Last week the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in HHS released a new study on opioid treatment and child welfare. The report, Medication-Assisted Treatment for Opioid Use Disorder in the Child Welfare Context: Challenges and Opportunities, outlines some of the challenges in providing treatment to families involved with child welfare. Four takeaways include:

• Limited availability of appropriate treatment. Quality treatment programs for parenting women are in short supply in many communities. In addition, limits on insurance coverage, including Medicaid coverage in some locations, often prevent sufficient treatment duration.

• Misunderstanding of MAT. MAT is not always well understood by stakeholders, who may encourage tapering of MAT prematurely and do not insist that medications be accompanied by necessary psychosocial and recovery support services, undermining clients’ opportunities for success. Divergent understanding and views of MAT also mean that parents with opioid use disorder receive mixed messages about appropriate treatment, which may undermine referral and treatment engagement efforts.

• Limited interaction between child welfare agencies and MAT providers. The opioid crisis has prompted new entrants to the substance use disorder treatment community who are not familiar with child welfare agencies, are often unaccustomed to the needs of child welfare system clients, and may be resistant (even with appropriate client consent) to providing the feedback on parents’ treatment progress needed for child welfare proceedings.
• Need for alignment of systems and stakeholders with different perspectives and objectives. Child welfare outcomes related to safety, permanency, and well-being depend on multiple stakeholders who may have different perspectives on MAT and different objectives regarding client outcomes.