Licensing Requirements Research Articles

Development of a Self-Assessment Tool for Safety Culture in Nuclear Installations

A study has been conducted to develop a self-assessment tool for safety culture that BAPETEN can use for nuclear installations in Indonesia. Safety culture is one of the safety and licensing requirements in nuclear energy laws and regulations. BAPETEN is also entrusted to conduct assessments and foster safety culture. BAPETEN has carried out these activities at BATAN nuclear installations from 2005 to 2012. As a follow-up, BATAN has taken various measures to evaluate and develop a safety culture at all its nuclear installations. In 2021, all Non-Ministerial Government Institutions in the research sector, including BATAN, were merged into one under the management of BRIN. This organizational change certainly has the potential to affect safety and safety culture performance. In practice, the results of inspections in the last two years have shown a tendency for an increase in the number of findings. BAPETEN has yet to have a documented, comprehensive method for assessing safety culture performance. Thus, this study aims to develop a documented and comprehensive method for assessing safety culture performance at nuclear installations. This study applies descriptive, qualitative, and analytical techniques, using primary and secondary data, and is conducted in several stages: literature study, presentation and discussion of information transfer and documentation from past practices, comparative study with a high-risk industry, safety culture assessment workshops, and review and validation. In conclusion, this study has produced safety culture assessment tools through a questionnaire survey, document analysis field observation, interviews, and focus groups. The four tools, which refer to the IAEA safety culture systematics with five characteristics, complement each other and can be expected to be comprehensive but realistic enough to be implemented. The study also recommends that an immediate assessment should be carried out using these four tools on the existing nuclear installations. At the end of the assessment, the assessment team should evaluate the implementation and effectiveness of the four tools for improvement. Keywords: safety culture, independent assessment, nuclear installation

CONDUCTING CONTROL (SUPERVISORY) ACTIVITIES IN RELATION TO LICENSEES

The article describes the conduct of control (supervisory) measures on the territory of the Kemerovo region – Kuzbass, as well as measures in relation to licensees (license applicants). A form of assessment of licensing requirements conformity is presented, which in turn is carried out in relation to the licensee to streamline the license register. The problems of regulating legal documents in the field of licensing due to the lack of a list of minimum equipment, tools, technical means, including measuring instruments, for carrying out work and providing services for extinguishing fires in settlements, industrial facilities and infrastructure facilities are disclosed. The problem of non-approved warning and inspection forms during preventive control (supervisory) measures, the lack of preventive conversation sheets and accounting logs during licensing is also considered.

Comparative Analysis of Medical School and Physician Assistant Education and the Use of Provisional Licenses.

The current shortage of physicians in the United States has prompted a reevaluation of medical education and licensure pathways. This paper analyzes medical school and physician assistant education, highlighting the differences in training, clinical experience, and licensing requirements. Additionally, the paper explores the emerging role of postgraduate licensure (PGL) programs, which allow unmatched medical graduates to obtain provisional licenses and practice under attending physician supervision. Through this analysis, we assert that medical graduates are underutilized assets in addressing the healthcare workforce deficit with PGL programs as a viable solution to alleviate physician shortages, particularly in primary care.

Researching into Preventing Harmful Rent-Seeking Practices: Strategic Policy Interventions Required and Lessons Learnt for Asian Countries

The author of this work argues that rent-seeking occurs in a situation wherein a company or individual seeks special privileges from another party, often the government, but does not reciprocate back. Its examples are (a) license requirements for professions; (b) creating barriers to entry for new businesses, and (c) grants, subsidies, or tariff protection. In the language of economics, rent is defined as “wealth gained via questionable, often manipulative means”.A closer look at the theoretical perspective and review of related literature is indicative of the fact that identification (and practice) of policy-induced harmful rents have been resorted to in many firms and for various purposes. More specifically, the practice of rent-seeking model has been found to be resulting in both economic ‘gains’, and ‘losses’. The bottom-line is that there is a lack of scientific research evidence and published data on how national governments and donor agencies (from across the regions of the globe) have formulated and adopted rent-seeking approaches. The author of this research essay argues that in view of these contradictions and controversies, it is important for the academic and research community to seek answers to pertinent questions on potential advantages of rent-seeking approach. The questions that need to be debated and researched into are:a) what are the approaches to identify policy-induced harmful rent-seeking practices? b) what are their respective strengths and weaknesses? c) how governments and donors have used them in different perspectives? The author, in this paper, aims to seek answer to the above prominent and key questions in the context of countries in the Asian region. In terms of research methodology, secondary data (that are largely ‘quantitative’ in nature) have been used and method of data analysis is descriptive (involving “desk-based research” approach). Data sources have been quoted in the text (including under references). The paper briefly concludes that the rent-seeking activity might be negative, but it might preserve a “growth-enhancing rent”. Even if the rent-seeking activity has a positive value, the “outcome-rent” might be negative. Governments, thus, need to be more transparent in adopting rent-seeking practices; people know how laws and regulations are produced. This renewed critical and multidisciplinary approach has important policy implications for the debates over institutional reform in rent-seeking practices for economies in Asia and the Pacific.In conclusion, the author says that the analysis of rents and rent-seeking practices has been primarily dominated by an economic point of view. This perspective places emphasis on assessing rents in accordance with their impact on “efficiency and economic growth”. As against political approach to rent-seeking (which assumes the negative impact of rents and their potential to derive from corrupt activities), monetary policy experts and economists classify rents as “growth-retarding” (or “growth-enhancing”).In terms of implications of harmful rent-seeking practices for monetary policy, the author of this work argues that the rent-seeking framework has to be extended by incorporating policy insights and strategies developed by stakeholders in the governmental sector and institutional economists if it is to explain the anomalous role played by rent-seeking in Asian countries. This mechanism includes detailed analysis of economy in the broader context in countries such as Thailand, Malaysia, the Philippines, and Indonesia (including the Indian sub-continent).

Equipping Preservice Teachers for Data Use: A Study of Secondary Educator Preparation Programs in Virginia

Because data-informed decision-making (DIDM) can help teachers meet diverse learners’ needs (van Geel et al., 2016), educator preparation programs (EPPs) must ensure that preservice teachers (PSTs) develop the data literacy skills needed for effective data use. However, little is known about the ways in which EPPs work towards building PSTs’ data literacy, despite licensure and accreditation requirements compelling EPPs to do so. In this study, we analyzed survey, document, and interview data from Virginia EPPs to determine what present practices for DIDM preparation are taking place across the state. Results point to a lack of uniformity among EPPs for how preparation is undertaken, and that PSTS seem to have limited coursework on data use. Additionally, there appears to be minimal collaboration between EPPs and clinical partners, such that PSTs infrequently have opportunities to engage in DIDM during field experiences.

Mandatory Employment Requirements: An Investigation of the Hidden Barriers for New Generation Professionals in the Library and Information Services Sector

ABSTRACT This paper will discuss ALIA NGAC’s explorations of the impact of mandatory employment requirements within the library and information services sector, with a focus on the challenges faced by new generation professionals. Using a qualitative research approach, we uncovered the real-life experiences faced by individuals encountering hidden barriers to employment, particularly those related to drivers licence requirements and the need to work across multiple locations. In late 2023, we conducted a survey which allowed respondents to express their feelings about these requirements and offer suggestions for how the library and information services sector could address them. Our findings reveal that these requirements often act as exclusionary barriers, especially for individuals with disabilities, leading to difficulties in job applications, the burden of disclosing disabilities, and feelings of underrepresentation and discrimination. Our research has identified several pathways to alleviate the impact of these mandatory employment requirements, fostering a more inclusive and equitable workforce in the LIS sector.

Emergency physicians perspectives of state continuing medical education requirements for medical licensure.

This study aims to better understand the perspectives of emergency medicine physicians' on the role that state-mandated, topic-specific continuing medical education (CME) plays in addressing knowledge gaps, its relevance to current emergency practice, its reported burden and costs of CME activities to emergency physicians, and its perceived improvement in patient care. A cross-sectional survey was designed by the Coalition of Board-Certified Emergency Physicians (COBCEP) and distributed in February 2023 to all American Board of Emergency Medicine (ABEM)-certified physicians. Statistical tests of significance (Pearson's chi-square and Fisher's exact test) assessed the cost and time spent on CME as well as the perceived value placed on CME by ABEM-certified physicians to improve patient care. Data were summarized using descriptive statistics. There were 5562 (13.0%) responses from the 43656 physicians who received the survey-5506 responses were included for analysis. Over half of the physicians (53.0%) had more than 15 years of post-residency practice experience. Most physicians (57.3%) spent less than $5,000 per year on obtaining CME. Most physicians practicing in states with state-mandated, topic-specific CME requirements believed that participation in ABEM continuing certification could be used to reduce the need for state-mandated, topic-specific CME requirements (83.6%) and state-mandated, topic-specific requirements were believed to be unlikely to improve patient care (70.8%). Although well-intended, state CME requirements may lack relevancy and can, at times, place an undue burden on emergency physicians. Tailoring CME requirements to increase relevance to their patient populations and reduce barriers to completing CME could enhance knowledge translation and improve patient outcomes.

Understanding Implications of Varied State Policies Regarding Alternative Pathways to Licensure for Special Educators

Alternative pathways to licensure (APL) programs have proliferated nationally as a potential solution to the ongoing critical shortage of qualified special education professionals. Although these programs attract more diverse teacher candidates, they have been criticized for a lack of preparation and support provided to new professionals. This likely exacerbates teacher shortages and contributes to the pervasive underachievement of students with disabilities. Additionally, due in part to wide variations in APL programs, limited research is available on the structure and subsequent impact of APL programs. To gain a landscape view of the ways policy shapes special education APL programs in the United States, the authors analyzed state policies and regulations that guide licensure requirements for special education APLs. To do this, they identified policy and regulation documents and analyzed them for themes related to APL requirements. The authors found wide variability nationally regarding entrance and completion requirements for APL participants, including testing and pedagogical requirements, field experiences, and employment status. This type of policy incoherence has implications for state and local educational agencies, researchers, teacher educators, and policymakers as they seek to evaluate APL programs and determine which structures will most effectively support the recruitment and retention of special educators.

Investigating performance of optical communication system with FSO/OWC channel

Abstract In recent years, the evolution of optical wireless communication (OWC) system has emerged as a viable alternative to radio frequency communication. These technologies provide an effective solution for addressing the need for point-to-point communication, offering benefits such as higher bandwidth, faster data rates, no licensing requirements, low power usage, quick and simple installation, enhanced security, and resistance to electromagnetic interference. In this article, we analyze two wireless optical communication systems: one using an FSO channel and the other using an OWC channel. The analysis focuses on range and quality factor as performance metrics. We examine the performance of one-to-many Tx/Rx FSO/OWC channel under three different atmospheric conditions: clear weather, haze, and fog, using eye diagrams. The system analysis includes mathematical models for the received optical power and the pointing error. Additionally, we investigate the impact of spatial diversity on the performance of FSO/OWC channel with configurations of 1 × 1, 2 × 2, 4 × 4, and 8 × 8. Our findings indicate that the 8 × 8 FSO/OWC configurations yield better results compared to other configurations and the OWC channel performs well over long distances up to 110 km, while the FSO channel is more suitable for short range communication up to 37 km.

Regulatory requirements for dietary supplements under food safety and standards authority of India (FSSAI) in comparison with Cambodia

The Food Safety and Standards Authority of India (FSSAI) regulates dietary supplements in India; this study looks at such regulations and compares them with those in Cambodia. Regulations regarding production, labelling, licensing, and advertising are compared and contrasted. Although both nations have set up regulatory systems, the FSSAI guidelines in India are more extensive and have more stringent licensing and labelling requirements. The laws in Cambodia, on the other hand, are more focused on post-market surveillance and are less specific. The present study underscores the necessity of achieving regulatory requirements harmonization and improvement in order to safeguard consumer safety and foster the expansion of the dietary supplement business in both nations. The results will provide insight into the regulatory environment around dietary supplements in India and Cambodia for consumers, industry stakeholders, and policymakers1.

Comprehensive Brand Analysis of the Telecommunication Industry in Delhi and Delhi NCR

The telecommunication sector in Delhi and the National Capital Region (NCR) is a crucial component of India's digital landscape, catering to a population exceeding 30 million and driving technological advancements in one of the country's most economically vibrant regions. In this dynamic environment, understanding the intricacies of brand strategies, market dynamics, and consumer behavior is paramount for industry stakeholders seeking to thrive amidst fierce competition and rapid technological evolution. This in-depth brand analysis embarks on a journey to unravel the complexities of the telecommunication sector in Delhi and the NCR. Through a meticulous blend of qualitative and quantitative methodologies, the research endeavors to shed light on the diverse array of factors shaping the regional telecommunications landscape. From the strategies adopted by industry contenders to the regulatory frameworks governing operations, this exploration aims to provide a comprehensive understanding of the opportunities and challenges inherent in the Delhi-NCR telecommunication market. The study delves into the strategies deployed by key players to navigate the competitive landscape. It illuminates how brands position themselves to capture market share, differentiate their offerings, and respond to evolving consumer demands. Additionally, the analysis dissects the regulatory context shaping operations within Delhi and the NCR, including licensing requirements, spectrum allocation policies, and consumer protection regulations. By examining the interplay between industry dynamics and regulatory frameworks, the research provides insights into the governance of the telecommunication sector in the region. As the telecommunication sector in Delhi-NCR continues to evolve, informed decision-making becomes imperative for industry participants, policymakers, and investors alike. By synthesizing insights gleaned from the analysis of market dynamics, consumer preferences, and regulatory frameworks, this examination serves as a strategic resource for navigating the complexities of the regional telecommunication market. Armed with actionable intelligence and a nuanced understanding of the telecommunication landscape, stakeholders can capitalize on emerging opportunities, address challenges, and contribute to the continued growth and innovation of the sector in Delhi and the NCR.

To Praxis Test or Not? Mathematics Content Knowledge Tests for Teacher Licensure and Programmatic Considerations on Moving the Preparation Field Forward

ABSTRACT This study examined the relationships between recommended mathematics coursework for secondary mathematics teacher preparation, internal program measures, prior academic performance, and the Praxis-II testing requirement for initial teacher certification used in several states. Using structural equation modeling and path analysis, the research aimed to understand these relationships and their policy implications. Conducted over six years and holding the program measures and design constant for five cohorts, the study found strong support for specialized content knowledge courses, particularly for secondary mathematics teacher candidates who were not well-prepared in high school. Additionally, the findings suggest that the Praxis-II exam might not be necessary for all teacher candidates in mathematics, especially those who were well-prepared in high school and engaged in advanced mathematics coursework for teachers while meeting rigorous program requirements for teacher licensing. The study argues for reconsidering programmatic design in light of these findings while providing program faculty suggestions for program improvements. State Departments of Education and policy makers may consider the research methodology, validity of internal measures, and testing requirements for Praxis-II for future discussions.

Older adults’ perceptions and behaviors on driving: A mixed method study

Understanding older adults' driving behavior based on their personal assessment, along with challenges they encounter when driving will support community leaders and policymakers to develop effective supportive strategies for their safety on the road. This study uses a mixed methodology approach, including a survey and an interview to examine older drivers' perceptions and concerns regarding their driving habits. Collecting data from cities in Texas and Nevada, to achieve diverse perspectives on older adults who live in environments with different land use patterns and road geometry.Using the survey to understand the older adults' self-evaluated driving skills, where most consider themselves very good drivers even though they have some challenges, based on the roads, their reflexes changing over the years, and the impact of their physical and cognitive health. Supplementing the survey results with the interview allows the study to identify older drivers' major challenges including adverse weather, construction sites, and in-vehicle distractions. Supporting that visual and cognitive challenges are limiting older adults’ driving patterns (e.g., not driving at night).To avoid any conflicts with aggressive drivers, the older adults are passively driving, and if accessible, utilizing in-vehicle technologies to increase their safety. However, older drivers suggested that all drivers, particularly younger drivers, should have access to more educational materials. They recommended that older adults' licensing requirements should be evaluated based on their health condition rather than age. Participants’ concern regarding roadway infrastructure elements and driver behavior can be resolved through improvements in road design and driver education.

Supplementing an Epidemiology Course with Online Lectures

Background: Online distance education is proving to be an effective pedagogical vehicle for enhancing learning outcomes of medical students. Epidemiology is a subject area underexplored as an appropriate content area for online delivery. We sought to determine whether online epidemiology videos were an effective companion teaching tool that could result in measurable improvements in student performance. Methods: In partnership with the Lecturio Corporation in Germany, an online Epidemiology class created, featuring 11 recorded lectures tailored to the USMLE medical licensing requirements. Free access to the lectures was offered to the students of a 4th year undergraduate Epidemiology course at the University of Ottawa. Improvements in this group from the midterm examination baseline to the final examination performance were assessed relative to improvements experienced by students who did not watch the videos. Results: Students who watched the videos saw their average mark increased by 1.2%, while the mark in the control group decreased by 2.6%, though this difference was not statistically significant. Qualitative comments were universally positive with respect to the instructional usefulness of the videos. Conclusions: Augmenting traditional university epidemiology courses with an online video component is an effective strategy that can result in improved student learning outcomes, though further research is needed to determine how best to deploy such tools either in isolation or in partnership with in-person instruction.

Examining the impact of mineral export controls on sustainable energy transition in the global south

Export control policies for mineral resources may constrain the development of countries in the Global South. This study used data from 31 countries from 2009 to 2021 and employed a double fixed effects (FE) model to explore the impact of mineral resource export control policies implemented by countries in the Global South on sustainable energy transition. Our results show that prohibiting the export of base metals and ores significantly inhibits energy transitions. Moreover, energy transition performance improves when only licensing requirements are implemented without the enforcement of export bans and taxes. This study also highlights the importance of improved governance in mitigating the adverse effects of export prohibitions. Improvements in governance, such as corruption control, regulatory quality, rule of law, and voice/accountability, provide institutional guarantees for sustainable energy transition. This study also provides insights into measures that can help the countries in the Global South to balance resource conservation and clean energy development.

Understanding health data social licence: An international comparison of community attitudes towards health data use across Canada and Australia

ObjectiveResearch has found general but conditional support for health data being used for public benefit. The term “social licence” describes which uses of health data the public supports and under what conditions. Here, we aim to compare two approaches to understanding community attitudes towards health data use, and how social licence may differ, between Canadian and Australian populations. ApproachFactors that affect community support for health data use include the specific population, the type(s) of data, and the engagement approach used. In Canada, facilitated dialogues were held to explore whether (i) there were uses of health data that diverse members of the public all supported and (ii) there was consensus on essential requirements for health data social licence. In Australia, national surveys and citizens’ juries were conducted to better understand (i) attitudes towards private sector data use and (ii) the ethical, legal and social implications of using general practice data in research. ResultsDespite the different approaches taken, many conditions for social licence were similar across Canadian and Australian participants. Both groups agreed on conditions for health data social licence related to equity, governance, privacy and transparency. However, there was a stark contrast between levels of support for private sector data use, personal control and consent. ConclusionThis comparative exercise contributes valuable insights into the ongoing dialogue surrounding community attitudes towards health data use. Continued research monitoring health data social licence across populations is imperative for public trust while gaining full benefits from health data use in research.

Preparing Early Education Leaders: An Analysis of UCEA Principal Preparation Programs

Purpose: Recently, a confluence of factors has focused elementary school leaders on early education. One factor is that nearly 60 percent of all public elementary schools in the U.S. today have a Pre-K program in the building. Yet, prior research reveals that leaders are often not prepared to effectively lead early education programs. This study assesses the current state of early education leadership preparation among UCEA-affiliated programs. Method: Using a sequential explanatory mixed-methods approach, our study draws on survey data from 232 principal preparation faculty members at UCEA-affiliated programs, follow-up interviews with 20 purposively sampled survey respondents, and content analysis of 113 program web pages. Findings: We found that preparation programs currently afford little attention to early education leadership coursework and content, despite faculty expressing it as an important goal. Only four percent of faculty from the survey reported that their program required a course focused on child development and/or early education—a finding corroborated by the website analysis. Last, our interviews reveal reasons for the limited engagement with early education leadership, including time constraints, limited faculty experience, and licensure and accreditation requirements. Implications: Policymakers aiming to improve early education leadership may revise principal certification requirements that could prompt revisions in principal preparation programs. Principal preparation programs, similarly, could revise their programming to intentionally expose principal candidates to key topics in early education leadership. A bi-directional and concerted reform effort is likely needed to meaningfully advance change in this area.

Perceptions of Nurse Practitioners and Physician Assistants/Associates Toward the Concept of Developing an Advanced Practice Postgraduate Residency/Fellowship Program at a Large Academic Medical Center.

Introduction There have been exponential growth and increased interest in postgraduate residency/fellowship formalized training among nurse practitioners (NPs) and physician assistants/associates (PAs). Although not a requirement for state licensure and entry-level practice, postgraduate NP and PA residency/fellowship programs offer a structured pathway for new graduates and experienced PAs and NPs looking to transition into a new medical or surgical specialty/subspecialty. In this article, we examine the perceptions of employed NPs and PAs toward postgraduate training including the concept of developing a program at our institution. Methodology This was a cross-sectional single-large academic medical center (AMC) study, where an anonymous electronic survey was initially developed by the director of advanced practice providers (APPs). The survey was piloted by members of the Advanced Practice Council (APC) comprising NPs, PAs, and certified registered nurse anesthetists (CRNAs), and their collective feedback was used to finalize the survey prior to distribution. Descriptive statistics were used to describe and summarize the data. In addition, we assessed the association between respondents' characteristics and perceptions regarding NP and PA residency/fellowship programs using chi-squared tests of independence. Results The majority of the respondents (69.1%; 65/94) believed that starting an advanced practice residency/fellowship program at our AMC has many benefits such as increasing specialty-specific knowledge and training (79.8%; 75/94), improving medical decision-making (73.4%; 69/94), promoting professional development and clinical education (73.4%; 69/94), and improving procedural competency (60.6%; 57/94). Moreover, over half of the respondents (53.2%; 50/94) indicated that there is value in an APP residency/fellowship program obtaining optional accreditation. Additionally, over half of the respondents (56.4%; 53/94)indicated that they would be interested in participating as a clinical preceptor if an APP residency/fellowship program was developed at our AMC. Lastly, about one-third of the respondents felt strongly that APP residency/fellowship training programs should offer post-professional doctoral degree options such as Doctor of Nursing Practice (DNP), Doctor of Medical Science (DMSc), and Doctor of Health Science (DHSc). Conclusion Although most respondents have never completed a formalized postgraduate training program and were less familiar with the published literature regarding these programs, our findings suggest that the attitudes ofemployed NPs and PAs aregenerally positivetoward the concept of postgraduate specialty-specific training.

Firearm injury hospitalizations and handgun purchaser licensing laws: longitudinal evaluation of state-level purchaser licensure requirements on firearm violence, 2000–2016

BackgroundHandgun purchaser licensing (HPL) laws mandate individuals to obtain a license from law enforcement before buying a firearm. Research indicates these laws effectively reduce various forms of fatal firearm violence, including homicides, suicides, and mass shootings. Our study sought to assess the impact of HPL laws on non-fatal firearm violence.MethodsUtilizing the augmented synthetic control method (ASCM), we estimated the average treatment effect on the treated (ATT) resulting from a full repeal of an HPL law in Missouri (2007), a partial repeal in Michigan (2012), and an adoption on HPL law in Maryland (2013) on firearm injury hospitalizations. We utilized RAND's healthcare cost and utilization project-based dataset from 2000 to 2016 for our outcome variable. We conducted in-time placebo testing and leave-one-out donor pool testing as sensitivity analyses.ResultsMaryland’s adoption was associated with a statistically significant 32.3% reduction in firearm-related injury hospitalization (FIH) rates (ATT = − 0.497, standard error (SE) = 0.123); Missouri’s repeal was associated with a statistically significant 35.7% increase in FIH rates (ASCM = 0.456, SE = 0.155); and Michigan’s partial repeal showed no statistically significant associations with FIH rates (ATT = − 0.074, SE = 0.129). Sensitivity analyses confirm the robustness of the estimated HPL effects.DiscussionHPL laws appear to be protective against hospitalizations for nonfatal firearm injuries. These findings align with prior research indicating that HPL laws are effective in reducing fatal firearm violence. States without such licensing systems ought to consider these robust policies as a means to address firearm violence.

Evidence-based treatment for opioid use disorder is widely unavailable and often discouraged by providers of residential substance use services in North Carolina

IntroductionOpioid agonist treatment (OAT) is the only treatment for opioid use disorder (OUD) proven to reduce overdose mortality, yet access to this evidence-based treatment remains poor. The purpose of this cross-sectional audit study was to assess OAT availability at residential substance use services in North Carolina. MethodsWe conducted a state-wide inventory of residential substance use service providers in North Carolina and subsequently called all providers identified, posing as uninsured persons who use heroin, seeking treatment services. Program characteristics, as reported in phone calls, were systematically recorded. We used Fisher's exact tests to assess what program characteristics were associated with OAT availability and with staff making discouraging comments about OAT. We used unsupervised agglomerative clustering to identify facilities with similar characteristics. ResultsOf the 94 treatment providers identified, we successfully contacted and collected data from 66. Of those, only 7 (10.6 %) provide OAT on site; an additional 9 (13.6 %) allow OAT through an outside or community-based prescriber. Only 8 (12.1 %) providers were licensed to provide residential substance use treatment. Staff from 33 (50.0 %) providers made negative, discouraging, or stigmatizing remarks about OAT—for example, that OAT substitutes one addiction for another or does not constitute “true recovery.” OAT availability was positively associated with a provider holding a state license for any substance use-related service (41.9 % vs 8.6 %, p = 0.002) and offering 12-step programming (36.1 % vs. 10/0 %, p = 0.020). OAT availability was negatively associated with faith-based programming (6.1 % vs 42.4 %, p = 0.001), dress codes (5.3 % vs 50.0 %, p < 0.001), and mandates that residents work in a provider-owned and -operated commercial enterprise (5.0 % vs 32.6 %, p = 0.026). Cluster analysis revealed that the most common (n = 21) type of service provider in North Carolina is an unlicensed, faith-based organization that prohibits OAT, imposes a dress code, and mandates that residents work, often in provider-owned and -operated commercial enterprises. ConclusionEvidence-based treatments for OUD are largely unavailable at providers of residential substance use services in North Carolina. The prohibition of OAT occurs most often among providers who are unlicensed and impose labor and/or 12-step mandates on residents. Changes to state licensure requirements and exemptions may help improve OAT availability.