Race Targeting and Race Congruence as Factors Affecting Outcomes in Long Term Residential Substance Abuse Treatment for Women

1
Race Targeting and Race Congruence as Factors
Affecting Outcomes in Long Term Residential
Substance Abuse Treatment for Women

• Xiaowu Chen, M.D., Caliber AssociatesKen
  Burgdorf, Ph.D., Caliber Associates Tracy
  Roberts, M.P.A., Caliber Associates
  
• James M. Herrell, M.P.H., Ph.D., CSAT
• 130th APHA Annual Meeting Exposition
• Philadelphia, November 12, 2002Study
  conducted under Contract 270-97-7030 funded by
  the Center for Substance Abuse Treatment,
  Substance Abuse and Mental Health Services
  Administration, U.S. Department of Health and
  Human Services. Center for Substance Abuse
  Treatment, 5600 Fishers Lane, Rockwall II, Suite
  740, Rockville, Maryland 20857, 301/443-5052.
  Contents are solely the responsibility of the
  authors and do not necessarily represent the
  official views of the agency.

2
CSATs RWC PPW Programs

• Demonstration projects funded by the Center for
  Substance Abuse Treatment (CSAT). Projects
  provide model substance abuse treatment that
• Is long-term residential (6 months or 12 months)
• Is gender-specific, targeted to pregnant and
  parenting women
• Includes provision for in-residence care of
  clients children
• Provides comprehensive, culturally appropriate
  services to women and children.

3
Cross-site Study Design

• The study coordinated collection (by grantees) of
  standardized sets of data elements concerning
  client and child characteristics at several
  points
• At admission to treatment
• Quarterly throughout treatment
• At discharge from treatment
• Six months after discharge from treatment.
• The cross-site data collection system was
  instituted in October 1996 and continued through
  March 2001.

4
The Sample

• The sample consists of 32 projects that met the
  threshold follow-up rate (50).
• The follow-up rate for this sample is 70, and
  includes 1181 clients.
• The data are weighted by length of stay (LOS) to
  adjust for underrepresented short-stay clients.
• Limitations
• self-report information mostly not validated
• no placebo group is available.

5
Outcome Measures

• Three summary indices of clients response to
  treatment
• Whether clients remained in treatment beyond the
  first 30 days
• Whether clients completed their treatment program
• Whether clients successfully maintained alcohol
  and drug abstinence through the six month
  follow-up period after discharge

6
This Analysis

• Examine ways that race may have been a factor
  affecting clients response to this kind of
  long-term residential treatment
• Are there overall differences among race groups
  in key outcomes?
• Do clients have better outcomes if treated in
  projects that target their race?
• Do clients have better outcomes if they are of
  same race as most other clients in the project?

7
Methods

• Pearson Chi-square tests were performed to
  examine overall associations between race
  measures and the outcomes.
• Hierarchical Linear Models (HLM) were constructed
  to assess the factors associated with the
  outcomes at the client level and project level.

8
Summary of Client Characteristics (n1181)

• Variable Level Percent
  Variable Level Percent
• Race Af-Amer 40
  Child in tx Yes 66
• White 32
  No 34
• Other 28
  Primary drug Cocaine 11
• Education H.S. 53
  Crack 40
• ltH.S. 47
  Heroin
  8
• Age (years) 18-25 24
  Alcohol 14
• 26-35 55
  CPS involved Yes 55
• 36 21
  No
  45
• Pregnant Yes 26
  Abstinent Yes 60
• No 74
  post-tx No 40
  

9
Treatment Outcomes by Race

• N LOSgt30d
  Completed Abstinent
• Race ()
  () ()
• African Am. 468 80 45
  62
• Hispanic 170 75 36
  56
• Native Am. 99 87 48
  57
• White 377 79
  44 59
• Results are not significant at .05 level.

10
Race Targeting and Treatment Outcomes

• N LOSgt30d
  Completed Abstinent
• Target ()
  () ()
• Group yesno
  yesno yesno
• African Am. 468 7782 5142
  6462
• Hispanic 170 7090 3056
  5268
• Native Am. 99 8877 5033
  5474
• plt0.05

11
Project Majority and Treatment Outcomes for
African Americans (n468)

• Majority LOSgt30d Completed
  Abstinent
• ()
  () ()
• African Am. 78 45
  82
• Different 94 47
  44
• No majority 82 44
  58
• P ns
  ns .03

12
Project Majority and Treatment Outcomes for
Hispanics (n170)

• Majority LOSgt30d Completed
  Abstinent
• ()
  () ()
• Hispanic 71 28
  56
• Different 76 43
  35
• No majority 82 52
  69
• P ns
  ns .03

13
Project Majority and Treatment Outcomes for
Native Americans (n99)

• Majority LOSgt30d Completed
  Abstinent
• ()
  () ()
• Native Am. 87 50
  54
• Different 100 53
  77
• No majority 78 35
  67
• P ns
  ns ns

14
Project Majority and Treatment Outcomes for
Whites (n377)

• Majority LOSgt30d Completed
  Abstinent
• ()
  () ()
• White 89 51
  59
• Different 76 43
  59
• No majority 73 39
  59
• P .003 .006
  ns

15
HLM Abstinence in Post-discharge

• Variable Description
  OR P
• Race African Am.
  1.41 .0899
• Hispanic
  Am. 1.00 .9941
• Native Am.
  1.22 .5988
• White
  1.00
• Race congruence no majority
  1.40 .1762
• different
  0.72 .2075
• same as
  client 1.00
• LOS 10 days
  increase 1.04 lt.0001
• Self-help group yes vs. no
  1.75 .0003
• Client-counselor ratio 0-8 vs. 8
  1.81 .0339
• Results adjusted for age, education, parenting
  status, primary drug, CPS or CJS involvement,
• therapeutic approach, time spent with clients,
  family involvement, and project location.

16
HLM Abstinence in Post-discharge

• Sixty percent of all clients who entered the
  program reported complete AOD abstinence for 6
  months after discharge.
• There was no statistically significant difference
  in abstinence between African American, Hispanic,
  Native American, and White clients.
• Whether or not the client stayed in projects in
  which her race was a majority did not affect her
  AOD abstinence in 6 months after discharge.

17
HLM Abstinence in Post-discharge

• Variation in treatment success (abstinence vs.
  relapse) was predictable. Results suggest
  important variables are
• At the project level intensity of clinical
  contact between clients and counselors.
• At the client level having a longer length of
  stay and participating in self-help groups after
  discharge were prognostically positive negative
  prognostic indicator was having pre-treatment
  involvement with CPS.

18
HLM Treatment Completion

• Variable Description
  OR P
• Race African Am.
  1.28 .2317
• Hispanic
  Am. 1.40 .2549
• Native Am.
  2.85 .0307
• White
  1.00
• Race congruence no majority
  1.85 .1896
• different
  1.08
  .7631
• same
  1.00
• With children yes vs. no
  4.48 lt.0001
• Age one year
  increase 1.65 lt.0001
• Client-counselor ratio 0-8 vs. 8
  1.61 .3093
• Results adjusted for education, primary drug, CPS
  involvement, mental health, therapeutic
• approach, time spent with clients, project size,
  and project location.

19
HLM Treatment Completion

• Clients were more likely to complete treatment if
  they
• were Native American
• brought children into treatment
• were older.
• Whether or not the client stayed in projects in
  which her race was a majority did not change the
  odds of treatment completion.
• None of the project level variables were
  associated with treatment completion.

20
Summary

• The study did not find any major differences in
  treatment retention, completion, or
  post-treatment AOD abstinence among race/ethnic
  groups.
• Clients race congruence was not associated with
  treatment retention, completion, or AOD
  abstinence.
• A variety of client level variables were
  significantly associated with treatment
  completion and AOD abstinence, including bringing
  children to treatment, pre-treatment CPS
  involvement, LOS, and participating in
  self-groups.