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Artificial Intelligence in Health ML approach for client and program effects in OUD retention

four had statistically significantly negative treatment effects. We found that only a small proportion of the sample,
It is important to note that these four programs with negative that is, 61 out of 627 OTPs (<10%), would statistically
treatment effects may potentially represent false discoveries. significantly benefit from workforce diversity when it comes
to retaining clients. This means that, notwithstanding
The comparison of characteristics of these 61 OTPs with
the other 566 OTPs is presented in Table 2. The 61 OTPs the level of workforce diversity, characteristics of these
that would benefit the most from workforce diversity had programs, other than workforce diversity, would cause
significantly lower percentages of Black clients (P < 0.001,), them to benefit more from diversity. The characteristics that
were more likely to be private-for-profit (P < 0.001), had amplified the impact of workforce diversity on retention
lower staff-to-client ratio (P < 0.001), much higher included: lower percentages of Black clients, lower staff-to-
client ratio, higher proportion of staff who had graduate
proportion of staff who had graduate degrees (P < 0.001), degrees, and lower percentage of unemployed clients. In
much lower percentage of unemployed clients (P < 0.001),
and were more likely to be newer programs (P < 0.001). addition, those OTPs were more likely to be private for-
The box plots of the percentage of clients in treatment for profit and newer.
more than 3 months, categorized based on the presence The characteristics of these 61 OTPs suggest that the
of high and low percentage of Black staff, in these 61 impact of workforce diversity is context-dependent, and
OTPs and the other 566 OTPs are presented in Figure 1. its effectiveness is shaped by a combination of program-
Higher percentages of Black staff were associated with the specific factors. For instance, programs with lower
increased percentage of clients in treatment to more than percentages of Black clients might benefit more from
3 months in these 61 OTPs. diversity because the presence of Black staff could provide
critical cultural insights and connections that are otherwise
4. Discussion lacking. Similarly, a lower staff-to-client ratio and higher
To study the role of the variation of workforce diversity staff education levels could facilitate more personalized
in improving OUD treatment retention, we explored the and culturally competent care, which is particularly
heterogeneous treatment effect with a novel machine- beneficial in diverse workforce environments. These
learning method called causal forest. Our analytical findings imply that workforce diversity alone is insufficient
method aimed to advance understanding of the variation for improving retention across all settings; rather, it is the
in the association between workforce diversity, that is, synergy between diversity and other favorable program
percentage of Black staff in an OUD treatment program, characteristics that drives positive outcomes.
and OUD treatment retention (percentage of clients in Moreover, the observation that private for-profit
treatment for more than 3 months). programs were more likely to benefit from diversity could

Figure 1. Box plots illustrating the heterogeneous effects of workforce diversity on treatment retention. (Left) Box plots of the percentage of clients in
treatment for more than 3 months, categorized based on the presence of high and low percentage of Black staff, in the 61 effective programs. (Right) Box
plots of the percentage of clients in treatment for more than three months, categorized based on the presence of high and low percentages of Black staff,
in the other 565 ineffective programs.
Abbreviations TX: Texas.

Volume 2 Issue 1 (2025) 109 doi: 10.36922/aih.3750