Explore the vast range of titles available.

We examined services to facilitate access to entering substance use disorder (SUD) treatment among a national sample of SUD treatment facilities. We analyzed data from the National Survey of Substance Abuse Treatment Services (N-SSATS) 2020. Facilities were included in the sample based on criteria such as SUD treatment provision and being in the U.S. Cluster analysis was conducted using variables including ownership, levels of care, and whether facilities provide services or accept payment options aimed at reducing treatment barriers. National and state-level data on the percentage of facilities in each cluster were presented. Among N = 15,788 SUD treatment facilities four distinct clusters were identified: Cluster 1 consisted of for-profit and government outpatient facilities with high proportions of services to reduce barriers (22.2%). Cluster 2, comprised of non-profit outpatient facilities, offered the most comprehensive array of services to minimize barriers to treatment among all four clusters (25.2%). Cluster 3 included facilities with diverse ownership and care levels and provided a moderate to high degree of services aimed at reducing entry barriers to treatment (26.0%). Cluster 4 was primarily for-profit outpatient facilities with a low proportion of these services (26.6%). This study revealed facility-level groupings with different services to reduce barriers to SUD treatment across various clusters of SUD treatment facilities. While some facilities offered extensive services, others provided fewer. Differences in cluster distributions point to possible facilitators to treatment access for some persons seeking admission to specific treatment facilities. Efforts should be made to ensure that individuals seeking SUD treatment can access these services, and facilities should be adequately equipped to meet their diverse needs.

Background: Youth from marginalized groups may be less likely to receive quality health care services. Adverse Childhood Experiences (ACEs) are known to impact long-term health, but it is unclear if there is a relationship between ACEs and receipt of Family Centered Care (FCC)—one indicator of high-quality health care. To assess this relationship, this study used a nationally representative sample of youth from the National Survey of Children’s Health 2016–2017 combined data set. Caregivers of children who had at least one health care visit in the last 12 months (sub-sample n = 63,662) were asked about five indicators of FCC including if they felt the provider: (1) spent enough time, (2) listened carefully, (3) helped family feel like a partner, (4) provided information requested, and (5) showed sensitivity to culture. Methods: Logistic regression analyses examined the association between ACE score and each FCC quality indicator, as well between ACEs score and the overall FCC dichotomous score. Results: ACE exposure did not significantly predict access to a health care visit in the past 12 months. However, children with higher rates of ACEs were significantly less likely to receive FCC. Other factors that significantly predicted lower FCC included child race and ethnicity, insurance type, language in the home, and access to a regular health provider. Conclusions: Providers and health systems must identify, implement, and advocate for effective trauma-informed and care coordination interventions that ensure quality health care services for vulnerable children and families.

Background Despite recent financial and policy support for harm reduction in the USA, information on the types of workers within organizations who design, implement, and actualize harm reduction services remains nascent. Little is known about how variability in the harm reduction workforce impacts referrals and linkages to other community supports. This exploratory mixed-methods study asked: (1) Who constitutes the harm reduction workforce? (2) Who provides behavioral health services within harm reduction organizations? (3) Are referral services offered and by whom? (4) Do referrals differ by type of harm reduction worker? Methods Purposive sampling techniques were used to distribute an electronic survey to U.S.-based harm reduction organizations. Descriptive statistics were conducted. Multivariate binary logistic regression models examined the associations (a) between the odds of the referral processes at harm reduction organizations and (b) between the provision of behavioral health services and distinct types of organizational staff. Qualitative data were analyzed using a hybrid approach of inductive and thematic analysis. Results Data from 41 states and Washington, D.C. were collected ( N  = 168; 48% response rate). Four primary types of workers were identified: community health/peer specialists (87%); medical/nursing staff (55%); behavioral health (49%); and others (34%). About 43% of organizations had a formal referral process; among these, only 32% had follow-up protocols. Qualitative findings highlighted the broad spectrum of behavioral health services offered and a broad behavioral health workforce heavily reliant on peers. Unadjusted results from multivariate models found that harm reduction organizations were more than 5 times more likely (95% CI [1.91, 13.38]) to have a formal referral process and 6 times more likely (95% CI [1.74, 21.52]) to have follow-up processes when behavioral health services were offered. Organizations were more than two times more likely (95% CI [1.09, 4.46]) to have a formal referral process and 2.36 (95% CI [1.11, 5.0]) times more likely to have follow-up processes for referrals when behavioral health providers were included. Conclusions The composition of the harm reduction workforce is occupationally diverse. Understanding the types of services offered, as well as the workforce who provides those services, offers valuable insights into staffing and service delivery needs of frontline organizations working to reduce morbidity and mortality among those who use substances. Workforce considerations within U.S.-based harm reduction organizations are increasingly important as harm reduction services continue to expand.