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Kong Y, Guerrero E, Frimpong J, Khachikian T, Wang S, D'Aunno T, Howard D. Identifying the Heterogeneity in the Association between Workforce Diversity and Retention in Opioid Treatment among Black clients. Res Sq 2024:rs.3.rs-3932153. [PMID: 38405811 PMCID: PMC10889050 DOI: 10.21203/rs.3.rs-3932153/v1] [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] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background This study investigates the impact of workforce diversity, specifically staff identified as Black/African American, on retention in opioid use disorder (OUD) treatment, aiming to enhance patient outcomes. Employing a novel machine learning technique known as 'causal forest,' we explore heterogeneous treatment effects on retention. Methods We relied on four waves of the National Drug Abuse Treatment System Survey (NDATSS), a nationally representative longitudinal dataset of treatment programs. We analyzed OUD program data from the years 2000, 2005, 2014 and 2017 (n = 627). Employing the 'causal forest' method, we analyzed the heterogeneity in the relationship between workforce diversity and retention in OUD treatment. Interviews with program directors and clinical supervisors provided the data for this study. Results The results reveal diversity-related variations in the association with retention across 61 out of 627 OUD treatment programs (less than 10%). These programs, associated with positive impacts of workforce diversity, were more likely private-for-profit, newer, had lower percentages of Black and Latino clients, lower staff-to-client ratios, higher proportions of staff with graduate degrees, and lower percentages of unemployed clients. Conclusions While workforce diversity is crucial, our findings underscore that it alone is insufficient for improving retention in addiction health services research. Programs with characteristics typically linked to positive outcomes are better positioned to maximize the benefits of a diverse workforce in client retention. This research has implications for policy and program design, guiding decisions on resource allocation and workforce diversity to enhance retention rates among Black clients with OUDs.
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Harris LM, Marsh JC, Khachikian T, Serrett V, Kong Y, Guerrero EG. What can we learn from COVID-19 to improve opioid treatment? Expert providers respond. J Subst Use Addict Treat 2023; 154:209157. [PMID: 37652210 PMCID: PMC10923184 DOI: 10.1016/j.josat.2023.209157] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/15/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND The COVID-19 pandemic has had devasting effects on drug abuse treatment systems already stressed by the opioid crisis. Providers within opioid use disorder (OUD) outpatient treatment programs have had to adjust to rapid change and respond to new service delivery provisions such as telehealth and take-home medication. Using the COVID-19 pandemic and subsequent organizational challenges as a backdrop, this study explores providers' perspectives about strategies and policies that, if made permanent, can potentially improve access to and quality of OUD treatment. METHODS This qualitative study was conducted in Los Angeles County, which has one of the largest substance use disorder (SUD) treatment systems in the United States serving a diverse population, including communities impacted by the opioid crisis. We collected qualitative interview data from 30 high-performing programs (one manager/supervisor per program) where we based high performance on empirical measures of access, retention, and program completion outcomes. The study team completed data collection and analysis using constructivist grounded theory (CGT) to describe the social processes in which the participating managers engaged when faced with the pandemic and subsequent organizational changes. We developed 14 major codes and six minor codes with definitions. The interrater reliability tests showed pooled Cohen's kappa statistic of 93 %. RESULTS Our results document the impacts of COVID-19 on SUD treatment systems, their programmatic responses, and the strategic innovations they developed to improve service delivery and quality and which managers plan to sustain within their organizations. CONCLUSION Providers identified three primary areas for strategic innovation designed to improve access and quality: (1) designing better medication utilization, (2) increasing telemedicine capacity, and (3) improving reimbursement policies. These strategies for system transformation enable us to use lessons from the COVID-19 pandemic to direct policy and programmatic reform, such as expanding eligibility for take-home medication and enhancing access to telehealth services.
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Affiliation(s)
- Lesley M Harris
- University of Louisville, Kent School of Social Work & Family Science, 2217 S 3rd St, Louisville, KY, USA.
| | - Jeanne C Marsh
- University of Chicago, Crown Family School of Social Work, Policy, and Practice, 969 East 60th Street, Chicago, IL, USA.
| | - Tenie Khachikian
- University of Chicago, Crown Family School of Social Work, Policy, and Practice, 969 East 60th Street, Chicago, IL, USA.
| | - Veronica Serrett
- I-Lead Institute, Research to End Healthcare Disparities Corp, 150 Ocean Park Blvd, 418, Santa Monica, CA, USA.
| | - Yinfei Kong
- California State University, Fullerton, Department of Information Systems and Decision Sciences, College of Business and Economics, CA, USA.
| | - Erick G Guerrero
- I-Lead Institute, Research to End Healthcare Disparities Corp, 150 Ocean Park Blvd, 418, Santa Monica, CA, USA
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Guerrero EG, Amaro H, Kong Y, Khachikian T, Marsh JC. Exploring Gender and Ethnoracial Differences and Trends in Methamphetamine Treatment. Subst Abuse 2023; 17:11782218231180043. [PMID: 37324059 PMCID: PMC10262604 DOI: 10.1177/11782218231180043] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/17/2023] [Indexed: 06/17/2023]
Abstract
Introduction Given the significant rise in methamphetamine use and related mortality in the United States, it is critical to explore differences in treatment trends with particular attention to women and ethnoracial groups in hard-hit areas like Los Angeles County. Methods We analyzed a large sample across 4 waves: 2011 (105 programs, 10 895 clients), 2013 (104 programs, 17 865 clients), 2015 (96 programs, 16 584 clients), and 2017 (82 programs, 15 388 clients). We completed a comparative analysis to identify differences across subgroups and a trend analysis of treatment episodes by gender and ethnoracial group to differentiate users of methamphetamine and users of other drugs. Results Treatment clients using methamphetamine increased over time for each gender and race. There were also significant differences across age groups. Women comprised a greater proportion of treatment episodes involving methamphetamine use (43.3%) compared to all other drugs combined (33.6%). Latinas represented 45.5% of methadone-related admissions. Compared with other drug users, methamphetamine users had a lower successful treatment completion rate and were served by programs with less financial and culturally responsive capacity. Conclusions Findings highlight a sharp increase in treatment admissions for methamphetamine users of all gender and ethnocultural groups. Women, especially Latinas, saw the most significant increases, with a widening gender gap over time. All subgroups of methamphetamine users had a lower treatment completion rate compared with users of other drugs, and critical differences existed in the programs where they received services.
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Affiliation(s)
- Erick G Guerrero
- Research to End Health Disparities Corp, I-Lead Institute, Los Angeles, CA, USA
| | - Hortensia Amaro
- Florida International University, Herbert Werthein College of Medicine and Robert Stempel College of Public Health and Social Work, Miami, FL, USA
| | - Yinfei Kong
- California State University, Fullerton, College of Business and Economics, Fullerton, CA, USA
| | - Tenie Khachikian
- University of Chicago, Crown Family School of Social Work and Social Policy, Chicago, IL, USA
| | - Jeanne C Marsh
- University of Chicago, Crown Family School of Social Work and Social Policy, Chicago, IL, USA
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Amaro H, Kong Y, Marsh JC, Khachikian T, Guerrero EG. Identifying gender differences in risk profiles and in opioid treatment outcomes in Los Angeles County. Eval Program Plann 2023; 97:102240. [PMID: 36702006 PMCID: PMC10121834 DOI: 10.1016/j.evalprogplan.2023.102240] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 06/17/2023]
Abstract
Policies and programs that aim to minimize wait time to enter opioid use disorder (OUD) treatment and maximize retention respond to potential differences in female and male clients' risk profiles. We conducted multigroup latent class analysis using significant individual risk factors. Our sample included 13,453 opioid treatment episodes from 135 unique substance use disorder treatment programs in Los Angeles County, California, in four waves: 2011 (66 programs, 1035 clients), 2013 (77 programs, 3671 clients), 2015 (75 programs, 4625 clients), and 2017 (69 programs, 4106 clients). Groups at risk of waiting longer included clients who were female, had mental health issues, received medication for OUD, had criminal justice involvement, received mandated referrals, had children in child protective services, and had caretaker responsibilities. All clients with children in protective services were likely to wait longer than those not in protective services, but women waited longer. Findings highlight that: (a) women and men in OUD treatment have significant health and social problems; (b) female and male clients have distinct risk profiles; and (c) targeted services responding to risk profiles may improve treatment access and engagement. Findings have implications for health policy and program evaluation and planning in the delivery of treatment services considering gendered risk factors.
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Affiliation(s)
- Hortensia Amaro
- Florida International University, Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, 11200 SW 8th St, AHC4, Miami, FL 33199, United States
| | - Yinfei Kong
- California State University, Fullerton College of Business and Economics, 800 N State College Blvd, Fullerton CA 92831, United States
| | - Jeanne C Marsh
- University of Chicago, School of Social Service Administration, 969 E. 60th Street, Chicago, IL 60637, United States
| | - Tenie Khachikian
- University of Chicago, School of Social Service Administration, 969 E. 60th Street, Chicago, IL 60637, United States
| | - Erick G Guerrero
- I-LEAD Institute, Research to End Healthcare Disparities Corp, 12300 Wilshire Blvd, Suite 210, Los Angeles, CA 90025, United States.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Frimpong JA, Guerrero EG, Kong Y, Khachikian T, Wang S, D'Aunno T, Howard DL. Predicting and responding to change: Perceived environmental uncertainty among substance use disorder treatment programs. J Subst Use Addict Treat 2023; 145:208947. [PMID: 36880916 DOI: 10.1016/j.josat.2022.208947] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/03/2022] [Accepted: 11/29/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Substance use disorder (SUD) treatment programs offering addiction health services (AHS) must be prepared to adapt to change in their operating environment. These environmental uncertainties may have implications for service delivery, and ultimately patient outcomes. To adapt to a multitude of environmental uncertainties, treatment programs must be prepared to predict and respond to change. Yet, research on treatment programs preparedness for change is sparse. We examined reported difficulties in predicting and responding to changes in the AHS system, and factors associated with these outcomes. METHODS Cross-sectional surveys of SUD treatment programs in the United States in 2014 and 2017. We used linear and ordered logistic regression to examine associations between key independent variables (e.g., program, staff, and client characteristics) and four outcomes, (1) reported difficulties in predicting change, (2) predicting effect of change on organization, (3) responding to change, and (4) predicting changes to make to respond to environmental uncertainties. Data were collected through telephone surveys. RESULTS The proportion of SUD treatment programs reporting difficulty predicting and responding to changes in the AHS system decreased from 2014 to 2017. However, a considerable proportion still reported difficulty in 2017. We identified that different organizational characteristics are associated with their reported ability to predict or respond to environmental uncertainty. Findings show that predicting change is significantly associated with program characteristics only, while predicting effect of change on organizations is associated with program and staff characteristics. Deciding how to respond to change is associated with program, staff, and client characteristics, while predicting changes to make to respond is associated with staff characteristics only. CONCLUSIONS Although treatment programs reported decreased difficulty predicting and responding to changes, our findings identify program characteristics and attributes that could better position programs with the foresight to more effectively predict and respond to uncertainties. Given resource constraints at multiple levels in treatment programs, this knowledge might help identify and optimize aspects of programs to intervene upon to enhance their adaptability to change. These efforts may positively influences processes or care delivery, and ultimately translate into improvements in patient outcomes.
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Affiliation(s)
| | - Erick G Guerrero
- Research to End Healthcare Disparities Corp., United States of America
| | - Yinfei Kong
- California State University, Fullerton, United States of America.
| | | | - Suojin Wang
- Texas A&M University, United States of America.
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Guerrero EG, Kong Y, Frimpong JA, Khachikian T, Wang S, D’Aunno T, Howard DL. Workforce Diversity and disparities in wait time and retention among opioid treatment programs. Subst Abuse Treat Prev Policy 2022; 17:74. [PMID: 36384761 PMCID: PMC9670430 DOI: 10.1186/s13011-022-00500-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Workforce diversity is a key strategy to improve treatment engagement among members of racial and ethnic minority groups. In this study, we seek to determine whether workforce diversity plays a role in reducing racial and ethnic differences in wait time to treatment entry and retention in different types of opioid use disorder treatment programs. METHODS We conducted comparative and predictive analysis in a subsample of outpatient opioid treatment programs (OTPs), who completed access and retention survey questions in four waves of the National Drug Abuse Treatment System Survey (162 OTPs in 2000, 173 OTPs in 2005, 282 OTPs in 2014, and 300 OTPs in 2017). We sought to assess the associations between workforce diversity on wait time and retention, accounting for the role of Medicaid expansion and the moderating role of program ownership type (i.e., public, non-profit, for-profit) among OTPs located across the United States. RESULTS We found significant differences in wait time to treatment entry and retention in treatment across waves. Average number of waiting days decreased in 2014 and 2017; post Medicaid expansion per the Affordable Care Act, while retention rates varied across years. Key findings show that programs with high diversity, measured by higher percent of African American staff and a higher percent of African American clients, were associated with longer wait times to enter treatment, compared to low diversity programs. Programs with higher percent of Latino staff and a higher percent of Latino clients were associated with lower retention in treatment compared with low diversity programs. However, program ownership type (public, non-profit and for-profit) played a moderating role. Public programs with higher percent of African American staff were associated with lower wait time, while non-profit programs with higher percent of Latino staff were related to higher retention. CONCLUSIONS Findings show decreases in wait time over the years with significant variation in retention during the same period. Concordance in high workforce and client diversity was associated with higher wait time and lower retention. But these relations inverted (low wait time and high retention) in public and non-profit programs with high staff diversity. Findings have implications for building resources and service capacity among OTPs that serve a higher proportion of minority clients.
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Affiliation(s)
- Erick G. Guerrero
- Research to End Healthcare Disparities Corp, I-Lead Institute, Los Angeles, CA USA
| | - Yinfei Kong
- Mihaylo College of Business and Economics, California State University, Fullerton, CA USA
| | - Jemima A. Frimpong
- Business, Organizations and Society, New York University, Abu Dhabi, United Arab Emirates
| | | | - Suojin Wang
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX USA
| | - Thomas D’Aunno
- Wagner Graduate School of Public Service, New York University, New York City, New York USA
| | - Daniel L. Howard
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX USA
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Alibrahim A, Marsh JC, Amaro H, Kong Y, Khachikian T, Guerrero E. Correction to: Disparities in expected driving time to opioid treatment and treatment completion: findings from an exploratory study. BMC Health Serv Res 2022; 22:620. [PMID: 35534862 PMCID: PMC9082904 DOI: 10.1186/s12913-022-07993-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Abdullah Alibrahim
- Industrial & Management Systems Engineering, College of Engineering & Petroleum, Kuwait University, Kuwait, Kuwait. .,Geo-Health Lab, Dasman Diabetes Institute, Kuwait, Kuwait.
| | - Jeanne C Marsh
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, USA
| | - Hortensia Amaro
- Robert Stempel College of Public Health and Social Work and Herbert Wertheim College of Medicine, Florida Internation University, Miami, USA
| | - Yinfei Kong
- College of Business and Economics, California State University Fullerton, Fullerton, USA
| | - Tenie Khachikian
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, USA
| | - Erick Guerrero
- I-Lead Institute, Research to End Healthcare Disparities Corp, Los Angeles, USA
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Alibrahim A, Marsh JC, Amaro H, Kong Y, Khachikian T, Guerrero E. Disparities in expected driving time to opioid treatment and treatment completion: findings from an exploratory study. BMC Health Serv Res 2022; 22:478. [PMID: 35410215 PMCID: PMC8996398 DOI: 10.1186/s12913-022-07886-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/07/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Commuting time to treatment has been shown to affect healthcare outcomes such as engagement and initiation. The purpose of this study is to extend this line of research to investigate the effects of driving time to opioid programs on treatment outcomes. METHODS We analyzed discharge survey data from 22,587 outpatient opioid use disorder treatment episodes (mainly methadone) in Los Angeles County and estimated the associated driving time to each episode using Google Maps. We used multivariable logistic regressions to examine the association between estimated driving time and odds of treatment completion after adjusting for possible confounders. RESULTS Findings show an average driving time of 11.32 min and an average distance of 11.18 km. We observed differences in estimated driving time across age, gender, and socioeconomic status. Young, male, less formally educated, and Medi-Cal-ineligible clients drove longer to treatment. A 10-min drive was associated with a 33% reduction in the completion of methadone treatment plans (p < .01). CONCLUSION This systemwide analysis provides novel time estimates of driving-based experiences and a strong relationship with completion rates in methadone treatment. Specifically, the result showing reduced treatment completion rates for drive times longer than 10 min may inform policies regarding the ideal geographic placement of methadone-based treatment programs and service expansion initiatives.
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Affiliation(s)
- Abdullah Alibrahim
- Industrial & Management Systems Engineering, College of Engineering & Petroleum, Kuwait University, Kuwait, Kuwait. .,Geo-Health Lab, Dasman Diabetes Institute, Kuwait, Kuwait.
| | - Jeanne C Marsh
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, USA
| | - Hortensia Amaro
- Robert Stempel College Of Public Health and Social Work and Herbert Wertheim College of Medicine, Florida Internation University, Miami, USA
| | - Yinfei Kong
- College of Business and Economics, California State University Fullerton, Fullerton, USA
| | - Tenie Khachikian
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, USA
| | - Erick Guerrero
- I-Lead Institute, Research to End Healthcare Disparities Corp, Los Angeles, USA
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Khachikian T, Amaro H, Guerrero E, Kong Y, Marsh JC. Disparities in opioid treatment access and retention among women based on pregnancy status from 2006 to 2017. Drug and Alcohol Dependence Reports 2022; 2. [PMID: 35369381 PMCID: PMC8975179 DOI: 10.1016/j.dadr.2022.100030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The purpose of this study is to assess differences in wait time and retention in opioid use disorder (OUD) treatment among a sample of pregnant and non-pregnant women from low-income urban communities in Los Angeles, California. Methods: Data were collected in 9 waves consisting of consecutive years from 2006 to 2011, and then including 2013, 2015, and 2017. The sample consisted of 12,558 women, with 285 being pregnant and 12,273 being non-pregnant. We compared pregnant women with non-pregnant women at admission on key characteristics and relied on two multilevel negative binomial regressions analyses to examine factors related to access (days on the waiting list) and retention (days in treatment). Results: We detected disparities existed in access and retention. Pregnant women spent less time waiting to initate treatment than non-pregnant women and, once in treatment, had longer treatment episodes. Among pregnant women, clients identifying as Latina or Other waited longer to enter treatment compared to clients identifying as non-Latina White or Black. Women entering residential waited longer than those entering methadone or counseling services. Pregnant women were more likely to be in treatment longer if they had mental health issues, greater parenting responsibilities (number of children less than 18), and greater SUD severity (number of prior treatment episodes). Conclusions: Findings suggest pregnant women’s access and retention can be improved through Medicaid coverage and through the implementation of a standard of care that includes MOUD (methadone) along with ancillary health and social services.
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Affiliation(s)
- Tenie Khachikian
- University of Chicago, School of Social Service Administration, 969 E. 60th Street, Chicago, IL 60637, USA
- Corresponding author.
| | - Hortensia Amaro
- Florida International University, Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, 11200 SW 8th St, AHC4, Miami, Florida 33199, USA
| | - Erick Guerrero
- I-LEAD Institute, Research to End Healthcare Disparities Corp, 12300 Wilshire Blvd, Suite 210, Los Angeles, CA 90025 USA
| | - Yinfei Kong
- California State University, Fullerton, College of Business and Economics, 800N State College Blvd, Fullerton CA 92831 USA
| | - Jeanne C. Marsh
- University of Chicago, School of Social Service Administration, 969 E. 60th Street, Chicago, IL 60637, USA
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Guerrero E, Amaro H, Kong Y, Khachikian T, Marsh JC. Gender disparities in opioid treatment progress in methadone versus counseling. Subst Abuse Treat Prev Policy 2021; 16:52. [PMID: 34162420 PMCID: PMC8220800 DOI: 10.1186/s13011-021-00389-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND In the United States, the high dropout rate (75%) in opioid use disorder (OUD) treatment among women and racial/ethnic minorities calls for understanding factors that contribute to making progress in treatment. Whereas counseling and medication for OUD (MOUD, e.g. methadone, buprenorphine, naltrexone) is considered the gold standard of care in substance use disorder (SUD) treatment, many individuals with OUD receive either counseling or methadone-only services. This study evaluates gender disparities in treatment plan progress in methadone- compared to counseling-based programs in one of the largest SUD treatment systems in the United States. METHODS Multi-year and multi-level (treatment program and client-level) data were analyzed using the Integrated Substance Abuse Treatment to Eliminate Disparities (iSATed) dataset collected in Los Angeles County, California. The sample consisted of 4 waves: 2011 (66 SUD programs, 1035 clients), 2013 (77 SUD programs, 3686 clients), 2015 (75 SUD programs, 4626 clients), and 2017 (69 SUD programs, 4106 clients). We conducted two multi-level negative binomial regressions, one per each outcome (1) making progress towards completing treatment plan, and (2) completing treatment plan. We included outpatient clients discharged on each of the years of the study (over 95% of all clients) and accounted for demographics, wave, homelessness and prior treatment episodes, as well as clients clustered within programs. RESULTS We detected gender differences in two treatment outcomes (progress and completion) considering two outpatient program service types (MOUD-methadone vs. counseling). Clients who received methadone vs. counseling had lower odds of completing their treatment plan (OR = 0.366; 95% CI = 0.163, 0.821). Female clients receiving methadone had lower odds of both making progress (OR = 0.668; 95% CI = 0.481, 0.929) and completing their treatment plan (OR = 0.666; 95% CI = 0.485, 0.916) compared to male clients and receiving counseling. Latina clients had lower odds of completing their treatment plan (OR = 0.617; 95% CI = 0.408, 0.934) compared with non-Latina clients. CONCLUSIONS Clients receiving methadone, the most common and highly effective MOUD in reducing opioid use, were less likely to make progress towards or complete their treatment plan than those receiving counseling. Women, and in particular those identified as Latinas, were least likely to benefit from methadone-based programs. These findings have implications for health policy and program design that consider the need for comprehensive and culturally responsive services in methadone-based programs to improve outpatient treatment outcomes among women.
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Affiliation(s)
- Erick Guerrero
- I-Lead Institute, Research to End Health Disparities Corp, 12300 Wilshire Blvd, Suite 210, Los Angeles, CA 90025 USA
| | - Hortensia Amaro
- Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th ST, AHC4, Miami, Florida 33199 USA
| | - Yinfei Kong
- College of Business and Economics, California State University Fullerton, 800 N. State College Blvd, Fullerton, CA 92831 USA
| | - Tenie Khachikian
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, 969 E. 60th Street, Chicago, IL 60637 USA
| | - Jeanne C. Marsh
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, 969 E. 60th Street, Chicago, IL 60637 USA
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Marsh JC, Amaro H, Kong Y, Khachikian T, Guerrero E. Gender disparities in access and retention in outpatient methadone treatment for opioid use disorder in low-income urban communities. J Subst Abuse Treat 2021; 127:108399. [PMID: 34134873 DOI: 10.1016/j.jsat.2021.108399] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 11/29/2020] [Revised: 02/16/2021] [Accepted: 04/06/2021] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to detect and understand gender disparities in access and retention among outpatient methadone treatment programs located in low-income urban communities in Los Angeles, California. The study collected client- and program-level data in 4 waves in 2011, 2013, 2015, and 2017 from 34 publicly funded methadone treatment programs serving 11,169 clients with opioid use disorder (OUD). The sample included 29.8% female and 70.2% male clients, where 10.6% identified as Black or African American, 41.5% as Latino, 44.2% as non-Latino white, and 3.8% as Other. We conducted two multilevel negative binomial regression models to examine direct and moderated relationships related to both access (days on the waitlist) and retention (days in treatment) while accounting for clients clustered within programs. Gender disparities existed in both access and retention where women spent more time than men waiting to enter treatment but then remained in treatment longer. Further, female clients identifying as African American, Latino, and Other were at greater risk for shorter treatment duration than those who identified as non-Latino white and men. Overall, OUD clients receiving methadone treatment in low-income neighborhoods experienced barriers to access and retention in treatment associated with mental illness, family responsibilities, and use severity. OUD clients with MediCal insurance eligibility were consistently more likely to gain access to and remain in methadone treatment. Overall, findings call for improving treatment access and retention for women with OUD who receive methadone in outpatient methadone treatment programs through comprehensive, gender-specific, and evidence-based programming.
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Affiliation(s)
- Jeanne C Marsh
- University of Chicago Crown Family School of Social Work, Policy and Practice, 969 E. 60th Street, Chicago, IL 60637, United States of America.
| | - Hortensia Amaro
- Florida International University, Herbert Wertheim College of Medicine and, Robert Stempel College of Public Health and Social Work, 11200 SW 8th St, AHC4, Miami, FL 33199, United States of America
| | - Yinfei Kong
- California State University, Fullerton, College of Business and Economics, 800 N State College Blvd, Fullerton, CA 92831, United States of America
| | - Tenie Khachikian
- University of Chicago Crown Family School of Social Work, Policy and Practice, 969 E. 60th Street, Chicago, IL 60637, United States of America
| | - Erick Guerrero
- I-LEAD Institute, Research to End Health Disparities Corp, 12300 Wilshire Blvd, Suite 210, Los Angeles, CA 90025, United States of America
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Guerrero E, Ober AJ, Howard DL, Khachikian T, Kong Y, van Deen WK, Valdez A, Trotzky-Sirr R, Menchine M. Organizational factors associated with practitioners' support for treatment of opioid use disorder in the emergency department. Addict Behav 2020; 102:106197. [PMID: 31862684 PMCID: PMC7547528 DOI: 10.1016/j.addbeh.2019.106197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/25/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite the significant increase in emergency room visits for opioid overdose, only few emergency departments (ED) have implemented best practices to treat people with opioid use disorders (OUD). Some implementation gaps may be due to practitioner factors; such as support for medication-assisted treatment (MAT) for OUD in the ED. In this study, we explore the relationship between inner setting characteristics of the EDs (e.g., leadership, readiness for change, organizational climate) and practitioner support for OUD treatment and attitudes towards people with OUD. METHODS We surveyed 241 ED practitioners (e.g., physicians, nurses, social workers) at one of the largest EDs in the United States. We used analysis of variance and chi-square global tests to compare responses from ED practitioners in differing roles. We also conducted five multivariate logistic regressions to explore associations between ED inner setting characteristics and five antecedents of implementation; ED practitioner (1) supports MAT for OUD in the ED, (2) supports best practices to treat OUD, (3) has self-efficacy to treat OUD, (4) has stereotypes of people who use drugs, and (5) has optimism to treat people with OUD. RESULTS We found nurses were more likely than physicians to support MAT for OUD in the ED and delivering other best practices to treat OUD. At the same time, nurses had greater bias than physicians against working with patients suffering from OUD. We also found the ED's climate for innovation and practitioners' readiness for change were positively associated with support for MAT for OUD in the ED and using best practices to treat OUD. CONCLUSIONS Findings suggest that professional roles and some ED inner setting factors play an important role in antecedents of implementation of OUD treatment in the ED. To prepare EDs to effectively respond to the current opioid overdose epidemic, it is critical to further understand the impact of these organizational factors on the implementation of evidence-based OUD treatment practices in the nation.
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Affiliation(s)
- Erick Guerrero
- I-LEAD Institute - Research to End Healthcare Disparities Corp, 150 Ocean Park Blvd, Santa Monica, CA, USA.
| | | | - Daniel L Howard
- Texas A&M University, Public Policy Research Institute, College Station, TX, USA.
| | | | - Yinfei Kong
- Mihaylo College of Business and Economics, California State University, Fullerton, CA, USA
| | - Welmoed K van Deen
- Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, CA, USA.
| | - Avelardo Valdez
- School of Social Work, University of Southern California, Los Angeles, CA, USA.
| | - Rebecca Trotzky-Sirr
- Emergency Department, Los Angeles County + University of Southern California, Los Angeles, CA, USA.
| | - Michael Menchine
- Emergency Department, Los Angeles County + University of Southern California, Los Angeles, CA, USA.
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Guerrero EG, Khachikian T, Frimpong JA, Kong Y, Howard DL, Hunter S. Drivers of continued implementation of cultural competence in substance use disorder treatment. J Subst Abuse Treat 2019; 105:5-11. [PMID: 31443891 PMCID: PMC7532800 DOI: 10.1016/j.jsat.2019.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/28/2018] [Revised: 07/19/2019] [Accepted: 07/19/2019] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to examine whether the key characteristics of organizational decision makers predicted continued implementation of five different practices that represent organizational cultural competence in one of the largest and most diverse substance use disorder (SUD) treatment systems in the United States. We analyzed data collected from SUD treatment programs at four-time points: 2011 (N = 115), 2013 (N = 111), 2015 (N = 106), and 2017 (N = 94). We conducted five mixed-effect linear regression models, one per each outcome to examine the extent to which program director's transformational leadership and ethnic background (Latino) predicted (1) knowledge of minority community needs; (2) development of resources and linkages to serve minorities; (3) reaching out to minority communities; (4) hiring and retention of staff members from minority backgrounds; and (5) development of policies and procedures to effectively respond to the service needs of minority patients. Results show that two of the five practices continued implementation at same degree (resources and linkages and policies and procedures), one practice increased degree of implementation (knowledge), while two practices reduced degree of implementation (staffing and outreach to communities) over the six-year period. Directorial leadership was positively associated with the continued implementation of all five practices. Latino directors were associated with an increase in knowledge of minority communities, but a decrease in resources and linkages and policies and procedures to serve minorities. On the other hand, interactions showed that leadership among Latino directors increased staffing over time and led to increases in resources and linkages and policies and procedures overtime. Overall, continued implementation of culturally responsive practices was uneven in the SUD treatment system studied. But program directors' transformational leadership and ethnic background played a critical role in increasing the implementation of key practices over time. Findings have implications for developing and testing culturally grounded leadership interventions for program directors to ensure the continued and increased implementation of practices that are necessary to improve standards of care in minority health.
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Affiliation(s)
- Erick G Guerrero
- I-Lead Institute, Research to End Healthcare Disparities Corp, 150 Ocean Park Blvd, 418, Santa Monica, CA 90405, United States of America.
| | - Tenie Khachikian
- Psychological Science, University of California, 5200 North Lake Road Merced, CA 95343, United States of America.
| | - Jemima A Frimpong
- Johns Hopkins University, Carey Business School, 100 International Dr., Baltimore, MD 21202, United States of America.
| | - Yinfei Kong
- Mihaylo College of Business and Economics, California State University, Fullerton, CA 90089, United States of America
| | - Daniel L Howard
- Texas A&M University, Public Policy Research Institute, 4476 TAMU College Station, TX 77843-4476, United States of America.
| | - Sarah Hunter
- Rand Corporation, 1776 Main Street, Santa Monica, CA 90401, United States of America.
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Khachikian T, Cameron LD. Perceptions and Beliefs Motivating Parental Discussions of Marijuana Use With Children. Ann Behav Med 2019; 53:169-179. [PMID: 29750410 DOI: 10.1093/abm/kay027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Parents can influence their children's use of marijuana and other substances through targeted parent-child discussions. Little is known about what factors motivate parents' decisions to discuss marijuana use with their children. Purpose Guided by an elaborated prototype-willingness model, we tested hypotheses that: (a) parental perceived risk of harms and negative prototypes of youth who use marijuana positively predict worry about their child using marijuana; (b) higher perceived risk and worry predict higher intentions to discuss marijuana use with one's child; (c) negative prototypes and worry positively predict willingness to have discussions; and (d) higher intentions and willingness predicts having discussions. Method We administered a longitudinal survey to 499 American parents of youth ages 10 to 17 assessing risk perceptions, prototypes, worry, discussion intentions, and willingness. One month later, 409 participants completed another survey assessing whether they had discussed marijuana use with their child. Results At follow-up, 40% of participants reported having marijuana use discussions in the previous month. Structural-equation modeling revealed that perceived risks and negative prototypes positively predicted worry about their child using marijuana. Worry positively predicted intentions and willingness to discuss marijuana use with children. Worry mediated the relationship between perceived risks and intentions, but not the relationship between prototypes and willingness. Intentions positively predicted likelihood of marijuana use discussions, whereas willingness did not. Conclusions These findings support most predictions of the adapted model and identify cognitive and affective factors that could be targeted in health communications promoting parental discussions of marijuana use with children.
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Affiliation(s)
- Tenie Khachikian
- Psychological Sciences, University of California, Merced, Merced, CA, USA
| | - Linda D Cameron
- Psychological Sciences, University of California, Merced, Merced, CA, USA
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Guerrero EG, Marsh JC, Khachikian T, Amaro H, Vega WA. Disparities in Latino substance use, service use, and treatment: implications for culturally and evidence-based interventions under health care reform. Drug Alcohol Depend 2013; 133:805-13. [PMID: 23953657 DOI: 10.1016/j.drugalcdep.2013.07.027] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [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: 04/16/2013] [Revised: 07/24/2013] [Accepted: 07/24/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The goal of this systematic literature review was to enhance understanding of substance use, service use, and treatment among Latino subgroups to improve access to care and treatment outcomes in an era of health care reform. METHODS The authors used 13 electronic databases and manually searched the literature from January 1, 1978, to May 30, 2013. One hundred (69%) of 145 primary research articles met the inclusion criteria. Two blinded, independent reviewers scored each article. Consensus discussions and a content expert reconciled discrepancies. RESULTS Current rates of alcohol and substance abuse among Latinos are comparable to or surpass other U.S. ethnic groups. Disparities in access and quality of care are evident between Latinos and other ethnic groups. As a heterogeneous group, Latinos vary by geographic region in terms of substance of choice and their cultural identity takes precedence over general ethnic identity as a likely determinant of substance abuse behaviors. There is growing research interest in systems influencing treatment access and adherence among racial/ethnic and gender minority groups. However, studies on Latinos' service use and immediate treatment outcomes have been both limited in number and inconsistent in findings. CONCLUSIONS This review identified human capital, quality of care, and access to culturally responsive care as key strategies to eliminate disparities in health and treatment quality. Implications are discussed, including the need for effectiveness studies on Latinos served by systems of care that, under health care reform, are seeking to maximize resources, improve outcomes, and reduce variation in quality of care.
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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, United States.
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Guerrero EG, Khachikian T, Kim T, Kong Y, Vega WA. Spanish language proficiency among providers and Latino clients' engagement in substance abuse treatment. Addict Behav 2013; 38:2893-7. [PMID: 24045032 DOI: 10.1016/j.addbeh.2013.08.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 08/16/2013] [Accepted: 08/21/2013] [Indexed: 11/19/2022]
Abstract
Quality of care, such as provision of services in Spanish, is a common factor believed to improve treatment engagement among Spanish-speaking Latinos in health care. However, there is little evidence that Spanish language proficiency among providers increases treatment access and retention in publicly funded substance abuse treatment. We analyzed client and program data collected in 2010-2011 from publicly funded treatment programs in Los Angeles County, California. An analytic sample of 1903 Latino clients nested within 40 treatment programs located in minority communities was analyzed using multilevel negative binomial regressions on days to initiate and spent in treatment. As hypothesized, Spanish language proficiency was negatively associated with client wait time and positively associated with retention in treatment, after controlling for individual and program characteristics. The path analysis models showed that Spanish language proficiency played a mediating role between professional accreditation and client wait time and retention. These preliminary findings provide an evidentiary base for the role of providers' Spanish language proficiency and Latino engagement in treatment for a population at high risk of treatment dropout. Implications related to health care reform legislation, which seeks to enhance linguistically competent 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, United States.
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