Recognizing the Contributors to Maternal Child Welfare Involvement: The Role of Trauma Exposure, Substance Use and Mental Health Issues

Background/Purpose:  Mothers make up a largely under-researched group within the child welfare (CW) system, with existing research highlighting significant challenges in maternal functioning including mental health challenges and substance use. These challenges have largely been viewed as factors that cause mothers to be ill-prepared to parent. Less researched, but increasingly documented, is the level of exposure to traumatic events experienced by mothers that contributes to said challenges in functioning. Identifying the source of challenges in functioning is of great import given that interventions are developed based on accurate problem definition. The relative dearth of information that recognizes the role of exposure to potentially traumatic events has lead to foci on interventions that include parenting classes and substance use treatment. Effective treatment interventions must recognize and respond to maternal exposure to trauma with  trauma-informed components. This study uses child welfare as an outcome measure in order to understand the complex relationship between exposure to four specific traumatic events (accident, non-sexual assault by a stranger, sexual assault by someone you know, and life threatening illness) and subsequent mental health diagnoses and substance use.

Methods: Data and Sample. Data from the Substance Abuse Research Demonstration data set were used. 452 women applying or recertifying for TANF were recruited for a field-based randomized controlled trial of intensive case management. Only the pre-randomization, baseline data of 302 substance dependent women and 150 non-substance dependent women were used for the current analysis. Sixty-six mothers in the clinical sample were actively involved with child welfare, while six of the control sample were actively involved.

Measures. Addictions Severity Index Female Version (ASI-F) collected demographic details along with composite scores of drug and alcohol use that established severity of substance use. Beck’s Depression Index II (BDI) a 21-item self reported measure of experienced distress from depressive symptoms. The Post Traumatic Diagnostic Scale, a 49-item self-report measure of exposure to potentially traumatic events, symptoms of PTSD, and self-evaluated functioning.

Analyses: Binary logistic regression analyses were implemented in steps. Currently active child welfare case (ACW) was the dichotomous independent variable. First we tested each predictor independently, then those that were significant were entered into the final model. 

Results: Significant independent predictors of ACW were depression (OR=1.03, 95% CI: 1.01, 1.05), drug use (OR=7.8, 95% CI: 1.6, 37.2), non-sexual assault by a stranger (OR=1.97, 95% CI: 1.07, 3.6), having a life threatening illness (OR=.44, 95% CI: .22, .88), and functional impairment of relationships with family due to trauma (OR=.47, 95% CI: .24, .92). When these predictors were entered simultaneously into the model, only BDI and life threatening illness remained significant. Additional analyses that compare mothers with any history of CW involvement will be included in the final presentation.

Conclusions & Implications: CW involved mothers have lives that are complex, with challenges that extend beyond substance use. Our findings highlight the need for supports for mothers, with implications f or robust, non-punitive mental health services, along with concrete supports to assist families in avoiding or interrupting the cycle of child welfare system involvement.