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

reflect the greater operational flexibility and resource desired outcomes unless other factors are addressed. This
availability in these settings, allowing for more effective study highlights program characteristics associated with
implementation of diversity initiatives. This raises a positive impact of workforce diversity on retention. As
important considerations for public and not-for-profit such, policymakers may want to allocate resources related to
programs, which may need additional support to create program characteristics that enhance the benefits of a diverse
environments where workforce diversity can flourish. workforce. It is also crucial to strike a balance between
These programs might require targeted investments in resource allocation and diversity goals, as less constrained
staff training, educational opportunities, and resource programs, often linked to positive outcomes, maximize
allocation to replicate the conditions under which diversity the benefits of diversity. Policies should support adequate
positively impacts retention in private for-profit settings. resource allocation, including staffing and educational
The characteristics of these 61 OTPs indicate that opportunities, while fostering diversity. In addition,
workforce diversity is most likely to improve client targeted strategies should prioritize retention rates among
retention when implemented in less constrained programs, Black clients, addressing their unique challenges through
that is, those with attributes often reported in the existing tailored interventions, culturally competent care, and efforts
literature to be associated with positive outcomes. This to reduce disparities in access and quality of treatment.
4,32
may explain why we did not see a significant association Moreover, as the landscape of opioid treatment continues
between the percentage of Black staff and the percentage to evolve, it will be essential for policymakers to remain
of clients in treatment for more than 3 months when flexible and responsive to new evidence on the factors that
considering the full sample of 627 OTPs. influence retention. This includes being open to revising
policies and practices as more is learned about the role of
Few studies have examined the general association workforce diversity in different contexts and the needs of
between Black workforce diversity and treatment retention client populations change over time. Overall, policies should
among Black clients. 16,21 These studies identified significant consider program characteristics, resource allocation,
associations that may have been driven by a small subgroup and diversity goals to improve retention rates, particularly
or population. In ddition, organizational characteristics among Black clients, in OUD treatment programs.
may alter the impact of workforce diversity in a different
direction. Findings in this paper inform rigorous analytical Several limitations of this study should be acknowledged.
approaches to understand relationships of individual and Most existing methods can only estimate the heterogeneous
program features with client outcomes. The benefit of this treatment effects for binary variables. Thus, we had to
approach is to help public health policymakers identify dichotomize the percentage of Black staff to obtain a binary
OTPs that might benefit from workforce diversity, or treatment variable. We chose the cutoff of 20% because
alternatively, OTPs with high workforce diversity that 48.2% (i.e., about one half) of programs had more than 20%
could benefit from greater resources. Black staff. Ideally, we would explore the heterogeneity with
the original continuous variable, that is, percentage of Black
Our study is also aligned with the national call to staff. The identified 61 OTPs would have a greater impact
diversify the workforce in addiction health services and on retention given their diverse workforce. However, there
thus informs how and when diversity could most benefit may be other heterogeneity among these 61 OTPs in the
client-centered outcomes. However, it is also important association between workforce diversity and retention. We
to recognize that the relationship between workforce did not examine such heterogeneity in this paper because the
diversity and client retention is complex and influenced higher treatment effects on these 61 OTPs were composite
by multiple factors beyond the demographic composition effects of several variables. In fact, we cannot observe
of the staff. The findings from this study highlight the significant treatment effects by altering the value of just
need for a more nuanced understanding of how diversity one variable, while keeping the others constant. Moreover,
interacts with program-specific characteristics to influence our finding that a lower percentage of Black clients being
outcomes. Future research should continue to explore associated with lower constraints, and therefore greater
these interactions, with a particular focus on identifying retention, should be further examined. Future studies should
the conditions under which workforce diversity is most scrutinize this finding to better understand the mechanisms
likely to enhance retention, and how these conditions can that drive this association and suggest concrete approaches
be fostered across different types of treatment programs. to improve outcomes equally and equitably.

Policymakers should recognize that while workforce
diversity is important, it is not a standalone solution for 5. Conclusion
improving client retention in OUD treatment programs. Our findings contribute to a deeper understanding of how
Policies solely focused on increasing diversity may not yield workforce diversity, particularly in the form of higher

Volume 2 Issue 1 (2025) 110 doi: 10.36922/aih.3750