementation Leadership With Organizational Climate in Mental Health. Psychiatr Serv 2017; 68:115-122. [PMID: 27691380 PMCID: PMC5462527 DOI: 10.1176/appi.ps.201600062] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Discrepancies, or perceptual distance, between leaders' self-ratings and followers' ratings of the leader are common but usually go unrecognized. Research on discrepancies is limited, but there is evidence that discrepancies are associated with organizational context. This study examined the association of leader-follower discrepancies in Implementation Leadership Scale (ILS) ratings of mental health clinic leaders and the association of those discrepancies with organizational climate for involvement and performance feedback. Both involvement and performance feedback are important for evidence-based practice (EBP) implementation in mental health. METHODS A total of 593 individuals-supervisors (leaders, N=80) and clinical service providers (followers, N=513)-completed surveys that included ratings of implementation leadership and organizational climate. Polynomial regression and response surface analyses were conducted to examine the associations of discrepancies in leader-follower ILS ratings with organizational involvement climate and performance feedback climate, aspects of climate likely to support EBP implementation. RESULTS Both involvement climate and performance feedback climate were highest where leaders rated themselves low on the ILS and their followers rated those leaders high on the ILS ("humble leaders"). CONCLUSIONS Teams with "humble leaders" showed more positive organizational climate for involvement and for performance feedback, contextual factors important during EBP implementation and sustainment. Discrepancy in leader and follower ratings of implementation leadership should be a consideration in understanding and improving leadership and organizational climate for mental health services and for EBP implementation and sustainment in mental health and other allied health settings.
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Affiliation(s)
- Gregory A Aarons
- Dr. Aarons, Ms. Torres, and Ms. Finn are with the Department of Psychiatry, University of California, San Diego, La Jolla (e-mail: ). They are also with the Child and Adolescent Services Research Center, San Diego. Dr. Ehrhart is with the Department of Psychology, San Diego State University, San Diego. Dr. Beidas is with the Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Mark G Ehrhart
- Dr. Aarons, Ms. Torres, and Ms. Finn are with the Department of Psychiatry, University of California, San Diego, La Jolla (e-mail: ). They are also with the Child and Adolescent Services Research Center, San Diego. Dr. Ehrhart is with the Department of Psychology, San Diego State University, San Diego. Dr. Beidas is with the Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Elisa M Torres
- Dr. Aarons, Ms. Torres, and Ms. Finn are with the Department of Psychiatry, University of California, San Diego, La Jolla (e-mail: ). They are also with the Child and Adolescent Services Research Center, San Diego. Dr. Ehrhart is with the Department of Psychology, San Diego State University, San Diego. Dr. Beidas is with the Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Natalie K Finn
- Dr. Aarons, Ms. Torres, and Ms. Finn are with the Department of Psychiatry, University of California, San Diego, La Jolla (e-mail: ). They are also with the Child and Adolescent Services Research Center, San Diego. Dr. Ehrhart is with the Department of Psychology, San Diego State University, San Diego. Dr. Beidas is with the Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Rinad S Beidas
- Dr. Aarons, Ms. Torres, and Ms. Finn are with the Department of Psychiatry, University of California, San Diego, La Jolla (e-mail: ). They are also with the Child and Adolescent Services Research Center, San Diego. Dr. Ehrhart is with the Department of Psychology, San Diego State University, San Diego. Dr. Beidas is with the Department of Psychiatry, University of Pennsylvania, Philadelphia
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Program Capacity to Eliminate Outcome Disparities in Addiction Health Services. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 43:23-35. [PMID: 25450596 DOI: 10.1007/s10488-014-0617-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We evaluated program capacity factors associated with client outcomes in publicly funded substance abuse treatment organizations in one of the most populous and diverse regions of the United States. Using multilevel cross-sectional analyses of program data (n = 97) merged with client data from 2010 to 2011 for adults (n = 8,599), we examined the relationships between program capacity (leadership, readiness for change, and Medi-Cal payment acceptance) and client wait time and treatment duration. Acceptance of Medi-Cal was associated with shorter wait times, whereas organizational readiness for change was positively related to treatment duration. Staff attributes were negatively related to treatment duration. Overall, compared to low program capacity, high program capacity was negatively associated with wait time and positively related to treatment duration. In conclusion, program capacity, an organizational indicator of performance, plays a significant role in access to and duration of treatment. Implications for health care reform implementation in relation to expansion of public health insurance and capacity building to promote health equities are discussed.
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Clark CD, Langkjaer S, Chinikamwala S, Joseph H, Semaan S, Clement J, Marshall R, Pevzner E, Truman BI, Kroeger K. Providers' Perspectives on Program Collaboration and Service Integration for Persons Who Use Drugs. J Behav Health Serv Res 2017; 44:158-167. [PMID: 26943642 PMCID: PMC5687573 DOI: 10.1007/s11414-016-9506-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Claire D Clark
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Staci Langkjaer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sara Chinikamwala
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Heather Joseph
- Division of HIV/AIDs Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Salaam Semaan
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jillian Clement
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rebekah Marshall
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Eric Pevzner
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benedict I Truman
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karen Kroeger
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-44, Atlanta, GA, 30333, USA.
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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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Khosla N, Zachary I. Perspectives of HIV agencies on improving HIV prevention, treatment, and care services in the USA. AIDS Care 2016; 28:1249-54. [PMID: 26875546 DOI: 10.1080/09540121.2015.1124977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HIV healthcare services in the USA are made available through a complex funding and delivery system. We present perspectives of HIV agencies on improvements that could lead to an ideal system of HIV prevention, treatment and care. We conducted semi-structured interviews with representatives from 21 HIV agencies offering diverse services in Baltimore, MD. Thematic analysis revealed six key themes: (1) Focusing on HIV prevention, (2) Establishing common entry-points for services, (3) Improving information availability, (4) Streamlining funding streams, (5) Removing competitiveness and (6) Building trust. We recommend that in addition to addressing operational issues regarding service delivery and patient care, initiatives to improve HIV service systems should address underlying social issues such as building trust.
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Affiliation(s)
- Nidhi Khosla
- a Department of Health Sciences , School of Health Professions, University of Missouri , Columbia , MO , USA
| | - Iris Zachary
- b Department of Health Management and Informatics , School of Medicine, University of Missouri , Columbia , MO , USA
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Tran BX, Nguyen LH, Nong VM, Nguyen CT, Phan HTT, Latkin CA. Behavioral and quality-of-life outcomes in different service models for methadone maintenance treatment in Vietnam. Harm Reduct J 2016; 13:4. [PMID: 26837193 PMCID: PMC4736621 DOI: 10.1186/s12954-016-0091-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 01/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrating HIV/AIDS and methadone maintenance treatment (MMT) services with existing health care delivery system is critical in sustaining efforts to fight HIV/AIDS in large injection-driven epidemics. However, efficiency of different integrative service models is unknown. This study assessed behavioral and health-related quality-of-life (HRQOL) outcomes of MMT in four service delivery models and explored factors associated with these outcomes of interest. METHODS A cross-sectional survey was conducted in two HIV epicenters in Vietnam: Hanoi and Nam Dinh Province. All patients in five selected MMT clinics were invited to participate, and 1016 were interviewed (80-90% response rate). RESULTS Respondents had a mean age of 35.8, taken MMT for average 16.5 months and 3.3% on MMT for 36-60 months. The MMT integrated with rural district health center (DHC) has the highest prevalence of concurrent drug use (11.3%). The percentage of condom use (last sexual intercourse) with primary and casual partners was lowest in the MMT at urban DHCs. Patients at the rural DHC reported very high proportions of pain/discomfort (37.8%), anxiety/depression (43.1%), and mobility (13.3%). In regression models, poorer HRQOL outcomes were found in MMT models in the rural areas or without general health care, and among those patients who were HIV positive, reported concurrent drug use, and had higher numbers of previous drug rehabilitation episodes. Mobility and anxiety/depression are factors that increased the likelihood of concurrent drug use among MMT patients. CONCLUSIONS Outcomes of MMT were diverse across different integrative service models. Policies on rapid expansion of the MMT program in Vietnam should also emphasize on the integration with comprehensive health care services including psychological supports for patients.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam. .,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Long Hoang Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Vuong Minh Nong
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | | | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Guerrero EG, Andrews C, Harris L, Padwa H, Kong Y, M S W KF. Improving Coordination of Addiction Health Services Organizations with Mental Health and Public Health Services. J Subst Abuse Treat 2016; 60:45-53. [PMID: 26350114 PMCID: PMC4679570 DOI: 10.1016/j.jsat.2015.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 07/30/2015] [Accepted: 08/03/2015] [Indexed: 11/24/2022]
Abstract
In this mixed-method study, we examined coordination of mental health and public health services in addiction health services (AHS) in low-income racial and ethnic minority communities in 2011 and 2013. Data from surveys and semistructured interviews were used to evaluate the extent to which environmental and organizational characteristics influenced the likelihood of high coordination with mental health and public health providers among outpatient AHS programs. Coordination was defined and measured as the frequency of interorganizational contact among AHS programs and mental health and public health providers. The analytic sample consisted of 112 programs at time 1 (T1) and 122 programs at time 2 (T2), with 61 programs included in both periods of data collection. Forty-three percent of AHS programs reported high frequency of coordination with mental health providers at T1 compared to 66% at T2. Thirty-one percent of programs reported high frequency of coordination with public health services at T1 compared with 54% at T2. Programs with culturally responsive resources and community linkages were more likely to report high coordination with both services. Qualitative analysis highlighted the role of leadership in leveraging funding and developing creative solutions to deliver coordinated care. Overall, our findings suggest that AHS program funding, leadership, and cultural competence may be important drivers of program capacity to improve coordination with health service providers to serve minorities in an era of health care reform.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089.
| | | | - Lesley Harris
- Kent School of Social Work, University of Louisville, KY, 40292.
| | - Howard Padwa
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Box 71579, 760 Westwood Plaza, Los Angeles, CA 90024.
| | - Yinfei Kong
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089.
| | - Karissa Fenwick M S W
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089.
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Guerrero EG, Fenwick K, Kong Y, Grella C, D'Aunno T. Paths to improving engagement among racial and ethnic minorities in addiction health services. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2015; 10:40. [PMID: 26503509 PMCID: PMC4624163 DOI: 10.1186/s13011-015-0036-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/15/2015] [Indexed: 11/21/2022]
Abstract
Background Members of racial and ethnic minority groups are most likely to experience limited access and poor engagement in addiction treatment. Research has been limited on the role of program capacity and delivery of comprehensive care in improving access and retention among minorities with drug abuse issues. The goal of this study was to examine the extent to which access and retention are enhanced when racial and ethnic minorities receive care from high-capacity addiction health services (AHS) programs and via coordination with mental health and receipt of HIV testing services. Methods This multilevel cross-sectional analysis involved data from 108 programs merged with client data from 2011 for 13,478 adults entering AHS. Multilevel negative binomial regression models were used to test interactions and indirect relationships between program capacity and days to enter treatment (wait time) and days in treatment (retention). Results Compared to low-capacity programs and non-Latino and non-African American clients, Latinos and African Americans served in high-capacity programs reported shorter wait times to admission, as hypothesized. African Americans also had longer treatment retention in high-capacity programs. Receipt of HIV testing and program coordination of mental health services played an indirect role in the relationship between program capacity and wait time. Conclusions Program capacity and coordinated services in AHS may reduce disparities in access to care. Implications for supporting low-capacity programs to eliminate the disparity gap in access to care are discussed.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA, 90089, USA.
| | - Karissa Fenwick
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA, 90089, USA.
| | - Yinfei Kong
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA, 90089, USA.
| | - Christine Grella
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Integrated Substance Abuse Programs, Los Angeles, USA.
| | - Thomas D'Aunno
- Wagner Graduate School of Public Service, New York University, New York, USA.
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Fields D, Roman P. Longitudinal Examination of Medical Staff Utilization in Substance Use Disorder Treatment Organizations. J Subst Abuse Treat 2015. [PMID: 26219681 DOI: 10.1016/j.jsat.2015.06.014] [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] [Indexed: 11/17/2022]
Abstract
This study examined changes in utilization of medical staff within organizations specializing in treatment of patients with substance use disorder (SUD) at two points in time (2007 and 2010). Utilization was calculated as the number of hours paid weekly for psychiatrists, physicians, nurses, and other medical staff working as employees or on contract. Study data come from a longitudinal national sample of 274 substance use disorder treatment centers. Average utilization of medical staff by these SUD treatment organizations increased by 26% from 2007 to 2010. The results showed that growing SUD treatment centers that obtained more referrals from health care providers, used case managers to coordinate comprehensive approaches to patient care, provided medication assisted treatment (MAT), and that were connected more closely with hospitals made increased use of medical staff over the 2007-2010 period. In 2010, these organizations seem to have been moving in directions consistent with trends forecasted for the SUD treatment environment after implementation of the Affordable Care Act.
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Affiliation(s)
- Dail Fields
- Center for Research on Behavioral Health and Human Services Delivery, Institute for Behavioral Research, University of Georgia, Athens, GA, USA.
| | - Paul Roman
- Center for Research on Behavioral Health and Human Services Delivery, Institute for Behavioral Research, University of Georgia, Athens, GA, USA; Department of Sociology, University of Georgia, Athens, GA, USA.
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Fields D, Riesenmy K, Roman PM. Exploring Diversification as A Management Strategy in Substance Use Disorder Treatment Organizations. J Subst Abuse Treat 2015; 57:63-9. [PMID: 26021404 DOI: 10.1016/j.jsat.2015.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/25/2015] [Accepted: 05/03/2015] [Indexed: 11/28/2022]
Abstract
Implementation of the Affordable Care Act (ACA) creates both environmental uncertainties and opportunities for substance use disorder (SUD) treatment providers. One managerial response to uncertainties and emergent opportunities is strategic diversification of various dimensions of organizational activity. This paper explored organizational outcomes related to diversification of funding sources, services offered, and referral sources in a national sample of 590 SUD treatment organizations. Funding diversification was related to higher average levels of census, organization size, and recent expansion of operations. Service diversification was related to higher average levels of use of medication-assisted treatment (MAT), organization size, and expansion. Referral source diversification was related only to greater average use of MAT. Overall, strategic diversification in the three areas explored was related to positive organizational outcomes. Considering alternative strategies of diversification may help position SUD treatment centers to deliver more innovative treatments such as MAT as well as enhance capacity to satisfy current unmet treatment needs of individuals with behavioral health coverage provided under the ACA.
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Affiliation(s)
- Dail Fields
- Center for Research on Behavioral Health and Human Services Delivery, Institute for Behavioral Research, University of Georgia.
| | | | - Paul M Roman
- Center for Research on Behavioral Health and Human Services Delivery, Institute for Behavioral Research and, Department of Sociology, University of Georgia.
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Guerrero EG, Kao D. Racial/ethnic minority and low-income hotspots and their geographic proximity to integrated care providers. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2013; 8:34. [PMID: 24059252 PMCID: PMC3848872 DOI: 10.1186/1747-597x-8-34] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 09/20/2013] [Indexed: 11/17/2022]
Abstract
Background The high prevalence of mental health issues among clients attending substance abuse treatment (SAT) has pressured treatment providers to develop integrated substance abuse and mental health care. However, access to integrated care is limited to certain communities. Racial and ethnic minority and low-income communities may not have access to needed integrated care in large urban areas. Because the main principle of health care reform is to expand health insurance to low-income individuals to improve access to care and reduce health disparities among minorities, it is necessary to understand the extent to which integrated care is geographically accessible in minority and low-income communities. Methods National Survey of Substance Abuse Treatment Services data from 2010 were used to examine geographic availability of facilities offering integration of mental health services in SAT programs in Los Angeles County, California. Using geographic information systems (GIS), service areas were constructed for each facility (N = 402 facilities; 104 offering integrated services) representing the surrounding area within a 10-minute drive. Spatial autocorrelation analyses were used to derive hot spots (or clusters) of census tracts with high concentrations of African American, Asian, Latino, and low-income households. Access to integrated care was reflected by the hot spot coverage of each facility, i.e., the proportion of its service area that overlapped with each type of hot spot. Results GIS analysis suggested that ethnic and low-income communities have limited access to facilities offering integrated care; only one fourth of SAT providers offered integrated care. Regression analysis showed facilities whose service areas overlapped more with Latino hot spots were less likely to offer integrated care, as well as a potential interaction effect between Latino and high-poverty hot spots. Conclusion Despite significant pressure to enhance access to integrated services, ethnic and racial minority communities are disadvantaged in terms of proximity to this type of care. These findings can inform health care policy to increase geographic access to integrated care for the increasing number of clients with public health insurance.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089, USA.
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