Paths to improving engagement among racial and ethnic minorities in addiction health services.
BACKGROUND
Members of racial and ethnic minority groups are most likely to experience limited access and poor engagement in addiction treatment. Research has been limited on the role of program capacity and delivery of comprehensive care in improving access and retention among minorities with drug abuse issues. The goal of this study was to examine the extent to which access and retention are enhanced when racial and ethnic minorities receive care from high-capacity addiction health services (AHS) programs and via coordination with mental health and receipt of HIV testing services.


METHODS
This multilevel cross-sectional analysis involved data from 108 programs merged with client data from 2011 for 13,478 adults entering AHS. Multilevel negative binomial regression models were used to test interactions and indirect relationships between program capacity and days to enter treatment (wait time) and days in treatment (retention).


RESULTS
Compared to low-capacity programs and non-Latino and non-African American clients, Latinos and African Americans served in high-capacity programs reported shorter wait times to admission, as hypothesized. African Americans also had longer treatment retention in high-capacity programs. Receipt of HIV testing and program coordination of mental health services played an indirect role in the relationship between program capacity and wait time.


CONCLUSIONS
Program capacity and coordinated services in AHS may reduce disparities in access to care. Implications for supporting low-capacity programs to eliminate the disparity gap in access to care are discussed.
School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA, 90089, USA. erickgue@usc.edu.
Erick G
EG
Guerrero
School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA, 90089, USA. kfenwick@usc.edu.
Karissa
K
Fenwick
School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA, 90089, USA. yinfeiko@usc.edu.
Yinfei
Y
Kong
Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Integrated Substance Abuse Programs, Los Angeles, USA. cgrella@mednet.ucla.edu.
Christine
C
Grella
Wagner Graduate School of Public Service, New York University, New York, USA. td2268@columbia.edu.
Thomas
T
D'Aunno
D001741:Black or African American / Q000523:psychology*; D016739:Behavior, Addictive / Q000523:psychology*; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D015141:Los Angeles; D008605:Mental Health Services / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000523:psychology*; D013997:Time Factors; D044465:White People / Q000523:psychology