title: Enhancing access and retention in substance abuse treatment: the role of Medicaid payment acceptance and cultural competence.
abstract: BACKGROUND
  Health insurance coverage and quality of care are common factors believed to improve access for and retention of racial and ethnic minority groups in health care. However, there is little evidence that acceptance of public insurance and provision of culturally responsive care decrease wait time and retention of minority populations in community-based substance abuse treatment.
  
  
  METHODS
  We analyzed client and program data collected in 2010-2011 from publicly funded treatment programs in Los Angeles County, CA. An analytical sample of 13,328 primarily African American and Latino clients nested within 104 treatment programs located in minority communities was analyzed using multilevel negative binomial regressions on count measures of days to initiate and days spent in treatment.
  
  
  RESULTS
  Programs that accepted public insurance (p<.001) and in which staff reported personal involvement (p<.01) and linkages and resources with minority communities (p<.001) were negatively associated with client wait time. Similarly, programs with culturally responsive policies and assessment and treatment practices (p<.05) were positively associated with retention in treatment, after controlling for individual and program characteristics.
  
  
  CONCLUSIONS
  These preliminary findings provide an evidentiary base for the role of community-based financial and cultural practices in improving accessibility and treatment adherence in a population at high risk of treatment dropout. Implications related to health care reform legislation, which seeks to expand public insurance and enhance culturally competent care, are discussed.
authors.affiliation: School of Social Work, University of Southern California, Los Angeles, CA 90089, USA. Electronic address: erickgue@usc.edu.
authors.forename: Erick G
authors.initials: EG
authors.lastname: Guerrero
mesh_terms: D001741:Black or African American / Q000208:ethnology*; D003430:Cross-Sectional Studies; D054521:Cultural Competency; D003625:Data Collection / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000191:economics; D006630:Hispanic or Latino / Q000208:ethnology*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D016320:Substance Abuse Treatment Centers / Q000191:economics / Q000379:methods; D019966:Substance-Related Disorders / Q000191:economics / Q000208:ethnology* / Q000628:therapy; D014481:United States / Q000208:ethnology
keywords: African Americans; Cultural and linguistic competence; Latinos; Public insurance acceptance; Retention; Wait time