Multilevel Factors Associated With On-Site Childcare Availability in Substance Use Disorder Treatment Settings, United States, 2024

Background: Most parents in need of substance use disorder (SUD) treatment do not receive it, due in part to childcare being a major barrier. Childcare availability likely depends on multiple factors at the facility, community, and state policy levels. Objective: To identify multilevel characteristics associated with childcare availability in SUD treatment settings, and whether state policies about drug use and treatment influenced childcare availability differently within states. Methods: We used the Mental Health and Addiction Treatment Tracking Repository (MATTR) and external geocoded data to identify all known licensed SUD outpatient treatment facilities in the United States (2024; N = 7796). We used multilevel logistic regression to model childcare availability. We included interactions to test whether state policies about drug use and childcare were associated with childcare access differently depending on census tract characteristics. Results: Only 4% of SUD treatment facilities offered childcare (n = 323). Location in a state that did not specifically mention methamphetamine in its child endangerment laws was most strongly associated with childcare access in communities with higher Black population density ( = −0.16, standard error = 0.06, P = .01). Conclusion: Some state policies influenced childcare access differently in different communities, suggesting that state policies should be flexible and tailored to the needs of diverse localities.