Substance use treatment facility access and utilization among mothers in child welfare

Introduction: Despite the severe consequences of substance use disorder (SUD), most Americans with SUD do not seek treatment. Uptake of treatment is especially important for mothers involved in the child welfare system (CWS), where SUD is common and can result in child maltreatment and loss of child custody. This study examines how local treatment accessibility influences utilization among CWS-involved mothers. Methods: Our sample includes 98,343 CWS referrals in Pennsylvania (2015–2019) in which the referred biological mother was receiving Medicaid. Using geocoded referral addresses and SUD treatment facilities statewide, we estimate how the drive time to and supply of SUD treatment is associated with maternal treatment uptake in the quarter following the referral. Given lack of consensus regarding the distance individuals will travel for SUD treatment (service areas), we consider multiple versions of our measures and allow operationalization of service areas to vary by county urbanicity and SUD treatment type. We use hierarchical logistic regression models with conditional autoregressive random effects to account for spatial autocorrelation to estimate treatment utilization. Results: Drive time is associated with lower outpatient utilization, particularly in large metropolitan areas with broader service area definitions. Greater treatment supply is associated with increased outpatient and inpatient utilization, with the magnitudes being higher for inpatient care. For both measures, levels of significance depend on urbanicity. Conclusions: The associations between the accessibility measures and treatment uptake are statistically significant but relatively small in magnitude. Greater attention to access barriers beyond drive time and supply of SUD treatment is needed to increase uptake among child welfare-involved mothers.