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Program Capacity to Eliminate Outcome Disparities in Addiction Health Services

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Abstract

We evaluated program capacity factors associated with client outcomes in publicly funded substance abuse treatment organizations in one of the most populous and diverse regions of the United States. Using multilevel cross-sectional analyses of program data (n = 97) merged with client data from 2010 to 2011 for adults (n = 8,599), we examined the relationships between program capacity (leadership, readiness for change, and Medi-Cal payment acceptance) and client wait time and treatment duration. Acceptance of Medi-Cal was associated with shorter wait times, whereas organizational readiness for change was positively related to treatment duration. Staff attributes were negatively related to treatment duration. Overall, compared to low program capacity, high program capacity was negatively associated with wait time and positively related to treatment duration. In conclusion, program capacity, an organizational indicator of performance, plays a significant role in access to and duration of treatment. Implications for health care reform implementation in relation to expansion of public health insurance and capacity building to promote health equities are discussed.

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Acknowledgments

We thank Director John Viernes, Tina Kim and her research staff at Los Angeles County, Substance Abuse Prevention and Control, who kindly provided the client data necessary for our analysis, as well as feedback on the final draft. We also appreciate all treatment providers who kindly provided the program data for our study. Finally, we thank Eric Lindberg, who assisted with the preparation and proofreading of the manuscript. Funding for this study was provided by the National Institute on Drug Abuse (R21DA035634-02) and the Hamovitch Center for Science in the Human Services at the School of Social Work, University of Southern California. Neither of these two institutions had further role in study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; nor in the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA, 90089, USA

    Erick G. Guerrero & William A. Vega

  2. Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr. (0812), San Diego, CA, 92093-0812, USA

    Gregory A. Aarons

  3. Integrated Substance Abuse Programs, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, 90025, USA

    Christine E. Grella

  4. Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA

    Bryan R. Garner

  5. Department of Psychiatry, Harvard Medical School, 2 West - Room 305 - 401 Park Drive, Boston, MA, 02215, USA

    Benjamin Cook

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Correspondence to Erick G. Guerrero.

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Guerrero, E.G., Aarons, G.A., Grella, C.E. et al. Program Capacity to Eliminate Outcome Disparities in Addiction Health Services. Adm Policy Ment Health 43, 23–35 (2016). https://doi.org/10.1007/s10488-014-0617-6

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