Role of Screening in a Model for Integrating Substance Abuse Treatment and Child Welfare Services

Background:Alcohol and other drug abuse are major problems for child welfare systems.  Substance abuse is believed to compromise appropriate parenting practices, increase the risk of child maltreatment, increase the risk of placement in foster care and decrease the odds of achieving family reunification.  To address this problem, the Illinois Department of Children and Family Services (DCFS) initiated the Title IV-E Alcohol and Other Drug Abuse  (AODA) Waiver Demonstration based on a model of service integration that includes components of (1) screening, (2) intensive case management, and (3) access to a range of health and social services. Few previous models of service integration have utilized standardized assessments for parents focused specifically on substance abuse.  In part, the lack of standardized assessments help explain why estimates of substance abuse in child welfare vary so widely (19% to 79%) throughout the literature. 

Methods: We analyze data from a standardized and comprehensive substance assessment (based on DSM criteria) that is utilized at the time of temporary custody in the Cook County family court as part of the AODA Waiver Demonstration in Illinois.  We analyze these assessment data (n=10,455) to (1) establish an accurate rate of substance abuse/dependence in child welfare; (2) determine is substance abuse contributes to the overrepresentation of African American families in child welfare systems; (3) determine if substance abuse is associated with family reunification; and (4) determine if substance abuse is associated with subsequent reports of maltreatment.  Assessment data were linked to administrative records of placement and allegations of maltreatment.  Survival models were used to estimate rates of permanency and safety.    

Results:Approximately 45% of all foster care placements are associated with a substance abuse diagnosis.  There is evidence to suggest that African American parents are more often inaccurately suspected (i.e. referred for screening and yet indicate no abuse/dependency issues) of abusing substances as compared with both Hispanic and White parents.  This pattern may help explain overrepresentation.  Cox proportional regression models indicate that substance abusing parents are significantly less likely (Exp(β) = .78) to achieve family reunification and significantly more likely (Exp(β) = 1.15) to be associated with subsequent reports of maltreatment as compared to similar non-substance abusing families in the foster care system. 

Conclusions: These findings indicate that although a substantial proportion of foster care placements are associated with substance abuse, the estimates indicate that the majority do not meet DSM criteria.  The findings indicate that controlling for a wide range of important covariates, substance abuse plays a critical role is the child welfare systems ability to achieve the primary mission of creating stability in the lives of children (permanency) and protecting children from future reports of abuse and neglect (safety).  Overall, the findings point to the central of role of screening and assessment in models of service integration for understanding program effectiveness and for insuring delivery of appropriate and equitable services.