Abstract: Substance Use Disorder Treatment Accessibility and Utilization Among Mothers in Child Welfare (Society for Social Work and Research 30th Annual Conference Anniversary)

Schedule:

Thursday, January 15, 2026

Monument, ML 4 (Marriott Marquis Washington DC)

* noted as presenting author

Dylan Jones, PhD, Postdoctoral Scholar, The Pennsylvania State University, PA

Sarah Font, PhD, Associate Professor, Pennsylvania State University, PA

Marci Cross, Doctoral Student, The Pennsylvania State University, PA

Ezra Goldstein, PhD, Assistant Professor, Georgia Institute of Technology, GA

Background and Purpose
Over 100,000 individuals in the U.S. die each year from drug overdoses. While the rate of overdose deaths dipped by 4% from 2022 to 2023, the 2023 rate is still approximately twice what it was in 2015. Millions more individuals suffer from various problems related to health, social, and emotional well-being associated with substance use disorder (SUD). Despite the severe consequences of SUD, most Americans with SUD do not seek treatment.

Rates of SUD are high among mothers involved in the child welfare system (CWS), with current estimates at around 65%. Uptake of treatment is especially important for this population. The absence of treatment utilization may result in loss of child custody after involvement in a CWS referral, or failure to regain custody should the child be placed in foster care. These consequences have direct impacts on the child’s health and wellbeing. This study examines how local treatment accessibility influences utilization among CWS-involved mothers.

Methods
Our sample consists of 98,000 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 the 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 when estimating treatment utilization.

Results
Rates of treatment utilization are low for both outpatient (22%) and inpatient (4%). For both drive time and supply, levels of significance vary by operationalization of service areas, urbanicity, and treatment type. In large metropolitan areas, a one standard deviation (SD) increase in drive time is associated with an 11% reduction in odds of outpatient treatment utilization (p<0.05). Greater treatment supply is associated with increased outpatient and inpatient utilization, with the magnitudes being higher for inpatient care. In large urban areas, a one SD increase in supply of inpatient care is associated with a 25% increase in odds of inpatient treatment utilization (p<0.05). A supplemental analysis conducted only for mothers with an allegation of substance use was present on the referral did not result in meaningful changes in results.

Conclusions and Implications
The associations between the accessibility measures and treatment uptake are statistically significant but often relatively small in magnitude, particularly for outpatient treatment. Limitations to accessibility are likely only a small set of issues among a much larger set of issues explaining low rates of treatment utilization among this population. Greater attention to access barriers beyond drive time and supply of SUD treatment is needed to increase uptake among child welfare-involved mothers.