Organizational characteristics that foster early adoption of cultural and linguistic competence in outpatient substance abuse treatment in the United States

Recent years have seen an increased interest in developing culturally and linguistically responsive systems of care in substance abuse treatment in the United States. This study examines the extent to which external and internal organizational pressures contributed to the degree of adoption of culturally and linguistically responsive practices in the nation's outpatient substance abuse treatment system early in the period of development of this system of care. Findings show that a higher degree of adoption of culturally competent practices was most likely in treatment programs with high dependence on external funding and regulation. Internally, programs with a larger number of professionals were associated with the lowest degree of adoption, while managers’ cultural sensitivity contributed significantly to a high degree of adoption of these responsive practices. Considering the passage of recent legislation enforcing the use of cultural and linguistic competence in health care, implications of these baseline findings on early adoption patterns are discussed for future research and health care policy evaluation.     

Why do drug treatment organizations use contingent staffing arrangements? An analysis of market and social influences

Contingent staffing arrangements are defined as conditional and transitory work arrangements. In the drug abuse treatment sector, contingent staffing arrangements have the potential to improve treatment if they are used to increase access to needed services. Alternatively, such arrangements could interfere with the development of consistent, long-term client-staff relationships. Unfortunately, little is known about the consequences of or influences on contingent staff arrangements in this sector. The goal of this study is to examine the conditions under which outpatient substance abuse treatment organizations are more likely to use contingent staffing arrangements. Building on previous research on the social organization of health care structures and practices, we develop a conceptual model based in market economics and institutional perspectives to suggest that treatment organizations choose contingent arrangements in response to market conditions and uncertainty, institutional demands, and client needs. Using data from a nationally representative study conducted in 1988, 1990, and 1995, we find limited evidence that drug treatment units use contingent staff in response to market pressures. Labor market and demand uncertainty, however, are systematically associated with greater use of contingent staff. Study results suggest that expectations and norms from the institutional environment, particularly the organizational context of the treatment unit are strong predictors of the use of contingent staff. By considering both market and social influences of contingent staffing, we contribute to a growing body of research on how markets and institutions interact to influence organizational structures and practices in the health care system.     

An institutional analysis of HIV prevention efforts by the nation's outpatient drug abuse treatment units.

Drawing from an institutional-theory perspective on innovations in organizations, this paper examines the use of human immunodeficiency virus (HIV) prevention practices by the nation's outpatient substance abuse treatment units during a critical period from 1988 to 1995. An institutional perspective argues that organizations adopt new practices not only for technical reasons, but also because external actors actively promote or model the use of particular practices. We examine the extent to which treatment units use several practices to prevent HIV infection among their clients and among drug-users not in treatment. Results from random-effects regression analyses of national survey data show that treatment units significantly increased their use of HIV prevention practices from 1988 to 1995. Further, the results show that treatment units' use of prevention practices was related to clients' risk for HIV infection, unit resources available to support these practices, and organizational support for the practices. Implications are discussed for an institutional view of organizational innovation as well as for research on HIV prevention.     

Counselor Turnover in Substance Abuse Treatment Centers: An Organizational-Level Analysis

This article draws on institutional and ecological perspectives on work and organizations to develop a workplace level model of variation in voluntary counselor turnover rates across privately funded substance abuse treatment centers in the United States. Results show that participatory management structures reduce turnover rates principally by promoting organizational commitment. The analysis also tests hypotheses regarding the effects on turnover rates of other relevant theoretic domains of treatment center structure and organization. We discuss theoretical implications of the findings and suggest directions for future research.     

Economic evaluation of continuing care interventions in the treatment of substance abuse: recommendations for future research

The chronic and relapsing nature of substance abuse points to the need for continuing care after a primary phase of treatment. This article reviews the economic studies of continuing care, discusses research gaps, highlights some of the challenges of conducting rigorous economic evaluations of continuing care, and offers research guidelines and recommendations for future economic studies in this emerging field. Rigorous economic evaluations are needed by health care providers and policy makers to justify the allocation of scarce resources to continuing care interventions. The adoption of cost-effective continuing care services can reduce long-term consequences of addiction, thereby potentially increasing overall social welfare.     

Exploring the Nature of the Relationship Between Poverty and Substance Abuse

Abstract

Poverty and substance abuse are two serious social problems that are often assumed to be interrelated. This article explores what is currently known about the relationship between these two problems. Four possible models for describing the interrelationship are identified: causal, risk factor, exacerbation, and spurious. The theoretical explanations from both the substance and poverty literature are discussed in light of their implications for these types of models. The public health perspective is selected from the substance abuse theoretical literature as the model that best subsumes and directs thinking about the relationship between poverty and substance abuse, because its focus on agent, host, and environment draws attention to the range of factors that can influence both problems, as well as the ways in which they come together. Findings from the research literature are then discussed within the framework of the public health model. The article concludes by outlining the gaps in knowledge and an agenda for future research.     

Examination of the Role of Therapeutic Alliance,Treatment Dose,and Treatment Completion in the Effectiveness of The Seven Challenges

Adolescent alcohol and illicit drug (AOD) use is a major public health concern. This longitudinal study examines the effectiveness of The Seven Challenges in reducing adolescent substance use and mental health problems, as well as the process by which it is effective. Participants were 89 adolescents (72 male, 17 female) enrolled in a 3 month intensive outpatient adolescent substance abuse treatment program using The Seven Challenges and who provided self-report data at pre- and post-treatment. Results indicated that The Seven Challenges was effective at increasing the number of days refrained from using AOD, reducing use of tetrahydrocannabinol (THC) and other drugs, and reducing substance use problems and internal mental distress. Results also indicated that The Seven Challenges drug counselors effectively established and maintained therapeutic alliance but this seems to not play a role in the effectiveness of The Seven Challenges. Both treatment dose and completion played a role in the effectiveness of The Seven Challenges; they were both positively related to post-treatment days refrained from AOD use, and negatively related to days of THC use, substance use problems, and internal mental distress. However, the strength of the influence of treatment completion was stronger when treatment dose was low than when it was high. Despite a small sample and other limitations, findings add to existing literature that suggests that The Seven Challenges is an effective substance abuse treatment for adolescents. Furthermore, findings suggest that adolescent substance abuse treatment should focus on clients meeting pre-determined program goals as well as on dose.     

The impact of mental health issues, substance use, and exposure to victimization on pregnancy rates among a sample of youth with past-year foster care placement

The purpose of this study is to (1) compare youth entering substance abuse treatment with and without a history of foster care placement to determine any differences in mental health, substance use, and exposure to victimization, and (2) determine if mental health, substance use, and/or exposure to victimization predict past pregnancy among the sample with a history of foster care placement. The pooled dataset consisted of 17,124 adolescents (12-17 years of age) who completed the Global Appraisal of Individual Needs at intake for substance abuse treatment in 2009. Of these, 366 (2.1%) reported having been in foster care in the past year. When compared with a non-foster care sample, the foster care sample reported significantly higher internal mental distress scores, behavior complexity scores, and general victimization scores, after controlling for race, gender, and level of care. Problems associated with substance use did not differ between groups, though regular tobacco use was present at a higher rate in the foster care sample. Multivariate logistic regression results revealed that, within the foster care sample, internal mental distress and gender predicted past pregnancy. There may be room for intervention within substance abuse treatment centers for youth with a history of foster care, who may be at risk for pregnancy if their levels of internal mental distress are high.     

The effects of adoption openness and type on the mental health,delinquency, and family relationships of adopted youth

ABSTRACT

Analyzing the 2007 National Survey of Adoptive Parents, this study examines the impact of open adoption, demographics, and other factors on adopted children’s mental health, delinquent behavior, and family relationships. Specifically, we compare findings for youth in private and public (i.e., foster care) adoptions and identify key similarities and differences between predictors of children’s well-being across these two types of adoption. We find that youth in open foster care adoptions are more likely to receive an attachment disorder diagnosis than those in closed foster care adoptions but are also more likely to have family relationships characterized by trust and adoptive parents’ willingness to recommend adoption to others. Further, we find children in both public and private adoptions who are older at placement are more likely to have posttraumatic stress disorder diagnoses. For children in private adoptions, no statistically significant predictors affected youths’ delinquency outcomes or family relationships, with the exception of parents of private adoptees in households characterized by lower levels of poverty indicating they would be more likely to recommend adoption to others. The implications of the key findings are discussed with regard to service provision for multiple types of adoptive families.     

Comorbid Substance Use and Mental Disorders Among Offending Youth

ABSTRACT

This study examines the offense, substance use, and mental illness characteristics for a subset of adolescent juvenile detainees receiving services through a federally funded system of care initiative. Findings indicate that 65% of these youth were comorbid for both mental and substance use disorders. Female detainees were at greater risk on almost every measure of mental health impairment and dual substance use and mental disorders. Study results highlight the need for effective, integrated treatment models that can serve youth involved in multiple child-serving systems, and address the challenging constellation of comorbid conditions faced by many juvenile offenders.     

Organizational innovativeness and its determinants in South Korean nonprofit human service organizations

This study compares the level of organizational innovativeness and its determinants in different types of nonprofit human service organizations. Based on theoretical conceptualizations of organizational innovation, it was hypothesized that community service organizations (CSOs) would be more innovative than residential service organizations (RSOs), and determinants of organizational innovation (such as organizations' characteristics, internal and external properties, and executive leadership) would influence innovativeness. Data from a survey of two types of human service organizations in South Korea (127 RSOs for children and 220 CSOs) revealed that the level of innovation in both types of organizations was not significantly different. The determinants of decentralization and formalization showed significant impacts on innovativeness in CSOs. Decentralization also had a significant positive effect on innovativeness in RSOs. However, executive leadership was a significant determinant of organizational innovativeness in CSOs only. Based on these results, administrative implications are suggested for the facilitation of organizational innovation in nonprofit human service organizations.     

ATOD-TV: A Case Study on Developing Interactive Multimedia

ABSTRACT

ATOD-TV (Alcohol, Tobacco, and Other Drugs-TV), an interactive multimedia program funded by the National Institute on Drug Abuse, was designed to teach the general public about the importance of substance abuse research and treatment. This article examines the process used to develop the program and argues that its success is due more to careful planning and formative evaluation than the use of sophisticated tools and techniques.     

Tools of innovative public procurement in health care in Poland

This paper sets out to map the issues of innovation in public procurement in Poland with specific reference to health care and presents case studies of Polish hospitals using an innovative approach to public procurement. It is based on the analysis of secondary data collected using Internet search engines, introductory research conducted in hospitals which have recently used innovative procurement tools (e.g. technical dialogue and competitive dialogue) and the experience of two Polish hospitals involved in projects aimed at increasing the efficiency of procurement through innovations, described in a case study form. Although innovative procurement in Poland is at an early stage of development, it is also a topic of growing interest to both public authorities and hospitals and some hospitals are adopting new procurement methods such technical and competitive dialogue. However, barriers to the adoption of new procurement approaches are evident and these delay this process of adoption. Barriers encountered include the conservative organizational culture of hospitals, lack of awareness and know-how and a lack of trust and understanding of new procurement approaches.     

COMPARISON OF CHARACTERISTICS OF PRIVATE PRODUCT PRODUCING ORGANIZATIONS AND PUBLIC SERVICE ORGANIZATIONS

This analysis explores whether propositions and empirical findings of contemporary theories of organizations directly apply to both private product producing organizations (PPOs) and public human service organizations (PSOs). Eight central characteristics are compared: organizational values and goals, incentives, organizational structure, raw materials, power-dependency relationships, technology, revenues and accountability, and environmental constraints. Major differences between PPOs and PSOs suggest that organization theories developed from findings about PPOs inadequately describe PSOs. Comparative research would demonstrate the need for new models of these organizational types. Since these types derive from contradictory assumptions and have differing characteristics, each should be sampled to the other's exclusion and generalizations made only to that type. The findings refute the popular assumption that all PSOs can privatize with equal success This is not a failure by PSOs to achieve PPOs' standards; rather the types pursue different values and accomplish different goals.     

Use of concurrent mixed methods combining concept mapping and focus groups to adapt a health equity tool in Canada

The aim of this project was to identify and prioritize a set of conditions to be considered for incorporating a health equity tool into public health practice. Concept mapping and focus groups were implemented as complementary methods to investigate the conditions of use of a health equity tool by public health organizations in Quebec. Using a hybrid integrated research design is a richer way to address the complexity of questions emerging from intervention and planning settings. This approach provides a deeper, operational, and contextualized understanding of research results involving different professional and organizational cultures, and thereby supports the decision-making process. Concept mapping served to identify and prioritize in a limited timeframe the conditions to be considered for incorporation into a health equity tool into public health practices. Focus groups then provided a more refined understanding of the barriers, issues, and facilitating factors surrounding the tools adoption, helped distinguish among participants’ perspectives based on functional roles and organizational contexts, and clarified some apparently contradictory results from the concept map. The combined use of these two techniques brought the strengths of each approach to bear, thereby overcoming some of the respective limitations of concept mapping and focus groups. This design is appropriate for investigating targets with multiple levels of complexity.     

Negotiating case decisions in substance abuse managed care

In substance abuse managed care, the number of treatment sessions that a provider can deliver is constrained by the policies and procedures of the specialized managed care organizations (MCOs) that typically administer the substance abuse portions of healthcare plans. Managed care organizations commonly are alleged to control treatment providers through rules, but they also might rely on a particular patterned authorization of discretion, whereby they determine when and how frequently to respond to providers' appeals of rule-based decisions. The current paper uses data from a national random sample of managed care contracts between MCOs and substance abuse providers to test the hypotheses that (1) managed care organizations' "logics" about the types of provider discretion to allow affect the rate to which they concede to appeals, and (2) the rate of conceding to appeals, in turn, affects the providers' duration of substance abuse treatment. Results from generalized linear estimation models support the hypotheses and suggest that many MCOs pattern discretion to balance strict rules with concern about the quality or cost of care. The results more generally suggest that MCOs use discretion in planned ways, and thus that the patterns of control are more complex and sophisticated than commonly described in the literatures on managed care, transaction cost economics, or other perspectives.     

Organizational access to research settings: Entering secondary schools

Fieldworkers have long acknowledged the problems of gaining access to research settings but often failed to analyze them systematically. In this article we provide preliminary evidence that, when seeking to enter formal bureaucracies, access problems can be better understood and more easily resolved by referring to the organizational logic of the setting. Adopting an organizational perspective to analyze access issues, we compare public schools and private religious schools and show how access problems and the strategies to overcome them vary according to the variation in the schools’ organizational features. We develop our argument in four steps. First, we examine the organizational literature on formal institutionalized organizations to highlight the structural problems of gaining entry to public schools for research purposes. Second, we adopt an organizational perspective to identify strategies for overcoming problems of access to public schools. Third, we compare the access to private religious schools and to public schools to demonstrate that problems and solution strategies vary according to the schools’ variation in organizational features. Fourth, we demonstrate the usefulness of organizational access by showing that researchers’ ability to gain entry is enhanced by a preliminary understanding of the organizational characteristics of a formal research setting. Throughout our discussion, we provide illustrative examples from the senior author’s research in public schools and private religious schools in a large Midwestern city.     

The Impact of Interdisciplinary Teams on Organizational Relationships

Based upon research in an alcoholism treatment organization, the study explores the impact of interdisciplinary team treatment on organizational participants and structure. The findings suggest that alternate organizational arrangements are necessary for organizations which use the team method. The implications of team treatment for professionals were confounded because of power relationships within the organization. Role bargaining between professionals was observed to be virtually non-existent because of the dominance of a single discipline. A surprising finding was the extent to which supervisory personnel were disadvantaged in the study. Caution is suggested for those organizations most likely to adopt the team method, large public health organizations.     

Innovation,Professional Interests,and Nonprofit Organizations: The Case of Health Care in Poland

Nonprofit organizations have a role in spreading technological innovation. The experience in Poland illustrates that entrepreneurial health care professionals prefer nonprofit organizations over for-profit organizations to introduce novel services to the market because nonprofits create favorable public perceptions of those services.