Purpose: Despite involvement with child welfare and substance abuse systems, some parents continue to abuse alcohol and other drugs. Consequently, children within substance abusing families are exposed to a continued risk of maltreatment. Similarly, the mothers within these families are at an increased risk for delivering their first or perhaps even a subsequent Substance Exposed Infant (SEI). The purpose of the current study is twofold: (1) investigate the efficacy of Recovery Coaches on preventing SEIs and (2) identify other predictors of SEIs for substance abusing women involved with public child welfare.

Methods: The sample includes 940 women who were enrolled in the Illinois Title IV-E Waiver Demonstration. Subsequent to temporary custody, parents were randomly assigned to either a control (n=261) or experimental (n=679) condition. Parents in the control group received traditional substance abuse services. Parents in the experimental group received traditional services plus the services of a Recovery Coach. The Recovery Coaches assist parents with obtaining needed treatment services and in negotiating departmental and judicial requirements associated with drug recovery and concurrent permanency planning. More than 20 factors including socio-demographics, substance use, adult correctional involvement, psychological functioning, previous treatment history and social relations were examined for their potential relationship with SEI allegations. We use Cox regression to model the relationships between such factors and SEIs.

Findings: Of 931 women, 73 (7.8 %) were associated with a new SEI allegation including 45 caregivers (6.6 %) in the experimental group and 28 caregivers (10.7 %) in the control group (X2 = 4.426, df =1, p < .05). Caregivers associated with cocaine and marijuana were more likely to be associated with a new SEI allegation – relative to other alcohol and drug users. Women with high school diplomas were less likely to have subsequent SEI allegations. The results of Cox regression analyses also indicated that caregiver age and prior involvement with child welfare services were significant predictors of SEI allegations. Specifically, younger women were more likely to have subsequent SEI allegations. In addition, the risks of subsequent allegations were increased by the total number of children in foster care.

Conclusion: Using an experimental design, and working with a high risk group of substance abusing caregivers, the current study indicates that the use of Recovery Coaches in child welfare decreases the risk of SEI. This study also highlights the need for the continual development for the intake profiles for women with high risk of subsequent SEI allegations. In addition, findings indicate that child welfare programs must develop interventions that are specifically tailored to meet the need for this at-risk population.