School‐Based Services May Eliminate Substance Treatment Disparities: Results From a Nonrandomized Program Evaluation

Abstract

ABSTRACTBackgroundThere are known health disparities in adolescent substance treatment access and engagement. The purpose of this project is to compare outcomes from school‐ and clinic‐based substance treatment and to evaluate if providing school‐based substance treatment reduces disparities in treatment access and engagement.MethodThis quality improvement retrospective chart review compares baseline and outcome data for adolescents accessing school‐based (n = 531) and clinic‐based (n = 523) substance treatment in a natural quasi‐experimental study with nonequivalent control group design. Baseline demographic and clinical measures include age, sex, ethnicity, race, and clinical diagnoses. Outcome measures include the number of sessions completed, proportion reaching a week of self‐reported abstinence, and proportion providing a negative urine drug screen.ResultsCompared to the clinic‐based sample, the school‐based sample includes more female (47.65% vs 26.77%) and Hispanic/Latinx (59.89% vs 46.46%) adolescents. The school‐based group has a similar proportion reaching a negative urine drug screen (31.84% vs 28.83%, p = .5259) or a week of abstinence (43.15% vs 41.03%, p = .6718) as the clinic‐based sample. There are significant differences in total session completion over a period of 16 weeks between school‐based and clinic‐based adolescents. In multivariable analyses, there was a significant interaction effect of race/ethnicity by location on the number of sessions completed.ConclusionProviding school‐based substance treatment increases access to care and treatment engagement for female, African American, and Hispanic/Latinx adolescents without diminishing outcomes.