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Characterizing Multisystem Barriers to Women’s Residential SUD Treatment: A Multisite Qualitative Analysis in Los Angeles

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Abstract

Residential substance use disorder (SUD) treatment programs are challenged by the differing values of the problem-solving court (PSC) and child welfare (CW) systems, along with communication barriers between staff. This study aimed to understand, from the viewpoints of SUD treatment providers, how divergent values and communication barriers adversely affect women’s residential SUD treatment. We conducted qualitative semistructured interviews with 18 SUD treatment clinicians and six directors from four women’s residential SUD treatment programs. Using a thematic analysis framework, we identified salient themes across specified codes. Analysis revealed six main themes, suggesting differing values and communication barriers across the SUD, PSC, and CW systems adversely affect the provision of SUD treatment. For differing values, three main themes emerged: (a) unaddressed trauma and fear of mental health treatment seeking; (b) perceptions of mothers with a SUD; and (c) the Adoption and Safe Families Act (ASFA) timeline as a barrier to SUD treatment provision. For communication barriers, three themes emerged: (a) inadequate communication and responsiveness with PSC and CW systems adversely affect treatment coordination, induce patient stress, and treatment disengagement; (b) lack of PSC and CW communication regarding child visitation planning adversely affects treatment motivation and retention; and (c) competing ASFA, PSC, and CW priorities and inadequate cross-system communication adversely affect treatment planning. Treatment providers face significant barriers in providing effective treatment to women simultaneously involved in the CW and PSC systems. Aligning values and addressing communication barriers, changes in policy, and enhanced cross-system training are crucial. Additionally, it is essential to reevaluate the ASFA timeline to align with the long-term treatment needs of mothers with a SUD. Further research should explore the viewpoints of patients, CW, and PSC staff to gain deeper insights into these SUD treatment barriers.

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Data Availability

The data supporting the findings of this study are available from the corresponding author, D.R., upon reasonable request. The data are not publicly available due to the sensitivity of interview transcripts containing information that could compromise research participant privacy and their relatioships with other agencies.

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Acknowledgements

This research was supported by a grant from the California State University Office of the Chancellor and the Chancellor’s Doctoral Incentive Program. The ideas and opinions expressed herein are those of the authors, and endorsement of those opinions by funders is not intended nor inferred. The authors are grateful to the SUD treatment directors and clinicians from the four study programs who participated in this research.

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Authors and Affiliations

  1. Columbia School of Social Work, Columbia University, 1225 Amsterdam Ave., New York, NY, 10027, USA

    Dean Rivera, Anindita Dasgupta & Elwin Wu

  2. Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34 Street, MRF 214, Los Angeles, CA, 90089, USA

    Benjamin F. Henwood & Suzanne Wenzel

  3. Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA, 90033, USA

    Steve Sussman

  4. Columbia University Irving Medical Center Department of Psychiatry and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, Room 3719, New York, NY, 10032, USA

    Aimee N. C. Campbell

  5. Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8Th Street, Miami, FL, 33199, USA

    Hortensia Amaro

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  1. Dean Rivera
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Contributions

Dean Rivera: conceptualization, methodology, investigation, project administration, writing—original draft, data curation, visualization, and funding acquisition. Benjamin F. Henwood: methodology, formal analysis, writing, review and editing, and visualization. Steve Sussman: methodology, formal analysis, writing, review and editing, and visualization. Suzanne Wenzel: methodology, formal analysis, writing, review and editing, and visualization. Anindita Dasgupta: review and editing and visualization. Aimee N. C. Campbell: review and editing and visualization. Elwin Wu: review and editing and visualization. Hortensia Amaro: conceptualization, methodology, writing, review and editing, and visualization.

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Correspondence to Dean Rivera.

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Rivera, D., Henwood, B.F., Sussman, S. et al. Characterizing Multisystem Barriers to Women’s Residential SUD Treatment: A Multisite Qualitative Analysis in Los Angeles. J Urban Health (2024). https://doi.org/10.1007/s11524-024-00857-9

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