Residential Care and Reunification for Substance Abusing Parents in Child Welfare

Purpose: A primary goal for child welfare systems is to improve family functioning and achieve family reunification. Yet this goal has proven particularly difficult for children with substance abusing caregivers - a group that often achieves the absolute lowest rates of reunification. Children in substance abusing families remain in substitute care placements for significantly longer periods of time, and experience significantly lower rates of family reunification relative to almost every other subgroup of families in the child welfare system (U.S. General Accounting Office, 2003). Unfortunately very little is known about the specific treatment services are most likely to improve the chances for achieving family reunification. The current study addresses this gap in the literature. We focus particular attention on the role of residential treatment, and the role of residential treatment in combination with other community based approaches (e.g. outpatient, recovery homes) for substance abusing caregivers in child welfare.

Methods and Results: The current study utilizes a diverse sample of 212 substance exposed infants and their maternal caregivers. The infants and caregivers are part of the Illinois Title IV-E Alcohol and Other Drug Abuse (AODA) waiver demonstration. The current study utilizes a variety of survey and administrative data sources, including official reports of maltreatment, detailed records of treatment services, and caseworker assessments of caregiver problems and treatment progress. We utilize survival analysis, logistic regression, and life tables to understand the relative benefits of residential care, and the effects of this modality on treatment progress and reunification. The sample is 86% African American, and 64% of the caregivers are associated with multiple substance exposed infants. Approximately 53% of the parents received some form of residential treatment. The findings from the logistic regression indicate that residential treatment is effective, but not in isolation. Residential treatment is only more effective when it is combined with other community base transitional services (Exp(b) 16.4, p<.01). The findings from the survival analysis indicate a similar pattern with regard to achieving reunification. That is, reunification is most likely to occur when substance abusing parents receive residential treatment and at least one community based transitional service (Exp(b) 4.0, p<.01). These effects remain even after controlling for a wide range of important covariates including but not limited to race, age, gender, mental health problems, and domestic violence.

Conclusions: Residential services are an important component for families in the child welfare system. Yet, in the current economic climate, such services are likely to encounter a significant loss of resources. This is especially true for residential services associated with substance abusing caregivers in the child welfare system. The current study clearly identifies the potential benefits of residential care in terms of both treatment progress and family reunification, but only when residential is delivered in combination with community based transitional services. State and agency administrators should rely on the available empirical evidence to make informed decisions about which services best meet the complex needs of children and families involved with child welfare systems.