the university of georgia adoption of innovative treatment techniques in public and private...
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![Page 1: The University of Georgia Adoption of Innovative Treatment Techniques in Public and Private Substance Abuse Programs Hannah K. Knudsen, Ph.D. Paul M. Roman,](https://reader035.vdocuments.site/reader035/viewer/2022072016/56649ee05503460f94bf0a69/html5/thumbnails/1.jpg)
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
![Page 2: The University of Georgia Adoption of Innovative Treatment Techniques in Public and Private Substance Abuse Programs Hannah K. Knudsen, Ph.D. Paul M. Roman,](https://reader035.vdocuments.site/reader035/viewer/2022072016/56649ee05503460f94bf0a69/html5/thumbnails/2.jpg)
The University of Georgia
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
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The University of Georgia
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
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The University of Georgia
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
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The University of Georgia
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)
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The University of Georgia
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
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The University of Georgia
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)
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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
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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
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The University of Georgia
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)
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The University of Georgia
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%
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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
% Recovering Counselors ----- NS
Doctor On-Staff ----- 3.497
Contract Physician ----- NS
Environmental Scanning ----- NS
Collection of Satisfaction Data ----- 1.681
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The University of Georgia
Logistic Regression: Naltrexone Adoption
Odds Ratio Odds Ratio
Government-Owned .301 .405
Publicly Funded Non-Profit .219 .332
For-Profit NS NS
Size ----- NS
Age ----- NS
Rural ----- NS
Inpatient-only ----- NS
Mixed IP & OP ----- 1.951
% Master’s Counselors ----- 1.009
% Recovering Counselors ----- NS
Doctor On-Staff ----- 2.048
Contract Physician ----- NS
Environmental Scanning ----- 1.270
Collection of Satisfaction Data ----- 1.260 (p=.06)
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The University of Georgia
Logistic Regression: Motivational Incentives Adoption
Odds Ratio Odds Ratio
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
Inpatient-only ----- NS
Mixed IP & OP ----- NS
% Master’s Counselors ----- NS
% Recovering Counselors ----- NS
Doctor On-Staff ----- NS
Contract Physician ----- NS
Environmental Scanning ----- NS
Collection of Satisfaction Data ----- NS
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The University of Georgia
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
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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
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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