Co-Production and Substance Use Disorder Treatment Clinics' Service Output Patterns

Background/Purpose. Human service providers are interested in and encouraged to engage service users in service production process—often known as co-production. Recent conceptual advancements suggest multiple co-production mechanisms may operate in a service field with unique strengths and weaknesses. For instance, directly collaborating with patients in clinical decision-making (i.e., patient-centered care) might be challenging in the substance use disorder (SUD) treatment field, due to pervasive mutual distrust and power imbalance between patients and clinicians as discussed by previous social work scholars. Instead, clinics may hire staff with lived experience of addiction as patients’ advocates (i.e., peer co-production). This study examines potentials and limitations of two co-production efforts in the SUD treatment field with the following question: how SUD treatment clinics’ use of patient-centered care and peer co-production mechanisms is associated with organizational service availability and utilization patterns?

Methods: This study uses the National Drug Abuse Treatment System Survey data—a nationally representative survey of approximately 700 SUD treatment clinics in the U.S. Using original survey questions designed for this study, I developed five main explanatory variables capturing organizational use of two co-production mechanisms (e.g., a composite variable of shared decision-making and person-centered processes and whether staff with lived experience possessed equal or greater levels of influence over organizational/strategic decision-making process). Dependent variables include availability (i.e., a clinic offers a service or not; 1=Yes, 0=No) and utilization rates (i.e., proportions of patients utilized a service; ranging 0-100%) of eight services that facilitate patient’s long-term recovery (e.g., opioid aftercare, medications, harm reduction services, and ancillary services. I used logistic regression to predict service availability and Tobit regression to estimate the proportion of service utilized patients, with various environment and organization-level control variables.

Findings: More than a half of SUD clinics across the U.S. implemented either patient-centered care or peer co-production mechanisms to incorporate patient’s perspectives into care processes. In terms of service availability, the patient-centered care composite variable was positively associated with the offerings of overdose prevention educational materials and routine health care. The proportion of staff with lived experience had negative associations with the availability of opioid maintenance therapy and methadone. The patient-centered care composite variable was positively correlated with patients’ utilization of routine medical care. The predicted proportion of patients utilizing transportation assistance was 10% higher among clinics inviting patients to participate in the clinical decision-making process. When staff with lived experience possesses an equal or greater level of influence on organizational or strategic decisions, patients were more likely to utilize condoms and transportation assistance.

Conclusion: The prevalence of co-production efforts in a field serving one of the most stigmatized populations signals the potential of co-production across human service fields. The findings suggest that collaborative process can be an important way to address the opioid crisis, encouraging policy makers and government officials to emphasize and incentivize co-production efforts at SUD clinics. Additionally, this research encourages human service managers to think about various ways to co-produce with service users, such as peer co-production.