The Office of the Assistant Secretary for Planning and Evaluation (ASPE) of the U.S. Department of Health and Human Services released a new brief, Challenges in Providing Substance Use Disorder Treatment to Child Welfare Clients in Rural Communities, that focuses on the barriers rural communities face in providing substance use disorder (SUD) treatment, particularly to parents involved with the child welfare system.

According to the new report, in 2018, AFCARS data revealed that 36 percent of children who were removed from the home were due to parental drug use and that five percent was due to parental alcohol use. Child welfare cases involving substance use are more complex, and rural communities are particularly hit the hardest. “Poverty and other challenges, such as limited transportation and technology, can prevent parents from accessing or prioritizing treatment.”

One of the challenges is that rural communities often lack the resources to provide services to parents struggling with substance use issues. Rural economics, transportation, and technological limitations exacerbate these challenges. Across the country, there is a lack of substance use disorder treatment, and for rural communities, the options are minimal. Twenty percent of the U.S. population lives in rural communities, and only 14 percent of behavioral health outpatient treatment facilities are available in the areas. Additionally, less than half have a primary focus on substance use disorder treatment.
Workforce challenges in rural communities, including recruiting and retaining appropriately trained and accredited professionals, is a problem for rural providers. The ability to provide holistic services and supports in rural communities is less likely, such as wraparound services, social services, and physical and behavioral health.

The timeliness of child welfare protocols creates additional barriers for parents struggling with substance use in rural communities, specifically when parents have to wait for available treatment services. These conditions make it hard to comply with achieving permanency and decisions of removing children from the home or reunification. Another challenge is that child welfare agencies and substance use treatment providers face particular obstacles to collaboration with one another in rural communities. Cross-agency coordination in rural areas is not as formalized, which can create barriers with information sharing and coordinated case management — stigma, lack of anonymity, and misinformation compound these issues.

Finally, strategies specifically tailored to rural communities are needed to improve service access, develop workforce capacity, and improve collaboration. Adequate access to health insurance, specifically Medicaid, is critical for parents seeking substance use disorder, especially for families in rural communities that tend to have slightly higher rates of being uninsured than non-rural areas. Family drug treatment courts are promising collaborative, multidisciplinary alternatives that promote collaboration between agencies and improve family outcomes. In addition, Family First can be leveraged to support parent’s access treatment service if barriers of state matching funds were secured. In a future brief, ASPE will be sharing promising models for rural communities that address the needs of parents with substance use issues and are involved in the child welfare system.