Understanding cultural sensitivity in the National Drug Abuse Treatment System Survey (NDATSS) Study

Background: The 2001 Surgeon General's landmark findings identified an unarguably significant racial disparity in publicly provided behavioral health care that results in overrepresentation, underdiagnosis, inappropriate treatment, and inaccessibility of services for minorities. Many policy initiatives focusing on behavioral health have examined the system level or the unit level (i.e., case managers) with some success. However, little is known about the specific system-level characteristics that are related to cultural sensitivity. This analysis goes beyond the taken-for-granted nature of racial disparities in public substance abuse service delivery and assesses the extent to which system level variables predict cultural sensitivity in outpatient substance abuse treatment (OSAT) units.

Methods: The data were collected for the National Drug Abuse Treatment System Survey (NDATSS) data set and includes two waves of data from 1995 and 2005. Logistic regression and multi-level models examined the relationship of OSAT unit cultural sensitivity to confounders such as client, director, and supervisor demographics; levels of therapy (i.e. individual, group, family); various aspects of treatment protocol; and the percentage of care provided to specific ethnic groups.

Results: In the multivariable analysis final models, results indicate that OSAT units within hospital or mental health settings which served patients who were younger than 50 years old and had co-occurring mental health and substance abuse disorders were more likely to be culturally competent.

Conclusion: Focusing on organizational characteristics that may positively predict cultural sensitivity can aid researchers, policymakers, and clinicians to identify ways to foster and develop culturally competent treatment practices. Establishing a strong foundation for cultural sensitivity when working with substance abuse patients may also contribute to a treatment unit's ability to achieve longer, more positive client outcomes.