Substance Use Disorder Treatment Prevalence and Patterns Among Parents of Young Children in Foster Care

Background: Parental substance abuse (PSA) is the most common reason that children enter the Kansas foster care system. Although PSA is recognized as a child maltreatment risk factor, different substances may influence parenting and child safety differently. However, little is known about the substance use disorder (SUD) treatment patterns (e.g., primary substance, administration route, treatment episodes, usage, and discharge reasons) among parents with young children in care. As part of a five-year regional partnership project, this study sought to describe the prevalence and patterns of SUD and treatment among parents with young children (0-3) placed out-of-home due to PSA.

Methods:  Eligible families were randomly assigned to treatment and control groups. The control group received services-as-usual. Treatment participants were recruited and consented: (1) to participate in a 16-week parenting skills program (N=143 families & N=211 adults); and (2) to allow access to their SUD treatment records since 2013. Treatment records for all individuals who signed both consents (N=188) were requested from the state agency responsible for SUD treatment services, following CFR-42 confidentiality requirements.

Results: In total, 138 treatment records were received, which pertained to 88 individuals and 79 different families. Parents with treatment records were predominantly: female (72.7%), white (84.1%), between 18-53 years old (57.8% were 18-30), with low income (88.6%), and had reported co-occurring mental health issues (70.5%). Eleven (13.9%) of the independent families had treatment records for two parents. Methamphetamine was the primary substance identified in 55% of the treatment records; marijuana 23%; synthetic drugs and other opiates (other than heroin) 8%; alcohol 5%; heroin 5%; and cocaine and Phencyclidine (PCP) under 2%. Thirty-four individuals (38.6%) had multiple treatment records, ranging from 2-6 treatment episodes.

Over half (55.1%) reported methamphetamine as their primary substance, with 36.4% reporting daily use. Of the 76 treatment records related to methamphetamine use, smoking (65%) and injection (29%) were the primary administration routes. Forty-two percent of the treatment episodes had not been discharged, and 19.7% were transferred to another program (as discharge reason). The most frequently used service was ambulatory non-intensive at both intake (56.8%) and discharge (16%). At discharge, 10.2% reported methamphetamine use.

Discussion and Implications: The rates of SUD treatment for methamphetamine in this sample are more than double the rates of Kansas in 2014 (22.7%). Given the high rates and frequency of methamphetamine use in this study, the severe addictive properties, and the potential aggressive side effects from methamphetamine use, reunification may be delayed for these families, if it occurs at all. This finding provides insight into the prevalence and patterns of SUD and treatment records of parents with young children in foster care. To achieve the Social Work Grand Challenge of ensuring healthy development for all children, collaborative, integrated, and holistic service delivery is necessary to meet the complex needs of families with SUD. Considering the vulnerability and safety of young children, increased attention should be given to those families in which both parents have SUDs. Social work practice and policy implications will be discussed, particularly around access to treatment.