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Community Context and Healthcare Quality: The Impact of Community Resources on Licensing and Accreditation of Substance Abuse Treatment Agencies

  • Matthew E. Archibald
  • Caddie Putnam Rankin
Article

Abstract

This study examines variation in healthcare quality among substance abuse treatment agencies. Using an organizations framework, the authors predict that resource advantages benefit certain types of healthcare organizations, especially those located in affluent communities. As a result, levels of licensing and accreditation of substance abuse treatment agencies will differ across United States counties. The authors model these resources at both the organizational and community levels in an effort to understand the variability of licensing and accreditation between agencies and their local contexts. In multivariate models, the findings confirm that organizational characteristics such as private ownership (compared to public ownership), managed care contracts, inpatient and residential programs (compared to outpatient settings), as well as socioeconomic, racial/ethnic, and healthcare system advantage promote higher levels of licensing and accreditation. Public ownership and outpatient settings, as well as socioeconomic, racial/ethnic, and healthcare system disadvantage, are associated with lower levels of licensing and accreditation.

Keywords

Substance Abuse Treatment Community Resource Public Ownership Accreditation Body Substance Abuse Program 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors would like to thank Kendralin Freeman of Hobart and William Smith Colleges and Sonal Nalkur of Emory University for data collection; Lloyd Liang and Daniel Hussey for their editorial assistance; and several anonymous reviewers for their helpful comments.

Conflict of Interest Statement

The authors declare that no conflict of interest exists with regard to this manuscript. We did not receive any financial support from outside funders to complete this research project.

References

  1. 1.
    Kirby JB, Kaneda T. Neighborhood socioeconomic disadvantage and access to health care. Journal of Health and Social Behavior 2005; 46:15–31.PubMedCrossRefGoogle Scholar
  2. 2.
    Wilson WJ. The Truly Disadvantaged. Chicago: The University of Chicago Press, 1987.Google Scholar
  3. 3.
    Massey DS, White MJ, Phua VC. The dimensions of segregation revisited. Sociological Methods and Research 1996; 25:172–206.CrossRefGoogle Scholar
  4. 4.
    Massey DS. Categorically Unequal: The American Stratification System. New York, NY: Russell Sage Foundation. 2007.Google Scholar
  5. 5.
    Kimberley JR, McLellan TA. The business of addiction treatment: A research agenda. Journal of Substance Abuse Treatment 2006; 31:213–219.CrossRefGoogle Scholar
  6. 6.
    Chriqui JF, Eidson SK., McBride DC, et al.. Assessing State Regulation of Outpatient Substance Abuse Treatment Programs in the U.S. Along a Quality Continuum. Research Paper Series 34. Robert Wood Johnson Foundation, 2006.Google Scholar
  7. 7.
    US Congress. Healthcare Research and Quality Act. Statutes at Large. Vol. 113, Sec. 1653, 1999Google Scholar
  8. 8.
    Wells R, Lemak CH, Alexander JA, et al. Do licensing and accreditation matter in outpatient substance abuse treatment programs. Journal of Substance Abuse Treatment 2007; 33:43–50. PubMedCrossRefGoogle Scholar
  9. 9.
    McLellan AT, McKay JR, Forman R, et al. Reconsidering the evaluation of addiction treatment: from retrospective follow-up to concurrent recovery monitoring. Addiction 2005; 100(4):447–58.PubMedCrossRefGoogle Scholar
  10. 10.
    Join Together. Rewarding Results – Improving the Quality of Treatment for People with Alcohol and Drug Problems: Recommendations from a National Policy Panel. Boston: Boston University School of Public Health, 2003.Google Scholar
  11. 11.
    Center for Substance Abuse Treatment. A National Review of State Alcohol and Drug Treatment Programs and Certification Standards for Substance Abuse Counselors and Prevention Professionals. Rockville, MD. US Department of Health and Human Services, 2005Google Scholar
  12. 12.
    Corredoira RA, Kimberly JR. Industry evolution through consolidation: Implications for addiction treatment. Journal of Substance Abuse Treatment 2006; 31:255–265PubMedCrossRefGoogle Scholar
  13. 13.
    D’Aunno T. The role of organization and management in substance abuse treatment: Review and roadmap. Journal of Substance Abuse Treatment 2006; 31:221–233.PubMedCrossRefGoogle Scholar
  14. 14.
    Knott AM, Corredoira RA, Kimberly JR. Improving consistency and quality of service delivery: Implications for the addiction treatment field. Journal of Substance Abuse Treatment 2008; 35:99–108.PubMedCrossRefGoogle Scholar
  15. 15.
    Archibald ME. Socioeconomic and racial/ethnic disparities in substance abuse treatment provision, treatment needs and utilization. In: Kronenfeld, JJ (Ed), Research in the Sociology of Health Care, 2008; 25:171–201.Google Scholar
  16. 16.
    Archibald ME, Putnam Rankin C. A spatial analysis of community disadvantage and access to healthcare services. Social Science and Medicine. in press.Google Scholar
  17. 17.
    Beaulieu ND, Epstein AM. National committee on quality assurance health-plan accreditation: Predictors, correlates of performance and market impact. Medical Care 2002; 40:325–337.CrossRefGoogle Scholar
  18. 18.
    Edwards JR, Knight DK, Flynn PM. Organizational correlates of service availability in outpatient substance abuse treatment programs. Journal of Behavioral Health Services & Research 2011; 38:432–443.CrossRefGoogle Scholar
  19. 19.
    Wells R, Lemak CH, Alexander JA, et al. Do licensing and accreditation matter in outpatient substance abuse treatment programs? Journal of Substance Abuse Treatment 2007; 33:43–50.PubMedCrossRefGoogle Scholar
  20. 20.
    Scott WR, Davis GF. Organizations and Organizing: Rational, Natural, and Open System Perspectives, Upper Saddle River: Pearson Prentice Hall, 2007.Google Scholar
  21. 21.
    Mulvey KP, Hubbard S. Hayashi S. A national study of the substance abuse treatment workforce. Journal of Substance Abuse Treatment 2003;24: 51–57.PubMedCrossRefGoogle Scholar
  22. 22.
    Kirby JB. Poor people, poor places and access to health care in the United States. Social Forces 2008; 87:325–355.CrossRefGoogle Scholar
  23. 23.
    Beaulieu ND, Epstein AM. National committee on quality assurance health-plan accreditation: Predictors, correlates of performance and market impact. Medical Care 2002; 40:325–337.CrossRefGoogle Scholar
  24. 24.
    Chriqui JF, Terry-McElrath Y, McBride DC, et al. Does state certification or licensure influence outpatient substance abuse treatment program practices? The Journal of Behavior Health Services & Research 2007; 34(3):309–328.CrossRefGoogle Scholar
  25. 25.
    Edwards JR, Knight DK, Flynn PM. Organizational correlates of service availability in outpatient substance abuse treatment programs. Journal of Behavioral Health Services & Research 2011; 38:432–443.CrossRefGoogle Scholar
  26. 26.
    Wells R, Lemak CH, Alexander JA, et al. Do licensing and accreditation matter in outpatient substance abuse treatment programs. Journal of Substance Abuse Treatment 2007; 33:43–50.PubMedCrossRefGoogle Scholar
  27. 27.
  28. 28.
    Edwards JR, Knight DK, Flynn PM. Organizational correlates of service availability in outpatient substance abuse treatment programs. Journal of Behavioral Health Services & Research 2011; 38:432–443.CrossRefGoogle Scholar
  29. 29.
    D’Aunno T, Vaughn TE. An organizational analysis of service patterns in outpatient drug abuse treatment units. Journal of Substance Abuse 1995; 7(1):27–42.PubMedCrossRefGoogle Scholar
  30. 30.
    Hubbard RL, Craddock SG, Anderson J. Overview of 5-year follow-up outcomes in the drug abuse treatment outcome study. Journal of Substance Abuse Treatment 2003; 25(3):125–134.PubMedCrossRefGoogle Scholar
  31. 31.
    Harrison PA, Asche SE. Comparison of substance abuse treatment outcomes for inpatients and outpatients. Journal of Substance Abuse Treatment 1999; 17(3):207–220.PubMedCrossRefGoogle Scholar
  32. 32.
    Olmstead TA, White W, Sindelar JL. The impact of managed care on substance abuse treatment services. Health Services Research 2004; 39(2):319–344.PubMedCrossRefGoogle Scholar
  33. 33.
    Substance Abuse and Mental Health Services Administration. Results from the 2011 National Survey on Drug Use and Health. NSDUH Series H-44, HHS publication no. SMA 12-4713, Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.Google Scholar
  34. 34.
    Jacobson JO. Place and attrition from substance abuse treatment. Journal of Drug Issues 2004; 34:23–50.CrossRefGoogle Scholar
  35. 35.
    Jacobson JO. Do drug treatment facilities increase clients’ exposure to potential neighborhood-level triggers for relapse? A small-area assessment of a large, public treatment system. Journal of Urban Health 2006; 83(2):150–161.PubMedCrossRefGoogle Scholar
  36. 36.
    Wilson WJ. The Truly Disadvantaged. Chicago: The University of Chicago Press, 1987.Google Scholar
  37. 37.
    Massey DS, White MJ, Phua VC. The dimensions of segregation revisited. Sociological Methods and Research 1996; 25:172–206. CrossRefGoogle Scholar
  38. 38.
    Massey DS. Categorically Unequal: The American Stratification System. New York, NY: Russell Sage Foundation. 2007.Google Scholar
  39. 39.
    Chaskin RJ, Brown P, Venkatesh S, et al. Building community capacity. Hawthorne, NY: Aldine de Gruyter, 2001.Google Scholar
  40. 40.
    Small ML, Jacobs EM, Massengill RP. Why organizational ties matter for neighborhood effects: a study of resource access through childcare centers. Social Forces 2008; 87(1):387–414.CrossRefGoogle Scholar
  41. 41.
    U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. National Survey of Substance Abuse Treatment Services (N-SSATS) 2004 (Computer file). Prepared by Synectics for Management Decisions, Incorporated. Icpsr04256-V2. Ann Arbor, MI: Inter-university Consortium for Political and Social Research (distributor), 2006.Google Scholar
  42. 42.
  43. 43.
    U.S. Health Resources and Services Administration: Bureau of Health Professions, Department of Health and Human Services, 2009–2010.Google Scholar
  44. 44.
    Lohr KN. Institute of Medicine. Medicare: a Strategy for Quality Assurance. Volume I. Washington, D.C.: National Academy Press, 1990.Google Scholar
  45. 45.
    Chriqui JF, Eidson SK., McBride DC, et al. Assessing State Regulation of Outpatient Substance Abuse Treatment Programs in the U.S. Along A Quality Continuum. Research Paper Series 34. Robert Wood Johnson Foundation, 2006.Google Scholar
  46. 46.
    Chriqui JF, Terry-McElrath Y, McBride DC, et al. Does state certification or licensure influence outpatient substance abuse treatment program practices? The Journal of Behavior Health Services & Research 2007; 34(3):309–328.CrossRefGoogle Scholar
  47. 47.
    U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. National Survey of Substance Abuse Treatment Services (N-SSATS) 2004 (Computer file). Prepared by Synectics for Management Decisions, Incorporated. Icpsr04256-V2. Ann Arbor, MI: Inter-university Consortium for Political and Social Research (distributor), 2006Google Scholar
  48. 48.
    Olmstead TA, White W, Sindelar JL. The impact of managed care on substance abuse treatment services. Health Services Research 2004; 39(2):319–344.PubMedCrossRefGoogle Scholar
  49. 49.
    Wodtke, G, Harding, DJ, Elwert, F. Neighborhood effects in temporal perspective. American Sociological Review 2011;6(5) 713736 CrossRefGoogle Scholar
  50. 50.
    Sampson RJ, Morenoff JD, Gannon-Rowley T. Assessing neighborhood effects: social processes and new directions in research. Annual Sociological Review 2002; 28:443–478.CrossRefGoogle Scholar
  51. 51.
    Massey DS, White MJ, Phua VC. The dimensions of segregation revisited. Sociological Methods and Research 1996; 25:172–206. CrossRefGoogle Scholar
  52. 52.
    Wilson WJ. When Work Disappears: The New World of the Urban Poor. New York: Alfred A. Knopf, 1996. Google Scholar
  53. 53.
    Desai M, Begg MD. A comparison of regression approaches for analyzing clustered data. American Journal of Public Health 2008; 98(8):1495–1429.CrossRefGoogle Scholar
  54. 54.
    Rabe-Hesketh S, Skrondal A. Latent variable modeling. Statistical Methods in Medical Research 2008; 17:3–4.PubMedCrossRefGoogle Scholar
  55. 55.
  56. 56.
  57. 57.
    Carroll GR, Hannan MT. Demography of Corporations and Industries. Princeton, NJ: Princeton University Press, 2000.Google Scholar
  58. 58.
    Rabe-Hesketh S, Skrondal A. Latent variable modeling. Statistical Methods in Medical Research 2008; 17:3–4.PubMedCrossRefGoogle Scholar
  59. 59.
  60. 60.
    Griffith DM, Childs EL, Eng E, et al. Racism in organizations: The case of a county public health department. Journal of Community Psychology 2007; 35:287–302.PubMedCrossRefGoogle Scholar
  61. 61.
    McAuliffe WE, Woodworth R, Zhang C, et al. Identifying substance abuse treatment gaps in substate areas. Journal of Substance Abuse Treatment 2002; 23(33):199–208.PubMedCrossRefGoogle Scholar
  62. 62.
    Schmidt L, Greenfield T, Mulia N. Unequal treatment: racial and ethnic disparities in alcoholism treatment services. Alcohol Research Health 2006; 29(1):49–54.PubMedGoogle Scholar
  63. 63.
    Daley M. Race, managed care, and the quality of substance abuse treatment. Administration and Policy in Mental Health 2005; 32(4):457–476.PubMedCrossRefGoogle Scholar
  64. 64.
    Agency for Healthcare Research and Quality. National Healthcare Disparities Reports: Summary. Rockville, MD: 2003. Retrieved from http://www.ahrq.gov/qual/nhdr03/nhdrsum03.htm
  65. 65.
    Miller SC, Papandonatos G, Fennell M, et al. Facility and county effects on racial differences in nursing home quality indicators. Social Science & Medicine 2006; 63:3046–3059.CrossRefGoogle Scholar
  66. 66.
    Ryan O, Murphy D, Krom, L. Vital signs: Taking the pulse of the addiction treatment workforce, a national report, version 1. Kansas City: Addiction Technology Transfer Center National Office in Residence at the University of Missouri-Kansas City, 2012Google Scholar
  67. 67.
    Robert SA, House JA. Socioeconomic inequalities in health: Integrating individual-, community-, and societal-level theory and research. Handbook of Social Studies in Health and Medicine. London: Sage Publications, 2000.Google Scholar
  68. 68.
    Krieger N. Women and social class: A methodological study comparing individual, household, and census measures as predictors of black/white differences in reproductive history. Journal of Epidemiology of Community Health 1991; 45:35–42.CrossRefGoogle Scholar
  69. 69.
    Morenoff JD, Lynch JW. What makes a place healthy? Neighborhood influences on racial/ethnic disparities in health over the life course. Critical Perspectives on Racial and Ethnic Differences in Health in Late Life. Washington, D.C.: National Academies Press, 2004.Google Scholar
  70. 70.
    McAuliffe WE, Dunn RP. Substance abuse treatment needs and access in the USA: Interstate variations. Addiction 2004; 99:999–1014.PubMedCrossRefGoogle Scholar
  71. 71.
    Small ML, Jacobs EM, Massengill RP. Why organizational ties matter for neighborhood effects: a study of resource access through childcare centers. Social Forces 2008; 87(1):387–414.CrossRefGoogle Scholar
  72. 72.
    Chaskin RJ, Brown P, Venkatesh S, et al. Building Community Capacity. Hawthorne, NY: Aldine de Gruyter, 2001.Google Scholar
  73. 73.
    Small ML. Neighborhood institutions as resource brokers: childcare centers, interorganizational ties and resource access among the poor. Social Problems 2006; 53:274–292.CrossRefGoogle Scholar
  74. 74.
    National Institute of Drug Abuse. Drug abuse among racial/ethnic minorities. National Institutes of Health Division of Epidemiology and Prevention Research. Rockville, 1998Google Scholar
  75. 75.
    McAuliffe WE, Dunn RP. Substance abuse treatment needs and access in the USA: Interstate variations. Addiction 2004; 99:999–1014.PubMedCrossRefGoogle Scholar
  76. 76.
    Substance Abuse and Mental Health Services Administration. Siting Drug and Alcohol Treatment Programs: Legal Challenges to the NIMBY Syndrome. Technical Assistance Publication (TAP) Series 14. Rockville, MD: Substance Abuse and Mental Health Services Administration. HHS publication no. SMA 95-3050, 1995.Google Scholar

Copyright information

© National Council for Community Behavioral Healthcare 2013

Authors and Affiliations

  1. 1.Department of SociologyColby CollegeWatervilleUSA
  2. 2.Organizational Leadership ProgramUniversity of Maryland Eastern ShorePrincess AnneUSA

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