The Substance Abuse and Crime Prevention Act (SACPA), passed in California in 2000, mandated drug treatment in lieu of incarceration for nonviolent first- and second-time drug offenders. The percentage of Latino clients in SACPA has consistently increased over time , and Latinos represent the second-largest ethnic group among program clients . Notably, many Latino clients are entering drug treatment for the first time under SACPA . Due to significant legal implications (e.g., incarceration) for failure to satisfy treatment requirements, it is of critical importance to identify effective substance abuse treatment (SAT) interventions for Latinos in SACPA and other mandated SAT programs.
Reviews of mandated or coerced SAT support the general effectiveness of such treatment and suggest that legal pressure increases client retention and treatment completion [4, 5]. Previous research has also indicated that criminal justice referrals to drug treatment can enable treatment program completion, particularly among minority groups [6–8]. However, client intake characteristics such as having a lengthy criminal history, lower treatment motivation, more severe employment, and psychiatric problems as well as drug use at intake have been found to be associated with dropout from court-mandated SAT . Factors that may contribute to higher completion rates for mandated SAT in some cases include the administrative and individual monitoring offered by the criminal justice system through drug and probation courts [9, 10]. Court-supervised SAT can prove effective [7, 8] but is contingent upon client engagement and motivation to remain in treatment . Adapting existing SACPA treatment practices with culturally responsive services may increase treatment effectiveness and facilitate client motivation, potentially resulting in increased treatment completion.
Treatment completion is likely to be increasingly employed as a measure of program performance given new health care reform legislation [11, 12]. In large administrative data sets, treatment completion reflects both achievement of treatment goals at the client level and program performance at the system level. Most studies on health disparities in the United States have focused on client-level factors: differences in client demographics, primary substance used, and addiction severity [11, 13, 14]. Findings from the national Treatment Episode Data Set  have identified seven client characteristics related to successful treatment completion in outpatient SAT: (1) non-Latino White race, (2) female gender, (3) older than 40 years, (4) more than 12 years of education, (5) employment, (6) use of alcohol as primary substance, and (7) less than daily substance use at admission. Referral source was included as a service factor and found to be related to treatment completion, highlighting the need to examine program factors that may impact client response to treatment.
The need to develop an evidentiary base for what constitutes quality of care for racial and ethnic minority clients is recognized [15–18], but little attention has been paid to treatment practices that affect treatment completion in specific racial and ethnic groups entering treatment for the first time [11, 19, 20]. It is clear that shorter treatment duration and unmet service needs result in lower completion rates for African Americans and Latinos [13, 20–24], whereas lack of economic resources is more often associated with poor treatment completion among Whites [8, 13].
Data on drug treatment outcomes for Latinos show significantly shorter treatment duration and lower completion rates [25, 26] compared to other racial/ethnic groups. This may be partly due to Latinos’ accessing programs with poor quality of care [15, 16, 22]. High-quality care that engages the often bilingual and bicultural Latino population is generally present in programs with adequate service resources (social service availability and intensity), services in Spanish, and services provided by staff skilled in cross-cultural counseling [15, 17, 18, 27, 28]. Cultural and linguistic competence is broadly defined as “a set of congruent behaviors, knowledge, attitudes, and policies that come together in a system, organization, or among professionals that enables effective work in cross-cultural situations” (Cross et al., 1989, p. 13) . In treatment organizations, culturally and linguistic competence is generally operationalized as a set of service-related practices through which organizations recognize and respond to the needs of culturally diverse populations . Such practices generally incorporate clients' native language, cultural nuances and family and community dynamics . Emerging evidence suggests that a program’s ability to introduce the linguistic, cultural, familial, and community norms of Latinos in treatment is associated with greater access, duration, and treatment completion rates [19, 27, 29, 30].
This manuscript builds on previous findings  regarding higher completion rates among Latinos referred to publicly funded drug treatment by identifying culturally responsive program practices linked to treatment completion. The goal of this study is to test the evidentiary basis for the use of culturally and linguistically responsive practices that aim to facilitate successful completion of mandated SAT among first-time Latino clients. Findings from this study may support evidence-based practices for Latinos involved in the criminal justice system, resulting in a reduction in health disparities among this underresearched minority population .
Experts in the field indicate quality of care for Latinos can be represented by providers' Spanish-language proficiency and knowledge of cultural nuances associated with service provision. This culturally responsive care may strengthen the therapeutic alliance necessary to increase treatment adherence [15, 32]. However, provision of culturally and linguistically responsive services in SAT varies a great deal, particularly in terms of service comprehensiveness and intensity . Although emerging evidence suggests that single practices, such as matching counselors and clients based on language and ethnicity, benefit Latinos and African Americans , programs that incorporate several culturally and linguistically responsive practices are believed to have a cumulative impact on treatment outcomes among minorities . Thus, Hypothesis 1 posited that Latinos who receive SAT services from SACPA providers with the highest implementation of culturally competent practices will be most likely to successfully complete treatment. Considering that up to 76% of Latinos in California report speaking Spanish at home , we expect that specific linguistically competent practices will support Latinos' efforts to complete treatment. Thus, Hypothesis 2 posited that Latinos who receive SAT services from SACPA providers that offer (1) Spanish-speaking counselors, (2) Spanish-language translation, (3) Spanish-language program materials, or (4) Spanish-language health education will be most likely to successfully complete treatment.