Organizational Cultural Competence In Outpatient Substance Abuse Treatment: Measurement and Relationship to Wait Time and Retention

Background and Purpose: Organizational cultural competence is broadly acknowledged to be an important strategy to increase the quality of services for racial/ethnic minorities in substance abuse treatment. However, few empirically derived measures of this organizational level construct exist, and relatively little is known about how these measures affect treatment outcomes. The purpose of this presentation is to highlight the measurement methodology employed to find a cluster of indicators representing the latent variable (organizational cultural competence) and test the extent to which these measures explain managers' reports of the average number of days clients wait to start treatment and the average number of months they remain in treatment. Findings are used to inform future studies.

Methods: Using a nationally representative sample of outpatient substance abuse treatment (OSAT) programs, this study used item response theory to create two measures of cultural competence—organizational practices and managers' culturally sensitive beliefs—and examined their relationship to client wait time and retention using Poisson regression modeling. A zero inflated Poisson model was employed in the wait time model in light of two issues, (1) significant variability, also referred as to overdispersion, and (2) a high proportion of zero values reported (62% of sample). Multiple imputation was used to fill in missing values; data were assumed to be missing at random, and the highest rate of missing data for any variable in the sample was approximately 16%.

Results: The most common and precisely measured organizational practices reported by OSAT managers included matching providers and clients based on language/dialect; offering cross-cultural training; and fostering connections with community and faith-based organizations connected to racial and ethnic minority groups. The most culturally sensitive belief among OSAT managers was support for language/dialect matching for racial and ethnic minority clients. Results of regression modeling indicate that organizational practices were not related to either outcome. However, managers' culturally sensitive beliefs were negatively associated with average wait time (p < 0.05), and positively associated with average retention (p < 0.01).

Conclusions and Implications: The field of cultural competence calls for rigorous measurement of this amorphous concept in order to improve the standard of care for racial/ethnic minorities. In this study adding managers' beliefs to the traditional measurement of organizational practices improves the explanatory power of this concept. Managers' culturally sensitive beliefs—considered to be influential for effective implementation of culturally competent practices—may be particularly relevant in influencing wait time and retention in OSAT organizations that mainly treat Latinos and African American clients. These findings contribute to an evidentiary base of management practices— the role of culturally responsive attitudes among leaders, which may indirectly contribute to minority clients' positive treatment outcomes.