SWK 5001| Week 10: Becoming a Research-Minded

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Lack of Accessible, Affordable Treatment Services

Tierainie C. Johnson, MS, MCAP

Capella University

SWK 5001- Research in Social Work

Dr. Selina Matis

May 14, 2026

Lack of Accessible, Affordable Treatment Services

Problem Statement

Relevance to Social Work

The issue of lack of accessible and affordable treatment services is a social problem that has a significant impact on the social work profession. Financial, provider, and systemic inequities prevent millions of Americans from accessing timely and sufficient care for mental health and substance use disorders (Coombs et al., 2021). Social workers, who are at the intersection of individual need and institutional systems, regularly meet with clients who fall through critical gaps of the treatment continuum. This issue is directly related to social work's central purpose of improving human well-being and fulfilling basic human needs. Clients without access to affordable and accessible services experience poorer outcomes, longer suffering, and greater cycles of poverty and social marginalization.

Connection to the NASW Code of Ethics

The National Association of Social Workers (NASW) Code of Ethics is based on human dignity, service, and justice. Geography, cost, and insurance pose real barriers to accessing the required care, undermining a person's human dignity and reflecting structural injustice. These conditions are the ethical responsibility of the social worker to address, lobby for systemic change, and dismantle barriers to client access to services. This moral duty is reflected in all aspects of practice. The ethical framework of the profession requires that those working in the field acknowledge systemic factors that are barriers to well-being and take action through direct practice, interdisciplinary collaboration, and policy advocacy (NASW, 2021).

Core Values and Ethical Standards

This issue relates to two core NASW values. One is social justice, which means that social workers are committed to actively working for systemic change on behalf of vulnerable and oppressed individuals and groups (NASW, 2021, Section 6.01). The disparity in treatment according to the income, race, or geographical location is a basic social injustice that the profession must confront. The second, dignity and worth of the person, is concerned with treating each individual with dignity and respect, and promoting meaningful self-determination (NASW, 2021, Section 1.02). If treatment is not available, clients are denied the conditions that enable them to make choices and to sustain recovery, and thereby denied the opportunity for lasting well-being

Literature Review Summary

To estimate the magnitude of barriers to mental health care access among adults with mental health conditions in the United States, Coombs et al. (2021) performed a cross-sectional, population-based analysis of 2017-2018 National Health Interview Survey data of 50,103 adults. 95.6% of the respondents reported at least one barrier, the most common being lack of insurance and cost. Adults experiencing high levels of psychological distress were significantly more likely to be without a care provider, which deepens the understanding of how financial inequities are leaving the most vulnerable out. The study demonstrates limited cultural responsiveness as it does not account for racial and ethnic disparities in access to treatment. This is a serious issue for social work practice, especially because the populations most impacted by access barriers are disproportionately communities of color, and the findings of the study fail to reflect the unique experiences of these communities. However, it was published in a peer-reviewed journal, SSM: Population Health, and the large, nationally representative data set carries a high level of credibility. It provides a direct focus on cost, insurance, and structural barriers, making it very relevant to social workers involved in advocacy, policy change and equitable services delivery planning with underserved communities.

Cernasev et al. (2021) systematically reviewed literature from the United States (U.S.) that focused on barriers and facilitators to access to medications for opioid use disorder (MOUD) from a patient perspective. Four electronic databases were searched and stigma, financial cost, limited provider availability, and inadequate transportation were the most commonly reported. The findings add to the understanding of the issue by foregrounding the lived patient experience and by revealing the interplay between structural and attitudinal barriers that deter ongoing treatment. Racially and ethnically diverse groups were underrepresented in included studies, which raises concerns for cultural responsiveness as a significant limitation. In the practice of social work, this restricts the applicability of the findings for designing interventions that are equitable and community-focused and take into account the diversity of populations routinely served by workers. However, the open-access, peer-reviewed article published in Exploratory Research in Clinical and Social Pharmacy follows strict methodological standards. It clearly has a patient-centred perspective, and because of its direct applicability to access to opioid use disorder treatment, it is also relevant to social work advocacy and design of culturally competent interdisciplinary treatment programs.

Farhoudian et al. (2022) conducted a systematic review of 12 systematic reviews to determine barriers and facilitators to SUD treatment while using AMSTAR criteria to assess methodological quality. Stigma, treatment unaffordability, insurance shortcomings, and waitlist wait times were identified as the most common barriers, while peer support and integrated models of care were identified as key facilitators. The findings support the notion that treatment access barriers are ubiquitous and of a structural concern pertinent to social workers and social work knowledge. A major limitation is that most of the reviews included did not specifically address the experiences of culturally diverse and/or marginalized groups, potentially raising concerns for social work practice. This negatively impacts the ethical utility of outcomes when translating practical applications for those communities most affected by inequities in treatment. However, it is a peer-reviewed overview published in Substance Abuse (SAGE Journals) that makes it credible and comprehensive. These financial and structural barriers are supported by several independent reviews and directly relevant to social work practice, which focuses on equity goals, interdisciplinary treatment planning and systemic policy advocacy.

References

Cernasev, A., Hohmeier, K. C., Frederick, K., Jasmin, H., & Gatwood, J. (2021). A systematic literature review of patient perspectives of barriers and facilitators to access, adherence, stigma, and persistence to treatment for substance use disorder. Exploratory Research in Clinical and Social Pharmacy, 2, 100029. https://doi.org/10.1016/j.rcsop.2021.100029

Coombs, N. C., Meriwether, W. E., Caringi, J., & Newcomer, S. R. (2021). Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study. SSM - Population Health, 15(2), 1–8. https://doi.org/10.1016/j.ssmph.2021.100847

Farhoudian, A., Razaghi, E., Hooshyari, Z., Noroozi, A., Pilevari, A., Mokri, A., Mohammadi, M. R., & Malekinejad, M. (2022). Barriers and facilitators to substance use disorder treatment: An overview of systematic reviews. Substance Abuse: Research and Treatment, 16(16). https://doi.org/10.1177/11782218221118462

NASW. (2021). Social Workers’ Ethical Responsibilities to the Broader Society. NASW - National Association of Social Workers. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English/Social-Workers-Ethical-Responsibilities-to-the-Broader-Society