Poverty, Maternal Addiction, and Family Reunification

Background/Purpose:  The rates of children coming into foster care due to parental drug use have risen markedly in recent years.  Although prior research has established that parental substance use disorders (SUD) are associated with poor foster care outcomes, few earlier studies have sought to differentiate families with parental SUD who do and do not reunify.  This study applied the intersectional social determinants of health framework to examine the effect of socioeconomic (SES) risks and parent gender on foster care outcomes among families with parental SUD.  Proportional hazards models tested differences in reunification for 325 mother-child dyads.  Consistent with cumulative risk measurement theory, this study evaluated the impact of four dichotomized SES risks separately and cumulatively.

Method: The sample comprised 480 parent-child dyads who participated in an evidence-based parenting program (EBP) for families with children in foster care and parental substance use disorders (SUD) in a Midwestern state between 2008 and 2012.  Secondary analysis of EBP data permitted linking of parent-level variables (e.g., income) with administrative child welfare data to track time in foster care and reason for exit (i.e., reunification). Bivariate analyses of fathers and mothers on key SES variables established increased SES risk among mothers. Missing data, which was high on certain model variables (e.g., income), were addressed using multiple imputation with chained equations.  Multivariate proportional hazards models with mother-child dyads (n = 325) assessed effects on reunification of four SES risks factors separately and cumulatively: single parent, income <$15,000, unemployment, and severe housing issues.  Median survival times were also estimated to explore differences in time in care depending on SES risk-level. All analyses were conducted using Stata 13.

Results: Study results revealed that mothers had significantly higher SES risk scores compared to fathers.  Multivariate analyses revealed that none of the SES factors alone reduced chances of reunification for mother-child dyads, but did so in combination.  Compared to cases with one risk, cases with three risks were 40% less likely to reunify and four-risk cases were 50% less likely to reunify.  Cases with zero, one, and two risks did not significantly differ. The group that spent the fewest days in care were cases with zero risk factors (median days in care: 454).  The highest median survival time was observed for the three-risk group (median days in care: 873), while the four-risk group reunified more quickly (median days in care: 671).   

Implications: The primary implication of this study is that families with maternal SUD in child welfare are a heterogeneous group whereby reunification depends on SES risk severity.  Families with three SES risks were afforded more time to reunify, but ultimately faced barriers to reunification compared to families with less SES risk.  Families with four SES risks were least likely to reunify and termination of parental rights occurred more quickly than lower-risk families.  In practice, these findings suggest that improving reunification for families with maternal SUD may be aided by reducing the total number of socioeconomic risk factors, rather than eliminating specific risks.