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Increasing Program Capacity to Eliminate Outcome Disparities in Addiction Services

Erick Guerrero
Effective leadership, organizational readiness for change, and acceptance of Medi-Cal have each been shown to be associated with reducing disparities in substance use disorder (SUD) treatment outcomes. These three important organizational characteristics can represent “program capacity.” Little is known about the mechanisms by which program capacity might lead to better client outcomes, especially in outpatient substance abuse treatment (OSAT) programs. In a study published by Administration and Policy in Mental Health and Mental Health Services Research, Dr. Erick Guerrero and his research team tested whether higher program capacity is associated with better client treatment outcomes in OSAT programs. Authors measured program capacity using the following constructs:
  • Directorial leadership: Transformational leadership (i.e. promoting intellectual stimulation and support for innovation) and transactional leadership (i.e. job delegation).
  • Regulatory environment: Acceptance of Medi-Cal payments, which include compliance with Medicaid regulatory expectations.
  • Readiness for change: Program’s preparation to implement new practices, measured through resources, climate, staff motivation and attributes for change.
Program capacity was expected to be associated with better outcomes by producing the types of supports to implement higher quality practices and deliver effective care. To test this, the research team also explored whether the relationship between program capacity and client outcomes could be explained by the degree of cultural competence of the program. They hypothesized that higher program capacity would lead to better outcomes when programs also had a higher degree of culturally competent practices. The evaluation relied on staff survey responses linked with administrative information about each specific treatment episode between 2010 and 2011. These providers served predominantly Latino and African-American residents of Los Angeles County. The 97 programs analyzed included 8,599 client episodes. 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. The goal of the study was to test whether client outcomes improved depending on the capacity of the program. To determine the client outcomes, the research team used two common measures in the field, wait time (in days) to start treatment and the totals days the client spent in treatment (i.e. “duration”). The program-level survey questions were used to measure the three sets of organizational characteristics that make up program capacity, as well as the degree of cultural competence in services delivered to Black and Latino clients. To evaluate the hypotheses, the research team used a method that incorporates the responses from multiple individuals who are being analyzed within the same organization. They ran separate analyses for the two client outcomes. Additionally, they ran two types of analyses, where they either 1) tested each of the three sets of organizational characteristics that define program capacity, or 2) tested an overall measure of program capacity, made up of those three factors. The researchers found the following:
  • Medi-Cal acceptance was associated with shorter wait times for clients.
  • Motivation for change within an organization, one measure of readiness for change, was related to longer treatment duration for clients.
  • High program capacity was associated with shorter wait times for clients.
  • High program capacity was associated with longer treatment duration for clients.
  • High cultural competence is associated with longer treatment duration for clients.
  • The degree of culturally competent practices did not mediate the positive relationship between program capacity and client outcomes.
Overall, the research team concludes that high-capacity programs are associated with better client outcomes, and Medi-Cal acceptance is the most important single component of capacity. This may be because Medicaid eligibility helps clients initiate and stay in treatment, so programs that build the capacity to accept Medicaid may be better prepared to improve access for their clients. To view the study in its entirety, please click here. Source: “Program Capacity to Eliminate Outcome Disparities in Addiction Health Services”, 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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