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Description
Approved in 2015, California implemented the Drug Medi-Cal Organized Delivery System (DMC-ODS) which increased treatment funding, access, and quality of care. DMC-ODS covers 95% of Medicaid-eligible individuals with substance use disorders (SUD), yet only 5% of people who need treatment receive it. This study examines California providers’ perspectives of barriers to SUD treatment and compared them with providers from other states through a social-ecological lens. From October 2021-January 2022, data were collected from 181 participants using online surveys. Participants were people who provided services for those with substance use disorders. Data were gathered using snowball sampling and online platforms. The majority of participants were AOD counselors and behavioral health technicians (40%), followed by medical providers (27%), with the top two facility types being a hospital setting (22%) and county-funded (12%). Bivariate and multiple regression models were used to compare California (CA) providers’ perspectives with providers surveyed who were not in California (non-CA), controlling for facility type and job title. Results showed significant associations with CA providers’ perspectives on fewer barriers existing compared to what the providers who were not in CA thought were barriers, such as co-occurring treatment (OR: 0.079; CI: 1.14-1.71), patients refusing treatment for fear of losing their home (OR:0.086; CI: 0.66-0.10), and prioritizing a job (OR: 0.081; CI: 0.65-0.97). When exploring CA providers, the univariate analysis reported environmental barriers as stigma (70%), transportation (65%), prioritizing taking care of their family (61%), and thinking they can get better on their own (68%). Organizational barriers such as patient ability to detox before treatment (60%), co-occurring disorders (59%) including patients with co-occurring disorders should seek treatment at a separate facility (64%), and documentation demands (62%). Findings show that the CA providers in this study reported observing fewer barriers for their patients than the non-CA providers did. The perspectives of the CA providers showed that a statewide comprehensive system of care may be effective for reducing barriers to SUD treatment. However, the CA data also showed organizational and environmental risk factors as persistent barriers to treatment. The findings have implications for future research and improving practice for substance use disorder treatment.
