News Studies

How Organizations Implement Evidence-Based Substance Abuse Treatment in Minority Communities

Erick Guerrero
Delivery of evidence-based substance abuse treatment practices in racial and ethnic minority communities is essential for reducing health care disparities. Unfortunately, SAT providers face many barriers to implementing evidence-based practices (EBP), such as contingency management treatment (CMT) and medication-assisted treatment (MAT), that have been shown to produce promising outcomes. In a study published in Administration and Policy in Mental Health and Mental Health Services Research, Dr. Erick Guerrero and his research team examined whether the following factors could help increase the implementation of CMT and/or MAT to help publicly-funded SAT organizations overcome these barriers:
  • Regulatory environment: Public funding (i.e. Medicaid payment acceptance), licensure (i.e. county license), and professional accreditations (i.e. The Joint Commission)
  • Directorial leadership: Transformational leadership (i.e. promoting intellectual stimulation and support for innovation) and transactional leadership (i.e. job delegation)
  • Readiness for change: Program’s resources, climate, staff motivational readiness, and staff attributes for change
  • Regulatory Environment Combined with Readiness for Change: Supervisors’ openness to EBPs in organizations that also have more resources, such as ability to accept private insurance and parent organizations
  • Supervisor Capacity: Supervisors’ graduate education, years of experience, attitudes regarding EBPs, and attributes that are associated with readiness for change
The evaluation was done by surveying 122 addiction health providers in 2011 that serve predominantly Latino and African-American residents of Los Angeles County, California. 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 randomly selected programs; and 3) reviewed printed material available at each provider site. To measure an organization’s implementation of CMT and/or MAT, the providers were asked how often, from never to always, each of these two practices were used in programming. To measure the first set of characteristics regarding regulatory environment, the researchers created measures for public funding and ability to accept Medicaid and private insurance, as well as yes/no indicators for whether the program was state licensed and had received accreditation. Secondly, program directors were asked nine questions regarding their leadership style. These measures have been shown in previous research to be related to transformational leadership. Thirdly, organizational readiness for change was assessed through four types of staff attributes associated with openness towards EBPs. These were also combined with yes/no variables measuring whether an organization accepted private insurance or had a parent organization, to assess if openness to EBPs was more important for these organizations. Finally, the supervisor’s capacity to implement change was measured using five sets of questions that have been shown to represent positive attitudes towards EBPs. A statistical technique was used to test the relationship between the five sets of organizational characteristics and EBPs. Separate analyses were done for CMT and MAT, and the research team found:
  • Organizations offering private insurance were more likely to implement both CMT and MAT.
  • One measure of a provider’s readiness for change, openness to EBPs, was found to lead to both CMT and MAT implementation in organizations that accepted private insurance and in those that had a parent organization (both measures of more resources).
  • A supervisor’s capacity for implementing EBPs, specifically their openness and attitudes towards change, was positively associated with implementation of EPB practices.
Overall, the research team found that supervisor’s openness and attitudes towards change were key managerial capacity factors for implementation of EBPs. Because MAT is particularly expensive and resource-extensive, when a provider has external demands and resources (measured by accepting private insurance and parent organizations), a supervisor’s openness to EBPs can lead to implementation of pharmacotherapies. The study’s authors note this factor is particularly encouraging. To view the study in its entirety, please click here. Source: “Organizational Implementation of Evidence-Based Substance Abuse Treatment in Racial and Ethnic Minority Communities”, Administration and Policy in Mental Health and Mental Health Services Research

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.

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