The substance abuse treatment field faces an unprecedented challenge to reduce health disparities among racial and ethnic minority populations. Access to integrated substance abuse, mental health, and HIV prevention care is associated with positive health outcomes and reduced cost. The overall goal of the proposed study is to identify how changes precipitated by the Affordable Care Act (ACA) impact community- based outpatient substance abuse treatment (OSAT) program capacity to expand service delivery in racial and ethnic minority communities and eliminate outcome disparities among African American and Latino clients. The objective for this application is to examine the organizational impact of the current expansion of Medicaid on the capacity of community-based OSAT programs to enhance treatment access and retention among minorities residing in Los Angeles County (L.A.), California by developing and analyzing a panel dataset. Our conceptual framework, grounded in organizational development frameworks investigates the role of organizational capacity (i.e., leadership, readiness for change, Medi-Cal billing) in mediating the effect of Medicaid expansion (referred as Medi-Cal in California) on service delivery (i.e., mental health and HIV prevention services) and on treatment access and retention among African American and Latino clients.
In Aim 1 and 2 we will examine baseline data to refine our conceptual model of organizational capacity factors likely to impact the delivery of mental health and HIV prevention services in OSAT programs in racial and ethnic minority communities, prior to ACA enactment. We will resurvey in 2013, 2015 and 2017 the same representative sample of 147 OSAT programs located in minority communities to form a panel data set. These repeated measures of program data will be concatenated with administrative client outcome data (N~10,800 clients) at each data point to examine in Aims 3 and 4 the longitudinal impact of insurance expansion on service delivery in minority communities and rates of access and retention among African American and Latino clients with mental health and HIV risk conditions. The overall public health impact of the proposed study includes identifying promising organizational factors among publicly funded community-based OSAT programs that serve large proportions of low-income minority clients that play a mediating role between the ACA insurance expansion and client-centered process outcomes with the goal of eliminating health disparities.

Public Health Relevance

This study will identify how changes precipitated by the Affordable Care Act impact community-based outpatient substance abuse treatment program capacity to expand accessibility to mental health and HIV prevention care in racial and ethnic minority communities in Los Angeles County, California. As such, the public health relevance of this project relies on providing critical information for state insurance administrators, policy makers and community-based providers who seek to develop evidence-informed policies and practices to respond to health care reform and parity legislation and eliminate health disparities.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Exploratory/Developmental Grants (R21)
Project #
1R21DA035634-01
Application #
8535048
Study Section
Special Emphasis Panel (ZDA1-NXR-B (13))
Program Officer
Duffy, Sarah Q
Project Start
2013-05-01
Project End
2015-04-30
Budget Start
2013-05-01
Budget End
2014-04-30
Support Year
1
Fiscal Year
2013
Total Cost
$263,628
Indirect Cost
$102,879
Name
University of Southern California
Department
None
Type
Schools of Social Work
DUNS #
072933393
City
Los Angeles
State
CA
Country
United States
Zip Code
90089
Guerrero, Erick G; He, Amy; Kim, Ahraemi et al. (2014) Erratum to: Organizational Implementation of Evidence-Based Substance Abuse Treatment in Racial and Ethnic Minority Communities. Adm Policy Ment Health 41:750-2
Guerrero, Erick G; He, Amy; Kim, Ahraemi et al. (2014) Organizational implementation of evidence-based substance abuse treatment in racial and ethnic minority communities. Adm Policy Ment Health 41:737-49
Guerrero, Erick G; Aarons, Gregory A; Palinkas, Lawrence A (2014) Organizational capacity for service integration in community-based addiction health services. Am J Public Health 104:e40-7
Guerrero, Erick G; Kao, Dennis (2013) Racial/ethnic minority and low-income hotspots and their geographic proximity to integrated care providers. Subst Abuse Treat Prev Policy 8:34