The blog of the Urban Institute
June 24, 2019

How Can Insurers and Payers Raise Treatment Rates for Parents with Opioid and Other Substance Use Disorders?

More than half a million parents (623,000) with opioid use disorder (OUD) in the United States are living with their children younger than 18. But fewer than one in three of these parents have received treatment for substance use disorder (SUD).

An additional four million parents have a substance use disorder other than OUD, and these parents have even lower treatment rates. And estimates of prevalence based on survey data may be low, as a recent analysis showed that the actual prevalence of OUD in a population was about four times the rate estimated in survey data.

Findings from our recent study reveal the scope of the opioid crisis’s impact on parents and children and the persistence of problems with other substances. They also reveal the urgent need for health plans and payers to expand their engagement with those impacted by substance use disorder to deliver the services they need to recover and mitigate the adverse consequences on children and families.

The scope of the problem

Opioids aren’t the only issue. Forty-two percent of parents with OUD had one or more other substance use disorders, most commonly alcohol use disorder (22.4 percent).

Even more of these parents have mental health challenges. More than one in five parents with OUD (20.1 percent) had suicidal thoughts or behavior in the past 12 months, and a similar share had a major depressive episode (25.1 percent) or a serious mental illness (23.5 percent). All these rates are higher for parents with OUD than for parents with other substance use disorders (most commonly alcohol use disorder).

Treatment rates for substance use disorder and mental health problems vary widely among parents with a substance use disorder. Just over one-quarter of parents with OUD received drug or alcohol treatment at a specialty facility or other doctor’s office, compared with about 1 in 20 of those with other substance use disorders. Forty-two percent of parents with OUD received any treatment for mental health in the past 12 months, compared with 26 percent of those with other substance use disorders.

These facts reveal the need to improve parental care by improving whole-person health—including SUD and mental health—and to evaluate whether savings from addressing whole-person health can be found in maternal and pediatric care and in other sectors, such as education, child welfare, and juvenile justice settings.

Three strategies for payers to better connect parents to treatment

1. Better involve primary care and build new infrastructure for primary care providers to effectively address SUD.

Ideally, primary care practices would play a critical role in addressing SUD issues among parents, including screening and diagnosing substance use disorders, motivating behavior change, and facilitating initiation of treatment.

But funding for provider education, technical assistance, and other necessary infrastructure to integrate primary care and pediatrics, mental health, and SUD treatment is often lacking. As a result, not enough primary care providers have the time, training, technology, and support from specialists and other staff to effectively treat parents with an SUD.

2. Focus on parents and children.

Even though primary care spaces are starting to integrate mental health and SUD treatment and strategies are emerging, there is little apparent targeting of parents—not only parents with infants but also those trying to care for their young or adolescent children.

Discussion among providers, insurers, and payers around OUD and SUD often focuses on how to get people into treatment. But for parents especially, we need to discuss the supports needed to retain them in treatment, such as treatment facilities with family-friendly hours and child care.

We also need to discuss the outreach needed for those who do not want treatment, perhaps because they view it as not feasible (like parents balancing jobs and child-rearing), or they fear that a record of SUD treatment could increase the likelihood they lose their job or custody of their children.

We know that parental substance use and mental illness are major risk factors for children’s development and health and that providing accessible care for parents with SUD and mental health needs in primary care settings could be critical. But how can we offer the right incentives and culturally effective programming to develop a skilled and empathic provider workforce and make treatment attractive to parents?

This gap in the discussion and the data will continue to hinder efforts by payers, providers, and communities to achieve better outcomes.

3. Improve maternal screening and other strategies to improve holistic maternal health.

Screening for OUD or SUD is a critical first step to referral and treatment. Medicaid can offer a cost-effective solution for screenings because Medicaid often covers both mother and child. But Medicaid coverage of some maternal depression screenings in pediatric settings may not be enough. Are there other creative strategies that Medicaid and other payers can deploy to address the crisis through the lens of holistic maternal health?

Ultimately, we do not know which providers have the capacity and bandwidth to implement these strategies. To find the answer, we need to dig deeper, both quantitatively and qualitatively. With that knowledge, we can identify gaps and opportunities and develop the most effective solutions for parents over the near and long term.

Photo by AlexLinch via Getty Images.

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