Programs to address substance use in U.S. children’s hospitals: Untapped potential for expanding community prevention and treatment resources

Abstract

ObjectiveSubstance use affects Americans across the life course and there is need to understand how pediatric health care organizations implement new programs to address this need. The aim of this study was to understand what programs are currently offered and the institutional and community factors that predict hospitals undertaking this work. MethodsWe analyzed children’s hospitals’ community health needs assessments (CHNAs) and implementation strategies (2015–2019) to identify which hospitals were addressing substance use and categorized the programs they implemented. We conducted bivariate descriptive comparisons of hospitals that did or did not address substance use based on institutional, county-level, and community-benefit spending characteristics and calculated a logistic regression model to assess whether the extent of local need was associated with hospital service provision, independent of covariates. ResultsOnly 13% of children’s hospitals addressed substance use in their CHNA implementation strategies and of the 151 programs adopted, only 11 were pediatric-specific. The most common strategies hospitals outlined to address substance use included access to formal treatment and community outreach and education efforts. Children’s hospitals who did not address substance use in their communities were more likely to have worked independently on their community benefit plan and to work in counties with greater economic needs. The level of substance use needs in the community was not associated with hospital programs. Analysis of community benefit filings to the IRS confirmed that children’s hospitals not addressing substance use also spent fewer community benefit dollars on population health-related activities suggesting that overall spending may overlap with willingness to invest in complex behavioral health needs. ConclusionsFew children’s hospitals address substance use as a community health need, suggesting that these organizations are an underutilized resource for preventing and addressing the profound impact of substance use across the life course.