Organizational cultural competence is considered an effective component of services to respond to the current health disparities that affect ethnic minority groups. Although not all service providers have demonstrated enthusiasm for the concrete benefits of culturally competent practices, institutional funders and regulators at the federal and state level mandate cultural and linguistic competence in health services. Despite the need for culturally responsive services and the institutional pressure to adopt this approach, substance abuse treatment organizations (SAT) struggle to implement organizational cultural competence.
The aims of the study are to: 1) examine the institutional and organizational conditions that contribute to the adoption and implementation of organizational cultural competence; and 2) to examine the process and dynamics that accompany different implementation levels and ethnic minority clients' treatment outcomes. This study uses data from the National Drug Abuse Treatment System Survey (NDATSS), 1986-2006 - the largest sample of outpatient substance abuse treatment (OSAT) units in the U.S. containing comprehensive information about organizational characteristics arid culturally competent practices. In addition, this study will select four representative OSAT units with different implementation levels to conduct qualitative case studies. The quantitative analysis' outcomes include levels of implementation of organizational cultural competence, while the qualitative analysis focuses on implementation dynamics and processes that explain clients' treatment outcomes. The primary analytic strategy is based on quantitative multilevel models, which will provide information on the variance in the population of OSAT units based on their implementation levels. The secondary analytic strategy relies on qualitative case studies using interviews with staff and counselors to understand the relationship between program design and services rendered and clients' retention, satisfaction and substance abuse. Overall, the research questions will inform the developing of policies and interventions that improve OSAT units' adoption of services to address the unique needs of ethnic minority clients. By identifying the influence of institutional pressures and organizational structures, this study will highlight factors that contribute to organizational responsiveness and quality of services. Taken together, the proposed study aims to contribute to the understanding of organization's strategic responses, their adaptation and performance. Finally, this research will also provide the opportunity for a new investigator to develop substantive and innovative methodological and analytic skills to pursue a career researching service effectiveness to improve the well being of underserved and vulnerable populations.
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