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Bass B, Padwa H, Khurana D, Urada D, Boustead A. Adult use cannabis legalization and cannabis use disorder treatment in California, 2010-2021. J Subst Use Addict Treat 2024; 162:209345. [PMID: 38494048 DOI: 10.1016/j.josat.2024.209345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/08/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Many nations and jurisdictions have legalized non-medical adult use of cannabis, or are considering doing so. This paper contributes to knowledge of adult use legalization's associations with cannabis use disorder (CUD) treatment utilization. METHODS This study collected data from a dataset of all publicly funded substance use disorder treatment delivered in California from 2010 to 2021 (1,460,066 episodes). A logistic regression model estimates adult use legalization's impacts on CUD treatment utilization using an individual-level pre-post time series model, including individual and county-level characteristics and county and year-fixed effects. RESULTS Adult use legalization was associated with a significant decrease in the probability of admission to CUD treatment (average marginal effect (AME): -0.005, 95 % CI: -0.009, 0.000). Adult use legalization was also associated with a decrease in the probability of admission to CUD treatment for males (AME: -0.025, 95 % CI: -0.027, -0.023) Medi-Cal beneficiaries (AME: -0.025, 95 % CI: -0.027, -0.023) adults ages 21+ (AME: -0.011, 95 % CI: -0.014, -0.009) and Whites (AME: -0.012, 95 % CI: -0.015, -0.010), and an increase in the probability of admission to CUD treatment for patients referred from the criminal justice system (AME: 0.017, 95 % CI: 0.015, 0.020) and Blacks (AME: 0.004, 95 % CI: 0.000, 0.007) and Hispanics (AME: 0.009, 95 % CI: 0.006, 0.011). CONCLUSIONS Adult use legalization is associated with declining CUD treatment admissions, even though cannabis-related problems are becoming more prevalent. Policies and practices that protect public health, and engage people with CUD in treatment are needed.
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Affiliation(s)
- Brittany Bass
- University of California, Los Angeles, Department of Addiction Psychiatry, Semel Institute for Neuroscience and Human Behavior, 10911 Weyburn Avenue, Suite 200, Los Angeles, CA 90024, United States.
| | - Howard Padwa
- University of California, Los Angeles, Department of Addiction Psychiatry, Semel Institute for Neuroscience and Human Behavior, 10911 Weyburn Avenue, Suite 200, Los Angeles, CA 90024, United States.
| | - Dhruv Khurana
- University of California, Los Angeles, Department of Addiction Psychiatry, Semel Institute for Neuroscience and Human Behavior, 10911 Weyburn Avenue, Suite 200, Los Angeles, CA 90024, United States.
| | - Darren Urada
- University of California, Los Angeles, Department of Addiction Psychiatry, Semel Institute for Neuroscience and Human Behavior, 10911 Weyburn Avenue, Suite 200, Los Angeles, CA 90024, United States.
| | - Anne Boustead
- University of Arizona, School of Government and Public Policy, 331 Social Science Building, Tucson, AZ 85721, United States.
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Padwa H, Henwood BF, Ijadi-Maghsoodi R, Tran-Smith B, Darby A, Bluthenthal R, Chinchilla M, Vickery KD, Kuhn R, Lawton A, Fenderson E, Galarza E, Haynes A, King D, Martiniuk E, Marshall P, Mendoza S, Patton T, Shaw S, Stevens R, Gelberg L. Bringing Lived Experience to Research on Health and Homelessness: Perspectives of Researchers and Lived Experience Partners. Community Ment Health J 2023; 59:1235-1242. [PMID: 37204566 PMCID: PMC10198013 DOI: 10.1007/s10597-023-01138-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
Improving health and healthcare for people experiencing homelessness (PEH) has become a national research priority. It is critical for research related to homelessness to be guided by input from PEH themselves. We are a group of researchers and individuals who have personally experienced homelessness collaborating on a study focused on homelessness and housing. In this Fresh Focus, we describe our partnership, lessons learned from our work together, what we have gained from our collaboration, and considerations for future homelessness research-lived experience partnerships.
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Affiliation(s)
- Howard Padwa
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, 10911 Weyburn Avenue, Suite 200, Los Angeles, CA, 90024, USA.
| | - Benjamin F Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA, 90089, USA
| | - Roya Ijadi-Maghsoodi
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, 10911 Weyburn Avenue, Suite 200, Los Angeles, CA, 90024, USA
- Department of Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Bikki Tran-Smith
- Department of Biomedical & Health Sciences, University of Vermont, 149 Beaumont Avenue, Burlington, VT, 05405, USA
| | - Anna Darby
- Department of Emergency Medicine, University of California, Los Angeles, 924 Westwood Blvd, Los Angeles, CA, 90024, USA
| | - Ricky Bluthenthal
- Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA
| | - Melissa Chinchilla
- Department of Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Katherine Diaz Vickery
- Health, Homelessness, & Criminal Justice Lab, Hennepin Healthcare Research Institute, 825 8th St S., Minneapolis, MN, 55404, USA
| | - Randall Kuhn
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA, 90095, USA
| | - Alexander Lawton
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA, 90095, USA
| | | | | | - Anthony Haynes
- Skid Row Housing Trust, Los Angeles, CA, USA
- Corporation for Supportive Housing, Los Angeles, CA, USA
| | - Dennis King
- Skid Row Housing Trust, Los Angeles, CA, USA
- Corporation for Supportive Housing, Los Angeles, CA, USA
| | | | | | | | | | - Suzette Shaw
- National Alliance to End Homelessness, Los Angeles, CA, USA
- Los Angeles County Continuum of Care Board, Los Angeles, CA, USA
| | - Reba Stevens
- Los Angeles County Continuum of Care Board, Los Angeles, CA, USA
- Los Angeles County Mental Health Commission, Los Angeles, CA, USA
| | - Lillian Gelberg
- Department of Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
- Department of Family Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
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Henwood BF, Kuhn R, Padwa H, Ijadi-Maghsoodi R, Corletto G, Lawton A, Chien J, Bluthenthal R, Cousineau MR, Chinchilla M, Tran Smith B, Vickery KD, Harris T, Patanwala M, Akabike W, Gelberg L. Investigating the Comparative Effectiveness of Place-Based and Scatter-Site Permanent Supportive Housing for People Experiencing Homelessness During the COVID-19 Pandemic: Protocols for a Mixed Methods, Prospective Longitudinal Study. JMIR Res Protoc 2023; 12:e46782. [PMID: 37115590 PMCID: PMC10150866 DOI: 10.2196/46782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Permanent supportive housing (PSH) is an evidence-based practice to address homelessness that is implemented using 2 distinct approaches. The first approach is place-based PSH (PB-PSH), or single-site housing placement, in which an entire building with on-site services is designated for people experiencing homelessness. The second approach is scatter-site PSH (SS-PSH), which uses apartments rented from a private landlord while providing mobile case management services. OBJECTIVE This paper describes the protocols for a mixed methods comparative effectiveness study of 2 distinct approaches to implementing PSH and the patient-centered quality of life, health care use, and health behaviors that reduce COVID-19 risk. METHODS People experiencing homelessness who are placed in either PB-PSH or SS-PSH completed 6 monthly surveys after move-in using smartphones provided by the study team. A subsample of participants completed 3 qualitative interviews at baseline, 3 months, and 6 months that included photo elicitation interviewing. Two stakeholder advisory groups, including one featuring people with lived experience of homelessness, helped guide study decisions and interpretations of findings. RESULTS Study recruitment was supposed to occur over 6 months starting in January 2021 but was extended due to delays in recruitment. These delays included COVID-19 delays (eg, recruitment sites shut down due to outbreaks and study team members testing positive) and delays that may have been indirectly related to the COVID-19 pandemic, including high staff turnover or recruitment sites having competing priorities. In end-July 2022, in total, 641 people experiencing homelessness had been referred from 26 partnering recruitment sites, and 563 people experiencing homelessness had enrolled in the study and completed a baseline demographic survey. Of the 563 participants in the study, 452 had recently moved into the housing when they enrolled, with 272 placed in PB-PSH and 180 placed in SS-PSH. Another 111 participants were approved but are still waiting for housing placement. To date, 49 participants have been lost to follow-up, and 12% of phones (70 of the initial 563 distributed) were reported lost by participants. CONCLUSIONS Recruitment during the pandemic, while successful, was challenging given that in-person contact was not permitted at times either by program sites or the research institutions during COVID-19 surges and high community transmission, which particularly affected homelessness programs in Los Angeles County. To overcome recruitment challenges, flexible strategies were used, which included extending the recruitment period and the distribution of cell phones with paid data plans. Given current recruitment numbers and retention rates that are over 90%, the study will be able to address a gap in the literature by considering the comparative effectiveness of PB-PSH versus SS-PSH on patient-centered quality of life, health care use, and health behaviors that reduce COVID-19 risk, which can influence future public health approaches to homelessness and infectious diseases. TRIAL REGISTRATION ClinicalTrials.gov NCT04769349; https://clinicaltrials.gov/ct2/show/NCT04769349. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46782.
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Affiliation(s)
- Benjamin F Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Randall Kuhn
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Howard Padwa
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, United States
| | - Roya Ijadi-Maghsoodi
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, United States
- Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Gisele Corletto
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Alex Lawton
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Jessie Chien
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Ricky Bluthenthal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Michael R Cousineau
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Melissa Chinchilla
- Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Bikki Tran Smith
- Department of Biomedical and Health Sciences, College of Nursing and Health Sciences, University of Vermont, Burlington, VT, United States
| | - Katherine D Vickery
- University of Minnesota Medical School, Minneapolis, MN, United States
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
| | - Taylor Harris
- Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Maria Patanwala
- Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Whitney Akabike
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, United States
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Padwa H, Huang D, Mooney L, Grella CE, Urada D, Bell DS, Bass B, Boustead AE. Medical conditions of primary care patients with documented cannabis use and cannabis use disorder in electronic health records: a case control study from an academic health system in a medical marijuana state. Subst Abuse Treat Prev Policy 2022; 17:36. [PMID: 35527269 PMCID: PMC9080201 DOI: 10.1186/s13011-022-00467-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Approximately 3.8% of adults worldwide have used cannabis in the past year. Understanding how cannabis use is associated with other health conditions is crucial for healthcare providers seeking to understand the needs of their patients, and for health policymakers. This paper analyzes the relationship between documented cannabis use disorders (CUD), cannabis use (CU) and other health diagnoses among primary care patients during a time when medical use of marijuana was permitted by state law in California, United States of America. METHODS The study utilized primary care electronic health record (EHR) data from an academic health system, using a case-control design to compare diagnoses among individuals with CUD/CU to those of matched controls, and those of individuals with CUD diagnoses with individuals who had CU otherwise documented. Associations of documented CU and CUD with general medical conditions and health conditions associated with cannabis use (both medical and behavioral) were analyzed using conditional logistic regression. RESULTS Of 1,047,463 patients with ambulatory encounters from 2013-2017, 729 (0.06%) had CUD diagnoses and 3,731 (0.36%) had CU documented in their EHR. Patients with documented CUD and CU patients had significantly (p < 0.01) higher odds of most medical and behavioral diagnoses analyzed. Compared to matched controls, CUD-documented patients had highest odds of other substance use disorders (OR = 21.44: 95% CI 9.43-48.73), any mental health disorder (OR = 6.99; 95% CI 5.03-9.70) social anxiety disorder (OR = 13.03; 95% CI 2.18-77.94), HIV/AIDS (OR = 7.88: 95% CI 2.58-24.08), post-traumatic stress disorder (OR = 7.74: 95% CI 2.66-22.51); depression (OR = 7.01: 95% CI 4,79-10.27), and bipolar disorder (OR = 6.49: 95% CI 2.90-14.52). Compared to matched controls, CU-documented patients had highest odds of other substance use disorders (OR = 3.64; 95% CI 2.53-5.25) and post-traumatic stress disorder (OR = 3.41; 95% CI 2.53-5.25). CUD-documented patients were significantly more likely than CU-documented patients to have HIV/AIDS (OR = 6.70; 95% CI 2.10-21.39), other substance use disorder (OR = 5.88; 95% CI 2.42-14.22), depression (OR = 2.85; 95% CI 1.90-4.26), and anxiety (OR = 2.19: 95% CI 1.57-3.05) diagnoses. CONCLUSION The prevalence of CUD and CU notation in EHR data from an academic health system was low, highlighting the need for improved screening in primary care. CUD and CU documentation were associated with increased risk for many health conditions, with the most elevated risk for behavioral health disorders and HIV/AIDS (among CUD-documented, but not CU-documented patients). Given the strong associations of CUD and CU documentation with health problems, it is important for healthcare providers to be prepared to identify CU and CUD, discuss the pros and cons of cannabis use with patients thoughtfully and empathically, and address cannabis-related comorbidities among these patients.
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Affiliation(s)
- Howard Padwa
- Department of Psychiatry and Biobehavioral Sciences, University of California, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA.
| | - David Huang
- Department of Psychiatry and Biobehavioral Sciences, University of California, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA
| | - Larissa Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA
| | - Christine E Grella
- Department of Psychiatry and Biobehavioral Sciences, University of California, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA
| | - Darren Urada
- Department of Psychiatry and Biobehavioral Sciences, University of California, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA
| | - Douglas S Bell
- Division of General Internal Medicine, Department of Medicine, University of California, Los Angeles, USA
- Clinical and Translational Science Institute, University of California, Los Angeles, USA
| | - Brittany Bass
- Department of Psychiatry and Biobehavioral Sciences, University of California, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA
| | - Anne E Boustead
- School of Government & Public Policy, University of Arizona, Tucson, USA
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Mark TL, Treiman K, Padwa H, Henretty K, Tzeng J, Gilbert M. Addiction Treatment and Telehealth: Review of Efficacy and Provider Insights During the COVID-19 Pandemic. Psychiatr Serv 2022; 73:484-491. [PMID: 34644125 DOI: 10.1176/appi.ps.202100088] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Addiction treatment via telehealth expanded to unprecedented levels during the COVID-19 pandemic. This study aimed to clarify whether the research evidence on the efficacy of telehealth-delivered substance use disorder treatment and the experience of providers using telehealth during the pandemic support continued use of telehealth after the pandemic and, if so, under what circumstances. METHODS Data sources included a literature review on the efficacy of telehealth for substance use disorder treatment, responses to a 2020 online survey from 100 California addiction treatment providers, and interviews with 30 California treatment providers and other stakeholders. RESULTS Eight published studies were identified that compared addiction treatment via telehealth with in-person treatment. Seven found telehealth treatment as effective but not more effective than in-person treatment in terms of retention, therapeutic alliance, and substance use. One Canadian study found that telehealth facilitated methadone prescribing and improved retention. In the survey results reported here, California addiction treatment providers said that more than 50% of their patients were being treated via telehealth for intensive outpatient treatment, individual counseling, group counseling, and intake assessment. They were most confident that individual counseling via telehealth was as effective as in-person individual counseling and less sure about the relative effectiveness of telehealth-delivered medication management, group counseling, and intake assessments. CONCLUSIONS Telehealth may help engage patients in addiction treatment by improving access and convenience. Additional research is needed to confirm that benefit and to determine how best to tailor telehealth to each patient's circumstances and with what mix of in-person and telehealth services.
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Affiliation(s)
- Tami L Mark
- RTI International, Rockville, Maryland (Mark, Treiman), and Research Triangle Park, North Carolina (Henretty, Tzeng); Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles (Padwa, Gilbert)
| | - Katherine Treiman
- RTI International, Rockville, Maryland (Mark, Treiman), and Research Triangle Park, North Carolina (Henretty, Tzeng); Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles (Padwa, Gilbert)
| | - Howard Padwa
- RTI International, Rockville, Maryland (Mark, Treiman), and Research Triangle Park, North Carolina (Henretty, Tzeng); Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles (Padwa, Gilbert)
| | - Kristen Henretty
- RTI International, Rockville, Maryland (Mark, Treiman), and Research Triangle Park, North Carolina (Henretty, Tzeng); Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles (Padwa, Gilbert)
| | - Janice Tzeng
- RTI International, Rockville, Maryland (Mark, Treiman), and Research Triangle Park, North Carolina (Henretty, Tzeng); Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles (Padwa, Gilbert)
| | - Marylou Gilbert
- RTI International, Rockville, Maryland (Mark, Treiman), and Research Triangle Park, North Carolina (Henretty, Tzeng); Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles (Padwa, Gilbert)
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Padwa H, Bass B, Urada D. Homelessness and publicly funded substance use disorder treatment in California, 2016-2019: Analysis of treatment needs, level of care placement, and outcomes. J Subst Abuse Treat 2021; 137:108711. [PMID: 35012791 DOI: 10.1016/j.jsat.2021.108711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 11/04/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Both homelessness and substance use have increased in recent years. People experiencing homelessness (PEH) are at increased risk for health problems and early mortality, both of which can be exacerbated by substance use disorders (SUD). Specialty SUD treatment is likely needed to address substance use among PEH, and more than 232,000 PEH received treatment from U.S. publicly funded SUD programs in 2015. The objective of this paper is to develop a better understanding of the SUD services that PEH receive in publicly funded treatment programs by (1) describing the characteristics and needs of the PEH population served in publicly funded SUD treatment programs, compared to non-PEH populations; (2) determining if differences exist in treatment placement (level of care) for PEH and non-PEH; and (3) gauging how successful programs are in treating PEH compared to non-PEH. METHODS Observational study using a two-way fixed effect model to determine associations among homelessness, retention, and outcomes among Medicaid beneficiaries receiving SUD treatment in California from 2016 to 2019 (n = 638,953). The study team used ordinary least squares (OLS) regression to measure the degree to which homelessness was associated with baseline characteristics, SUD services received, and treatment outcomes. RESULTS PEH were significantly more likely than non-PEH to be having methamphetamine or heroin as their primary substance. PEH had greater frequency of primary substance use prior to entering treatment, greater ER and hospital utilization, more criminal justice involvement, and greater prevalence of mental health diagnoses and unemployment. PEH were 9.82% more likely than non-PEH to receive residential treatment and 7.11% less likely than non-PEH to receive treatment intensive outpatient modalities. Homelessness was associated with an 11.90% decrease in retention, and a 19.40% decrease in successful discharge status. These trends were consistent across outpatient, intensive outpatient, and residential modalities. CONCLUSIONS Developing SUD treatment capacity and housing supports can improve treatment outcomes for PEH. Potential strategies to improve SUD services for PEH include providing more contingency management, opioid pharmacotherapies, programming designed to treat individuals with co-occurring mental health disorders, and resources for housing options that can support PEH in their recovery.
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Affiliation(s)
- Howard Padwa
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA 90025, United States of America.
| | - Brittany Bass
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA 90025, United States of America
| | - Darren Urada
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA 90025, United States of America
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Mark TL, Hinde JM, Barnosky A, Joshi V, Padwa H, Treiman K. Is implementation of ASAM-based addiction treatment assessments associated with improved 30-day retention and substance use? Drug Alcohol Depend 2021; 226:108868. [PMID: 34237614 DOI: 10.1016/j.drugalcdep.2021.108868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/04/2021] [Accepted: 06/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The American Society of Addiction Medicine (ASAM) criteria were developed to provide a systematic, evidence-based, and transparent approach to addiction treatment assessment and level-of-care recommendations. In 2017, California began a Medicaid demonstration that required that providers in participating counties to adopt ASAM-based intake assessments and level-of-care criteria. We hypothesized that ASAM implementation would increase the proportion of patients retained in addiction treatment and successfully completing their treatment plan. METHODS We implemented a comparative interrupted time series analysis with 407,792 treatment episodes by Medicaid beneficiaries in specialty addiction treatment settings from 2015 to mid-2019. We compared the change in retention rates and successful completion rates in counties that adopted ASAM-based assessments relative to counties that did not adopt ASAM-based assessments and used only clinical judgment for level-of-care decisions. Treatment retention was defined as staying in addiction treatment for at least 30 days. Successful completion of the treatment plan was determined by the patient's clinician. RESULTS After one year, ASAM implementation was associated with a 9% increase in 30-day retention among treatment episodes that started in a residential setting, but no change in retention among episodes starting in outpatient settings. We found no statistically significant association between ASAM adoption and successful treatment completion. CONCLUSIONS Implementation of ASAM-based assessment may lead to improved retention for individuals who begin treatment in residential treatment, which may be encouraging to the many state Medicaid programs that are adopting ASAM-based criteria. More research is needed to clarify the mechanism by which ASAM leads to improved outcomes and to clarify how to maximize the potential benefits of ASAM, such as through patient-centered implementation.
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Affiliation(s)
- Tami L Mark
- RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, 27709-2194, United States.
| | - Jesse M Hinde
- RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, 27709-2194, United States
| | - Alan Barnosky
- RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, 27709-2194, United States
| | - Vandana Joshi
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd, Los Angeles, CA, 90095-1759, United States
| | - Howard Padwa
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd, Los Angeles, CA, 90095-1759, United States
| | - Katherine Treiman
- RTI International, 6110 Executive Blvd, #900, Rockville, MD, 20852, United States
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Snyder H, Kalmin MM, Moulin A, Campbell A, Goodman-Meza D, Padwa H, Clayton S, Speener M, Shoptaw S, Herring AA. Rapid Adoption of Low-Threshold Buprenorphine Treatment at California Emergency Departments Participating in the CA Bridge Program. Ann Emerg Med 2021; 78:759-772. [PMID: 34353655 DOI: 10.1016/j.annemergmed.2021.05.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/14/2021] [Accepted: 05/24/2021] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVE We retrospectively evaluated the implementation of low-threshold emergency department (ED) buprenorphine treatment at 52 hospitals participating in the CA Bridge Program using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. METHODS The CA Bridge model included low-threshold buprenorphine, connection to outpatient care, and harm reduction. Implementation began in March 2019. Participating hospitals reported aggregated clinical data monthly after program initiation. Outcomes included identification of opioid use disorder, buprenorphine administration, and linkage to outpatient addiction treatment. Multivariable models assessed associations between hospital location (rural versus urban) and teaching status (clinical teaching hospital versus community hospital) and outcomes in adopting the CA Bridge Program. RESULTS Reach: A diverse and geographically distributed group of 52 California hospitals were enrolled in 2 phases (March and August 2019); 12 (23%) were rural and 13 (25%) were teaching hospitals. Effectiveness: Over a 14-month implementation period, 12,009 opioid use disorder patient encounters were identified, including 7,179 (59.7%) where buprenorphine was administered and 4,818 (40.1%) where follow-up visits were attended. Adoption: In multivariable analysis, adoption did not differ significantly between rural and urban or teaching and nonteaching hospitals. IMPLEMENTATION By program completion, all 52 (100%) hospitals treated opioid use disorder with buprenorphine; 45 (86.5%) administered buprenorphine after naloxone reversal; 41 (84.6%) offered buprenorphine for inpatients; 48 (92.3%) initiated buprenorphine in pregnant women; and 29 (55.8%) offered take-home naloxone. Maintenance: At 8-month follow-up, all 52 sites reported continued buprenorphine treatment. CONCLUSION Low-threshold ED buprenorphine treatment implemented with a harm reduction approach and active navigation to outpatient addiction treatment was successful in achieving buprenorphine treatment for opioid use disorder in diverse California communities.
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Affiliation(s)
- Hannah Snyder
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA; CA Bridge Program, Public Health Institute, Oakland, CA
| | - Mariah M Kalmin
- Department of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Aimee Moulin
- CA Bridge Program, Public Health Institute, Oakland, CA; Department of Emergency Medicine and Psychiatry, UC Davis Medical Center, Sacramento, CA
| | - Arianna Campbell
- CA Bridge Program, Public Health Institute, Oakland, CA; Department of Emergency Medicine, US Acute Care Solutions at Marshall Medical Center, Placerville, CA
| | - David Goodman-Meza
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Howard Padwa
- Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, CA
| | | | | | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Andrew A Herring
- CA Bridge Program, Public Health Institute, Oakland, CA; Department of Emergency Medicine and Internal Medicine, Highland Hospital-Alameda Health System, Oakland, CA; University of California San Francisco, San Francisco, CA.
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Padwa H, Treiman K, Mark TL, Tzeng J, Gilbert M. Assessing Assessments: Substance use disorder treatment providers' perceptions of intake assessments. Subst Abus 2021; 43:451-457. [PMID: 34282997 DOI: 10.1080/08897077.2021.1946891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Assessments to determine patients' treatment needs and preferences when they begin substance use disorder (SUD) treatment are essential. The objectives of this paper are to identify the perspectives of providers who conduct assessments on (1) assessments' utility in determining the level of care where patients will receive treatment, (2) strategies to engage patients in treatment during assessments, and (3) assessment strengths and shortcomings. Methods: Semi-structured interviews were conducted with 30 California treatment providers who routinely perform SUD assessments for Medicaid beneficiaries. Interviews asked about the utility of assessment tools in determining appropriate levels of care, patient engagement during assessments, and strengths and shortcomings of intake assessment processes. Interviews were audio-recorded, transcribed, and analyzed by multiple researchers using template analysis. Results: Providers reported that assessments linked to level-of-care decision rules sometimes generate recommendations inconsistent with their clinical judgment, and that the timing of assessments can influence the quality of the information collected. Providers described engagement strategies that help patients feel more comfortable during assessments and that encourage more thoughtful and accurate responses. Providers valued assessments that helped ensure comprehensive collection of patient information, that allowed flexibility to probe for additional information and context, and that facilitated treatment planning. Providers did not like assessments that were long and repetitive or those that did not collect detailed information about patients' mental health and recovery environments. Conclusions: Assessments can be improved if providers conduct them in a manner that makes patients feel comfortable while building trust and rapport. Ensuring that assessments are not long or repetitive and giving comprehensive assessments once patients have developed trusting relationships with treatment programs can improve assessment processes. Further research is needed to optimize SUD assessments.
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Affiliation(s)
- Howard Padwa
- Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Tami L Mark
- RTI International, Research Triangle Park, NC, USA
| | - Janice Tzeng
- RTI International, Research Triangle Park, NC, USA
| | - Marylou Gilbert
- Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, CA, USA
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10
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Henretty K, Padwa H, Treiman K, Gilbert M, Mark TL. Impact of the Coronavirus Pandemic on Substance Use Disorder Treatment: Findings from a Survey of Specialty Providers in California. Subst Abuse 2021; 15:11782218211028655. [PMID: 34285496 PMCID: PMC8264730 DOI: 10.1177/11782218211028655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/10/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND As the coronavirus pandemic public health emergency begins to ebb in the United States, policymakers and providers need to evaluate how the addiction treatment system functioned during the public health emergency and draw lessons for future emergencies. One important question is whether the pandemic curtailed the use of addiction treatment and the extent to which telehealth was able to mitigate access barriers. METHODS To begin to answer this question, we conducted a survey of specialty addiction treatment providers in California from June 2020 through July 2020. The survey focused specifically on provider organizations that served Medicaid beneficiaries. RESULTS Of the 133 respondents, 50% reported a decrease in patients since the stay-at-home order in March 2020, with the largest decline among new patients, and 58% said more patients were relapsing. Eighty-one percent of providers said that telemedicine use had increased since the stay-at-home order. Most said that telemedicine had moderately (48%) or completely (30%) addressed access barriers. CONCLUSION More efforts are needed to ensure that patients, and in particular new patients, receive addiction treatment during public health emergencies.
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Affiliation(s)
| | - Howard Padwa
- Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | | | - Marylou Gilbert
- Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | - Tami L Mark
- RTI International, Research Triangle Park, NC, USA
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11
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Abstract
This cohort study examines changes in initiations of treatment in specialty addiction treatment facilities before vs during the COVID-19 pandemic in California.
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Affiliation(s)
| | | | | | - Howard Padwa
- Department of Integrated Substance Abuse Programs, University of California, Los Angeles
| | - Vandana Joshi
- Department of Integrated Substance Abuse Programs, University of California, Los Angeles
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12
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Treiman K, Padwa H, Mark TL, Tzeng J, Gilbert M. “The assessment really helps you with the first step in recovery.” What do clients think substance use disorder treatment intake assessments should look like? Subst Abus 2021; 42:880-887. [DOI: 10.1080/08897077.2021.1878085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
| | - Howard Padwa
- University of California, Integrated Substance Abuse Programs, Los Angeles, California, USA
| | | | | | - Marylou Gilbert
- University of California, Integrated Substance Abuse Programs, Los Angeles, California, USA
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13
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Young SD, Padwa H, Bonar EE. Social Big Data as a Tool for Understanding and Predicting the Impact of Cannabis Legalization. Front Public Health 2019; 7:274. [PMID: 31637226 PMCID: PMC6787761 DOI: 10.3389/fpubh.2019.00274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 09/10/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sean D Young
- University of California Institute for Prediction Technology, Department of Informatics, University of California, Irvine, Irvine, CA, United States.,Department of Emergency Medicine, University of California, Irvine, Irvine, CA, United States
| | - Howard Padwa
- Integrated Substance Abuse Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Erin E Bonar
- Department of Psychiatry, Addiction Center, University of Michigan, Ann Arbor, MI, United States
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14
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Padwa H, Guerrero EG, Serret V, Rico M, Gelberg L. Adapting substance use brief interventions for adolescents: perspectives of adolescents living with adults in substance use disorder treatment. Subst Abuse Rehabil 2018; 9:137-142. [PMID: 30584386 PMCID: PMC6287412 DOI: 10.2147/sar.s177865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Brief interventions (BIs) have shown potential to reduce both alcohol and drug use. Although BIs for adults have been studied extensively, little is known about how to adapt them to meet the needs and preferences of adolescents. This article examines adolescents' preferences to consider when adapting BIs for use with adolescents. Methods Eighteen adolescents (age 9-17 years) living in Los Angeles County with adults receiving substance use disorder treatment were interviewed and asked about their perspectives on how to adapt a BI originally developed for adults for use with adolescents. Questions focused on adolescents' preferences for who should deliver BIs, how BIs should be delivered, and what content they would want to be included in BIs. Interviews were recorded, transcribed, and coded using summative content analysis. Results Adolescents did not express any discernable opinions concerning who delivers BIs or what content they would want to be included, but they did share perspectives on how BIs should be delivered. Most adolescents did not endorse incorporating text messaging or social media into BIs. Instead they preferred having BIs delivered face-to-face or over the telephone. They reported that they did not want BIs to incorporate text messaging or social media due to concerns about trust, the quality of information they would receive, and challenges communicating in writing instead of speaking. Conclusion Although the study has limitations because of its small sample size, findings indicate that adolescents may not want text messaging or social media to be incorporated into BIs for substance use. These findings warrant further research and consideration, particularly as work to enhance BIs for adolescents continues.
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Affiliation(s)
- Howard Padwa
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Integrated Substance Abuse Programs, Los Angeles, CA, USA,
| | - Erick G Guerrero
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA.,University of Southern California, Marshall School of Business, Los Angeles, CA, USA
| | - Veronica Serret
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
| | - Melvin Rico
- University of California, Los Angeles, David Geffen School of Medicine, Department of Family Medicine, Los Angeles, CA, USA
| | - Lillian Gelberg
- University of California, Los Angeles, David Geffen School of Medicine, Department of Family Medicine, Los Angeles, CA, USA.,University of California, Los Angeles, Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, CA, USA.,Department of Veterans Affairs Greater Los Angeles Healthcare System, Office of Healthcare Transformation and Innovation, Los Angeles, CA, USA
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15
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Starks SL, Arns PG, Padwa H, Friedman JR, Marrow J, Meldrum ML, Bromley E, Kelly EL, Brekke JS, Braslow JT. System Transformation Under the California Mental Health Services Act: Implementation of Full-Service Partnerships in L.A. County. Psychiatr Serv 2017; 68:587-595. [PMID: 28142386 PMCID: PMC6005368 DOI: 10.1176/appi.ps.201500390] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study evaluated the effect of California's Mental Health Services Act (MHSA) on the structure, volume, location, and patient centeredness of Los Angeles County public mental health services. METHODS This prospective mixed-methods study (2006-2013) was based in five Los Angeles County public mental health clinics, all with usual care and three with full-service partnerships (FSPs). FSPs are MHSA-funded programs designed to "do whatever it takes" to provide intensive, recovery-oriented, team-based, integrated services for clients with severe mental illness. FSPs were compared with usual care on outpatient services received (claims data) and on organizational climate, recovery orientation, and provider-client working alliance (surveys and semistructured interviews), with regression adjustment for client and provider characteristics. RESULTS In the first year after admission, FSP clients (N=174) received significantly more outpatient services than did usual care clients (N=298) (5,238 versus 1,643 minutes, p<.001), and a larger proportion of these services were field based (22% versus 2%, p<.001). Compared with usual care clients, FSP clients reported more recovery-oriented services (p<.001) and a better provider-client working alliance (p=.01). Compared with usual care providers (N=130), FSP providers (N=42) reported more stress (p<.001) and lower morale (p<.001). CONCLUSIONS Los Angeles County's public mental health system was able to transform service delivery in response to well-funded policy mandates. For providers, a structure emphasizing accountability and patient centeredness was associated with greater stress, despite smaller caseloads. For clients, service structure and volume created opportunities to build stronger provider-client relationships and address their needs and goals.
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Affiliation(s)
- Sarah L Starks
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
| | - Paul G Arns
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
| | - Howard Padwa
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
| | - Jack R Friedman
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
| | - Jocelyn Marrow
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
| | - Marcia L Meldrum
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
| | - Elizabeth Bromley
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
| | - Erin L Kelly
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
| | - John S Brekke
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
| | - Joel T Braslow
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
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Freese TE, Padwa H, Oeser BT, Rutkowski BA, Schulte MT. Real-World Strategies to Engage and Retain Racial-Ethnic Minority Young Men Who Have Sex with Men in HIV Prevention Services. AIDS Patient Care STDS 2017; 31:275-281. [PMID: 28530444 DOI: 10.1089/apc.2016.0310] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Racial/ethnic minority young men who have sex with men (YMSM)-particularly African Americans and Hispanics/Latinos-are at particularly high risk for HIV infection. Devising strategies to improve engagement and retention in HIV prevention services among minority YMSM is critical if the United States is going to achieve the National HIV/AIDS Strategy goal of reducing HIV health-related disparities. This article presents findings from a national summit on racial/ethnic YMSM services convened by the Substance Abuse and Mental Health Services Administration-funded Center of Excellence on Racial and Ethnic Minority Young Men Who Have Sex with Men and Other Lesbian, Gay, Bisexual, and Transgender Populations (YMSM + LGBT CoE) in September 2015. The summit included (1) subgroup discussions focused on issues related to treatment access, outreach/engagement/retention, continuing care/recovery support, and health literacy for minority YMSM; and (2) a ranking process, where the NIATx Nominal Group Technique was used to identify the strategies and approaches that summit participants believed to be most promising for engaging and retaining minority YMSM in HIV prevention services. Analyses of results from summit activities highlight four key cross-cutting strategies-utilizing peers, providing holistic care, making services fun, and utilizing technology-as critical for engaging minority YMSM in HIV prevention care. Examples of programs that utilize these strategies and implications of these findings for policy and practice are discussed.
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Affiliation(s)
- Thomas E. Freese
- Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, California
| | - Howard Padwa
- Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, California
| | - Brandy T. Oeser
- Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, California
| | - Beth A. Rutkowski
- Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, California
| | - Marya T. Schulte
- Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, California
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Schaper E, Padwa H, Urada D, Shoptaw S. Substance use disorder patient privacy and comprehensive care in integrated health care settings. Psychol Serv 2016; 13:105-9. [PMID: 26845493 DOI: 10.1037/a0037968] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Affordable Care Act (ACA) expands health insurance coverage for substance use disorder (SUD) treatment, underscoring the value of improving SUD service integration in primarily physical health care settings. It is not yet known to what degree specialized privacy regulations-Code of Federal Regulations Title 42, Part 2 (42 CFR Part 2), in particular-will affect access to or the utilization and delivery of SUD treatment in primary care. In addition to exploring the emerging benefits and barriers that specialized confidentiality regulations pose to treatment in early adopting integrated health care settings, this article introduces and explicates 42 CFR Part 2 to support provider and administrator implementation of SUD privacy regulations in integrated settings. The authors also argue that, although intended to protect patients with SUD, special SUD information protection may inadvertently reinforce stigma against patients by purporting the belief that SUD is different from other health problems and must be kept private. In turn, this stigma may inhibit the delivery of comprehensive integrated care.
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Affiliation(s)
- Elizabeth Schaper
- California Center for Population Research, University of California-Los Angeles
| | - Howard Padwa
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California-Los Angeles
| | - Darren Urada
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California-Los Angeles
| | - Steven Shoptaw
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California-Los Angeles
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Padwa H, Urada D, Gauthier P, Rieckmann T, Hurley B, Crèvecouer-MacPhail D, Rawson RA. Organizing Publicly Funded Substance Use Disorder Treatment in the United States: Moving Toward a Service System Approach. J Subst Abuse Treat 2016; 69:9-18. [DOI: 10.1016/j.jsat.2016.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/29/2016] [Accepted: 06/27/2016] [Indexed: 11/29/2022]
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Guerrero EG, Padwa H, Fenwick K, Harris LM, Aarons GA. Identifying and ranking implicit leadership strategies to promote evidence-based practice implementation in addiction health services. Implement Sci 2016; 11:69. [PMID: 27180231 PMCID: PMC4894378 DOI: 10.1186/s13012-016-0438-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/06/2016] [Indexed: 11/16/2022] Open
Abstract
Background Despite a solid research base supporting evidence-based practices (EBPs) for addiction treatment such as contingency management and medication-assisted treatment, these services are rarely implemented and delivered in community-based addiction treatment programs in the USA. As a result, many clients do not benefit from the most current and efficacious treatments, resulting in reduced quality of care and compromised treatment outcomes. Previous research indicates that addiction program leaders play a key role in supporting EBP adoption and use. The present study expanded on this previous work to identify strategies that addiction treatment program leaders report using to implement new practices. Methods We relied on a staged and iterative mixed-methods approach to achieve the following four goals: (a) collect data using focus groups and semistructured interviews and conduct analyses to identify implicit managerial strategies for implementation, (b) use surveys to quantitatively rank strategy effectiveness, (c) determine how strategies fit with existing theories of organizational management and change, and (d) use a consensus group to corroborate and expand on the results of the previous three stages. Each goal corresponded to a methodological phase, which included data collection and analytic approaches to identify and evaluate leadership interventions that facilitate EBP implementation in community-based addiction treatment programs. Results Findings show that the top-ranked strategies involved the recruitment and selection of staff members receptive to change, offering support and requesting feedback during the implementation process, and offering in vivo and hands-on training. Most strategies corresponded to emergent implementation leadership approaches that also utilize principles of transformational and transactional leadership styles. Leadership behaviors represented orientations such as being proactive to respond to implementation needs, supportive to assist staff members during the uptake of new practices, knowledgeable to properly guide the implementation process, and perseverant to address ongoing barriers that are likely to stall implementation efforts. Conclusions These findings emphasize how leadership approaches are leveraged to facilitate the implementation and delivery of EBPs in publicly funded addiction treatment programs. Findings have implications for the content and structure of leadership interventions needed in community-based addiction treatment programs and the development of leadership interventions in these and other service settings.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089, USA.
| | - Howard Padwa
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA
| | - Karissa Fenwick
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089, USA
| | - Lesley M Harris
- Kent School of Social Work, University of Louisville, Louisville, KY 40292, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, 9500 Gilman Dr. (0812), San Diego, La Jolla, CA 92093-0812, USA
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Padwa H, Teruya C, Tran E, Lovinger K, Antonini VP, Overholt C, Urada D. The Implementation of Integrated Behavioral Health Protocols In Primary Care Settings in Project Care. J Subst Abuse Treat 2016; 62:74-83. [DOI: 10.1016/j.jsat.2015.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/29/2015] [Accepted: 10/22/2015] [Indexed: 11/16/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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, Harris LM, Padwa H, Vega WA, Palinkas L. Health-care reform and its anticipated impact on the capacity of addiction health services to implement integrated care practices. Addict Sci Clin Pract 2015. [PMCID: PMC4347466 DOI: 10.1186/1940-0640-10-s1-a17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Evans E, Padwa H, Li L, Lin V, Hser YI. Heterogeneity of Mental Health Service Utilization and High Mental Health Service Use Among Women Eight Years After Initiating Substance Use Disorder Treatment. J Subst Abuse Treat 2015; 59:10-9. [PMID: 26321439 DOI: 10.1016/j.jsat.2015.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/27/2015] [Accepted: 06/22/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine mental health service utilization patterns among women treated for substance use disorders (SUD) and identify factors associated with patterns of high mental health service use. METHODS Data were provided by 4447 women treated for SUD in California during 2000-2002 for whom mental health services utilization records were acquired. A latent class model was fitted to women's high use of services (>6 services/year over 8 years). Multinomial logistic regression was used to identify predisposing, enabling, and need factors associated with utilization patterns. RESULTS In 8 years after initiating SUD treatment, 50% of women utilized mental health services. High use probability was consistently low for most women (76.9%); for others, however, it decreased immediately following SUD treatment and then increased over time (8.7%), increased immediately following SUD treatment and then decreased (9.3%), or remained consistently high (5.1%). Consistently high services use was negatively associated with marriage (OR 0.60, p<0.05) and employment (OR 0.53, p<0.05) and positively associated with older age (OR 1.04, p<0.001), homelessness (OR 1.68, p<0.05), public assistance (OR 1.76, p<0.01), outpatient SUD treatment (OR 3.69, p<0.01), longer SUD treatment retention (OR 1.00, p<0.01), treatment desire (ORs 1.46, p<0.001), and co-occurring disorder diagnosis (ORs 2.89-44.93, p<0.001). Up to 29% of women with co-occurring mental health disorders at SUD treatment entry did not receive any mental health treatment in the subsequent 8 years. CONCLUSIONS Mental health services utilization patterns among women treated for SUD are heterogeneous and dynamic. Understanding factors related to women's utilization patterns may aid efforts to optimize care and ensure appropriate use of mental health services.
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Affiliation(s)
- Elizabeth Evans
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, USA.
| | - Howard Padwa
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, USA
| | - Libo Li
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, USA
| | - Veronique Lin
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, USA
| | - Yih-Ing Hser
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, USA
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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. Adm Policy Ment Health 2015; 44:463-469. [PMID: 26008902 DOI: 10.1007/s10488-015-0662-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Abstract
OBJECTIVE The publication of the President's New Freedom Commission Report in 2003 led to hope and anticipation that system transformation would address barriers that have impeded the delivery of integrated services for clients with co-occurring mental health and substance use disorders. Have problems been resolved? This study analyzed providers' perspectives on serving clients with co-occurring disorders in a large mental health system that has undergone transformation. METHODS Six focus groups were conducted with providers at specialty mental health treatment organizations that received funding to transform services. Using content analysis, the authors identified major themes of the focus group discussions. RESULTS Participants reported several barriers within the mental health system and challenges associated with collaborating with specialty substance abuse treatment providers that impede the delivery of integrated care. CONCLUSIONS In spite of efforts to improve co-occurring disorder service delivery in a transformed mental health system, barriers that have historically impeded integrated treatment persist.
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Affiliation(s)
- Howard Padwa
- Dr. Padwa and Dr. Braslow are with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (e-mail: ). Dr. Guerrero and Ms. Fenwick are with the School of Social Work, University of Southern California, Los Angeles
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Padwa H, Ni YM, Barth-Rogers Y, Arangua L, Andersen R, Gelberg L. Barriers to drug use behavior change among primary care patients in urban United States community health centers. Subst Use Misuse 2014; 49:743-51. [PMID: 24354547 PMCID: PMC4026246 DOI: 10.3109/10826084.2013.866962] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In 2011 and 2012, 147 patients in urban United States Community Health Centers who misused drugs, but did not meet criteria for drug dependence, received a brief intervention as part of a National Institute on Drug Abuse-funded clinical trial of a screening and brief intervention protocol. Potential study participants were identified using the World Health Organization (WHO) Alcohol, Smoking, and Substance Involvement Screening Test. Data gathered during brief interventions were analyzed using grounded theory strategies to identify barriers patients believed inhibited drug use behavior change. Numerous perceived barriers to drug use behavior change were identified. Study implications and limitations are discussed.
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Affiliation(s)
- Howard Padwa
- 1Department of Psychiatry, University of California, Los Angeles, Los Angeles, California, USA
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Abstract
OBJECTIVE Improved understanding of the relative strengths and weaknesses of treatment organizations' dual diagnosis capability is critical in order to guide efforts to improve services. This study assesses programs' capacity to meet the needs of clients with dual diagnosis, identifies areas where they are well equipped to serve these clients, and determines where programmatic improvement is needed. The study also undertakes an initial exploration of the potential impact that funding sources have on dual diagnosis capability. METHODS We administered Dual Diagnosis Capability in Addiction Treatment (DDCAT) and Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) assessments at 30 treatment programs in two California counties. Seven of the programs received funding to provide both mental health and substance use disorder services, 13 received funding to provide mental health services, and 10 received funding to provide substance use disorder services. RESULTS The mean DDCAT/DDCMHT score of programs in the sample was 2.83, and just over 43% of the sample met or exceeded DDCAT/DDCMHT criteria for dual diagnosis capability. Programs scored highest and had the highest rates of dual diagnosis capability in domains related to assessment, training, and staffing, whereas scores were weakest and rates of dual diagnosis capability were lowest in the program structure, treatment, and continuity of care domains. Programs that received funding to provide both mental health and substance use disorder services consistently scored higher than the other programs in the sample, and mental health programs scored higher than substance use disorder treatment programs both on the overall assessments and in most domains. CONCLUSIONS Findings suggest that programs in the sample are functioning at a nearly dual diagnosis capable level. However, structural barriers continue to limit providers' capacity to serve clients with co-occurring mental health and substance use disorders, and many organizations have not yet translated their potential to deliver dual diagnosis capable services into practice. By enhancing their program structure, treatment services, and continuity of care services, these treatment organizations should be able to deliver fully dual diagnosis capable services. Observed differences in dual diagnosis capability based on funding source indicate a need for further research to better understand the impact that funding streams have on dual diagnosis capability.
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Affiliation(s)
- Howard Padwa
- UCLA Integrated Substance Abuse Programs, UCLA Center for Health Services and Society
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Padwa H, Urada D, Antonini VP, Ober A, Crèvecoeur-MacPhail DA, Rawson RA. Integrating substance use disorder services with primary care: the experience in California. J Psychoactive Drugs 2012; 44:299-306. [PMID: 23210378 PMCID: PMC3664544 DOI: 10.1080/02791072.2012.718643] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Integrating substance use disorder (SUD) services with primary care (PC) can improve access to SUD services for the 20.9 million Americans who need SUD treatment but do not receive it, and help prevent the onset of SUDs among the 68 million Americans who use psychoactive substances in a risky manner. We lay out the reasons for integrating SUD and PC services and then explore the models used and the experiences of providers as they have begun SUD/PC integration in California.
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Affiliation(s)
- Howard Padwa
- UCLA Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 100, Los Angeles, CA 90025-7535, USA.
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