Does State Certification or Licensure Influence Outpatient Substance Abuse Treatment Program Practices?

Abstract

In the United States, state governments legally authorize outpatient substance abuse treatment programs. In some states, programs are certified or accredited (ideal standards). Other states license programs (minimal standards). Additionally, some states authorize programs through "deemed status", which is afforded to programs attaining accreditation from a national accrediting body. Primary legal research and the National Survey of Substance Abuse Treatment Services' (N-SSATS) data were used to examine the relationships between state authorization type (certification/accreditation vs licensure with and without deemed status) and outpatient treatment program practices. Programs in certification/accreditation (vs licensure) states had significantly higher odds of offering wrap-around and continuing care/after care services associated with better long-term treatment outcome. Programs in states that allowed for certification/accreditation with deemed status had significantly lower odds of infectious disease testing, but higher odds of providing group and family counseling. Results suggest that state authorization type may impact services offered by outpatient treatment programs.

Drug treatment program ownership, Medicaid acceptance, and service provision

“…The study found that programs that accepted Medicaid were significantly more likely to be accredited by the CARF. An examination of the criteria for accreditation by CARF includes continuity of care that involves social service linkages, discharge planning, and the other ancillary/transitional services examined in this article (Meisenheimer, 1997;Chriqui et al, 2007). Accepting Medicaid may well be a part of an overall organizational commitment, regardless of type of ownership, to offering a wide range of evidence-based services that include ancillary and transitional services.…”

“…First, a four-level variable reflecting state outpatient SAT program authorization type based on 2004 state laws (Chriqui, Terry-McElrath, McBride, Edison, & Vander Waal, 2007) coded as follows: 1 = licensure only, 2 = certification/accreditation only, 3 = licensure and deemed status, and 4 = certification/accreditation and deemed status. This variable accounts for recent research suggesting that a combination of state treatment program authorization type (i.e., licensure vs. certification/ accreditation) combined with state recognition of "deemed status" (i.e., state recognition of accreditation by national accrediting bodies such as the Joint Commission or the Commission on the Accreditation of Rehabilitation Facilities [CARF] in lieu of state authorization) is related to differential service offerings (Chriqui et al, 2007). Second, outpatient SAT Medicaid policy eligibility criteria (no Medicaid coverage; coverage for categorically needy only; coverage for medically needy; coverage for both categorically and medically needy) were based on primary legal research using data from the Kaiser Family Foundation's Online Database of Medicaid Benefits and through verification efforts with state Medicaid offices.…”

State policies matter: The case of outpatient drug treatment program practices

“…Data sources 2.1.1. Independent variables: State policy data State policy requirements governing state-authorized standard outpatient substance abuse treatment programs (for further discussion of the state authorization process and its relationship to outpatient treatment program practices, see Chriqui et al, 2007) were captured using primary legal research methods (Mersky & Dunn, 2002). For purposes of this research, "state" was defined to include each of the 50 states and the District of Columbia.…”

“…First, although federal, state, and local governments are the primary payers of substance abuse treatment services in the United States, the majority of substance abuse treatment services in the United States are paid for by state governments (Mark et al, 2005); thus, states have a vested interest in seeing that clients receive quality treatment services. Second, with the exception of federal regulations for certifying opioid treatment programs, state governments are primarily responsible for authorizing substance abuse treatment programs in the United States (Chriqui, Terry-McElrath, McBride, Eidson, & VanderWaal, 2007). Consequently, substance abuse treatment programs are governed by a diverse set of state policies.…”

Adoption of Injectable Naltrexone in U.S. Substance Use Disorder Treatment Programs

“…Wraparound services go beyond the direct treatment of SUD to address patients' co-occurring medical, mental health, and other problems and are associated with better client retention and treatment outcomes (Chriqui et al, 2007;Ducharme et al, 2007). Rogers ' (2003) diffusion theory views innovations as practices that are considered new to an organization.…”