News Studies

How Community-Based Addiction Health Organizations Can Provide More Integrated Services

Erick Guerrero
Coordinating addiction, mental health, and/or medical care is associated with improved health outcomes and reduced healthcare costs, particularly among vulnerable populations. In fact, one of the Affordable Care Act’s main principles is to respond holistically to the healthcare needs of populations facing significant barriers to access this type of integrated care. Addiction health providers in ethnic-minority communities, where many clients enter with multiple disorders, can become a focal point for providing these services. Unfortunately, these community-based providers struggle to either provide these types of services or coordinate with programs that provide them. In a study published by the American Journal of Public Health, Dr. Erick Guerrero and his research team at Integrated Substance Abuse Treatment to Eliminate Disparities (iSATed) tested whether the following organizational characteristics predict more collaboration with providers of mental health, public health, and HIV testing:
  • Regulatory environment: Public funding (Medicaid), licensure, and professional accreditations (i.e. The Joint Commission).
  • Readiness for change: Program’s resources, climate, staff motivational readiness, and staff attributes for change.
  • Directorial leadership: Transformational leadership (i.e. promoting intellectual stimulation and support for innovation) and transactional leadership (i.e. job delegation).
The evaluation was done by combining responses to a survey and information about each specific treatment episode over a specific time-period from addiction health providers that serve predominantly Latino and African-American residents of Los Angeles County. The 104 programs analyzed were surveyed in 2011 and information was used from 14,379 episodes they treated between July 1, 2010 and December 31, 2011. To make sure the measures from the surveys were accurate, the research team also: 1) reviewed information reported by the providers to the funding organization (LA Department of Public Health); 2) interviewed counselors and clinical supervisors in 30 of the programs; and 3) reviewed printed material available at each provider site. To measure coordination (i.e. the outcome of interest), the survey asked three sets of questions. It asked how often, from never to always, the programs collaborated with mental and public health service providers, and about coordination of on-site or off-site HIV testing that resulted in clients receiving HIV testing. The survey questions also included organizational characteristics of the program related to funding, regulation and readiness for change. These are key drivers of service delivery. The research team used standard statistical techniques to analyze the relationship between the organizational factors and each of the three measures of coordination separately. They found that:
  • Professionally accredited programs were more likely to coordinate with mental health programs.
  • Clients in programs with more public funding were more likely to be tested for HIV.
  • Motivational readiness and organizational climate, as measures of readiness for change, were associated with more coordination with both mental health and public health providers.
  • Organizational resources for promoting change was associated with clients more likely to receive HIV testing.
  • There was no support for measures of directorial leadership and measures of coordination.
Overall, the research team concludes that regulatory factors, such as professional accreditation, and aspects of readiness for change play an important role in coordinating services with providers delivering mental health, public health, and HIV testing. They note that this may be because certain external pressures and incentives, as well as internal staff motivation, are important to extend services beyond addiction care for these relatively small community-based providers. The organizational characteristics found to be important are components of what the authors call “program capacity for change.” As community-based providers respond to the Affordable Care Act, they must increase their capacity for change, and this study points to a few clear modifications that providers could implement to do so. To view the study in its entirety, please click here. Source: “Organizational Capacity for Service Integration in Community-Based Addiction Health Services”, American Journal of Public Health

About Erick Guerrero

Erick Guerrero usc

Dr. Erick Guerrero is the research director at I-Lead Institute at Red Corp

Professor Erick Guerrero has recieved awards every year since 2009 for his program on research on Latino disparities in behavioral health services and implementation of culturally responsive evidence based practices in health care settings.

Before Completing his doctorate, Dr Guerrero was a clinician for 13 years serving hundreds of families affected by child and or partner abuse

Trained as an organizational and implementation scientist, Professor Erick Guerrero has published more than 50 peer-reviewed articles in top scientific journals in his field. Dr Erick Guerrero was the first Mexican National who graduated with a Ph.D from the University of Chicago School of Social Service Administration.

Other Articles

Measuring Disparities In Substance Use Treatment
Program Acceptance of Medicaid
What Researchers Discovered about Drug Treatment Outcomes among Different Racial/Ethnic & Gender Groups