Health Related Issues

This webpage identifies the major literature in the field of substance abuse and child welfare practice: health related issues. The time frame is from January 2000 through December 2014.

Bouchery, E. E., Harwood, J. H, Dilonardo, J. & Vandivort-Warren, R. (2012). Type of health insurance and the substance abuse treatment gap. Journal of Substance Abuse Treatment, 42(3), pp. 289-300. DOI: 10.1016/j.jsat.2011.09.002

This study examines the correlation between type of insurance coverage and receipt of substance abuse treatment, controlling for other observable factors that may influence treatment receipt. The authors of the study claim that the likelihood of treatment entry is estimated by type of insurance coverage. Results show that individuals with private insurance have lower treatment entry rates than individuals with public insurance. The authors suggest that the Affordable Care Act should improve coverage for individuals who need it, however the possibility remains that the reform may miss the opportunity to make significant improvements to those who need coverage.

Busch, S. H., Epstein, A. J., Harhay, M. O., Fiellin, D.A., Un, H., Leader, D. J., & Barry, C. L. (2014). The effects of federal parity on substance use disorder treatment. The American Journal of Managed Care, 20(1), pp. 76-83.

The objective of this study is to examine the effects of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) on substance use disorder treatment. The authors claim that in the first year of the implementation of MHPAEA there was not a significant change in the proportion of enrollees using substance use disorder treatment, however there was a small increase in spending in treatment. The authors could also not find any significant change in the identification, treatment initiation or treatment engagement of enrollees. The authors suggest that more research is needed during year 2 of the implementation to determine if any significant changes have occurred in treatment.

Centers for Disease Control and Prevention. (2013). Drug Induced Deaths – United States, 1999-2010. MMWR: 62 (Supplement 3): pp. 161-163

The purpose of this report is to raise awareness of disparities by age, gender, racial/ethnic and/or geographic differences and prompt actions to reduce disparities regarding drug-induced deaths in the United States. Results show that the highest percentage of deaths occurred amongst American Indian/Alaska Natives followed by non-Hispanic whites. Prescription drugs have replaced illicit drugs as the leading cause of drug-related overdose deaths.

Gurewich, D., Prottas, J., & Sirkin, J. T. (2014). Managing care for patients with substance abuse disorders at community health centers. Journal of Substance Abuse Treatment, 46(1), pp. 227-231.

The aim of this study was to look at operational practices in a sample of community health centers (CHCs) which have been able to effectively coordinate substance use disorder services. The study looked at how the CHCs identified patient needs and linked them with appropriate services. The case study results reflected that the integration of behavioral health staff with primary care staff was one of the critical key transitions made with successful CHCs. One of the main challenges faced by CHCs included the coordination of services between primary care and SUD providers.

Knudsen, H. K., Oser, C. B., Abraham, A. J., & Roman, P. M. (2012). Physicians in the substance abuse treatment workforce: Understanding their employment within publicly funded treatment organizations. Journal of Substance Abuse Treatment, 43(2), pp. 152–160. DOI: 10.1016/j.jsat.2011.12.003

This study examined organizational and environmental factors associated with the employment of physicians in substance abuse settings. Results show that some funding barriers were present in the employment of physicians, including the costs of physicians and inadequate reimbursement by funders. Programs unaware that they could use state contract funding to pay for medical staff employed fewer numbers of physicians than programs aware of this type of state policy. Attempts to increase physician employment in substance abuse treatment may require attention to both organizational and environmental factors rather than simply trying to attract individuals to the field.

Mark, T.L., & Vandivort-Warren, R. (2012). Spending trends on substance abuse treatment under private employer-sponsored insurance, 2001–2009. Drug and Alcohol Dependence, 125(3), pp. (2012) 203– 207. DOI: 10.1016/j.drugalcdep.2012.02.013.

The aim of this study is to identify trends from 2001 through 2009 in spending and utilization on substance abuse services by individuals with employer-sponsored health insurance. By analyzing these trends the authors hope to reveal how access, utilization, expenditures, and the mix of treatment may have changed and assess changes that may occur due to recent policy changes. Results of the study reflect that spending remained constant throughout the years analyzed. The study has implications for anticipating the effects of the federal parity law, in that the low share of substance abuse treatment means that even large increases in substance abuse utilization and spending are unlikely to have a significant impact on total health care costs.

Molfenter, T. D. (2014). Addiction treatment centers’ progress in preparing for health care reform. Journal of Substance Abuse Treatment, 46(1), pp. 158-164.

The researchers of this study designed the Health Reform Readiness Index (HRRI) for addiction treatment organizations to assess their readiness for the Patient Protection and Affordable Care Act (PPACA). They administered the tool to 27 organizations completed the survey, the results reflected that agencies with annual budgets of less than 5 million were least likely to be prepared for the PPACA than agencies with annual budgets of more than 5 million. The authors make the claim that smaller treatment agencies are not preparing adequately for health care reform and those organizations that are preparing are only making modest gains.

Reich, A. W. & Fuger, L. K. (2012). Accessing child developmental services predicts in-home placement of substance – and HIV-affected children. Children and Youth Services Review. 34(12), pp. 2474-2480.

This article focuses on the impact of service provision on child placement in AIA-funded services across the U.S. The findings of the study support the AIA model, the author’s state that comprehensive services, including services geared towards pediatric and developmental needs, may have strong effects on family stabilization and permanency.

Shin, P., & Sharac, J. (2012). Opportunities and challenges for community health centers in meeting women’s health care needs. Women’s Health Issues, 22(2), pp. 119-121.

This article reviews how the Affordable Care Act (ACA) and community health centers can increase the chances that low-income women get the coverage and care they need. However, the caveats behind the CHCs are their inability to meet the needs of the large number of newly insured patients seeking assistance at these centers. Although CHCs present an effective option for increasing access to primary care for women under the ACA, they face significant challenges in expanding their capacity to meet the projected increase in demand for care.

Sutherland, M. A., Fantasia, H. C., McClain, N., Hill, C., & Lowell, M. A. (2013). Abuse experiences, substance use, and reproductive health in women seeking care at an emergency department. Journal of Emergency Nursing. 39(4), pp. 326-333.

The purpose of this study was to describe child sexual abuse experiences, intimate partner violence, substance use, and reproductive health outcomes in a sample of adult women who were seeking care from a rural emergency department to better understand the health care needs of this unique population. According to the study results, the participants had high rates of abuse, harmful drinking patterns, and substance use and were at risk for sexually transmitted infections. The authors argue that with proper training, nurses in the ER could serve as liaisons between this population and appropriate referrals.

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