The Impact of Parental Substance Abuse on Family Reunification Among Children with Demonstrated Mental Health Needs

Background and Purpose:

Parental substance abuse affects a considerable number of families involved in the child welfare system. Between 50% and 80% of child welfare-involved children are estimated to have substance-abusing parents. Child welfare-involved children also experience high rates of mental and behavioral health challenges, with nearly half identified as having a clinically significant emotional or behavioral health problem. Parental substance abuse and child mental health need are both associated with poorer child welfare outcomes, including reduced likelihood of, and increased time to, reunification.

This presentation aims to contribute to this research by examining the relationship between parental substance abuse and reunification among child welfare-involved children with existing mental health needs.

Method:

This study is a secondary analysis of data collected for the Children’s Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant evaluation in one Mid-Atlantic state. Child welfare administrative data and Medicaid claims data were merged for 406 children who were placed out-of-home by child welfare and had received [Medicaid-funded] mental health services prior to removal. Parental substance abuse was defined as whether a parent’s drug and/or alcohol abuse was identified as a reason for removal by the caseworker. Reunification was defined as whether reunification with the parent(s) was the reason for exit from placement; time to reunification was measured as the number of months between removal and reunification.

A Cox regression model tested whether parental substance abuse predicts relative “risk” of reunification. Data were right-censored at non-reunification exit from placement, the child’s eighteenth birthday, or October 31, 2014 (through which placement data were available). Child age, gender, race, placement setting (family vs. group), whether child behavior problem was a reason for removal, and whether the child used psychiatric inpatient/emergency department (ED) services prior to removal (as a proxy for severity of mental health need) were included as covariates. A Kaplan-Meier test compared the estimated mean time to reunification between children with and without substance-abusing parents.

Results:

Parental substance abuse was significantly predictive of reunification. Children with substance-abusing parents had a 74% lower relative “risk” of reunification than those without substance-abusing parents (HR=.26, p<.001). The estimated mean time (months) to reunification was significantly longer for children with substance-abusing parents (M=112.98, SEM=14.19) than those without substance-abusing parents (M=78.31, SEM=6.09; Mantel-Cox log rank x²[1]=6.13, p=.013).

Over time, children with a behavioral health problem (HR=.95, p<.001) or prior inpatient/ED service (HR=.95, p<.001) had significantly decreasing rates of reunification, compared to those without a behavioral health problem or prior inpatient/ED service, respectively.

Implications:

Parental substance abuse, child behavioral health problem, and prior inpatient/ED use were all associated with lower reunification over time. These findings demonstrate the impact that these co-occurring needs have on reunification. Child welfare-involved families with co-occurring problems often do not receive the full array of services that they need, resulting in poorer outcomes. Recovery coaching as a form of intensive case management offers a promising intervention for effectively coordinating services for child welfare-involved families with substance-abusing parents and other co-occurring needs.