the university of georgia adoption of innovative treatment techniques in public and private...

The University of Georgia

Adoption of Innovative Treatment Techniques

in Public and Private Substance Abuse Programs

Hannah K. Knudsen, Ph.D.

Paul M. Roman, Ph.D.

Meredith Huey, M.A.Center for Research on Behavioral Health

and Human Services Delivery

American Public Health Association, November 2004


The “Research to Practice” Gap

• There is ongoing concern in the substance abuse treatment field that the pace of innovation adoption is slow

• A growing literature is beginning to examine the organizational predictors of innovation adoption in these healthcare settings

• Key gaps in the research literature include:– Comparisons of public & private treatment facilities– Applications of broader organizational theory in this

context– Consideration of both aggregate innovativeness as

well as the processes underlying the adoption of specific innovations


Organizational Research on Innovation Adoption

• In the larger literature, most research focuses on individual innovations– Substance abuse treatment literature follows this pattern—

adoption of specific techniques, attitudes toward a given innovation, technology transfer within an organization

• Rogers’ concept of “organizational compatibility” is useful in understanding the adoption of particular innovations– There needs to be a “fit” between the characteristics of a given

innovation and the organization’s culture & structural resources

• The emphasis on individual innovations complicates the development of general theory about innovation adoption


Aggregate Innovation

• Some organizational theorists have called for research on aggregate measures of innovativeness– Such a measure usually involves an additive count of the

number of innovations adopted

• The goal of such research is to identify the broader organizational & managerial processes that increase an organization’s propensity to adopt innovations

• It allows for the development of theory that addresses the variation in innovation adoption


Aggregate Innovation and Absorptive Capacity

• Cohen & Levinthal (1990) define “absorptive capacity” as the extent to which an organization can procure, process, & assimilate information

• Three organizational behaviors that indicate greater absorptive capacity:– The employment of a professional workforce– Environmental scanning (the use of external sources of

information, e.g. journals, professional development)– Collection of satisfaction data from organizational

“buyers” and suppliers” (i.e. gathering information about unmet needs that could be addressed with innovations)


Absorptive Capacity:Applications in Substance Abuse

Treatment Organizations• Absorptive capacity may be a key organizational

resource that can support the adoption of innovations

• To date, absorptive capacity and aggregate innovation has only been examined in private treatment organizations (Knudsen & Roman, 2004)– It is unclear if the utility of this construct generalizes to the

public sector

• It is less clear if absorptive capacity will also have applicability to specific treatment innovations


Research Questions

• Is there variation in aggregate innovation across government-owned, public non-profits, private non-profits, and for-profits?

• Does absorptive capacity predict aggregate innovation in a sample of public & private treatment facilities?

• Is absorptive capacity associated with the adoption of specific innovations?– Buprenorphine– Naltrexone– Motivational incentives/vouchers (a.k.a. contingency

management)


Methods• Nationally representative samples of publicly funded and

private funded substance abuse treatment facilities (n = 746)

• Dependent variables– Aggregate Innovation: sum of 14 techniques (4 medications

and 9 psycho-social techniques) Mean = 4.60 (SD = 2.69)

– Buprenorphine Adoption: dichotomous measure of center currently uses vs. does not use

10.0% have adopted

– Naltrexone Adoption: dichotomous measure of center currently uses vs. does not use

30.4% have adopted

– Motivational Incentives Adoption: dichotomous measure of center currently uses vs. does not use

25.4% have adopted


Methods (continued)

• Absorptive Capacity• Workforce professionalism

– % Master’s-level counselors– % counselors in recovery– Physician resources (doctors on payroll, contract doctors,

no doctors as reference category)

• Environmental Scanning: additive index of five items of use of external information sources

• Collection of Satisfaction Data: sum of two items measuring data collected from referral sources & third party payers


Methods (continued)

• Organizational Characteristics– Center type: government-owned, publicly funded

non-profit, for-profit, privately funded non-profit (reference category)

– Size: natural log-transformed number of employees

– Age: natural log-transformed years

– Rural location: center in non-MSA county vs. center in MSA county

– Levels of care: inpatient-only, mixed inpatient & outpatient, outpatient-only (reference category)


Negative Binomial Regression: Aggregate Innovation

% Change

in Expected Count

% Change

in Expected Count

Government-Owned -21.6% NS

Publicly Funded Non-Profit -25.0% -12.3%

For-Profit -13.7% NS

Size ----- NS

Age ----- NS

Rural ----- NS

Inpatient-only ----- 14.2%

Mixed IP & OP ----- 24.4%

% Master’s Counselors ----- 0.2%

% Recovering Counselors ----- NS

Doctor On-Staff ----- 38.6%

Contract Physician ----- 25.8%

Environmental Scanning ----- 9.5%

Collection of Satisfaction Data ----- 8.3%


Logistic Regression: Buprenorphine Adoption

Odds Ratio Odds Ratio

Government-Owned .113 .155

Publicly Funded Non-Profit .224 .385

For-Profit NS NS

Size ----- NS

Age ----- NS

Rural ----- NS

Inpatient-only ----- NS

Mixed IP & OP ----- 2.306

% Master’s Counselors ----- NS


Doctor On-Staff ----- 3.497

Contract Physician ----- NS

Environmental Scanning ----- NS

Collection of Satisfaction Data ----- 1.681


Logistic Regression: Naltrexone Adoption


Government-Owned .301 .405

Publicly Funded Non-Profit .219 .332

For-Profit NS NS

Size ----- NS

Age ----- NS

Rural ----- NS


Mixed IP & OP ----- 1.951

% Master’s Counselors ----- 1.009


Doctor On-Staff ----- 2.048


Environmental Scanning ----- 1.270

Collection of Satisfaction Data ----- 1.260 (p=.06)


Logistic Regression: Motivational Incentives Adoption


Government-Owned 1.913 1.822

Publicly Funded Non-Profit 2.251 2.439

For-Profit .501 (p=.052) .449

Size ----- NS

Age ----- .695

Rural ----- NS


Mixed IP & OP ----- NS

% Master’s Counselors ----- NS


Doctor On-Staff ----- NS


Environmental Scanning ----- NS

Collection of Satisfaction Data ----- NS


Summary: Innovation & Center Type

• Innovation adoption varied by center type• Privately funded non-profits scored highest in

aggregate innovation, while publicly funded non-profits were the lowest– These differences largely mediated by absorptive

capacity & organizational characteristics

• Private sector more likely to adopt buprenorphine & naltrexone than public sector

• Public sector more likely to adopt motivational incentives– These differences persisted after controlling for

absorptive capacity & organizational characteristics


Summary: Absorptive Capacity• Measures of absorptive capacity worked well in the

model of aggregate innovation– Workforce professionalism, environmental scanning, and

collection of satisfaction data all significantly associated with aggregate innovation, net of organizational characteristics

• Absorptive capacity less useful in predicting adoption of specific innovations– Modest support for buprenorphine, clearer support for

naltrexone, and no support for motivational incentives

• Models of organizational compatibility—that look at “fit” between innovation’s characteristics and the organization’s culture/structure—may be more predictive of the adoption of specific innovations


Acknowledgements

• This research was supported by the National Institute on Drug Abuse (R01-DA-13110 and R01-DA-14482).

• More information about the National Treatment Center Study can be found online at http://www.uga.edu/ntcs

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