Abstract: Workforce Diversity and Disparities in Opioid Treatment Wait Time and Retention (Society for Social Work and Research 27th Annual Conference - Social Work Science and Complex Problems: Battling Inequities + Building Solutions)

Schedule:

Friday, January 13, 2023

Valley of the Sun B, 2nd Level (Sheraton Phoenix Downtown)

* noted as presenting author

Erick Guerrero, PhD, Research Director / Faculty, Research to End Healthcare Disparities Corp, Los Angeles, CA

Yinfei Kong, PhD, Associate Professor, California State University, Fullerton, Fullerton, CA

Tenie Khachikian, PhD, Research Associate, University of Chicago, Chicago

Thomas D'Aunno, PhD, Professor, New York University, New York, NY

Daniel Howard, PhD, PhD, Texas A&M University

Soujin Wang, Ph.D., Professor, Texas A&M University, TX

Background: Drawing from a theoretical framework on demographic diversity in the workplace, we seek to determine the role of workforce diversity in improving opioid treatment wait time and retention for individuals self-identified as Black/African American or Latino/Hispanic. To examine associations with diversity and outcomes, we considered the context of Medicaid-expansion and treatment structure (funding, regulation and professionalization) among opioid treatment programs (OTP) located across the United States.

Methods: We examined four waves of the National Drug Abuse Treatment System Survey (NDATSS), a nationally representative longitudinal dataset (2010- 2017), to assess the effect of OTPs’ structure, organization, and service delivery on wait time to treatment and retention in treatment. We conducted comparative and predictive analysis in an analytic sample of treatment programs (162 in 2000, 173 in 2005, 282 in 2014, and 300 in 2017). We considered the moderated effect of workforce diversity and treatment structure on wait time and retention.

Results: The main findings suggest significant differences in wait time and in retention. Average waiting days decreased in the last two waves of the NDATSS (2014-2017) (post Medicaid expansion per the Affordable Care Act), while retention rates varied across years. Key findings show that programs with both a higher percent of African American staff and a higher percent of African American clients were associated with longer wait times to enter treatment. Programs with both a higher percent of Latino staff and a higher percent of Latino clients were negatively associated with retention in treatment.

Discussion: Findings show decreases in wait time over the years with significant variation in retention during the same period. Higher workforce diversity was associated with higher wait time and lower retention when programs also had high percentages of African American and Latino clients. Findings have implications for the role of high diversity in OTPs, which may also represent OTPs with low resources and training potentially explainig lower access and engagement. This work contributes to the conceptual and empirical literatures on the role of diversity, as an main indicator of cultural competence, and the fault lines that determine when diversity may contribute to positive minority outcomes.