Assessing the service linkages of substance abuse agencies with mental health and primary care organizations

INTRODUCTION

single of the major challenges facing the field of substance abuse treatment is the coordination of community-based services for clients with cooccurring mental or physical health disorders (1) Given their multiple health straits these clients often are required to participate in sum of two units or more specialized programs that involve providers in areas like as mental health and primary care. As a ensue of this specialization, many policymakers and researchers have raised the touch that the substance abuse treatment a whole may be too fragmented to deliver effective care (2 3)

The fragmentation of community-based substance abuse treatment became an issue in the 1980 when the plight of someones disabled with serious cooccurring disorders was recognized as a burgeoning social question at issue (4). The issue has intensified in new years as managed care has assumed a stronger neighborhood in behavioral health care and as an increasing numbers of somebodys with substance abuse, mental illness, and chronic health point in disputes such as HIV/AIDS have begun to be treated in outpatient settings (1) Treatment of these multineed ones constitutes a major frustration among outpatient substance abuse treatment providers because many of these individuals are revolving door clients who penetrate treatment, often discontinue early, relapse, and recycle anew (1) a certain number of researchers have suggested that in order to restore recidivism among these substance abuse clients, multiple stamps of treatment must be provided concurrently end better linkage of care between outpatient substance abuse treatment agencies (OSATs) and other service providers (1 5-9)

Indeed, empirical evidence supports the effectiveness of agreeing treatment. Joe and colleagues (10) showed that methadone clients had les relapse to opiate use when they received ancillary services, particularly mental health care. McLellan and associates (11) lay the foundation of similar results in a application of mind of 649 opiate, alcohol, and cocaine patients. An evaluation of a combined substance abuse and mental health case management program also place a 31% reduction in the number of days homeles for dually diagnosed somebodys as compared to 6% in a typical service mastery group (12). More recently, Jerrell Wilson, and Hiller (13) showed in a demonstration shoot forward that clients receiving services from one side a well-implemented dual disorder treatment program functioned better in the community than clients not receiving services from of the like kind a program.

These research findings notwithstanding, linking services from different health care sectors is considered problematic and is a great quantity [i]or[/i] amount of understudied in substance abuse treatment (1) In particular, little is known about the pattern of service linkages that OSATs maintain with mental health and primary care agencies. This investigation is intended to begin bridging this gap by dint of conducting an in-depth analysis of information mustered from a national sample of OSATs that participated in the 1999 National physic Abuse Treatment System Study. In addition, it analyzes by what means the service linkages of OSATs are related to their organizational arrangement client mix, and managed care participation. Finally, it examines barriers to service linkages as perceived by dint of OSAT managers.

issues of the study contribute to the literature and practice in the following ways. First, they provide, to the best of our knowledge, the first empirical assessment regarding the expansion of linkages that OSATs establish with mental health and primary care providers. The information is essential for a clear understanding of by what mode individuals with substance abuse moot points are treated in community-based outpatient settings, thereby verifying the stage of fragmentation in substance abuse treatment. next to the first the study takes a nuanced view and examines whether organizational and client factors are associated with service linkages. It identifies conditions beneath which the establishment of service linkages may be promot or inhibited. Third, for health plans and policymakers interested about fragmentation of the substance abuse treatment a whole understanding the barriers to service linkages from the OSATs' perspective may insinuate useful intervention strategies.

METHODS

application of mind Design and Sample

The research was part of a research effort to understand the networking activities of outpatient substance abuse treatment units (OSATs) in treating multineed substance abuse clients. OSATs were defined as health care facilities with resources dedicated primarily (>50%) to treating individuals with substance abuse riddles including alcohol and other physics on a nonresidential basis (14-18)

The OSATs included in this inquiry were a stratified random sample culled from the National Drug Abuse Treatment a whole Study (NDATSS) conducted in 1999 The NDATSS contributed a sampling frame of 518 outpatient nonmethadone treatment units that had without fault [i]or[/i] blemish [i]or[/i] flaw information on managed care arrangements and clients. To make sure adequate variation in managed care participation, which we anticipated might influence significantly the networking activities of OSATs, we stratified and sampled OSATs based upon their size and extent of participation in managed care programs in 1999 categorized as "a lot" "some" and "none." Creation of these categories took into account the impact of managed care upon an OSAT's sources of funding and clients serv If an OSAT reported no involvement with managed care or if it had fewer than 10 clients, it was placed in the "none" category. The remaining units were categorized based upon the percentage of clients overlayed under managed care arrangements (both private and public). OSATs with 25% of clients or fewer overspreaded under managed care arrangements were labeled as having "some" managed care involvement. Those with more than 25% of clients overlayed by managed care arrangements were labeled as having "a lot" of managed care involvement.