Mental Health and Substance Use Problems of Parents Involved with Child Welfare: Are Services Offered and Provided?

Background and Purpose:

Parents who maltreat their children are significantly more likely to have substance use (SU) or mental health (MH) disorders than parents who do not maltreat their children. Little is known about whether parents receive services for MH/SU problems. The research questions are: 1) When child welfare caseworkers identified parents with MH and SU problems, were MH and SU services offered and provided? 2) Were services targeted to the identified problems? 3) Were parents with both SU and MH problems more likely to be offered services than parents with only one of the problems?

Methods:

A secondary analysis of the 1994 National Study of Protective, Preventive, and Reunification Services Delivered to Children and their Families was conducted. Data collection for the 1994 Study consisted of a one-time structured interview with child welfare caseworkers of 2109 families. Caseworkers were read a list of problems and asked whether the parent experienced it. They were read a list of services and asked whether the service was offered, and if offered, whether it was provided. Caseworkers were selected using a two-stage probability sampling design. In order to obtain national estimates, weights were calculated and included in the data set. WesVarPC software was used for analysis. Analysis consisted of calculating percentages and frequencies and chi-squares. Weighted n's are provided in the results section.

Results:

Seventy-eight percent of parents with MH problems were offered MH services; of those offered services, 84% were provided services. Sixty-six percent of parents with SU problems were offered SU services; 67.5% of those were provided them.

Parents with MH and SU problems were significantly more likely to be offered services than parents without these problems x2 (1, N=1242539)=286.25, p < .001 and x2 (1, N=1242539)=870.57 p < .001, respectively. Still, MH services were offered to 27% of parents not identified with MH problems.

Eight-two percent of parents with MH and SU problems were offered MH services, compared to 76% with MH problems only (ns). SU services were significantly more likely to be offered to parents with both problems than to parents with SU problems only, x˛ (1, N=1242538)=17.47, p <.001. SU services were offered to 82% with both problems and to 61% with a SU problem only.

Conclusions and Implications:

The rate of services utilization was higher than in the general population, where less than 1/3 of adults with mental disorders receive services. Child welfare caseworkers may serve as “gatekeepers” for parents by making appropriate service referrals. More research is needed to understand why parents with SU problems have a higher level of unmet need. Limitations include that information was not available on parent functioning/coping, which likely influences whether services were offered. Data were not available on why services were not offered when problems were identified (or offered when problems were not identified) or why services were not provided when offered. These and other questions need to be answered by future research.