Chapter 4

Facility Characteristics and Services

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Facility Operation and Primary Focus

Type of Care Offered

Client Substance Abuse Problem Treated

Facilities with Opioid Treatment Programs (OTPs)

Facility Size

Facility Capacity and Utilization Rates

Programs or Groups for Specific Client Types

Adolescents
Clients with co-occurring disorders
Criminal justice clients
Persons with HIV or AIDS
Gays or lesbians
Seniors or older adults
Pregnant or postpartum women
Women
Men
DUI/DWI offenders


 

Services Offered

Services in Sign Language for the Hearing Impaired and in Languages Other than English

Payment Options

Facility Licensing, Certification, or Accreditation

Facility Funding

Client Outreach


 


This chapter describes key characteristics of facilities and programs in 2003. 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. They are also described in terms of the facility’s primary focus: substance abuse treatment services, mental health services, a mix of mental health and substance abuse treatment services, general health care, and other.

Facility Operation and Primary Focus

Table 4.1. Overall, 61 percent of facilities reported that providing substance abuse treatment services was their primary focus of activity. Slightly more than one-quarter (26 percent) of all facilities considered a mix of mental health and substance abuse treatment services to be their primary focus. Nine percent of all facilities reported the provision of mental health services as their primary focus, while 2 percent focused on general health care.

Private organizations were most likely to regard provision of substance abuse treatment services as their primary focus (64 percent of for-profit organizations and 62 percent of non-profit organizations, compared with 50 to 60 percent of government-operated facilities). State, local, and tribal government-operated facilities had higher proportions of facilities providing a mix of mental health and substance abuse treatment services, about one-third of facilities at each level of government, compared with 27 percent of private for-profit facilities and 25 percent of private non-profit and Federal government-operated facilities. The Federal government had the largest proportion of facilities (19 percent) that reported a general health care focus. The large number of facilities operated by the Department of Veterans Affairs (VA) greatly influenced this—among facilities operated by the VA, most of which are hospital-based,1 29 percent reported a focus on general health care.


1
Of the 196 facilities operated by the VA, 166 (85 percent) reported that they were located in or operated by a hospital [data not shown].

Type of Care Offered

Tables 4.2a and 4.2b. Outpatient treatment was the most widely available type of care, offered by 80 percent of all facilities. Outpatient treatment was most likely to be available in facilities operated by the Federal government (96 percent), private for-profit organizations and facilities operated by tribal governments (91 percent each), and facilities operated by local governments (88 percent). Outpatient services were most likely to be available in facilities providing a mix of mental heath and substance treatment services, at 90 percent.

Regular and intensive outpatient care were offered by 73 percent and 43 percent of all facilities, respectively. Sixteen percent of all facilities provided outpatient day treatment or partial hospitalization programs.

Outpatient detoxification was offered at 11 percent of facilities. Outpatient detoxification was most likely to be offered by facilities operated by the Federal government (40 percent), largely because half (50 percent) of VA-operated facilities provided outpatient detoxification. Outpatient detoxification was also relatively widely available in private for-profit organizations (17 percent).

Outpatient methadone or LAAM maintenance was offered at 7 percent of facilities. Outpatient methadone or LAAM maintenance was most likely to be offered by facilities operated by private for-profit organizations (13 percent). Outpatient methadone or LAAM maintenance was also relatively widely available in facilities operated by the Federal government (12 percent), largely because 20 percent of VA-operated facilities provided outpatient methadone or LAAM maintenance.

Non-hospital residential treatment was offered by 28 percent of all facilities. Non-hospital residential treatment was most likely to be available in facilities operated by private non-profit organizations (36 percent of these facilities), and in facilities focusing on the provision of substance abuse treatment services (36 percent).

Non-hospital residential long-term treatment (more than 30 days) was offered by 23 percent of facilities. Twelve percent offered non-hospital residential short-term care (30 days or less), and 7 percent offered non-hospital residential detoxification.

Hospital inpatient treatment was offered by 7 percent of facilities. Hospital inpatient treatment was most likely to be available in facilities operated by Federal and State governments (21 percent and 14 percent, respectively). Hospital inpatient treatment was available at 44 percent of facilities with a general health care focus, and at 15 percent of facilities focused on the provision of mental health services.

Hospital inpatient detoxification was offered by 7 percent of all facilities, and hospital inpatient treatment by 5 percent of all facilities.

Client Substance Abuse Problem Treated

Table 4.3. Almost all facilities (93 percent) had clients in treatment for both alcohol and drug abuse on March 31, 2003. Over three-quarters had clients in treatment for abuse of alcohol alone (79 percent) and for abuse of drugs alone (78 percent). These proportions were relatively constant across facility operation 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 (CSAT), 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 (FDA).

Table 4.4. OTPs were available at 8 percent of all substance abuse treatment facilities on March 31, 2003 [Table 2.2]. Private for-profit facilities operated 42 percent of all OTPs, although they operated only 25 percent of all substance abuse treatment facilities [Table 4.1]. Over half (55 percent) of all OTPs provided both maintenance and detoxification. Thirty-four percent provided maintenance only, and 12 percent provided detoxification only.

Facilities with OTPs were likely to be dedicated entirely or almost entirely to treatment with methadone or LAAM. Overall, 85 percent of clients in facilities with OTPs were receiving methadone or LAAM on March 31, 2003. This proportion was highest (94 percent) in private for-profit facilities and in facilities focused on the provision of substance abuse treatment services (89 percent).

Facility Size

Table 4.5. The median number of clients in substance abuse treatment at a facility on March 31, 2003, 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, from a median of 1 client in outpatient detoxification to 28 clients in regular outpatient care and 185 clients receiving outpatient methadone or LAAM maintenance. In facilities offering non-hospital residential care, the median number of clients in treatment on March 31, 2003, was 18. In hospital inpatient facilities, the median number of clients was 9.

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 54 clients in treatment on March 31, 2003. This was due to the large number of clients in treatment at VA facilities, which had a median of 92 clients in treatment on that date.

The median number of clients also varied according to primary focus of the facility. In facilities with a primary focus on the provision of substance abuse treatment services, the median number of clients in treatment was 45. In contrast, facilities focused on the provision of mental health services had a median of 22 clients in treatment.

Table 4.6. Facilities with a primary focus on the provision of substance abuse treatment services tended to be larger than other facilities. Some 22 percent of these facilities had 120 or more clients in treatment on March 31, 2003. In contrast, only 8 percent of facilities focused on the provision of mental health services were that large, and 37 percent had fewer than 15 clients in treatment on that date. Facilities with a general health care focus also tended to be smaller, with 37 percent having fewer than 15 clients in treatment on March 31, 2003.

Facility Capacity and Utilization Rates

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 non-hospital residential or hospital inpatient clients by the number of non-hospital 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 4.7. Some 3,526 facilities reported having 110,772 non-hospital residential beds designated for substance abuse treatment. On March 31, 2003, 94 percent of all non-hospital residential beds designated for substance abuse treatment were in use.2 Utilization rates ranged from 89 percent in non-hospital residential facilities operated by private for-profit organizations and tribal governments to 109 percent in non-hospital residential facilities operated by State governments.

Table 4.8. Some 888 facilities reported having 13,830 hospital inpatient beds designated for substance abuse treatment. On March 31, 2003, 80 percent of all hospital inpatient beds designated for substance abuse treatment were in use.3 Utilization rates ranged from 72 percent in hospital inpatient facilities operated by local governments to 233 percent in hospital inpatient facilities operated by tribal governments. Facilities focused on the provision of mental health services had a utilization rate of 94 percent, well above the overall utilization rate of 80 percent.

Figure 9 and Tables 4.7 and 4.8 show the distribution of the facility-level utilization rates separately for non-hospital residential and hospital inpatient beds. Facilities with non-hospital residential beds had generally higher utilization rates than facilities with hospital inpatient beds. Fifty-six percent of facilities with non-hospital residential beds had utilization rates of 91 to 100 percent. Only 29 percent of facilities with hospital inpatient beds had utilization rates in that range, and 25 percent had utilization rates of 50 percent or less. About 12 percent of hospital inpatient facilities and 8 percent of non-hospital residential facilities had utilization rates over 100 percent.


2
Non-hospital residential utilization rates are based on a subset of 3,204 facilities that reported for themselves alone and that reported numbers greater than zero for both designated beds and clients.
3 Hospital inpatient utilization rates are based on a subset of 583 facilities that reported for themselves alone and that reported numbers greater than zero for both designated beds and clients.


 

Figure 9
Non-Hospital Residential and Hospital Inpatient Utilization Rates:
March 31, 2003
Figure 9, Non-Hospital Residential and Hospital Inpatient Utilization Rates:
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

Facilities may offer treatment programs or groups designed to address the specific needs of specific client types. These client types include adolescents, clients with co-occurring mental health and substance abuse disorders, persons with HIV or AIDS, gays or lesbians, and pregnant or postpartum women. Special programs or groups may also be offered for women, for men, and for seniors or 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.

In response to concerns about over-reporting of special programs or groups, the survey question was revised in 2003 to distinguish between those facilities that accepted specific client types and those facilities that had specially designed programs or groups for each client type. Although the number and proportion of facilities offering programs or groups for each of the specified client types decreased in 2003 in comparison with previous years, 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.

Tables 4.9a and 4.9b. These tables indicate the proportions of facilities that accept each client type into treatment. Most facilities accepted most client types. Acceptance ranged from 82 percent accepting pregnant or postpartum women to 96 percent accepting gays or lesbians. Adolescents were the exception—they were accepted as clients in only 52 percent of facilities.

Tables 4.10a and 4.10b. These tables indicate the proportions of facilities that offered specially designed substance abuse treatment programs or groups exclusively for specific client types. Overall, 84 percent of facilities offered special programs or groups directed at a specific client type. This proportion was fairly consistent across operating organizations, with the exception of the Federal government, where only two-thirds (67 percent) of facilities had programs or groups designed for specific client types. Facilities focused on general health care also had a relatively low availability of such programs, at 64 percent, as did facilities focused on the provision of mental health services (73 percent).

Adolescents

Thirty-two percent of facilities offered programs or groups for adolescents. The highest proportions of adolescent programs were found in facilities operated by tribal governments (50 percent) or local governments (36 percent). Programs or groups for adolescents were available in 42 percent of facilities whose focus was the provision of a mix of mental health and substance abuse treatment services.

Clients with co-occurring disorders

Overall, 35 percent of all facilities provided programs or groups for clients with co-occurring mental health and substance abuse disorders. These services were most likely to be provided in government-operated facilities. They were offered in 46 percent of State-operated facilities, 42 percent of Federally-operated facilities, and in 40 percent of local government-operated facilities.

Facilities whose focus was provision of mental health services or a mix of mental health and substance abuse treatment services were most likely to offer programs or groups for clients with co-occurring disorders, at 44 percent and 52 percent, respectively.

Criminal justice clients

Twenty-seven percent of all facilities provided programs or groups for criminal justice clients other than DUI/DWI offenders. (Facilities treating incarcerated persons only were excluded from this report; see Chapter 1.) Thirty percent of both private for-profit and local government facilities had such programs. Twenty-nine percent of facilities with a mixed focus on provision of mental health and substance abuse treatment services had programs or groups for criminal justice clients.

Persons with HIV or AIDS

Eleven percent of facilities offered programs or groups for persons with HIV or AIDS. Facilities operated by State governments were most likely to offer such programs (15 percent). Among facilities focused on provision of substance abuse treatment services, 12 percent offered programs or groups for persons with HIV or AIDS, compared with 10 percent of facilities focused on providing general health care.

Gays or lesbians

Special programs or groups for gays or lesbians were available in 6 percent of all facilities. They were most likely to be offered in private for-profit facilities (7 percent). Eight percent of facilities whose primary focus was provision of a mix of mental health and substance abuse treatment services had programs for gays and lesbians, while only 2 percent of facilities focused on mental health services had such programs or groups.

Seniors or older adults

Seven percent of all facilities provided programs or groups for seniors or older adults. Facilities most likely to have this type of program were Federal and tribal government-operated facilities (12 percent and 11 percent, respectively). Ten percent of facilities focused on provision of a mix of mental health and substance abuse treatment services had programs or groups for seniors or older adults, as did 9 percent each of facilities whose focus was general health care or mental health services.

Pregnant or postpartum women

Programs or groups for pregnant or postpartum women were offered by 14 percent of all facilities. These programs were most likely to be available in local government facilities (22 percent). Among facilities focused on the provision of substance abuse treatment services, 15 percent offered programs or groups for pregnant or postpartum women, compared with only 7 percent of facilities focused on providing general health care and 4 percent of facilities focused on mental health services.

Women

Special programs or groups for women were offered in 35 percent of all facilities. These were most likely to be available in State and local government facilities (44 percent and 39 percent, respectively). Similarly, 40 percent of facilities focused on provision of substance abuse treatment services had programs or groups for women.

Men

Special programs or groups for men were available in 27 percent of all facilities. One-third (32 percent) of tribal government facilities had programs or groups for men. Similarly, about one-third (30 percent) of facilities focused on provision of substance abuse treatment services had programs or groups for men.

DUI/DWI offenders

Special programs or groups for DUI/DWI offenders were offered by 33 percent of all facilities. Almost half (49 percent) of private for-profit facilities had such programs, as did 36 percent of tribal government-operated facilities and 35 percent of local government-operated facilities. Programs or groups for DUI/DWI offenders were most likely to be offered by facilities providing a mix of mental health and substance abuse treatment services (41 percent).

Services Offered

Facilities were asked about the types of services they offered. Services were grouped into six broad categories. (See Appendix A, the 2003 N-SSATS Questionnaire, Question 10, for specific services within each category.)

The majority of facilities offered one or more of the specific services in each category, although the availability of services varied somewhat by facility operation and primary focus. Differences were most apparent in testing, transitional services, and other services.

Tables 4.11a and 4.11b. At least one of the assessment services was available in 95 percent of all facilities, and their availability differed little by facility operation. The exception was mental health assessment and diagnosis, which was more readily available in Federal, State, and local government-operated facilities (65 percent, 54 percent, and 52 percent, respectively) than in facilities operated by other entities.

Substance abuse therapy and counseling services, offered by 99 percent of all facilities, differed little by facility operation. Pharmacotherapies, available in 20 percent of all facilities, were far more readily available in Federal and State government-operated facilities (68 percent and 34 percent, respectively) than in facilities operated by other entities.

Testing services were available in 85 percent of all facilities. Good availability of a wide range of tests was most frequently found in State and Federal government-operated facilities, and least likely to be found in tribal government facilities. Similarly, facilities operated by private for-profit organizations were less likely than other facilities operated by other entities to offer any of the specific transitional or other services.

Tables 4.12a and 4.12b. The overall availability of assessment services (95 percent) differed little by facility focus. However, mental health assessment and diagnosis was far more readily available in facilities focused on provision of mental health services, a mix of mental health and substance abuse treatment services, and general health care (92 percent, 83 percent, and 74 percent, respectively) than in facilities primarily providing substance abuse treatment services (20 percent).

Although the overall availability of substance abuse therapy and counseling services (99 percent) differed little by primary focus, most specific services were less likely to be offered in facilities whose focus was the provision of mental health services or general health care than in other facilities. Pharmacotherapies, available in 20 percent of all facilities, were more readily available in facilities focused on provision of general health care (49 percent) or a mix of mental health and substance abuse treatment services (28 percent) than in facilities primarily providing substance abuse treatment services (16 percent).

Testing services were available in 85 percent of all facilities, and good availability of a wide range of tests was found in facilities whose focus was general health care (94 percent of these facilities offered testing) and least likely to be found in facilities focused on providing mental health services (61 percent). Similarly, facilities focused on providing mental health services were less likely than other facilities to offer many of the specific transitional and other services.

Services in Sign Language for the Hearing Impaired and in Languages Other than English

Table 4.13. Substance abuse treatment services in sign language for the hearing impaired were offered in 28 percent of all facilities. Facilities operated by local and State governments were most likely to offer these services (43 percent and 37 percent, respectively).

Substance abuse treatment services in a language other than English were provided in 44 percent of all facilities. Facilities operated by local governments were most likely, at 51 percent, to provide these services. Although substance abuse treatment services were available in a wide range of languages, Spanish was the most commonly reported language, with treatment services in Spanish offered by 40 percent of all facilities and 48 percent of facilities operated by local governments. Treatment services in American Indian/Alaska Native languages were offered in 2 percent of facilities overall. However, 50 percent of facilities operated by the Indian Health Service and 36 percent of facilities operated by tribal governments offered these services.

Payment Options

Tables 4.14a and 4.14b. Cash or 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). State-financed health insurance, Federal military insurance, and Medicare were each accepted by about one-third of all facilities (36 percent, 35 percent, and 35 percent, respectively).

A sliding fee scale for substance abuse treatment charges was used by 64 percent of all facilities. More than half (55 percent) of all facilities offered treatment at no charge to eligible clients who could not pay, and 4 percent provided treatment at no charge to all clients.

The type of payment accepted varied considerably by facility operation and primary focus. Facilities operated by local and State governments had relatively high proportions of acceptance of a wide range of payment options. They were most likely to use a sliding fee scale (82 percent and 72 percent, respectively), and to offer treatment at no charge to eligible clients who could not pay (71 percent and 75 percent, respectively). However, while 9 percent of State-operated facilities provided treatment at no charge to all clients, only 3 percent of facilities operated by local governments did so.

Private for-profit facilities were less likely than facilities operated by other entities to accept public payment sources such as Medicare, Medicaid, or other State-financed health insurance. They were less likely to use a sliding fee scale (50 percent) or to provide treatment at no charge to eligible clients who could not pay (26 percent). Treatment at no charge for all clients was provided by less than 1 percent of private for-profit facilities. In contrast, 30 percent of facilities operated by tribal governments provided treatment at no charge to all clients, and 89 percent provided treatment at no charge to eligible clients who could not pay.

Facilities focused on the provision of substance abuse treatment services were less likely than other facilities to accept payment options other than cash or self-payment—60 percent accepted private health insurance, 45 percent accepted Medicaid, 29 percent accepted other State-financed health insurance, 24 percent accepted Federal military insurance, and 21 percent accepted Medicare.

Facility Licensing, Certification, or Accreditation

Facilities were asked whether they were licensed, 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 4.15a and 4.15b. Overall, 95 percent of all facilities reported that they were licensed, certified, or accredited by one or more agencies or organizations. Most facilities (81 percent) named the State substance abuse agency, 34 percent listed the State mental health department, and 32 percent listed the State public health department/board of health. Accreditation by JCAHO was reported by 24 percent of facilities, but accreditation by CARF, COA, or NCQA were relatively rare (13 percent, 5 percent, and 3 percent, respectively).

Fourteen percent of all facilities reported licensing, certification, or accreditation by a State or local agency or organization that was not specifically included in the N-SSATS questionnaire. The proportion of facilities accredited by another organization than was listed in the questionnaire was relatively high for tribal government facilities (30 percent) and private for-profit facilities (16 percent).

Facility Funding

Facilities were asked several questions about sources of funding, including 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, or local government funds for the provision of substance abuse treatment.

Table 4.16. 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-operated facilities were less likely to have such agreements or contracts than were privately-operated facilities (41 percent or less, compared to 53 percent or more). Facilities providing a mix of mental health and substance abuse treatment services were most likely to have agreements or contracts with managed care organizations (62 percent), while facilities providing general health care were the least likely to have managed care agreements or contracts (45 percent).

Two-thirds (66 percent) of all facilities received Federal, State, or local government funds for the provision of substance abuse treatment services. Not surprisingly, government-operated and private non-profit organizations were more likely to receive these funds than were private for-profit facilities (69 percent or more, compared to 26 percent).

Client Outreach

Facilities were asked several questions about client outreach, including whether the facility operated a hotline responding to substance abuse problems, whether it had Internet access, and whether it had a web site providing information about its substance abuse treatment programs.

Table 4.17. One-quarter (25 percent) of all facilities reported that they operated a hotline responding to substance abuse problems. Hotlines were most likely to be operated by local and State government-operated facilities (40 percent and 31 percent, respectively). Higher proportions of hotline operation were reported by facilities providing mental health services or a mix of mental health and substance abuse treatment services (38 percent and 36 percent, respectively) than by facilities focused on providing substance abuse treatment services (20 percent).

Almost all facilities (89 percent) reported that they had access to the Internet. Half of all facilities (50 percent) had web sites providing information about their substance abuse treatment programs. These were most common among facilities operated by private non-profit organizations (57 percent). They were relatively uncommon (38 percent) among facilities operated by private for-profit organizations.

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