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Staff Quality in Methadone Treatment Programs

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Project Summary:

Most opioid treatment programs (OTPs) adopt a multifaceted approach to treatment, providing a mix of services that could include psychological counseling; treatment for other substances; medical care; and family, legal, counseling, housing, and financial services. Programs differ in the types and level of services they provide and by whether they provide a particular service directly or through linkages with other organizations. This heterogeneity in the level of support and ancillary services offered can be expected to be reflected in different staffing patterns across OTPs nationwide and, in turn, the quality of care provided by the OTP. In this study, we will measure staff quality at OTPs, taking into account these multifaceted dimensions. Specifically, we will focus on direct care staff at OTPs (clinical supervisor, nurses, case managers, intake workers, and physicians), including their characteristics, training, experience, and types and level of services they provide. Through this data component of our analysis, we will answer the following research questions: 1. What is the national profile of direct care staff at OTPs as measured by their demographic characteristics, background, experience, and certifications? 2. What is the national profile of the type and level of services provided by direct care staff? 3. Are differences across OTPs in direct care staffing profiles and level of services provided related to such factors as the racial/ethnic composition of the patient population, the size or profit status of the OTP, or the urban-rural location of the OTP? To answer these research questions, we will conduct descriptive and multivariate analyses using data that were originally collected for the Evaluation of Opioid Treatment Programs Accreditation Project, funded by the Center for Substance Abuse Treatment (CSAT). These data were collected from 144 OTPs between April 2000 and July 2001 in 15 states. Sampling weights were also created to generalize the results to OTPs nationwide. In this study, we will conduct a latent class (LC) cluster analysis to provide staffing profiles by OTP to answer Research Questions 1 and 2. To determine whether there are differences between OTP clusters and particular OTP characteristics, Research Question 3 will analyze differences between OTP clusters by the race/ethnicity composition of their patient population and their profit status, size, and urban-rural status. We will conduct multiple comparisons using analysis of variance (ANOVA) or chi-square tests among the groups to determine if particular components of the staff quality clusters are influencing differences between different types of treatment programs. Results from this study will be disseminated through conference presentations and journal articles. Findings from this study can be used to assist policy-makers in understanding whether programs with differing levels of staff quality reflect differing needs of their patient populations or are related more to organizational priorities. This information is important as OTP program structures are changing, with some continuing to provide a variety of support and ancillary services, (for example, public, not-for-profit, inner city) while others are offering more streamlined services, (for example, for-profit, suburban). In addition, it will provide insights into the quality of care available to Hispanic patients, the fastest growing segment of the patient population, relative to white and black patients. Results of this study will also inform the work of accrediting bodies as they develop, with greater specificity, the requirements that will ensure qualification of the staff providing opioid treatment.

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