The Clinical Benefits of Infrastructure Improvements in Southern Rural Substance Use Disorder Agencies

BACKGROUND AND PURPOSE: Substance use disorders (SUD) are a behavioral health crisis in the rural United States and are one of the top ten priorities in Rural Healthy People 2020. This is a particularly significant concern in the rural Southern United States that has the greatest substance use services rural-urban disparity in the country. Substance use treatment agencies in rural communities often have unique infrastructure barriers such as a lack of technology, poor internet access, and inadequate capital improvements. Implementing evidence-based social work interventions in these underserved agencies to address the needs of this population can therefore be challenging. To improve policy, social work practice, and research in this area, this study explored the clinical benefits of infrastructure improvements in rural substance use treatment agencies.

METHODS: Group and individual interviews were conducted with 28 key stakeholders and 26 clients at 6 substance use treatment agencies serving rural communities in a southeastern state that received state funding for infrastructure improvements. Stakeholders included board members, agency staff, and professionals from partner agencies. Qualitative analyses were used to identify the clinical benefits of infrastructure improvements in rural substance use agencies. Fourteen qualitative interview transcripts and 6 sets of program-specific researcher field notes about each of the substance use treatment agencies were analyzed using MaxQDA software. First-cycle coding was performed using provisional codes derived from interview prompts, with additional open coding to further categorize the data and provide analytic leads for exploration. After discussion and consensus about the findings as related to facilitators and barriers to care, second-cycle axial coding was then performed to differentiate and organize codes used to identify the most salient themes related to the clinical benefits of infrastructure improvements.

RESULTS:  Among the infrastructure improvements made at these substance use treatment agencies, new internet systems, computer and phone system upgrades, and capital improvements (i.e., paint, remodeled lobbies, agency relocation) were the most common. Access to adequate internet services was a common barrier in these rural agencies. The qualitative data analysis resulted in the identification of two overarching themes reflecting the clinical benefits of infrastructure improvements: 1) enhanced clinical skills of SUD practitioners, and 2) improved client outcomes. Stakeholders and clients identified 6 subthemes related to these benefits: lower agency cost, time saving, employee retention, improved clinical tele-supervision, better resources for client interventions, enhanced client satisfaction and decreased client stigma.

CONCLUSIONS AND IMPLICATIONS: This study identifies the clinical benefits of infrastructure improvements in rural substance use treatment agencies related to policy, social work practice, and research and highlights essential areas for consideration to improve SUD outcomes in these underserved geographic regions. These findings can be used to inform client-centered social work care to individuals with substance use disorders living in rural communities.