Research That Matters (January 17 - 20, 2008)

Background and Purpose: Screening is an important first step in providing quality health care, and may be one tactic in an overall strategy to address the disproportionate morbidity and mortality experienced by subgroups defined by age, gender and race-ethnicity. Because drug use is highly correlated with a range of health problems such as HIV and hepatitis, there is an opportunity to screen and assess for those conditions when people access treatment in a substance abuse (SA) setting. This research will first identify the extent to which substance abuse (SA) facilities in the United States screen clients for health problems, and then analyze organizational characteristics (e.g., ownership, primary payment source, specializations) that are associated with screening. In light of broad epidemiological evidence of disparities in health status and treatment outcomes, it is hypothesized that substance abuse settings with the most demographically diverse caseloads are least likely to screen for health problems. Methods: Data are from randomly selected substance abuse treatment facilities (n=13,371) that responded to the most recent annual National Survey of Substance Abuse Treatment Services (N-SSATS) (2005). The survey asked about screening for hepatitis B, hepatitis C, HIV, tuberculosis, and sexually transmitted diseases (STDs). Separate dichotomous dependent variables were created for each health screen (yes or no) and an aggregate “any health screen.” Independent variables include type of setting (inpatient, outpatient, residential care, detox), facility ownership, services provided, and payment sources accepted. A range of variables are used as proxies of diversity of client population, including proportion of caseload under age 18, acceptance of women, and number of languages other than English spoken to provide services. A series of bivariate and multiple logistic regressions, appropriately weighted and adjusted for sample design, were used to estimate the effect of caseload diversity on health screening, controlling for other organizational correlates. Results: Between one fifth and one third of SA facilities conduct screening for any of the health problems, with testing for HIV/AIDS being most common. Screening for “any health problem” was inversely associated with the proportion of clients under age 18, the provision of services in multiple languages, and the provision of mental health services. When caseload and agency characteristics were analyzed together, agency ownership (0.89) and payment source (0.75) significantly lowered the odds of any health screening (p<.05). Conclusions and Implications: Within the limitations posed by reliance on secondary data, findings indicate that most SA facilities do not screen for health problems, especially when the client population is diverse in age, language spoken, and mental health needs. Organizational constraints appear to be directly related to ownership and payment source, with individuals in public facilities and public payment sources having the least opportunity for screening. Social workers in SA settings may need to obtain training and education regarding the need for and ability to conduct health screening with diverse populations. At the same time, it is recommended that legislative and agency-level advocacy efforts work to ensure that screening becomes part of routine care in agencies serving the potentially most vulnerable clients.