Chapter 4

Facility Characteristics and Services

Facility Operation and Primary Focus
Type of Care Offered
Client Substance Abuse Problem and Co-occurring Mental Health Disorders
Facility Size
Facility Capacity and Utilization Rates
Services Provided
Clinical/Therapeutic Approaches
Programs or Groups for Specific Client Types
Services in Sign Language for the Hearing Impaired and in Languages Other than English
Detoxification Services
Client Outreach
Facility Licensing, Certification, or Accreditation
Facility Standard Operating Procedures
Payment Options
Facility Funding
Facilities with Opioid Treatment Programs (OTPs)
Counseling offered by Facilities

This chapter outlines key characteristics of facilities and programs in 2009.

Facility Operation and Primary Focus

Table 4.1. Facilities were asked to designate the type of entity responsible for the operation of the facility. They were also asked to designate the facility’s primary focus of activity.

  • The proportions of all facilities by facility operation were:
    • Private non-profit organizations
    • Private for-profit organizations
    • Local, county, or community governments
    • State governments
    • Federal government9
    • Tribal governments
  • The proportions of all facilities by primary focus were:10
    • Substance abuse treatment services
    • Mix of substance abuse treatment and mental heath services
    • Mental health services
    • General health care
    • Other and unknown focus

 
58 percent
29 percent
6 percent
3 percent
3 percent
1 percent
 
61 percent
30 percent
6 percent
1 percent
1 percent

Type of Care Offered

Table 4.2b. Type of care offered was made up of three broad categories {outpatient, residential [non-hospital], and hospital inpatient}, each with several subcategories. A facility could offer more than one type of care. The proportions of all facilities offering the different types of care were:11

  • Outpatient treatment
    • Regular outpatient care
    • Intensive outpatient treatment
    • Outpatient day treatment/partial hospitalization
    • Outpatient detoxification
    • Outpatient methadone/buprenorphine maintenance
  • Residential (non-hospital) treatment
    • Long-term treatment (more than 30 days)
    • Short-term care (30 days or fewer)
    • Detoxification
  • Hospital inpatient treatment
    • Detoxification
    • Treatment

81 percent
74 percent
44 percent
13 percent
10 percent
12 percent
26 percent
21 percent
12 percent
7 percent
6 percent
5 percent
4 percent

Almost three quarters (74 percent) of private non-profit facilities provided outpatient care and more than one third (34 percent) provided residential (non-hospital) care. In contrast, 92 percent of private for-profit facilities provided outpatient care and 13 percent provided residential (non-hospital) care.

Client Substance Abuse Problem and Co-occurring Mental Health Disorders

Table 4.3. Facilities were asked to estimate the proportions of clients in treatment for both alcohol and drug abuse, for alcohol abuse only, and for drug abuse only. They were also asked to estimate the proportion of clients with diagnosed co-occurring substance abuse and mental health disorders.

Facility Size

Table 4.4. Facility size, that is, the median number of clients in substance abuse treatment at a facility on March 31, 2009, was 42 clients.

    • Outpatient treatment
      • Regular outpatient care
      • Intensive outpatient treatment
      • Outpatient day treatment/partial hospitalization
      • Outpatient detoxification
      • Outpatient methadone/buprenorphine maintenance
    • Residential (non-hospital) treatment
      • Long-term treatment (more than 30 days)
      • Short-term care (30 days or fewer)
      • Detoxification
    • Hospital inpatient treatment
      • Treatment
      • Detoxification

50 clients
30 clients
12 clients
3 clients
1 client 
105 clients
19 clients
16 clients
10 clients
3 clients
10 clients
6 clients
5 clients

Table 4.5. Facilities were sorted into five size groups based on the total number of clients in treatment on March 31, 2009. The smallest facilities were defined as having fewer than 15 clients and the largest as having 120 clients or more.

Facilities operated by the Federal government were generally larger than facilities operated by other entities—37 percent had 120 clients or more in treatment on March 31, 2009, compared to 22 percent of all facilities.

Facility Capacity and Utilization Rates

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

Table 4.6. Some 3,248 facilities reported having 110,795 residential (non-hospital) beds designated for substance abuse treatment on March 31, 2009. The utilization rate12 was 89 percent, and ranged from 82 percent in facilities operated by tribal government to 96 percent in facilities operated by the Federal government.

Table 4.7. Some 743 facilities reported having 12,829 hospital inpatient beds designated for substance abuse treatment on March 31, 2009. The utilization rate13 was 84 percent, and ranged from 75 percent in facilities operated by local governments to 113 percent in facilities operated by the Federal government. By facility focus, utilization rates ranged from 73 percent in facilities primarily focused on general health care to 289 percent in facilities focused on other types of services.

Tables 4.6 and 4.7 and Figure 7 show the distribution of facility-level utilization rates for residential (non-hospital) beds and for hospital inpatient beds. Facilities with residential (non-hospital) beds had generally higher utilization rates than facilities with hospital inpatient beds. Forty-eight percent of facilities with residential (non-hospital) beds had utilization rates of 91 to 100 percent, while 24 percent of facilities with hospital inpatient beds had utilization rates in that range.


Figure 7
Residential (Non-Hospital) and Hospital Inpatient Utilization Rates: March 31, 2009

Bar chart comparing Residential (Non-Hospital) and Hospital Inpatient Utilization Rates: March 31, 2009

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration,
National Survey of Substance Abuse Treatment Services (N-SSATS), 2005-2009.

Services Provided

Tables 4.8 and 4.9. Facilities were asked about the types of services they provided. Services were grouped into the six broad categories shown below.

Clinical/Therapeutic Approaches

Table 4.10. Facilities were asked to indicate whether they used any of 12 specific clinical/therapeutic approaches.

Programs or Groups for Specific Client Types

Table 4.11b. Facilities were asked about the provision of treatment programs or groups specially designed for specific types of client. Overall, 81 percent of facilities offered at least one special program or group to serve a specific client type.

  • The proportions of facilities providing special programs or groups were:
    • Clients with co-occurring mental health and substance abuse disorders
    • Adult women
    • Adolescents
    • Persons arrested for DUI or DWI
    • Other criminal justice clients14
    • Adult men
    • Pregnant or postpartum women
    • Persons with HIV or AIDS
    • Seniors or older adults
    • Gays or lesbians

 
36 percent
32 percent
28 percent
29 percent
26 percent
25 percent
13 percent
9 percent
6 percent
5 percent

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

Table 4.12b. Facilities were asked about the provision of substance abuse treatment services in sign language for the hearing impaired. They were also asked if treatment was provided in languages other than English, if this treatment was provided by a staff counselor or by an on-call interpreter, and in what languages staff counselors provided treatment.

Detoxification Services

Table 4.13. Facilities that provided detoxification services were asked to indicate whether they detoxified clients from specified substances, and whether medication was routinely used during detoxification.

  • The proportions of detoxification facilities providing detoxification from specific substances were:
    • Opiates
    • Alcohol
    • Benzodiazepines
    • Cocaine
    • Other substances
  • Medications were routinely used during detoxification in 77 percent of the facilities providing detoxification services.

 
85 percent
68 percent
60 percent
55 percent
14 percent

Client Outreach

Tables 4.14 and 4.9. Facilities were asked whether they had a website providing information about their substance abuse treatment programs.

Facility Licensing, Certification, or Accreditation

Facilities were asked to report licensure, certification, or accreditation by specified agencies or organizations. These included the State substance abuse agency, State mental health department, State department of health, hospital licensing authority, the Joint Commission, CARF, NCQA, COA, and other State or local agency or organization.15

Table 4.15b. Overall, 95 percent of all facilities reported that they were licensed, certified, or accredited by one or more agencies or organizations. The proportions of facilities reporting the specified agencies or organizations were:

  • State substance abuse agency
  • State department of health
  • State mental health department
  • Hospital licensing authority
  • Joint Commission
  • CARF
  • COA
  • NCQA
  • Another State or local agency or other organization

82 percent
41 percent
34 percent
7 percent
20 percent
22 percent
5 percent
3 percent
9 percent

Table 4.16b. Facility licensing, certification, or accreditation was associated with the type of care offered.

    • State department of health
    • Hospital licensing authority
    • Joint Commission
    • CARF
    • NCQA

72 percent
57 percent
81 percent
16 percent
12 percent

Facility Standard Operating Procedures

Table 4.17b. Facilities were asked to indicate whether they followed specified practices as part of their standard operating procedure. All the standard practices listed were used by two-thirds or more of all facilities.

    • Continuing education for staff
    • Regularly scheduled case review with a supervisor
    • Periodic client satisfaction surveys
    • Periodic client drug testing
    • Periodic utilization reviews
    • Case review by an appointed quality assurance committee
    • Post-discharge outcome follow-up

97 percent
94 percent
91 percent
85 percent
84 percent
70 percent
67 percent

Payment Options

Table 4.18b. Facilities were asked to indicate whether they accepted specified types of payment or insurance for substance abuse treatment. They were also asked about use of a sliding fee scale and if they offered treatment at no charge to clients who could not pay.

    • Cash or self-payment
    • Private health insurance
    • Medicaid
    • State-financed health insurance
    • Medicare
    • Federal military insurance

90 percent
63 percent
54 percent
38 percent
33 percent
32 percent

Facility Funding

Table 4.19. Facilities were asked if they received Federal, State, or local government funds or grants to support their substance abuse treatment programs.

Facilities with Opioid Treatment Programs (OTPs)

Opioid Treatment Programs (OTPs) are certified by SAMHSA to provide medication-assisted therapy in the treatment of opioid addiction. Currently, methadone and buprenorphine are the only opioid medications approved for the treatment of opioid addiction.

Counseling offered by Facilities

Table 4.23. Individual counseling was the most frequently reported form of counseling, by 96 percent of facilities and marital/couples counseling was reported least frequently, by 48 percent of facilities.


9 Data for the Federal agencies specified in the survey (the Department of Veterans Affairs, the Department of Defense, the Indian Health Service, and other unspecified Federal agencies) are detailed in the tables.
10 Percentages do not sum to 100 Percent because of rounding.
11 Facility percentages sum to more than 100 percent because a facility could provide more than one type of care.
12 Residential (non-hospital) utilization rates are based on a subset of 3,100 facilities that reported for themselves alone and that reported numbers greater than zero for both designated beds and clients.
13 Hospital inpatient utilization rates are based on a subset of 499 facilities that reported for themselves alone and that reported numbers greater than zero for both designated beds and clients.
14 Facilities treating incarcerated persons only were excluded from this report; see Chapter 1.
15 Joint Commission: formerly JCAHO (Joint Commission on Accreditation of Healthcare Organizations); CARF: formerly Commission on Accreditation of Rehabilitation Facilities; NCQA: National Committee for Quality Assurance; and COA: Council on Accreditation.
16 Available only in AK, AZ, CA, CO, CT, DC, FL, HI, IA, ID, IL, IN, LA, MI, MO, MT, NJ, NM, OH, OK, RI, TN, TX, WA, WI, and WY. See table 6.19a for number of facilities accepting ATRs by State.

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