title: Program Capacity to Eliminate Outcome Disparities in Addiction Health Services.
abstract: We evaluated program capacity factors associated with client outcomes in publicly funded substance abuse treatment organizations in one of the most populous and diverse regions of the United States. Using multilevel cross-sectional analyses of program data (n = 97) merged with client data from 2010 to 2011 for adults (n = 8,599), we examined the relationships between program capacity (leadership, readiness for change, and Medi-Cal payment acceptance) and client wait time and treatment duration. Acceptance of Medi-Cal was associated with shorter wait times, whereas organizational readiness for change was positively related to treatment duration. Staff attributes were negatively related to treatment duration. Overall, compared to low program capacity, high program capacity was negatively associated with wait time and positively related to treatment duration. In conclusion, program capacity, an organizational indicator of performance, plays a significant role in access to and duration of treatment. Implications for health care reform implementation in relation to expansion of public health insurance and capacity building to promote health equities are discussed.
authors.affiliation: School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA, 90089, USA. erickgue@usc.edu.
authors.forename: Erick G
authors.initials: EG
authors.lastname: Guerrero
authors.affiliation: Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr. (0812), San Diego, CA, 92093-0812, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Aarons
authors.affiliation: Integrated Substance Abuse Programs, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, 90025, USA.
authors.forename: Christine E
authors.initials: CE
authors.lastname: Grella
authors.affiliation: Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA.
authors.forename: Bryan R
authors.initials: BR
authors.lastname: Garner
authors.affiliation: Department of Psychiatry, Harvard Medical School, 2 West - Room 305 - 401 Park Drive, Boston, MA, 02215, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Cook
authors.affiliation: School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA, 90089, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Vega
mesh_terms: D000068:Accreditation; D001741:Black or African American; D002140:California; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D007857:Leadership; D008484:Medicaid; D008605:Mental Health Services / Q000458:organization & administration*; D055361:Multilevel Analysis; D015397:Program Evaluation; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists; D044465:White People
keywords: Leadership; Program capacity; Racial and ethnic disparities; Readiness for change; Treatment outcomes