How “Integrated” Are Integrated Substance Abuse and Domestic Violence Programs: A Survey of Organizations

BACKGROUND/PURPOSE. Our study explores the relationship between key structural/organizational characteristics and substance abuse (SA) and intimate partner violence (IPV) service integration. Despite a 50% co-occurrence of SA/IPV and economic and policy incentives for integrated IPV/SA services, little research exists to support “one stop shopping” as a practice model. This paper, the first quantitative study of integrated IPV/SA services, addresses this deficit by describing service integration (SI) reported in a sample of 237 agencies self-identifying as providing dual programming. Our aims are to collect detailed structural and organizational data on SI, pilot a measure of IPV/SA SI, and generate hypotheses for future research. METHODS. We collected agency data using key-informant internet surveys. A sampling frame was constructed using published lists, referrals, internet searches, solicitation of agencies identified in the literature, and snowball procedures. We recruited an initial list of 488 agencies, of which 237 (48.8%) key agency informants completed the full questionnaire. We categorized 50 agencies as originally SA, 94 as IPV, and 93 as multiservice. Indicators of SI were (1) a newly developed Index of Service Integration (ISI), (2) a dichotomous variable for programs which require participants be affected by both IPV and SA, and (3) a dichotomous variable for recruitment of staff with expertise in both IPV and SA. Our exploratory 10-item ISI was found to be internally consistent (Cronbach alpha=.74) and normally distributed (M=4.73, SD=2.56, MD=5.00, Range=0-10). In addition to univariate and bivariate description, we also employed OLS and logistic regression to explore the relative contribution of key variables to our indicators of service integration. RESULTS. Although all agencies in the sample were recruited based on providing services related to both IPV and SA, there was wide-ranging variation in the level of integration. ANOVA of the ISI by agency type found significant difference in levels of service integration (F=3.56, p<.05) with IPV agencies (M=4.23, SD=3.27) trending toward significantly lower levels of integration than SA (M=5.14, SD=2.57) or multi-service (M=5.13, SD=2.61) organizations. Similarly significant differences were found between SA (30.4%), multiservice (15.8%), and IPV (7.5%) agencies in having a dedicated program for IPV/SA (chisquare=11.5, p<.01). Finally, the occurrence of co-trained staff was 63.3% overall, with no significant difference between agency type, although the same trend was observed. No other measured organizational variables predicted any of the SI measures. CONCLUSIONS. Our results suggest that even among agencies offering some level of both IPV and SA services, SA and multi-service agencies are more likely than IPV agencies to provide integrated services, and at higher levels of integration. Several perspectives explain these results, including institutional analysis, organizational stage-of-change, and field analysis. Funding, political, and philosophical issues may also inhibit agencies from moving toward service integration. Given the likelihood that integrated services may be more common in the future, as well as objections to integration, research using mixed methods and building on the exploratory work in this paper is indicated.