Medication-Assisted Treatment Improves Child Permanency Outcomes for Opioid-Using Families in the Child Welfare System

BACKGROUND AND PURPOSE: Parents who use opioids and are involved in the child welfare system are less likely to retain custody of their children than parents who use other drugs. Medication-assisted treatment (MAT) for opioid use disorders is an evidence-based practice, though no previous studies have described the relationship between MAT utilization and child permanency outcomes among this population. The Sobriety Treatment and Recovery Team (START) model is an intervention focused on families with co-occurring substance use and child abuse / neglect. This study examined the prevalence and correlates of MAT utilization among parents in the START program with a history of opioid use, and compared child outcomes for families who received MAT to families who did not.

METHODS: The sample consisted of 596 adult opioid users (65.8% women; 8.2% African American; 90.3% White; 1.5% Other races) within 413 families residing in urban, small city, and rural areas of one Midwestern state. Parents entered the program between 2007 and 2015. Data analysis consisted of two steps. First, individuals who received no MAT and those with at least 1 month of MAT (methadone, buprenorphine, or naltrexone) were compared on the following variables: demographics (gender; age; race; county of residence), drug use (seven categories of psychoactive substances), and permanency status (all children remained with parents vs. all other outcomes) at case closure. In step two, months of MAT, along with demographic variables, were entered as independent variables into a multiple logistic regression model to identify correlates of permanency status at case closure.

RESULTS: Of the 596 individuals with a history of opioid use, 55 (9.2%) received at least 1 month of MAT. Receipt of MAT services did not differ by gender, age, county of residence, or drug use, though individuals who identified as White were more likely to participate in MAT. In a multiple logistic regression model, each additional month of MAT was associated with a 10% increase in the odds of parents retaining custody of their children (odds ratio, 1.1; 95% CI, 1.01-1.19).

CONCLUSIONS AND IMPLICATIONS: A relatively small portion of opioid users in this sample of families involved in the child welfare system received MAT. We are not aware of other studies describing prevalence of MAT utilization among this population, however, capacity, availability, and stigma may explain underutilization. This is the first study showing that duration of MAT is positively associated with parents in the child welfare system retaining custody of their children. The average length of a START case is 14 months; compared to parents in the study who received no MAT, 14 months of MAT increased the odds of parents retaining custody of their children by 140%. This finding is consistent with previous studies showing other positive outcomes of increased duration of MAT (e.g., reduced drug use, criminal activity, and disease transmission). To address barriers to MAT, educational interventions may be needed for the child welfare workforce, as well as programs to improve collaboration and decision-making between the child welfare workforce, court personnel, and drug addiction treatment providers.