Parental Drug Use and Permanency for Young Children in Foster Care: A Competing Risks Analysis of Reunification, Guardianship, and Adoption

Background/Purpose:

The rates of children coming into foster care due to parental drug use have risen markedly in recent years.  The number of young children (ages 0-3) in foster care has also increased over a similar timeframe.  Frequently, studies show that although young children are less likely to reunify after foster care, they are more likely to achieve adoption; therefore, the overall goal of permanency is achieved.  However, parental drug removals are an established barrier to permanency, and the extent to which drug removals differentially affect young children is unknown.  This study examined the interaction of child age and drug removal status on likelihood of three competing permanency exits: reunification, adoption, and guardianship.   

Method:

The sample comprised 32,680 children who entered foster care in a Midwestern state between years 2005 and 2015.  Cases were observed for a minimum of 273 days and a maximum of 3,922 days (>10 years).  Four mutually exclusive subgroups of children were compared: children age 0-3 with and without drug removals and children age >3 with and without drug removals.  The trajectories to three types of permanency (reunification, adoption, and guardianship) for each group were examined with cumulative hazard curves.  The likelihood of achieving each type of permanency was estimated with multivariate competing risks regression models.  All analyses were conducted using Stata 13.

Results: Results suggest that child age and drug removals interact in such a way to inhibit young children’s permanency differentially.  Children 0-3 with drug removals were least likely to reunify but did not compensate for that disparity with a relative increase in adoption likelihood; children 0-3 without drug removals were 118% more likely to exit to reunification but only 82% less likely to exit to adoption.  Drug removals were also associated with reduced reunification for children age >3, but increases in adoption rates were compensatory.  Children 0-3 with drug removals were least likely to exit to guardianship. 

Implications: Zero to three is a critical developmental timeframe.  Prolonged stress and trauma during this phase can leave children’s neural architecture, health, and wellbeing, permanently affected.  Parental substance use disorders are a key risk factor for young children, and, reflecting this, infants and young children comprise the largest proportion of children in foster care and are less likely to reunify than older children.  Any potential concern regarding these findings is often assuaged because children 0-3 are much more likely to be adopted compared to older children.  However, the current study suggests that young children removed due to parental drug use do not experience the same adoption rates as similarly-aged children without parental drug use.  Addressing this disparity will require services aimed at improving both reunification and adoption rates for these children, including robust substance abuse treatment to mothers with substance use disorders and education and support to potential adoptive parents worried about the child’s exposure to parental drug use.  Future studies on substance abuse in child welfare must account for child age in order to correctly observe dynamics of risk.