How Profit Status Makes a Difference in the Delivery of Substance Abuse Treatment Services

Transcription

1 How Profit Status Makes a Difference in the Delivery of Substance Abuse Treatment Services Paul M. Roman J. Aaron Johnson Hannah K. Knudsen Center for Research on Behavioral Health and Human Services Delivery The University of Georgia We gratefully acknowledge the support of Research Grants R01-DA-13110, R01-DA , and R01-DA from NIDA, and Research Grant R01-AA from NIAAA

2 Service Delivery of Substance Abuse Treatment in the Private Sector

3 Significance of Studying Profit Status

4 Research Questions Have the patterns of change over time for-profit private substance abuse treatment centers significantly differed from non-profit centers with regard to services offered, staffing patterns, organizational performance, and the adoption of treatment innovations? Are there significant mean differences between forprofit and non-profit private substance abuse treatment centers with regard to services offered, staffing patterns, organizational performance, and the adoption of treatment innovations?

5 Methods Nationally representative sample of privately funded substance abuse treatment centers Private centers receive less than 50% of their funds from federal, state, or local block grants Data collected in , , N = 303 centers still open at Wave 3 Data collected during on-site interviews with administrators and clinical directors Use of repeated measures ANOVA to examine trends over time and mean differences by profit status

6 Measures Profit status (1 = for-profit) Levels of Care (adult IP, adolescent IP, adult psychiatric, adol. psych., partial hospitalization, intensive outpatient, outpatient Specialty Tracks (for women, adolescents, HIV/AIDS, racial minorities, relapsers, impaired professionals) Staffing (Total FTEs, % M.A. counselors, % certified, % in recovery, % women, % minorities, counselor turnover) Client Demographics (% caseload women, adolescents, racial minorities, relapsers, court-involved clients) Client Reimbursement Sources (% covered by Medicaid, Medicare, self-paying, charity) Efficiency (clients per FTE) Capacity Adoption of Innovations (current use of Naltrexone, LAAM, SSRIs, motivational enhancement therapy, motivational incentives, community reinforcement approach, music therapy, art therapy, acupuncture)

7 Profit Status and Center Closure The percentage of forprofit centers decreased by 5 percentage points between 1995 and % 30% 25% 31% This change is the result of significantly greater likelihood of center closure among for-profit facilities 20% 15% 10% 5% 0% 17% Closure by 2001 For Profit Non- Profit

8 Levels of Care by Profit Status No profit status-by-time interactions for any level of care Two mean differences: For profit centers more likely to offer inpatient adolescent psychiatric level of care For profit centers less likely to offer intensive outpatient level of care 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% W1 W2 W3 FP Adol Psych NP Adol Psych FP IOP NP IOP

9 Specialty Treatment Tracks by Profit Status Two significant profit status-by-time interactions Faster rate of adoption of HIV/AIDS track in forprofit centers Faster rate of adoption of relapser track in for profit centers Two significant mean differences For-profit centers more likely to offer a specialty track for racial minorities For-profit centers more likely to offer an HIV/AIDS track 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 1st Qtr 2nd Qtr 3rd Qtr FP HIV NP HIV FP Relapser NP Relapser FP Minority NP Minority

10 Center Staffing Patterns:Size and Counselor Turnover Significant profit statusby-time interaction for FTEs For profit centers grew in FTEs over time which non-profit centers stable No significant differences in counselor turnover by profit status W1 W2 W3 FP FTEs NP FTEs

11 Counseling Staff Diversity Significant profit statusby-time interaction for percentage of female counselors The growth in female employment was significant greater in forprofit centers While no interaction effect over time, there was a significant mean difference in the percentage of minority counselors For-profit centers averaged higher percentages of minority counselors 65% 55% 45% 35% 25% 15% 5% W1 W2 W3 FP % Female NP % Female FP % Minority NP % Minority

12 Counseling Staff: Professionalization No significant differences in % M.A. degree counselors by profit status No significant differences in % counselors in recovery by profit status Significant profit-status by time interaction for % certified counselors Non-profit centers had steeper drop in % certified For profit centers had significantly smaller % certified overall 85% 80% 75% 70% 65% 60% 55% 50% 45% 40% W1 W2 W3 FP % Certified NP % Certified

13 Client Demographics No significant differences in % of caseload who are adolescents, relapsers, or court-involved Significant profit statusby-time interaction for % female clients For-profit centers experience greater growth in % female clients Significant mean difference in % minority clients For-profit centers treat greater % minority clients 40% 35% 30% 25% 20% W1 W2 W3 FP % Female NP % Female FP % Minority NP % Minority

14 Center Performance: Efficiency and Capacity No significant differences in capacity by profit status Significant profit statusby-time interaction in efficiency Clients per FTE increase and then decrease in forprofit centers over time Clients per FTE increase in non-profit centers over time W1 W2 W3 FP Clients Per FTE NP Clients Per FTE

15 Adoption of Innovations Few significant differences in the adoption of treatment innovations by profit status For-profit centers more likely to have adopted LAAM For-profit centers more likely to have adopted art therapy For-profit centers less likely to have adopted motivational incentives LAAM Art Therapy MI 12% 11% 5% 23% 52% 62% 0% 25% 50% 75% Non Profit For Profit

16 Summary of Findings