Columbia School of Social Work, Columbia University, 1225 Amsterdam Ave., New York, NY, 10027, USA.
Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34 Street, MRF 214, Los Angeles, CA, 90089, USA.
J Urban Health. 2024 Jun;101(3):653-667. doi: 10.1007/s11524-024-00857-9. Epub 2024 Apr 17.
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.
住宅物质使用障碍 (SUD) 治疗计划面临着解决问题法院 (PSC) 和儿童福利 (CW) 系统的不同价值观的挑战，以及工作人员之间的沟通障碍。本研究旨在从 SUD 治疗提供者的角度了解不同的价值观和沟通障碍如何对女性的住宅 SUD 治疗产生不利影响。我们对来自四个女性住宅 SUD 治疗计划的 18 名 SUD 治疗临床医生和六名主任进行了定性半结构式访谈。使用主题分析框架，我们根据指定的代码确定了突出的主题。分析揭示了六个主要主题，表明 SUD、PSC 和 CW 系统之间的不同价值观和沟通障碍对 SUD 治疗的提供产生不利影响。对于不同的价值观，出现了三个主要主题：(a) 未解决的创伤和对寻求心理健康治疗的恐惧；(b) 对患有 SUD 的母亲的看法；以及 (c)《收养和安全家庭法》(ASFA) 时间表作为提供 SUD 治疗的障碍。对于沟通障碍，出现了三个主题：(a) 与 PSC 和 CW 系统沟通不畅和反应迟钝会对治疗协调产生不利影响，导致患者压力和治疗脱轨；(b) 缺乏 PSC 和 CW 关于儿童探视计划的沟通会对治疗动机和保留产生不利影响；以及 (c) 竞争的 ASFA、PSC 和 CW 优先事项以及不足的跨系统沟通会对治疗计划产生不利影响。治疗提供者在同时为参与 CW 和 PSC 系统的女性提供有效治疗方面面临重大障碍。调整价值观和解决沟通障碍、政策变更以及增强跨系统培训至关重要。此外，重新评估 ASFA 时间表以适应患有 SUD 的母亲的长期治疗需求也很重要。应进一步研究以探索患者、CW 和 PSC 工作人员的观点，以更深入地了解这些 SUD 治疗障碍。
