The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #60474

Kathleen C. Thomas, MPH, PhD¹, Joseph P. Morrissey, PhD¹, Shoou-Yih Daniel Lee, PhD², and W. Craig Carter, PhD¹. (1) Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, 101 Conner Dr. Ste. 302, Willowcrest Bldg., CB #3386, Chapel Hill, NC 27599-3386, (919)966-3387, kathleen_thomas@unc.edu, (2) Cecil G. Sheps Center for Health Services Research, University of North Carolina Chapel Hill, 101 Conner Dr. Ste.302, Willowcrest Bldg., CB#3386, Chapel Hill, NC 27599

Substance abuse services are effective if clients receive a broad range of services concomitantly. In order to determine how agencies that treat clients with substance abuse problems are set up to accomplish treatment for comorbidities, we collected data on a random national sample of substance abuse agencies. Additional interviews with the mental health and primary care agencies that they work with to meet the needs of their clients provide a rich source of information on the entire network of agencies treating substance abuse clients, yielding a sample of 229 agencies, nested within 62 agency networks. We estimate a hierarchical linear model of mixed effects to model the impact of agency and network characteristics. We hypothesize that both making other services and obtaining them through a network will have a positive impact on access, but the interaction will be negative. Preliminary results indicate that 30 percent of the agencies provide all 3 services of interest (substance abuse, mental health, and primary care) in-house. Twenty-two percent of the agencies provide access to all three services through relationships with other providers. Through efforts like these, 86 percent of the agencies report that their clients get all three services. This analysis moves the literature forward in two ways. First, detailed information on network characteristics can help to discern if some kinds of linkages have more impact than others. Second, the mixed effects modeling approach allows us to look at a broader array of agencies that provide services to clients with substance abuse problems.

Learning Objectives:

• Describe the access of substance abuse clients to mental health and primary care services.
• Describe the organizational structures by which substance abuse clients obtain access to a breadth of services.
• Assess the relative impact of agencies making or buying ancillary services on client access to care.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.