The Association of Organizational Characteristics, Policy Factors, and Social Climate with Delivery of Population-Specific Substance Use Treatment
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Date
2015-01-22
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Johns Hopkins University
Abstract
Objective. To investigate the impact of organizational characteristics, state and federal policies, and social climate on the provision of services designed to meet the needs of specific patient populations in substance use treatment.
Methods. The primary data source was the National Survey of Substance Abuse Treatment Services (NSSATS). Multilevel logistic regression was used to estimate the association of organizational and policy factors with provision of services designed specifically for adult women, adult men, adolescents, seniors, individuals at-risk for HIV, HIV positive individuals, and lesbians, gays, and bisexuals (LGBs). Social climate was also included in models of HIV-related and LGB services.
Results. Organizational characteristics, policy factors, and social climate were all associated with provision of specialized services, although the direction and size of these associations varied across services. Medicaid acceptance and non-profit status were associated with provision of specialized services for women, adolescents, and persons with HIV. Services for LGBs and seniors were more likely to be provided in for-profit centers and those accepting private insurance and Medicare, respectively. Facilities in rural areas and those with religious affiliation were less likely to offer services for women and persons with HIV, while those providing mental health services were more likely to offer services for LGBs and persons with HIV.
Increased state Medicaid spending on treatment was associated with increased provision of gender-based services and services for seniors, while state Medicaid coverage of outpatient treatment was associated with provision of age-based services. In addition, state HIV-designation by the Substance Abuse and Mental Health Services Administration significantly increased odds of provision of HIV-related services. Negative social climate was strongly associated with facilities providing only HIV prevention services as opposed to offering services for HIV-positive individuals. Negative social climate was also marginally associated with not providing services for LGBs.
Conclusion. There is variation in the impact of organizational characteristics on delivery of treatment services for specific patient populations. Negative social climate appears to significantly impede delivery of services for individuals with HIV and LGBs. The impact of state and federal policies suggests their expansion may serve as a solution for increasing provision of these services.
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Keywords
substance use treatment, substance abuse, policy factors, organizational factors, social climate, discrimination, hiv, lgbt