Association for Public Policy Analysis & Management

Co-production has received increasing attention as a vehicle to compensate for diminishing public investment by leveraging civil society resources, while also improving service responsiveness (Brandsen & Honingh, 2016). However, scholars have limited understanding of the determinants and outcomes of co-production, particularly in highly professionalized fields serving stigmatized vulnerable populations. Using the substance use disorder (SUD) treatment field in the United States as a case, this study investigates (1) which internal and external factors influence whether SUD clinics co-produce services with patients, and (2) how co-production efforts impact clinics’ service offerings and utilization patterns. To address these questions, I use the National Drug Abuse Treatment System Survey—a nationally representative longitudinal split-panel survey of approximately 700 alcohol and drug abuse treatment facilities in the U.S.

In the SUD treatment field, users often possess little influence over service decisions, resulting in the production of unresponsive and inefficient service for users with multifaceted and complex needs. I theorize that two co-production mechanisms may help ensure patients’ meaningful engagement in and influence over care decisions. First, SUD clinics may be motivated to co-produce by policies that mandate implementation of “patient-centered care” practices (Humphreys & Frank, 2014). In addition to granting access to SUD services for millions of new users, the ACA mandated health service providers to measure and report service quality and experience from a patient’s perspective. Thus, SUD service providers are pushed to legitimatize their practices, outcompete market competitors, and comply with regulatory requirements by co-producing SUD treatment services. Second, SUD clinics may hire staff members with lived experiences to facilitate co-production by bridging SUD service users and professional clinicians without addiction history. SUD patients are often characterized as untrustworthy and manipulative individuals making true co-production difficult, but staff with lived experience may be seen as more reliable and trustworthy information sources for professional clinicians (White, 2014). For service users, staff members with SUD histories may be relatively trustworthy partners, who can connect to their struggles and provide needed support.

Findings show that 75% of treatment centers implemented at least one co-production mechanism in 2014. Diverse factors predicted SUD clinics’ adoption of co-production, including greater public insurance income and being public or nonprofit (as opposed to for-profit). Both mechanisms are associated with availability and utilization of ancillary services for patients’ long-term recovery—such as housing assistance and aftercare services. In addition to offering rare evidence of co-production using a nationally representative data, this paper demonstrates how staff with lived experience can facilitate co-production with highly marginalized groups by leveraging their experiential knowledge and bridging professionals and users. 

References

Brandsen, T., & Honingh, M. (2016). Distinguishing Different Types of Coproduction: A Conceptual Analysis Based on the Classical Definitions. Public Administration Review, 76(3), 427–435.

Humphreys, K., & Frank, R. G. (2014). The Affordable Care Act will revolutionize care for substance use disorders in the United States. Addiction, 109(12), 1957–1958.

White, W. L. (2014). Slaying the dragon: the history of addiction treatment and recovery in America (2nd ed.). Bloomington, IL: Chestnut Health Systems/Lighthouse Institute.