The Association Between Culturally Competent Practices and Therapeutic and Ancillary Services Availability in a National Sample of Opioid Treatment Programs

Opioid treatment programs (OTPs) vary substantially in their provision of therapeutic and ancillary services that support recovery from opioid use disorder (OUD). Using the 2023 National Drug Abuse Treatment System Survey (NDATSS; N = 150), the only data wave including comprehensive Culturally and Linguistically Appropriate Services (CLAS) measurement via the Cultural Competency Organizational Assessment-360 (COA360), we examined whether organizational cultural competence is associated with service availability and perceived treatment effectiveness. We applied CLAS-aligned cultural competence measures from COA360 surveys completed by program directors and clinical supervisors to estimate adjusted regression models for perceived effectiveness of Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) 12-step treatment models, availability of HIV and Hepatitis C testing, and provision of group counseling during the COVID-19 period. We found that higher director- and supervisor-reported cultural competence was associated with more favorable 12-step model effectiveness perceptions. Additionally, specific cultural competency CLAS standards were significantly associated with the offering of HIV and Hepatitis C testing. Among clinical supervisors, the CLAS-standard related to addressing cross-cultural conflicts and discrimination complaints was positively associated with offering group counseling during the COVID-19 period. Across outcomes, associations clustered in leadership-reported CLAS domains related to communication, engagement, accountability, and organizational infrastructure, suggesting that leadership perspectives on culturally and linguistically appropriate practices play a critical role in how services are structured and delivered.