Understanding Parents with Co-Occurring Substance Abuse and Mental Health Issues within Child Welfare

Background and Purpose:

Parents with co-occurring substance abuse and mental health issues have become of major concern in child welfare systems.  Prior research recognizes two major challenges in working with parents with co-occurring issues: 1) parents with comorbidity experience multiple problems with limited resources, which prevents their recovery process and often leads to violence at home; 2) parents with co-occurring issues, particularly those in public child welfare system, are less likely to access, engage in, and complete their services, and this can put their children at greater risk for maltreatment recurrence.  However, the current knowledge on this population’s experiences as well as effective intervention strategies for them is very limited.  In response, this study attempted to understand individual and behavioral characteristics and service needs for parents with comorbidity whose children are placed in out-of-home care, in comparison to parents who only have substance abuse issues. 

Methods

The current study utilized a subset of data from Illinois Alcohol and Drug Abuse Waiver Demonstration (AODA).  The sample included 457 mothers with substance abuse issues whose child(ren) were placed in out-of-home care.  Of these 457 mothers, 113 mothers (24.7%) had co-occurring substance abuse and mental health disorders.  Descriptive and bivariate analyses were used as main methods of data analysis.

Results

When demographic and behavioral characteristics of mothers with comorbidity were examined in comparison to those only with substance abuse issues, both groups looked similar: no significant differences were observed between the two groups in their age, race, marital status, living arrangements, income levels, educational attainment, and employment status.  For example, approximately a quarter of mothers in both groups were reported to be homeless (p=.890).  However, the two groups were different in their choice of drugs: cannabis use was more commonly noted for parents with comorbidity (p<0.05) while opioid use was more frequently reported for parents only with substance issues (p<0.05).

The study results indicated that parents with comorbidity had significantly higher levels of needs and challenges than those only with substance abuse issues in many domains, including transportation, housing, education, job training, child care, parenting education, family counseling, domestic violence services, and legal service.  For example, 40.7% (n=46) of parents with comorbid issues were found to have housing needs, and the comparable percentage was 10.8% (n=37) for those only with substance abuse issues (p<0.001).  Similarly, parenting education was identified as an area of need for 81.4% (n=92) of mothers with comorbidity and for 25.9% (n=89) of those only with substance abuse issues (p<0.001).  Additionally, mothers with comorbidity were less likely to have health insurance than those only with substance abuse issues (p<0.01).

Conclusions and Implications

The findings of the study illustrate that parents with comorbidity experience many challenges and needs, which are significantly higher than those only with substance abuse issues.  This suggest that more intensive, comprehension services and treatments be provided for this population.  It also points out a need for future studies that examine the impact of this population’s challenges and needs on their relationship with children and child welfare outcomes.