Organizational Capacity for Service Integration in Community-Based Addiction Health Services

Guerrero, Erick G.; Aarons, Gregory A.; Palinkas, Lawrence A.

doi:10.2105/ajph.2013.301842

Cited by 36 publications

(41 citation statements)

References 59 publications

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“…However, the presence of humble leadership does not necessarily mean that EBPs will be implemented effectively. It is likely that effective leadership is a necessary but not sufficient condition for effective implementation and leadership is one component of organizational capacity for implementation (49). Further research is needed to better understand the nuances of how leader-follower discrepancies develop and influence follower experiences of their workplace as well as examining additional factors that may impact effective implementation for both leaders and followers.…”

Section: Discussionmentioning

confidence: 99%

The Humble Leader: Association of Discrepancies in Leader and Follower Ratings of Implementation Leadership With Organizational Climate in Mental Health

Aarons¹,

Ehrhart²,

Torres³

et al. 2017

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Objectives Discrepancies between leaders' self-ratings and follower ratings of the leader are common but usually go unrecognized. Research on discrepancies is limited but there is evidence that discrepancies are associated with organizational context. This study examined the association of leader-follower discrepancies in Implementation Leadership Scale (ILS) ratings of mental health clinic leaders, and the association of those discrepancies with organizational climate for involvement and performance feedback. Both involvement and performance feedback may be important for evidence-based practice implementation in mental health. Methods A total of 593 supervisors (i.e., leaders, n=80) and clinical service providers (i.e., followers, n=513) completed surveys including ratings of implementation leadership and organizational climate. Polynomial regression and response surface analyses were conducted to examine the associations of discrepancies in leader-follower ILS ratings with organizational involvement climate and performance feedback climate, aspects of climate likely to support EBP implementation. Results Both involvement climate and performance feedback climate were highest where leaders rated themselves low on the ILS and their followers rated those leaders high on the ILS (i.e., “humble leaders”). Conclusions Teams with “humble leaders” showed more positive organizational climate for involvement and for performance feedback, contextual factors important during EBP implementation and sustainment. Discrepancy in leader and follower ratings of implementation leadership should be a consideration in understanding and improving leadership and organizational climate for mental health services and for evidence-based practice implementation and sustainment in mental health and other allied health settings.

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Section: Discussionmentioning

confidence: 99%

The Humble Leader: Association of Discrepancies in Leader and Follower Ratings of Implementation Leadership With Organizational Climate in Mental Health

Aarons¹,

Ehrhart²,

Torres³

et al. 2017

Self Cite

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“…Other studies on detox readmissions found that larger programs (measured by number of beds) had higher readmission rates (Callaghan & Cunningham, 2002; Campbell et al, 2009). SUD treatment organizational characteristics also effect the integration of the SUD treatment system with mental health and public health systems (Guerrero, Aarons, & Palinkas, 2014). Future research could build off this study and this related research to examine the impact of organizational networks on SUD, medical, and other service integration.…”

Section: Discussionmentioning

confidence: 99%

Design and impact of bundled payment for detox and follow-up care

Quinn

Hodgkin

Perloff

et al. 2017

Journal of Substance Abuse Treatment

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Introduction Recent payment reforms promote movement from fee-for-service to alternative payment models that shift financial risk from payers to providers, incentivizing providers to manage patients’ utilization. Bundled payment, an episode-based fixed payment that includes the prices of a group of services that would typically treat an episode of care, is expanding in the United States, including mandatory models in Medicare. Bundled payment has not been developed specifically for substance use disorder (SUD) treatment. Yet, bundled payment has been recommended as a way to pay for comprehensive SUD treatment and has the potential to improve treatment engagement after detox, which could reduce detox readmissions, improve health outcomes, and reduce medical care costs. However, if moving to bundled payment creates large losses for some providers, it may not be sustainable. The objective of this study was to design a bundled payment for detox and follow-up care and to estimate its impact on provider revenues. Methods Massachusetts Medicaid beneficiaries’ behavioral health, medical, and pharmacy claims from July 2010–April 2013 were used to build and test a detox bundled payment for continuously enrolled adults (N=5,521). A risk adjustment model was developed using general linear modeling to predict beneficiaries’ episode costs. The projected payments to each provider from the risk adjustment analysis were compared to the observed baseline costs to determine the potential impact of a detox bundled payment reform on organizational revenues. This was modeled in two ways: first assuming no change in behavior and then assuming a supply-side cost sharing behavioral response of a 10% reduction in detox services and an increase of one individual counseling and one group counseling session. Results The mean total 90-day detox episode cost was $3,743. Nearly 70 percent of the total mean cost consists of the index detox, psychiatric inpatient care, and short-term residential care. Risk mitigation, including risk adjustment, substantially reduced the variation of the mean episode cost. There are opportunities for organizations to gain revenue under this bundled payment design, but many providers will lose money under a bundled payment designed using historic payment and costs. Conclusions Designing a bundled payment for detox and follow-up care is feasible, but low case volume and the adequacy of the payment are concerns. Thus, a detox episode-based payment will likely be more challenging for smaller, independent SUD treatment providers. These providers are experiencing many changes as financing shifts away from block grant funding toward Medicaid funding. A detox bundled payment in practice would need to consider different risk mitigation strategies, pooling providers, and an increased reimbursement rate, but could incentivize care coordination, which is important to reducing detox readmissions and engaging patients in care.

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“…Estimates of the degree to which SUD facilities co-locate and integrate treatment for CODs range widely based on the methodology and data source utilized (Bond and McGovern, 2013; Ducharme et al, 2006, 2007; Gil-Rivas and Grella, 2005; Gotham et al, 2010; Guerrero et al, 2014; Knudsen et al, 2004; Lambert-Harris et al, 2013; McGovern et al, 2006, 2007, 2014; Timko et al, 2005). Data collected from program providers typically utilize a single item to assess the capability to treat CODs.…”

Section: Introductionmentioning

confidence: 99%

Classifying substance use disorder treatment facilities with co-located mental health services: A latent class analysis approach

Mauro

Furr‐Holden

Strain³

et al. 2016

Drug and Alcohol Dependence

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Background The Affordable Care Act calls for increased integration and coordination of behavioral health services, as people with co-occurring disorders (CODs), meeting criteria for both substance use and psychiatric disorders, are overrepresented in treatment samples. Nationwide estimates of mental health (MH) service co-location in substance use disorder (SUD) treatment facilities are needed. We empirically derived a multiple-indicator categorization of services for CODs in SUD treatment facilities. Methods We used latent class analysis to categorize 14,037 SUD treatment facilities in the United States and territories included in the 2012 National Survey of Substance Abuse Treatment Services. Latent class indicators included MH screening and diagnosis, MH support services, psychiatric medications, groups for CODs, and psychosocial approaches. Multinomial logistic regression compared facility-identified primary focus (i.e., SUD, MH, mix of SUD-MH, and general/other) and other facility characteristics across classes. Results A four-class solution was chosen with the following classes: Comprehensive MH/COD Services (25%), MH without COD Services (25%), MH Screening Services (21%), and Limited MH Services (29%). The former two classes with co-located MH services were less likely to report a SUD-primary focus than the latter classes reporting only MH screening or Limited MH Services. Only the Comprehensive MH/COD Services class also had a high probability of providing special groups for CODs. Conclusions Approximately half of SUD treatment facilities were in classes with co-located mental health services, but only a quarter provided comprehensive COD services. Future studies should assess differences in patient experiences and treatment outcomes across facilities with and without COD services.

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Organizational Capacity for Service Integration in Community-Based Addiction Health Services

Cited by 36 publications

References 59 publications

The Humble Leader: Association of Discrepancies in Leader and Follower Ratings of Implementation Leadership With Organizational Climate in Mental Health

The Humble Leader: Association of Discrepancies in Leader and Follower Ratings of Implementation Leadership With Organizational Climate in Mental Health

Design and impact of bundled payment for detox and follow-up care

Classifying substance use disorder treatment facilities with co-located mental health services: A latent class analysis approach

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