Classifying substance use disorder treatment facilities with co-located mental health services: A latent class analysis approach.
The Affordable Care Act calls for increased integration and coordination of behavioral health services, as people with co-occurring disorders (CODs), meeting criteria for both substance use and psychiatric disorders, are overrepresented in treatment samples. Nationwide estimates of mental health (MH) service co-location in substance use disorder (SUD) treatment facilities are needed. We empirically derived a multiple-indicator categorization of services for CODs in SUD treatment facilities.



We used latent class analysis to categorize 14,037 SUD treatment facilities in the United States and territories included in the 2012 National Survey of Substance Abuse Treatment Services. Latent class indicators included MH screening and diagnosis, MH support services, psychiatric medications, groups for CODs, and psychosocial approaches. Multinomial logistic regression compared facility-identified primary focus (i.e., SUD, MH, mix of SUD-MH, and general/other) and other facility characteristics across classes.



A four-class solution was chosen with the following classes: Comprehensive MH/COD Services (25%), MH without COD Services (25%), MH Screening Services (21%), and Limited MH Services (29%). The former two classes with co-located MH services were less likely to report a SUD-primary focus than the latter classes reporting only MH screening or Limited MH Services. Only the Comprehensive MH/COD Services class also had a high probability of providing special groups for CODs.



Approximately half of SUD treatment facilities were in classes with co-located mental health services, but only a quarter provided comprehensive COD services. Future studies should assess differences in patient experiences and treatment outcomes across facilities with and without COD services.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY 10032, USA. Electronic address: pm2838@cumc.columbia.edu.
Pia M
PM
Mauro
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA. Electronic address: cfurrho1@jhu.edu.
C Debra
CD
Furr-Holden
Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA. Electronic address: estrain1@jhmi.edu.
Eric C
EC
Strain
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA. Electronic address: rcrum1@jhu.edu.
Rosa M
RM
Crum
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA. Electronic address: rmojtab1@jhu.edu.
Ramin
R
Mojtabai
D015897:Comorbidity; D003191:Comprehensive Health Care / Q000145:classification / Q000458:organization & administration; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy; D008605:Mental Health Services / Q000145:classification* / Q000458:organization & administration; D010067:Ownership; D058991:Patient Protection and Affordable Care Act; D010361:Patients; D011619:Psychotropic Drugs / Q000627:therapeutic use; D016320:Substance Abuse Treatment Centers / Q000145:classification* / Q000458:organization & administration; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000628:therapy*; D011795:Surveys and Questionnaires; D014481:United States
D011619:Psychotropic Drugs
Co-occurring disorders; Mental health; Substance use disorder; Treatment