The Disparate Impact of Alcohol, Methamphetamine and Other Drugs on Family Reunification after Foster Care

Purpose:  Arguably one of the most influential studies in recent decades found that childhood risk factors, including parental substance use and child abuse, are associated with health and wellbeing disparities across the lifespan and markedly decrease life expectancy (Felitti, et al., 1998).   Social workers have long recognized the intersection of these risks in the prevalence of substance use disorders among parents involved in the child welfare system.  Prior research has established that parental substance use bodes poorly for child welfare outcomes; however, the relative role of substance type in delaying reunification has remained elusive.  Identifying subgroups within child welfare is needed in order to ensure appropriate services (Testa & Smith, 2009).  Additionally, knowledge regarding the discrete impact of parental methamphetamine use relative to other drugs in the child welfare system is in its infancy.   This study sought to understand the unique impact of parental use of alcohol, methamphetamine, other drugs, and poly-substances on reunification rates for children in foster care. 

Method: Administrative foster care data from a Midwestern state were used to evaluate the effect of each substance use domain on reunification.  Using an entry cohort design, all children placed into foster care with a first placement during the study period (March 2007-March 2012) were included in the sample (N=16,220).   Data analyses involved univariate, bivariate, and multivariate statistics; survival analysis was the primary technique. A hierarchical Cox regression model compared reunification rates between five groups: 1) alcohol; 2) methamphetamine; 3) other drugs; 4) poly-substance; or 5) neither alcohol or other drugs.  Life tables provided an assessment of differences in median time in foster care.

Results: Of the 16,220 children, 45% reunified with a median time to reunification of 572 days. The hierarchical Cox regression model was significant, suggesting that parental substance use significantly slows reunification [χ2 (4) = 24.608, p< .001], controlling for relevant covariates.  Among substance use groups, parental methamphetamine use showed the most clinically significant impact on time to reunification [H.R. =.781, p=.002,], followed by other drugs [H.R.=.879, p<.001], and poly-substances [H.R.=.881, p=.023].  These hazard ratios show that the methamphetamine group is 21.5% less likely to reunify, and drug and poly-substance groups are about 13% less likely to reunify, after controlling for covariates.  Life tables indicated that compared to the neither AOD group, the methamphetamine group spends 49 additional days in care; the drug only group, 150 additional days in care; and the poly-substance group, 155 additional days in care.

Implications: This study provides new evidence that substance type impacts reunification differently, with poly-substance use delaying reunification the longest.  Methamphetamine was also shown to be a significant problem facing fragile families.  The finding that methamphetamine involved families reunified more quickly than other-drug involved families, but were least likely to reunify, suggests that caseworkers were less likely to strive toward reunification with these families.   Child welfare workers as well as policy makers must be educated on the disparate impact of substances in order to ensure appropriate services and improve outcomes across the lifespan.