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

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

doi:10.1186/s13011-015-0036-z

Abstract

BackgroundMembers 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.MethodsThis 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).ResultsCompared 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.ConclusionsProgram 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.

Highlights

Members of racial and ethnic minority groups are most likely to experience limited access and poor engagement in addiction treatment
Building on a recent study suggesting that high program capacity helps reduce client wait time and increase retention in addiction health services (AHS) programs [6], the current study examined the extent to which access and retention are enhanced when racial and ethnic minorities receive care from high-capacity AHS programs and via coordination with mental health providers and receipt of HIV testing services
Because mental health and HIV testing services are two of the most needed services for clients in publicly funded AHS programs [5, 22, 25] and previous work has shown that components of highcapacity programs are associated with coordination of mental health and HIV testing services [26], we examined the extent to which coordinated care is the mechanism by which program capacity is associated with wait time and retention

Summary

Introduction

Members of racial and ethnic minority groups are most likely to experience limited access and poor engagement in addiction treatment. The Affordable Care Act provides an opportunity to expand AHS capacity by increasing access to public health insurance and encouraging service integration [2] This is critical for underserved populations that face numerous barriers to accessing AHS, resulting in disparities in access to needed services [3]. Among individuals seeking help for substance abuse issues, waiting to enter treatment is the most commonly cited barrier [7,8,9], and treatment access and retention are critical predictors of reduced posttreatment substance use [10, 11] Exploring program factors, such as program capacity, that enhance client wait time and retention in AHS is critical because these outcomes are important predictors of treatment success and increasingly used in program evaluation [5, 6, 12, 13].

Objectives

Methods

Results

Discussion

Conclusion