A Review of Interventions for Child Welfare Parents with Substance Use Disorders

Purpose: Over 8.3 million minors live with a parent that is dependent on or abuses alcohol or illegal drugs (SAMHSA, 2009). With substance abuse estimated to be a contributing factor to maltreatment in one- to two-thirds of child welfare cases (Semidei, Radel, & Nolan, 2001), the need to examine existing substance abuse interventions for child welfare parents is urgent. Little is currently known about which types of interventions are most effective for engaging these parents into treatment. In addition, little is known about the overall quality of the evidence in this area. This study fills this gap by addressing the following research questions: 1) When accounting for methodological quality, what interventions are effective in increasing parent's attendance in substance abuse treatment and increasing placement stability for their children? 2) Are interventions provided through the court system more effective than those that are community based? 3) Do interventions that provide services directly to children in addition to their parents produce better outcomes?

Methods: A systematic search of six databases resulted in 302 references from peer-reviewed journals. Title and abstracts were reviewed for the following inclusion criteria: all participants had to be an adult parent of a minor child, over 50% of participants must have been reported to child protective services at least once, the treatment was an intervention for substance abusing parents, and quantitative outcome measures had to be used. Reference lists and evidence-based databases were searched to find additional studies meeting the criteria. A final sample of 15 studies met the inclusion criteria. Methodological quality and outcome attainment were assessed as described in the conference abstract. Outcomes rated for this review included: substance use treatment attendance and placement stability including measures of out-of-home placement, reunification, and time to permanency. Outcomes were compared on whether the intervention was provided through involvement with the court system and whether or not a service was provided directly to the child.

Results: Overall, six studies were effective in increasing treatment attendance and six studies were effective in promoting placement stability. Interventions provided through the court system were no more effective at promoting parent attendance, however, they were more effective at promoting placement stability. Interventions which provided services directly to the children were less effective at promoting treatment attendance and less effective at promoting placement stability.

Conclusions and Implications: The provision of services directly to children is not necessary to promote parent attendance or positive placements for children. Elimination of these services may remove from children the burden of additional interventions and cut program costs. Interventions provided through the court system are likely to increase placement stability but surprisingly do not increase parent attendance. Lack of consistency in the measurement of outcomes across studies made comparisons difficult. Methodological quality in this area would be improved through the use of fidelity measures and stronger study designs.