Chapter 3
Facility Characteristics and Services

Contents

Primary Focus

Type of Care Offered

Client Substance Abuse Problem Treated

Facilities with Opioid Treatment Programs (OTPs)

Facility Size

Facility Capacity and Utilization

Programs or Groups for Special Populations
      Dually-diagnosed clients
      Adolescents
      Persons with HIV/AIDS
      Gays and lesbians
      Pregnant/postpartum women
      Women only
      Men only
      Seniors/older adults
      DUI/DWI offenders
      Other criminal justice clients

Services Offered

Services for the Hearing Impaired or in Languages Other than English

Payment Options

Facility Licensing, Approval, Certification, or Accreditation

Facility Administrative and Funding Characteristics

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This chapter describes key characteristics of facilities and programs in 2002. Facilities are described in terms of ownership/operation, that is, the type of entity owning or responsible for the operation of the facility: private for-profit, private non-profit, or government (Federal, State, local, or tribal). They are also described in terms of the facility's primary focus: substance abuse treatment services, mental health services, general health care, a mix of mental health and substance abuse treatment services, and other.

Primary Focus

Table 3.1. Overall, 60 percent of facilities reported that treating substance abuse problems was their primary focus of activity. Eight percent of all facilities reported the provision of mental health services as their main focus, while 3 percent focused on general health care. Slightly more than one-quarter of all facilities considered a mix of mental health and substance abuse treatment services to be their primary focus.

The Department of Veterans Affairs (VA) had the largest proportion of facilities (42 percent) that reported a general health care focus, and the smallest proportion (29 percent) primarily focused on substance abuse treatment. State government facilities had the highest proportion of facilities reporting a mental health focus (12 percent). Tribal and local government facilities reported the highest proportion of facilities with a mix of mental health and substance abuse treatment services (33 percent each) as their primary focus.

Type of Care Offered

Tables 3.2a and 3.2b. Outpatient rehabilitation was the most widely available type of care, with regular and intensive outpatient care offered by 74 percent and 44 percent of all facilities, respectively. Residential rehabilitation was offered by 26 percent of all facilities, while hospital inpatient rehabilitation was offered by 4 percent of facilities. Fifteen percent of all facilities provided day treatment/partial hospitalization programs. Outpatient detoxification was offered at 12 percent of facilities, while residential detoxification and hospital inpatient detoxification were provided by 8 percent and 7 percent, respectively, of all facilities.

As a group, Federally-owned facilities were more likely to offer all types of outpatient care, including regular and intensive, day treatment/partial hospitalization, and detoxification (95 percent, 57 percent, 26 percent, and 40 percent, respectively). Outpatient methadone maintenance was offered by 24 percent of VA facilities and by 13 percent of private for-profit facilities. Residential rehabilitation was most likely to be offered by VA and private non-profit facilities (41 percent and 34 percent, respectively).

Facilities that focused primarily on substance abuse treatment were least likely to provide hospital inpatient care (either rehabilitation or detoxification) and most likely to provide residential care (both rehabilitation and detoxification). Facilities with general health care as a primary focus were most likely to provide hospital inpatient care (both rehabilitation and detoxification, at 14 percent and 47 percent, respectively), as well as outpatient detoxification (29 percent) and day/treatment partial hospitalization (28 percent).

Client Substance Abuse Problem Treated

Table 3.3. Nearly all facilities (92 percent) had clients in treatment for both alcohol and drug abuse on March 29, 2002. About three-quarters had clients in treatment for abuse of alcohol alone and for abuse of drugs alone (76 percent and 74 percent, respectively). These proportions were relatively constant across ownership categories and by the primary focus of the facility.

Facilities with Opioid Treatment Programs (OTPs)

Opioid Treatment Programs (OTPs) are certified by the Center for Substance Abuse Treatment, SAMHSA, to use the opioids methadone or LAAM in the treatment of narcotic addiction. Prior to May 18, 2001, such programs required approval by the Food and Drug Administration.

Table 3.4. OTPs were available at 8 percent of all substance abuse treatment facilities on March 29, 2002 (Table 2.1). Private for-profit facilities operated 42 percent of all OTPs, although they operated 25 percent of all substance abuse treatment facilities (Table 2.1). More than half (57 percent) of all OTPs provided both maintenance and detoxification. Thirty-three percent provided maintenance only, and 11 percent provided detoxification only. Almost all clients received methadone rather than LAAM.

Facilities with OTPs were likely to be dedicated entirely or almost entirely to treatment with methadone/LAAM. Overall, 83 percent of clients in facilities with OTPs were receiving methadone/LAAM on March 29, 2002. Among ownership categories, this proportion was highest (95 percent) in private for-profit facilities. Among facility focus categories, the proportion was highest among facilities focused on substance abuse treatment services (88 percent).

Facility Size

Table 3.5. The median number of clients in treatment at a facility on March 29, 2002, was 40. Facility size varied by type of care offered. In facilities offering outpatient care, the median number of clients was 45. However, this represented a range by type of outpatient care, including a median of 29 clients in treatment for regular outpatient care and 180 clients for outpatient methadone/LAAM maintenance. In facilities offering residential care, the median number of clients in treatment on March 29, 2002, was 18. In hospital inpatient facilities, the median number of clients was 8.

Government-operated facilities were generally larger than private for-profit or private non-profit facilities. Facilities operated by the Federal government had a median of 58 clients in treatment on March 29, 2002. This was because of the large number of clients in treatment at VA facilities.

The median number of clients also varied according to primary focus of the facility. In facilities with a primary focus on substance abuse treatment, the median number of clients in treatment was 45. In contrast, facilities focused on the provision of mental health services had a median of 20 clients in treatment.

Table 3.6. Facilities with a primary focus on substance abuse treatment tended to be larger than other facilities. Some 63 percent of these facilities had 30 or more clients in treatment on March 29, 2002. In contrast, 61 percent of facilities focused on the provision of mental health services had fewer than 30 clients in treatment on that date.

Facility Capacity and Utilization

Facilities were asked to report non-hospital residential and hospital inpatient beds designated for substance abuse treatment. Utilization rates were calculated by dividing the number of residential or hospital inpatient clients by the number of residential or hospital inpatient designated beds. Because substance abuse treatment clients may also occupy non-designated beds, utilization rates may be more than 100 percent.

Table 3.7. Some 3,781 facilities reported having 113,807 non-hospital residential beds designated for substance abuse treatment. On March 29, 2002, 90 percent of all residential beds designated for substance abuse treatment were in use. Utilization rates varied little, from 86 percent in facilities operated by local governments to 97 percent in Federally-operated facilities. However, there was significant variation among Federally-operated facilitiesthe utilization rate in VA facilities was 99 percent, but it was 37 percent in Department of Defense-owned facilities, and 74 percent in Indian Health Service facilities.

The utilization rate in facilities focused on the provision of mental health services was well above average, at 237 percent. However, the average number of designated beds in these facilities was 12, compared with 28 to 36 beds in other facilities.

Table 3.8. There were 15,736 hospital inpatient beds designated for substance abuse treatment in 1,069 reporting facilities. On March 29, 2002, 89 percent of all hospital inpatient beds designated for substance abuse treatment were in use. Utilization rates in facilities operated by State and Federal governments were well above the average, at 154 percent and 122 percent, respectively. Facilities focused on the provision of mental health services had utilization rates well above average, at 153 percent.

Figure 5 shows the distribution of the facility-level utilization rates separately for residential and hospital inpatient beds. Facilities with residential beds had generally higher utilization rates than facilities with hospital inpatient beds. Fifty-two percent of facilities with residential beds had utilization rates of 90 percent or higher, whereas in facilities with hospital beds, 50 percent had utilization rates of 50 percent or less. About 7 percent of both residential and hospital inpatient facilities had utilization rates over 100 percent.
 


Programs or Groups for Special Populations

Tables 3.9a and 3.9b. Facilities may offer treatment programs or groups designed to address the specific needs of certain populations. These include dually-diagnosed clients (persons with co-occurring mental illness and substance abuse), adolescents, persons with HIV/AIDS, gays and lesbians, and pregnant/postpartum women. Special programs or groups may also be offered for women only, for men only, and for seniors/older adults. Many facilities offer treatment for persons arrested while driving under the influence of alcohol or drugs (DUI) or driving while intoxicated (DWI), as well as for other criminal justice clients.

Dually-diagnosed clients

Overall, 49 percent of all facilities provided programs or groups for dually-diagnosed clients. These services were most likely to be provided in government-owned facilities. They were available in 59 percent of Federal- and State-owned facilities, and in 54 percent of local government facilities.

Programs or groups for dually-diagnosed clients were available in 38 percent of facilities whose focus was substance abuse treatment, compared to 60 to 70 percent of facilities whose focus was mental health services, general health care, or a mix of mental health and substance abuse services.

Adolescents

Thirty-seven percent of facilities offered programs or groups for adolescents. These programs were found most often in facilities operated by tribal governments (64 percent) or local governments (42 percent). They were least likely to be found in Federal government facilities (8 percent). Among Federal government facilities, however, this ranged from 1 percent of VA and Department of Defense facilities to 75 percent of Indian Health Service facilities.

Programs or groups for adolescents were available in 50 percent of facilities whose focus was a mix of mental health and substance abuse treatment. They were least likely to be offered in facilities with a general health care focus (22 percent).

Persons with HIV/AIDS

One-fifth (20 percent) of facilities offered programs or groups for persons with HIV/AIDS. There was little variation across ownership/operation categories. Facilities focused on general health care were most likely to offer programs or groups for persons with HIV/AIDS (24 percent), and facilities focused on the provision of mental health services were the least likely (10 percent).

Gays and lesbians

Special programs or groups for gays and lesbians were available at 13 percent of all facilities. They were most likely to be offered in private for-profit facilities (16 percent), and least likely to be offered in Federal government facilities (10 percent). Fifteen percent of facilities whose primary focus was a mix of mental health and substance abuse treatment services had programs for gays and lesbians, while only 8 percent of facilities focused on mental health services had such programs or groups.

Pregnant/postpartum women

Programs or groups for pregnant/postpartum women were offered by 19 percent of facilities. These programs were most likely to be available in local, tribal, and State government facilities (29 percent, 24 percent, and 22 percent, respectively). They were least likely to be offered by private for-profit facilities (14 percent) and Federal government facilities (9 percent). Among Federal government facilities, however, this ranged from 4 percent of VA facilities to 39 percent of Indian Health Service facilities. Only 8 percent of facilities focused on the provision of mental health services had programs or groups for pregnant/postpartum women.

Women only

Special programs or groups for women only (other than pregnant/postpartum women) were offered in 38 percent of all facilities. Like programs for pregnant/postpartum women, these were most likely to be available in local and State government facilities (47 percent and 43 percent, respectively), and least likely to be offered in Federal government facilities (23 percent) and private for-profit facilities (30 percent). Facilities focused on mental health services (17 percent) or general health care (23 percent) were least likely to have programs or groups for women only.

Men only

Special programs or groups for men only were available in 30 percent of all facilities. Among tribal government facilities, they were available in 38 percent. Programs or groups for men only were least likely to be available in Federal government-owned and private for-profit facilities (17 percent and 26 percent, respectively). About one-third (34 percent) of facilities focused on substance abuse treatment had programs or groups for men only, compared to 18 percent of facilities focused on general health care and 12 percent of facilities focused on mental health services.

Seniors/older adults

Fourteen percent of all facilities provided programs or groups for seniors/older adults. Facilities most likely to have this type of program were tribal government-owned facilities (27 percent), Federal government-owned facilities (22 percent), and private for-profit facilities (17 percent). Among Federal government facilities, the proportion ranged from 8 percent of Department of Defense facilities to 50 percent of Indian Health Service facilities. Twenty-one percent of facilities focused on general health care had programs or groups for seniors/older adults, as did 18 percent of facilities whose focus was a mix of mental health and substance abuse treatment services. In comparison, 12 percent of facilities focused on providing substance abuse treatment services had programs or groups for seniors/older adults.

DUI/DWI offenders

Special programs or groups for DUI/DWI offenders were offered by 35 percent of all facilities. Half (50 percent) of private for-profit facilities had such programs, as did 46 percent of tribal government facilities and 39 percent of local government-owned facilities. Facilities operated by the Federal government and private non-profit facilities were least likely to have programs or groups for DUI/DWI offenders (27 percent and 29 percent, respectively). Among Federal government facilities, however, the proportion ranged from 18 percent of Indian Health Service facilities to 40 percent of Department of Defense-owned facilities. Almost half (45 percent) of facilities with a mixed focus on mental health and substance abuse treatment services had programs or groups for DUI/DWI offenders, compared to 20 percent of those focused on general health care and 26 percent of those focused on mental health services.

Other criminal justice clients

Thirty-five percent of all facilities offered programs or groups for criminal justice clients. (Facilities treating incarcerated persons only were excluded from this report; see Chapter 1.) Forty-three percent of local government-owned facilities had such programs, compared with 9 percent of Federally- owned facilities and 28 percent of facilities operated by tribal governments. Among Federal government facilities, however, the proportion ranged from 5 percent of VA facilities to 32 percent of Indian Health Service facilities. Thirty-nine percent of facilities with a mixed focus on mental health and substance abuse treatment services had programs or groups for criminal justice clients, compared to 15 percent of those primarily focused on providing general health care and 19 percent of those focused primarily on mental health services.

Services Offered

Facilities were asked about the types of services they offered. Services were grouped into six broad categories. (See Appendix A, the 2002 N-SSATS Questionnaire, Question 10, for services within each category.)

The majority of facilities offered one or more services in each category. Overall, substance abuse therapy and counseling was offered by the largest proportion of facilities (99 percent). The availability of most specific services varied somewhat by ownership/operation and primary focus. Differences were most apparent in testing and transitional services.

Tables 3.10a and 3.10b. In general, fewer private for-profit facilities than private non-profit or government-owned facilities offered a range of testing and transitional services. Private for-profit facilities were also less likely to provide services such as child care and transportation assistance than were private non-profit, Federal, State, and local government-owned facilities. Tribal government facilities were the least likely to offer testing services. Private non-profit facilities were least likely to provide pharmacotherapy services.

Tables 3.11a and 3.11b. Facilities focused on the provision of substance abuse treatment services were much less likely to provide comprehensive mental health assessment/diagnosis than they were to provide comprehensive substance abuse assessment/diagnosis. Facilities with a focus on general health care were more likely to provide testing than other facilities. Overall, facilities whose primary focus was mental health services were less likely than other facilities to offer testing, transitional, or other services such as HIV/AIDS counseling or child care.

Services for the Hearing Impaired or in Languages Other than English

Table 3.12. Substance abuse treatment services in sign language for the hearing impaired were offered in 25 percent of all facilities. Facilities operated by State and local governments were most likely to offer these services (35 percent and 44 percent, respectively), while Federal, tribal, and private for-profit facilities were the least likely to offer these services (12 percent, 13 percent, and 14 percent, respectively).

Substance abuse treatment services in a language other than English (including American Indian/Alaska Native languages) were provided in 40 percent of all facilities. Half of facilities operated by local governments had these services, as did 39 percent of tribal government and Indian Health Service facilities. There was little variation by primary focus of the facility, although facilities focused on mental health services were the least likely to provide treatment in languages other than English (34 percent).

Substance abuse treatment services were available in a wide range of languages, but Spanish was the most common secondary language. Treatment services in Spanish were offered in 37 percent of all facilities. Treatment services in American Indian/Alaska Native languages were offered in 2 percent of facilities overall, but in 39 percent of facilities operated by the Indian Health Service and 36 percent of tribal government-owned facilities.

Payment Options

Tables 3.13a and 3.13b. Cash/self-payment and private insurance were the most widely accepted forms of payment for substance abuse treatment (accepted by 90 percent and 68 percent of facilities, respectively). Medicaid was accepted by more than half of all facilities (53 percent). Medicare, Federal military insurance, and State-financed health insurance were each accepted by about one-third of all facilities (35 percent, 32 percent, and 32 percent, respectively).

The type of payment accepted varied considerably by ownership/operation. Facilities operated by State and local governments generally had a wide range of payment options. Federal government-owned facilities (predominantly operated by the VA and Department of Defense) were the least likely to accept State-financed health insurance and the most likely to accept Federal military insurance. Private for-profit facilities were less likely to accept public payment sources such as Medicare, Medicaid, or State-financed health insurance than were private non-profit facilities.

Facilities focused on the provision of substance abuse treatment were less likely than other facilities to accept payment options other than cash/self-payment; 21 percent accepted Medicare and Federal military insurance, 26 percent accepted State-financed health insurance, 46 percent accepted Medicaid, and 60 percent accepted private insurance.

A sliding fee scale for substance abuse treatment was offered by 65 percent of all facilities. The sliding fee scale was most likely to be offered in State and local government-owned facilities (74 percent and 82 percent, respectively). It was least likely to be offered in Federally-owned and tribal government facilities (20 percent and 30 percent, respectively). Facilities with a primary focus on general health care were less likely than other facilities to offer a sliding fee scale (42 percent).

Facility Licensing, Approval, Certification, or Accreditation

Facilities were asked whether they were licensed, approved, certified, or accredited by various organizations. These included the State substance abuse agency, State mental health department, State public health department or board of health, hospital licensing authority, or other State/local agency or organization. Also included were accreditation organizations: the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Rehabilitation Accreditation Commission (CARF), the National Committee for Quality Assurance (NCQA), and Council on Accreditation for Children and Family Services (COA).

Tables 3.14a and 3.14b. Overall, 95 percent of facilities were licensed, certified, etc., by one or more of the listed agencies and organizations. Most facilities (82 percent) named the State substance abuse agency, 34 percent listed the State mental health department, and 31 percent listed the State public health department/board of health. Thirteen percent reported licensing, certification, etc., by a State or local agency or organization that was not listed. Accreditation by JCAHO was reported by 24 percent of facilities, but accreditation by CARF, the COA, or the NCQA were relatively rare (11 percent, 4 percent, and 2 percent, respectively).

Facility Administrative and Funding Characteristics

Facilities were asked several questions about administrative and funding characteristics. These included whether the facility was part of an organization with multiple facilities or sites; whether the facility had agreements or contracts with managed care organizations for the provision of substance abuse treatment services; and whether the facility received Federal, State, county, or local government funds for the provision of substance abuse treatment.

Table 3.15. About two-thirds (68 percent) of all facilities reported that they were part of an organization with multiple facilities or sites. This proportion was 74 percent for private non-profit facilities, compared to 55 percent of private for-profit facilities. Facilities focused on general health care services were less likely than other facilities to be part of an organization with multiple sites (51 percent).

Just over half of all facilities (51 percent) reported that they had agreements or contracts with managed care organizations for the provision of substance abuse treatment services. In general, government-owned facilities were less likely to have such agreements or contracts than were privately-owned facilities (41 percent or less, compared to 53 percent or more). Facilities focus on provision of mental health services or a mix of mental health and substance abuse services were most likely to have agreements or contracts with managed care organizations (58 percent and 60 percent, respectively.)

Two-thirds (67 percent) of all facilities received Federal, State, county, or local government funds for the provision of substance abuse treatment services. Government-owned and private non-profit organizations were more likely to receive these funds than were private for-profit facilities (67 percent or more, compared to 27 percent). Facilities focused on substance abuse treatment or a mix of mental health and substance abuse services were most likely to receive public funds (70 percent and 66 percent, respectively.)

Tables