Abstract
BackgroundPrevious studies have found that even limited prevention-related interventions can affect health behaviors such as substance use and risky sex. Substance abuse treatment providers are ideal candidates to provide these services, but typically have little or no financial incentive to do so. The purpose of this study was therefore to explore why some substance abuse treatment units have added new prevention and outreach services. Based on an ecological framework of organizational strategy, three categories of predictors were tested: (1) environmental, (2) unit-level, and (3) unit leadership.ResultsA lagged cross-sectional logistic model of 450 outpatient substance abuse treatment units revealed that local per capita income, mental health center affiliation, and clinical supervisors' graduate degrees were positively associated with likelihood of adding prevention-related education and outreach services. Managed care contracts and methadone treatment were negatively associated with addition of these services. No hospital-affiliated agencies added prevention and outreach services during the study period.ConclusionFindings supported the study's ecological perspective on organizational strategy, with factors at environmental, unit, and unit leadership levels associated with additions of prevention and outreach services. Among the significant predictors, ties to managed care payers and unit leadership graduate education emerge as potential leverage points for public policy. In the current sample, units with managed care contracts were less likely to add prevention and outreach services. This is not surprising, given managed care's emphasis on cost control. However, the association with this payment source suggests that public managed care programs might affects prevention and outreach differently through revised incentives. Specifically, government payers could explicitly compensate substance abuse treatment units in managed care contracts for prevention and outreach. The effects of supervisor graduate education on likelihood of adding new prevention and outreach programs suggests that leaders' education can affect organizational strategy. Foundation and government officials may encourage prevention and outreach by funding curricular enhancements to graduate degree programs demonstrating the importance of public goods.Overall, these findings suggest that both money and professional education affect substance abuse treatment unit additions of prevention and outreach services, as well as other factors less amenable to policy intervention.
Highlights
Previous studies have found that even limited prevention-related interventions can affect health behaviors such as substance use and risky sex
These findings suggest that both money and professional education affect substance abuse treatment unit additions of prevention and outreach services, as well as other factors less amenable to policy intervention
The current study addresses this question in the context of substance abuse prevention, asking: "What factors make it more likely that substance abuse treatment units will add new community prevention, education, and outreach services?" The current inquiry focuses on outpatient substance abuse treatment providers, which provide the majority of substance abuse treatment in the United States [5]
Summary
Previous studies have found that even limited prevention-related interventions can affect health behaviors such as substance use and risky sex. The current study addresses this question in the context of substance abuse prevention, asking: "What factors make it more likely that substance abuse treatment units will add new community prevention, education, and outreach services?" The current inquiry focuses on outpatient substance abuse treatment providers, which provide the majority of substance abuse treatment in the United States [5]. These units may be self standing or based in hospitals, mental health centers, or other facilities. Like many health and human service providers, substance abuse treatment units are often organizations embedded in larger organizations
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