Intermediate and Ultimate Outcomes for Substance-Abusing Parents Involved with Child Welfare

Background and Purpose:

Parental substance abuse is a prominent theme in child welfare. Substance abuse treatment models include psychosocial, pharmacological, and legal interventions (Eggins, 2016). However, whereas the focus on child outcomes (e.g., re-unification) is clearly the long-term, or ultimate, goal, treatment engagement, attendance, retention and completion are important intermediate goals of the treatment system (Marsh, 2012). The purpose of this scoping review addresses the research question: “What is known about interventions that have assessed intermediate and ultimate goals for substance-abusing parents involved with child welfare?  Specifically, our aims included ascertaining how many studies linked the intermediate outcomes to the ultimate outcomes.

Methods:

We used Arksey, and O’Malley’s (2005) five-stage scoping review framework to identify, select, chart, collate, and report on relevant studies. Databases searched included Social Work Abstracts, Scopus, CINAHL, ERIC, Web of Science, PsychArticles, and PsychInfo, as well as reference lists in related review articles. We also searched the websites of existing networks and relevant organizations. Inclusion criteria of literature: peer-reviewed; no date or study design restrictions; used “child welfare” and “substance abuse” as search terms; and reported on intermediate and ultimate goals.  At each stage of the search each author read the abstract and the full article, as needed, to decide on articles to be included.

Results:

The search resulted in 26 peer-reviewed studies that met criteria, 21 published within the past 15  years. Studies were categorized using Eggins (2016) framework of treatment categories: Home-Visiting (n = 1); Family Treatment Drug Courts (FTDC) (6); Multidimensional Interventions (9); and Family, Parent or Child Focused Interventions (10). Study samples ranged from 15 to 1562 clients. Just over 45% of studies involved experimental (31%) or quasi-experimental (15%) designs.

Certain categories or specialized interventions within categories increase engagement over traditional child welfare services. These include family drug courts, recovery coaches, service matching, and intensive case management. These interventions also resulted in improved ultimate outcomes. However, only six of the studies included ultimate outcomes and only two of those studies directly examined the link between the intermediate and ultimate outcomes. Further, although these interventions were statistically effective, some studies also reported overall low rates of both service utilization and reunification.

Themes in non-experimental studies included the importance of therapists’ attitudes, child welfare involvement as an important motivator for engagement, and ongoing challenges of treatment access and structural barriers.

Conclusions and Implications:

The limited literature from this scoping study suggests various intervention models are successful in substance abuse treatment engagement, retention, and subsequent re-unification for families involved in child welfare. A next step is to further examine the linkage between the intermediate outcomes of engagement and treatment attendance and ultimate outcomes. Further, these should be mixed method studies that capture the salient components of the interventions that lead to increased intermediate outcomes and well as ultimate outcomes. Identification of the most useful interventions and mechanisms within the interventions are critical for informing best practices for the growing parental substance abuse problem within child welfare.