Criminal Justice Referred Clients and Wraparound Services in Substance Use Treatment Centers: Examining Moderation of Public Funding on Service Provision

Background and Purpose: Substance use disorders (SUD) among justice-involved individuals is a significant concern for the rehabilitation and reintegration into their communities. Further, the National Institute on Drug Abuse (NIDA) recommends a comprehensive model of treatment for those with SUD, which includes wraparound services. Wraparound services, such as medical care, educational, housing, and vocational services, are intended to treat the myriad of co-occurring problems faced by justice-involved SUD clients. However, previous studies have found that justice-involved clients often do not receive adequate service provision, and this may be influenced by proportions of SUD treatment facilities’ funding that include public sources (opposed to private), but this relationship remains untested. Thus, the purpose of this research was to examine the relationship between justice-involved SUD clients and the provision of wraparound services, and the moderating effect of public-sourced funding on wraparound services for justice-involved clients.

Methods: Data for this study come from a nationally representative sample of SUD treatment centers in the National Treatment Center Study (NTCS). These data were collected through two waves of on-site interviews conducted between 2009 and 2013 (N=372) with treatment center directors. Using the second wave, the independent variable, criminal justice referrals, was a continuous count-based measure of past-year referrals from DUI courts and other legal system sources (i.e., probation and parole). The moderating variable, public-sourced funding, was a binary measure identifying centers with a majority of past-year total operating funds from Medicaid/Medicare, grants, and other federal/state/local sources. The dependent variable, wraparound service provision, was created by indexing nine separate dichotomous measures of wraparound services offered. Controlling for the average age, race/ethnicity, and gender for each SUD treatment facility, a multivariate linear regression examined both main effects and the interaction of justice referrals and public-sourced funding using SAS software.

Results: The main effects model showed significant relationships for justice referrals (B= -0.11, p < .05) and public-sourced funding (B= 0.17, p < .01). The model also showed that percentage of racial/ethnic minorities (B= 0.14, p < .05) in a center’s caseload was associated with more wraparound service provision. Further, a significant non-linear relationship was found for percentage of women (B= -0.45, p < .01), where center caseloads with 80% women or higher were associated with more wrapround services. However, the interaction term between justice referrals and public-sourced center funding was not statistically significant (p < .36).

Conclusions and Implications: Findings from this study suggests that justice referred SUD clients receive fewer wraparound services. Additionally, centers that receive majority of funding from public sources are more likely to offer a wider range of wraparound services. Future research should seek to disentangle organizational-level factors that influence wraparound service provision for justice-involved SUD clients. For justice-involved individuals with SUDs, wraparound services can aid reintegration back into the community through treatment of co-occurring problems. This work also benefits social workers and treatment providers as organizational collaborations with service providers and measures to improve accountability for wraparound service provision are needed.