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Substance Abuse Treatment, Prevention, and Policy

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Open Access 01-12-2015 | Research

Paths to improving engagement among racial and ethnic minorities in addiction health services

Authors: Erick G. Guerrero, Karissa Fenwick, Yinfei Kong, Christine Grella, Thomas D’Aunno

Published in: Substance Abuse Treatment, Prevention, and Policy | Issue 1/2015

Abstract

Background

Members of racial and ethnic minority groups are most likely to experience limited access and poor engagement in addiction treatment. Research has been limited on the role of program capacity and delivery of comprehensive care in improving access and retention among minorities with drug abuse issues. The goal of this study was to examine the extent to which access and retention are enhanced when racial and ethnic minorities receive care from high-capacity addiction health services (AHS) programs and via coordination with mental health and receipt of HIV testing services.

Methods

This multilevel cross-sectional analysis involved data from 108 programs merged with client data from 2011 for 13,478 adults entering AHS. Multilevel negative binomial regression models were used to test interactions and indirect relationships between program capacity and days to enter treatment (wait time) and days in treatment (retention).

Results

Compared to low-capacity programs and non-Latino and non-African American clients, Latinos and African Americans served in high-capacity programs reported shorter wait times to admission, as hypothesized. African Americans also had longer treatment retention in high-capacity programs. Receipt of HIV testing and program coordination of mental health services played an indirect role in the relationship between program capacity and wait time.

Conclusions

Program capacity and coordinated services in AHS may reduce disparities in access to care. Implications for supporting low-capacity programs to eliminate the disparity gap in access to care are discussed.

Buck JA. The looming expansion and transformation of public substance abuse treatment under the Affordable Care Act. Health Aff. 2011;30:1402–10. doi:10.1377/hlthaff.2011.0480.CrossRef

Garfield RL, Lave JR, Donohue JM. Health reform and the scope of benefits for mental health and substance use disorder services. Psychiatr Serv. 2010;61:1081–6. doi:10.1176/ps.2010.61.11.1081.CrossRefPubMed

Andrews CM, Shin HC, Marsh JC, Cao D. Client and program characteristics associated with wait time to substance abuse treatment entry. Am J Drug Alcohol Abuse. 2013;39:61–8. doi:10.3109/00952990.2012.694515.CrossRefPubMed

Guerrero EG. Enhancing access and retention in substance abuse treatment: the role of Medicaid payment acceptance and cultural competence. Drug Alcohol Depend. 2013;132:555–61. doi:10.1016/j.drugalcdep.2013.04.005.CrossRefPubMed

Teruya C. Assessing the quality of care for substance use disorder conditions: implications for the state of California. Los Angeles: UCLA Integrated Substance Abuse Programs; 2012.

Guerrero EG, Aarons GA, Grella CE, Garner BR, Cook B, Vega WA. Program capacity to eliminate outcome disparities in addiction health services. Adm Policy Ment Health Ment Health Serv Res. 2014. doi:10.1007/s10488-014-0617-6.

Appel PW, Ellison AA, Jansky HK, Oldak R. Barriers to enrollment in drug abuse treatment and suggestions for reducing them: opinions of drug injecting street outreach clients and other system stakeholders. Am J Drug Alcohol Abuse. 2004;30:129–53. doi:10.1081/ADA-120029870.CrossRefPubMed

Claus RE, Kindleberger LR. Engaging substance abusers after centralized assessment: predictors of treatment entry and dropout. J Psychoactive Drugs. 2002;34:25–31. doi:10.1080/02791072.2002.10399933.CrossRefPubMed

Farabee D, Leukefeld CG, Hays L. Accessing drug-abuse treatment: perceptions of out-of-treatment injectors. J Drug Issues. 1998;28:381–94.

10.

Simpson DD, Joe GW, Brown BS. Treatment duration and follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychol Addict Behav. 1997;11:294–307. doi:10.1037/0893-164X.11.4.294.CrossRef

11.

Zhang Z, Friedmann PD, Gerstein DR. Does retention matter? treatment duration and improvement in drug use. Addiction. 2003;98:673–84. doi:10.1046/j.1360-0443.2003.00354.x.CrossRefPubMed

12.

NIATx: Health reform readiness index http://www.niatx.net/hrri/Instructions.aspx (2011). Accessed 12 Jan, 2014.

13.

McCarty D. Performance measurement for systems treating alcohol and drug use disorders. J Subst Abuse Treat. 2007;33:353–4. doi:10.1016/j.jsat.2007.04.002.PubMedCentralCrossRefPubMed

14.

Avolio BJ, Bass BM, Jung DI. Re-examining the components of transformational and transactional leadership using the Multifactor Leadership Questionnaire. J Occup Organ Psychol. 1999;72:441–62. doi:10.1348/096317999166789.CrossRef

15.

Edwards JR, Knight DK, Broome DM, Flynn PM. The development and validation of a transformational leadership survey for substance use treatment programs. Subst Use Misuse. 2010;45:1279–302. doi:10.3109/10826081003682834.PubMedCentralCrossRefPubMed

16.

Aarons GA. Transformational and transactional leadership: association with attitudes toward evidence-based practice. Psychiatr Serv. 2006;57:1162–9. doi:10.1176/ps.2006.57.8.1162.PubMedCentralCrossRefPubMed

17.

Claus R, Gotham HJ, Harper-Chang L, Selig K, Homer AL. Leadership styles and dual diagnosis capability: does transformational leadership make a difference? Paper presented at the Addiction Health Services Research Annual Meeting, Athens, GA; 2007.

18.

McConnell KJ, Hoffman KA, Quanbeck A, McCarty D. Management practices in substance abuse treatment programs. J Subst Abuse Treat. 2009;37:79–89. doi:10.1016/j.jsat.2008.11.002.PubMedCentralCrossRefPubMed

19.

Simpson DD, Flynn PM. Moving innovations into treatment: a stage-based approach to program change. J Subst Abuse Treat. 2007;33:111–20. doi:10.1016/j.jsat.2006.12.023.PubMedCentralCrossRefPubMed

20.

Greener JM, Joe GW, Simpson DD, Rowan-Szal GA, Lehman WEK. Influence of organizational functioning on client engagement in treatment. J Subst Abuse Treat. 2007;33:139–47. doi:10.1016/j.jsat.2006.12.025.PubMedCentralCrossRefPubMed

21.

Osborn D, Hinkle L, Hanlon C, Rosenthal J. Reducing racial and ethnic disparities through health care reform: state experience. Rockville: Agency for Healthcare Research and Quality; 2011.

22.

Guerrero EG, Marsh JC, Cao D, Shin HC, Andrews C. Gender disparities in utilization and outcome of comprehensive substance abuse treatment among racial/ethnic groups. J Subst Abuse Treat. 2014;46:584–91. doi:10.1016/j.jsat.2013.12.008.PubMedCentralCrossRefPubMed

23.

Marsh JC, Cao D, Guerrero E, Shin HC. Need-service matching in substance abuse treatment: racial/ethnic differences. Eval Program Plann. 2009;32:43–51. doi:10.1016/j.evalprogplan.2008.09.003.PubMedCentralCrossRefPubMed

24.

Beronio K, Glied S, Frank R. How the Affordable Care Act and Mental Health Parity and Addiction Equity Act greatly expand coverage of behavioral health care. J Behav Health Serv Res. 2014;41:410–28. doi:10.1007/s11414-014-9412-0.CrossRefPubMed

25.

Burnam MA, Bing EG, Morton SC, Sherbourne C, Fleishman JA, London AS, et al. Use of mental health and substance abuse treatment services among adults with HIV in the United States. Arch Gen Psychiatry. 2001;58:729–36. doi:10.1001/archpsyc.58.8.729.CrossRefPubMed

26.

Guerrero EG, Aarons GA, Palinkas LA. Organizational capacity for service integration in community-based addiction health services. Am J Public Health. 2014;104:e40–7. doi:10.2105/AJPH.2013.301842.PubMedCentralCrossRefPubMed

27.

Simpson DD, Joe GW, Rowan-Szal GA. Drug abuse treatment retention and process effects on follow-up outcomes. Drug Alcohol Depend. 1997;47:227–35. doi:10.1016/S0376-8716(97)00099-9.CrossRefPubMed

28.

Lehman WEK, Greener JM, Simpson DD. Assessing organizational readiness for change. J Subst Abuse Treat. 2002;22:197–209. doi:10.1016/S0740-5472(02)00233-7.CrossRefPubMed

29.

Lazarsfeld PF, Henry NW. Latent structure analysis. Boston, MA: Houghton Mifflin; 1968.

30.

Schaefer JL. Analysis of incomplete multivariate data. New York, NY: Chapman and Hall; 1997.CrossRef

31.

Little RJA, Rubin DB. Statistical analysis with missing data. 2nd ed. New York: John Wiley & Sons; 2002.

32.

Cameron AC, Trivedi PK. Microeconometrics using Stata. College Station: Stata Press; 2009.

33.

Stata. Stata 12 help for nbreg. http://www.stata.com/help.cgi?nbreg. Accessed 12 Nov 2012.

34.

Blakely TA, Woodward AJ. Ecological effects in multi-level studies. J Epidemiol Community Health. 2000;54:367–74. doi:10.1136/jech.54.5.367.PubMedCentralCrossRefPubMed

35.

Tingley D, Yamamoto T, Hirose K, Keele L, Imai K. Mediation: R package for causal mediation analysis. http://cran.r-project.org/web/packages/mediation/vignettes/mediation.pdf (2014). Accessed 12 Jan 2014.

36.

Guerrero EG, He A, Kim A, Aarons GA. Organizational implementation of evidence-based substance abuse treatment in racial and ethnic minority communities. Adm Policy Ment Health. 2014;41:737–49. doi:10.1007/s10488-013-0515-3.CrossRefPubMed

37.

National Council for Community Behavioral Healthcare. Addressing Health Disparities Leadership Program. http://www.thenationalcouncil.org/training-courses/addressing-health-disparities-leadership-program (2015). Accessed 5 Jan 2015.

38.

Addiction Technology Transfer Center Network. ATTC network training. http://attcnetwork.org/advancingintegration/index.aspx (2015). Accessed 22 Sep 2015.

39.

Substance Abuse and Mental Health Services Administration. Substance abuse treatment evidence-based practices (EBP). http://www.samhsa.gov/ebp-web-guide/substance-abuse-treatment (2015). Accessed 22 Sep 2015.

Title: Paths to improving engagement among racial and ethnic minorities in addiction health services
Authors: Erick G. Guerrero
Karissa Fenwick
Yinfei Kong
Christine Grella
Thomas D’Aunno
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Substance Abuse Treatment, Prevention, and Policy / Issue 1/2015
Electronic ISSN: 1747-597X
DOI: https://doi.org/10.1186/s13011-015-0036-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Paths to improving engagement among racial and ethnic minorities in addiction health services

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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