Abstract
BackgroundRetention in substance use treatment is one of the strongest predictors of improved outcomes among adolescents, making retention an important goal of treatment. We examined treatment providers’ perspectives on barriers and facilitators to treatment retention among adolescents, and their views on contributors to racial/ethnic disparities in retention including ways to address disparities.MethodsSemi-structured interviews were conducted with 19 providers at state-licensed detoxification, residential, and outpatient facilities serving adolescents for substance use disorders in Massachusetts. Interviews were coded by at least two independent coders.ResultsProviders identified barriers and facilitators at the policy/systems, facility, family, and client levels. Some of the barriers included insurance limits on sessions/length of stay and low reimbursement (policy/systems), staff turnover (facility), low family engagement (family), and low internal motivation (client). Some facilitators mentioned were support from state’s substance use agency (policy/systems), flexibility with meeting location (facility), family participation (family), and high internal motivation and presence of external motivators (client). Barriers that contributed to racial/ethnic disparities included lower socio-economic status, language barriers, and mistrust. Having bilingual/bicultural staff and multi-lingual materials, and facilitating transportation were identified as strategies for reducing disparities in treatment retention.ConclusionsIt is critical that adolescents who access substance use services remain and complete treatment and that there is equity in treatment retention. Provider perspectives in factors associated with retention can inform the development of comprehensive interventions and policies to help improve retention and reduce disparities.
Highlights
Retention in substance use treatment is one of the strongest predictors of improved outcomes among adolescents, making retention an important goal of treatment
The interviews contained questions related to barriers, facilitators, and disparities in access to treatment, but here we focus on the data related to retention only
Insurance barriers are commonly cited as impacting access to treatment [32], our findings suggest that limits on types of services covered and reimbursement rates impact length of time that adolescents remain in stabilization services or in treatment once they have already accessed those services
Summary
Retention in substance use treatment is one of the strongest predictors of improved outcomes among adolescents, making retention an important goal of treatment. Adolescents with a SUD are more likely to make risky decisions such as engaging in unsafe sex and driving under the influence. They experience problems in familial and peer relationships, academic issues, a loss of interest in healthy activities, impaired memory, mental health problems and an increased risk of overdose [1]. These short- and long-term repercussions suggest the importance of addressing substance use disorders at an early age
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