Improving Coordination for Addiction Programs with Mental and Public Health Services

Problems related to addiction are very common and most people who struggle with addiction simultaneously suffer from other behavioral and mental health problems. Because of this, it is more beneficial to provide addiction services to people in places that offer multiple services at once. Unfortunately, this has proven quite difficult for various reasons, and so far, the solution for most addiction services providers has been to improve coordination with other providers. With the aim of eventually moving towards providing more “integrated” services, Dr. Guerrero and his research team set out to understand what factors were associated with addiction programming that demonstrated high coordination with mental and health services. In a study published in the Journal of Substance Abuse Treatment, Dr. Guerrero and his team test whether the following two sets of provider characteristics are associated with better coordination across mental and behavioral services in their addiction programming:

• Regulatory and funding environment: Higher public funding and receipt of licensure and professional accreditation
• Practice implementation: Better leadership, readiness for change, and providing culturally responsive practices

The evaluation was done by surveying addiction health providers that serve predominantly Latino and African-American residents of Los Angeles County. Using an online survey, 122 providers were surveyed in 2011 and another 112 were surveyed in 2013. 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. The counselor interviews were especially important, as the team was able to observe the counselors’ work in real time and confirm programs that reported high levels of coordination. To measure the coordination (i.e. the outcome of interest), the survey asked how often, from never to always, the programs collaborated with mental and public health service providers. To measure the first set of characteristics tested, the researchers created a measure for public funding and yes/no indicators for whether the program was state licensed and had received accreditation. For the second set of characteristics tested, survey responses to a large number of questions were used to create a few set of index measures for “organizational readiness for change,” “directorial leadership,” and “cultural competency.” Standard statistical techniques were used for the survey responses to assess the relationship between the outcome of interest and the two sets of provider characteristics of interest. In addition, the research team transcribed the interviews conducted with 30 counselors and used a coding technique to develop patterns. These were used to create themes and interpret the counselors’ perceptions of coordinated care. The findings for the survey responses were:

• Addiction program providers reported more collaboration with mental and public health service providers in 2013 than in 2011.
• There did not appear to be a relationship between any of the measures of regulatory and funding environment and higher coordination.
• With regards to implementation, programs with more linkages to serve racial and ethnic minority communities coordinated more with both mental and public health services; and those with more knowledge about minority communities coordinated more with mental health.
• Personal involvement in minority communities made programs less likely to coordinate with mental health services.

The research team also gleaned findings from the interviews of program counselors:

• Addiction programs have become increasingly integrated with mental health treatment, but public health services are still generally provided separately.
• Effective coordination relies heavily on relationships with nearby organizations.
• The largest obstacle to providing integrated public health services is a lack of public funding, especially since Medicaid has strict rules regarding services provided to substance use clients.
• Diverse funding and flexible eligibility criteria for programs help facilitate delivery of integrated care, and an increase in these sources over time drove the higher levels of coordination.
• Leadership and staff readiness within the organization to accept and promote coordination and integration were the driving factors to increasing coordination.

The quantitative analysis buttressed by the qualitative interviews provide important lessons for continuing to improve coordination in addiction programs with mental and public health services. Transnational leadership was shown to play a large role by enabling and facilitating coordination. Cultural competence and relationships with minority communities were important, showing that programs should focus on building relationships. Finally, public funding is another major factor, which shows the challenges that lie ahead for racial and ethnic minority communities. To view the study in its entirety, please click here. Source: “Improving Coordination of Addiction Health Services Organizations with Mental Health and Public Health Service”, Journal of Substance Abuse Treatment