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

Background and purpose Coordination and integration of mental health, public health, and prevention care have been associated with reduced cost and positive client outcomes in addiction health services (AHS). However, little is known about system and organizational factors that help programs develop the capacity to offer highly coordinated care. This study examined factors associated with readiness to coordinate mental health, public health, and HIV testing among community-based AHS programs.

Methods: We analyzed client and program data collected in 2010–2011 from publicly funded AHS treatment programs in Los Angeles County, CA. A sample of 14,379 clients nested in 104 treatment programs was analyzed using logistic regressions examining odds of service coordination with mental health and public health providers. A separate analysis was conducted to examine the percentage of clients receiving HIV testing in each program.

Results: Motivational readiness and organizational climate for change were associated with higher odds of coordination and mental health and public services. Programs with professional accreditation had higher odds of cooordinating with mental health services, whereas  programs receiving public funding and methadone and residential programs (compared to outpatient) had a higher percentage of clients receiving coordinated HIV testing.

Conclusions:  These findings provide an evidentiary base for the role of motivational readiness, organizational climate, and external regulation and funding in improving the capacity of AHS programs to develop integrated care.  Implications for the implementation of the Affordable Care Act are discussed.