Health Services/Policy
Multilevel factors associated with on-site childcare availability within substance use disorder treatment settings, US, 2024 George Pro* George Pro Pro Pro Pro Pro University of Arkansas for Medical Sciences, Fay W. Boozman College of Public Health, Department of Health Behavior and Health Education
Background
Childcare is a major barrier to parents and caregivers in need of substance use disorder (SUD) treatment. Childcare services located within SUD treatment settings are increasing and offer a promising solution to a longstanding problem, but availability is limited. Epidemiologic and health services research are needed to identify multilevel factors related to childcare access in order to direct resource allocation and strengthen treatment systems.
Methods
We used the Mental Health and Addiction Treatment Tracking Repository to identify characteristics and the location of all known outpatient SUD treatment facilities in the US (N=7,796). The outcome of on-site childcare was modeled using multilevel regression, with a range of facility-, census tract-, county-, and state policy-level independent variables. First we estimated main effects, then added interactions between each state policy and the percentage of a census tract that was rural, Black, and Hispanic. Clustering was defined at the state level.
Results
Four percent of treatment facilities offered childcare (n=323). The model-based probability of childcare availability was highest (12%) in facilities located in communities with large Black populations in states that did not specifically mention methamphetamine in child endangerment laws (interaction p=0.01). Childcare availability was lowest (0%) in facilities located in rural communities in states that did not expand Medicaid (interaction p=0.06) (Fig. 1). 17% of the variation in childcare availability was attributable to unmeasured state characteristics (p<0.01).
Conclusion
Access to childcare in SUD treatment settings remains very low. Several state health and child abuse laws influenced access to childcare differently for various populations within states. The absence of methamphetamine language in laws defining child endangerment and Medicaid expansion showed the strongest effects in communities that were predominately Black and rural, respectively.
