|Number of Facilities
||Type of Care Offered|
|Facilities with Opioid Treatment Programs
||Programs or Groups for Specific Client Types|
This chapter presents trends in facility characteristics for 2000 to 2005 (no survey was conducted in 2001). 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.
Number of Facilities
Table 2.1. Between 2000 and 2005 the total number of facilities remained relatively constant, although there was considerable turnover from year to year in the reporting facilities. Between 2000 and 2005, the majority (between 81 and 90 percent) of the facilities responding to a given survey had also responded to the previous survey. However, between 10 percent and 19 percent of responding facilities were new each survey year, and between 11 percent and 20 percent of the facilities responding to a given survey had closed or were no longer providing substance abuse treatment by the following survey year.
Between 2004 and 2005, the number of facilities declined by 83 (less than 1 percent), from 13,454 in 2004 to 13,371 in 2005. Of these facilities, 11,979 (90 percent of the 2005 facilities) were in both the 2004 and 2005 surveys, 1,392 new facilities (10 percent of the 2005 facilities) were added between the 2004 and 2005 surveys, and 1,475 of the 2004 facilities (11 percent) had closed or were no longer providing substance abuse treatment in 2005.
Table 2.2 and Figure 1. Facilities are described in terms of operation, that is, the type of entity responsible for the operation of the facility: private non-profit; private for-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 substance abuse treatment system (as reflected in the N-SSATS facility operation data) changed very little from 2000 to 2005.
Facilities operated by private non-profit organizations made up the bulk of the treatment system, ranging from 59 to 61 percent of all facilities between 2000 and 2005, and were at 59 percent on March 31, 2005. Private for-profit facilities made up from 24 to 27 percent of all facilities between 2000 and 2005, and were at 27 percent on March 31, 2005. Facilities operated by local governments accounted for 7 to 8 percent of all facilities between 2000 and 2005, and State governments accounted for 3 percent. The proportions of facilities operated by Federal and tribal governments were unchanged between 2000 and 2005, at 2 percent and 1 percent, respectively, on March 31, 2005.
Type of Care Offered
Table 2.3 and Figure 2. The proportion of facilities offering the major types of care—outpatient, non-hospital residential, and hospital inpatient—changed very little between 2000 and 2005. On March 31, 2005, 81 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 2000, 82 percent of all facilities offered outpatient treatment, 27 percent offered non-hospital residential treatment, and 8 percent offered hospital inpatient treatment.
Facilities with Opioid Treatment Programs
Table 2.3 and Figure 2. In 2005, a total of 1,069 facilities (8 percent of all facilities) reported that they operated an Opioid Treatment Program (OTP) certified by the Substance Abuse and Mental Health Services Administration. This was a decrease from 9 percent in 2000. OTPs provide medication-assisted therapy with methadone and buprenorphine, the only two opioid medications approved for the treatment of opioid addiction.
Table 2.4 and Figure 3. In general, the term “managed care” refers to the prepaid health care sector where care is provided under a fixed budget within which costs are “managed.” Between 2000 and 2005, the proportion of facilities with managed care agreements or contracts generally declined. Forty-seven percent of facilities had agreements or contracts with managed care organizations in 2005, a decline from 54 percent in 2000. Private non-profit and private for-profit facilities had the highest proportions of facilities with managed care agreements or contracts on March 31, 2005, at 50 percent each. These represented declines from 56 percent each in 2000. Managed care agreements or contracts also declined among government-operated facilities, from 44 percent, 36 percent, and 23 percent in local, State, and Federal government-operated facilities, respectively, in 2000 to 36 percent, 33 percent, and 13 percent, respectively, on March 31, 2005. In contrast, the proportion of facilities operated by tribal governments remained the same at 27 percent between 2000 and 2005.
Programs or Groups for Specific Client Types
Table 2.5 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, criminal justice clients (other than DUI/DWI), persons with HIV or AIDS, gays or lesbians, seniors or older adults, adult women, pregnant or postpartum women, adult men, and DUI/DWI offenders.
In response to concerns about over-reporting of special programs or groups, the 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 that client type. As a consequence, the number and proportion of facilities offering programs or groups for each of the specified client types decreased after 2002. The numbers from the 2003 to 2005 surveys are believed to be a more accurate representation of the number of facilities providing special programs for the specific client types.
On March 31, 2005, special programs or groups for clients with co-occurring mental health and substance abuse disorders were reported by 38 percent of facilities. Thirty-three percent of the facilities offered special programs for adult women, 32 percent for adolescents, and 31 percent for DUI/DWI offenders. Twenty-eight percent of facilities offered special programs or groups for criminal justice clients and 25 percent for adult men. Facilities less frequently offered programs or groups for pregnant or postpartum women (14 percent), persons with HIV or AIDS (11 percent), seniors or older adults (7 percent), and gays or lesbians (6 percent).
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