Chapter 2
Trends in Facility Characteristics
This chapter presents trends in facility characteristics for 1997 to 2003. It should be kept in mind, however, that the facility universe, methods, and survey instrument have changed during this period. These changes are detailed in Appendix C.
Table 2.1. The number of reporting facilities increased by 25 percent between 1997 and 2003, from 10,860 in 1997 to 13,623 in 2003. The increase is most likely due to improved survey methodology rather than to an actual increase in the number of facilities. The principal improvements were an increase in the response rate from 86 percent in 1997 to 96 percent in 2003, and an extensive effort to improve the coverage of the facility universe. (See Appendix C).
Table 2.1 and Figure 1. Facilities are described in terms of operation, that is, the type of entity responsible for the operation of the facility: private for-profit; private non-profit; or government—local, county, or community; State; Federal; or tribal. Despite year-to-year fluctuations in the number of facilities reporting, the operational structure of the treatment system (as reflected in the N-SSATS facility operation data) changed very little from 1997 to 2003.
Facilities operated by private non-profit organizations made
up the bulk of the system (61 percent of all facilities) on March 31, 2003,
compared to 60 percent in 1997. Private for-profit facilities increased from 24
percent of all facilities in 1997 to 28 percent in 1998, then fell to between 25
and 26 percent from 1999 through 2003. Fluctuations in the proportion of
private-for-profit facilities are probably because of SAMHSA’s efforts to expand
survey coverage to these facilities, followed by the decision to exclude solo
practitioners that were not State agency-approved. Facilities operated by local
governments accounted for 8 percent of all facilities in 2003 and 7 percent in
1997. The proportions of facilities operated by State, Federal, and tribal
governments remained unchanged between 1997 and 2003, at 4 percent, 3 percent,
and 1 percent, respectively.
| Figure 1 Facility Operation: 1997-2003 |
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| SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Uniform Facility Data Set (UFDS), 1997-1999; National Survey of Substance Abuse Treatment Services (N-SSATS), 2000, 2002-2003. |
Table 2.2 and Figure 2. The major types of care offered
by facilities—outpatient, non-hospital residential, and hospital
inpatient—remained relatively stable between 1997 and 2003. On March 31, 2003,
80 percent of all facilities offered outpatient treatment, 28 percent offered
non-hospital residential treatment, and 7 percent offered hospital inpatient
treatment. (Percents sum to more than 100 percent because a facility could offer
more than one type of care.) In 1997, in comparison, 78 percent of all
facilities offered outpatient treatment, 28
percent offered non-hospital residential treatment, and 10 percent offered
hospital inpatient treatment.
| Figure 2 Type of Care Offered: 1997-2003 |
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| SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Uniform Facility Data Set (UFDS), 1997-1999; National Survey of Substance Abuse Treatment Services (N-SSATS), 2000, 2002-2003. |
Facilities with Opioid Treatment Programs
Table 2.2 and Figure 2. In 2003, a total of 1,067
facilities (8 percent of all facilities) reported that they dispensed methadone
or levo-alpha acetyl methadol (LAAM) as part of an Opioid Treatment Program (OTP)
certified by the Center for Substance Abuse Treatment (CSAT), SAMHSA. Prior to
May 18, 2001, such programs required approval by the Food and Drug
Administration (FDA). Through 2000, the survey counted all facilities reporting
that they dispensed methadone or LAAM. In 2002 and 2003, only those facilities
that were certified as OTPs by CSAT, SAMHSA, were included.
Managed Care
Table 2.3 and Figure 3. In general, the term "managed care" refers to the prepaid health care sector (e.g., HMOs) where care is provided under a fixed budget within which costs are "managed." Fifty-one percent of facilities had agreements or contracts with managed care organizations in 2003, compared to 46 percent in 1997. The percentage of facilities with managed care agreements or contracts generally fell between 1997 and 1998, but increased between 1998 and 1999 for all facility operation categories. Between 1999 and 2003, however, the proportion of facilities with managed care agreements or contracts generally stabilized or declined slightly. Private non-profit and private for-profit facilities had the highest proportion of facilities with managed care agreements or contracts on March 31, 2003, at 54 percent and 53 percent , respectively. Among local and State government-operated facilities, 41 percent and 38 percent, respectively, had managed care agreements or contracts. Facilities operated by Federal or tribal governments were least likely to have agreements or contracts with managed care organizations, at 19 percent and 21 percent, respectively.
| Figure 3 Facilities with Managed Care Contracts, by Facility Operation: 1997-2003 |
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| SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Uniform Facility Data Set (UFDS), 1997-1999; National Survey of Substance Abuse Treatment Services (N-SSATS), 2000, 2002-2003. |
Programs or Groups for Specific Client Types
Table 2.4 and Figure 4. Facilities may offer treatment programs or groups designed to address the specific needs of certain client types. These client types include adolescents, clients with co-occurring mental and substance abuse disorders, persons with HIV or AIDS, gays or lesbians, seniors or older adults, pregnant or postpartum women, women, and men. Data on programs or groups for adolescents, clients with co-occurring mental and substance abuse disorders, persons with HIV or AIDS, and pregnant or postpartum women have been collected since 1997. A question on the provision of programs or groups for women was added in 1998, and questions on programs or groups for gays or lesbians, seniors or older adults, and men were added in 2000.
In response to concerns about over-reporting of special programs or groups, the question was revised in the 2003 survey to distinguish between those facilities that accepted specific client types and those facilities that had specially designed programs or groups for that client type. As a consequence, the number and proportion of facilities offering programs or groups for each of the specified client types decreased in 2003. The numbers from the 2003 survey are believed to be a more accurate representation of the number of facilities providing special programs for the specific client types.
Special programs or groups for women and for clients with
co-occurring mental health and substance abuse disorders were each reported by
35 percent of facilities. One-third of facilities offered special programs for
DUI/DWI offenders (33 percent) and for adolescent clients (32 percent).
Twenty-seven percent of facilities offered special programs or groups for men
and for criminal justice clients. Less frequently offered were programs or
groups for pregnant or postpartum women (14 percent of facilities), persons with
HIV or AIDS (11 percent of facilities), seniors or older adults (7 percent of
facilities), and gays or lesbians (6 percent of facilities).
| Figure 4 Facilities with Programs or Groups for Specific Client Types: 1997-2003 |
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| SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Uniform Facility Data Set (UFDS), 1997-1999; National Survey of Substance Abuse Treatment Services (N-SSATS), 2000, 2002-2003. |