Parental Mental Health and Substance-Related Services Among CPS-Involved Families

Background

Parental mental health (MH) disorders and substance-related (SR) disorders are associated with child protective service (CPS) contact. Studies suggest both positive parent engagement and coercive forces increase service utilization during CPS involvement. Differential Response (DR) allows low- to moderate-risk families to forego traditional investigations (TI) and is designed to promote parent engagement. With CPS policies increasingly focused on preventing and interrupting maltreatment, more research is needed to promote MH/SR service uptake early in the case. This study examines family, case, and agency factors associated with MH/SR service utilization.

Methods

The initial sample consisted of 1041 adult caregivers of children with screened-in CPS cases who completed a family survey. The sample included 886 respondents from 21 counties participating in a DR pilot (DR = 63.0%; TI = 37.0%) and 155 TI respondents from five comparison counties not part of the pilot. Family survey data were merged with administrative records and agency-level data from a survey of CPS professionals.

DR and TI cases from pilot counties were matched to similar TI cases from comparison counties using a genetic matching algorithm. Matching variables were: threat to safety, race/ethnicity, living arrangement, allegation type, youngest child age, number of children involved, number of previous CPS reports, and reporter type. The matching procedure generated DR-matched (n=688) and TI-matched (n=440) datasets.

Random forest models (RFMs) assessed the relative importance of variables to MH/SD service use and included family (child and adult adverse experiences, social support, PTSD); case (meeting frequency, caregiver perceptions that CPS was needed, and court involvement); and agency (DR implementation, work environment, and availability of local MH/SR services) variables. Results from the RFMs informed multilevel logistic regression modeling.

Results

Over one-third of respondents (38.1%, n=362) reported needing MH (33.2%) or SD (12.2%) services. Of those who reported needing MH/SD services, 67.8% received a referral and 70.4% received services. RFMs for DR- and TI-matched samples found that race/ethnicity, living arrangement, allegation type, and reporter type were least important to MH/SD service utilization. The remaining variables were retained in regression models. In the DR-matched sample, MH/SD service usage was associated with court involvement (OR=11.6, CI=4.5, 29.5); more family meetings with CPS staff (OR=1.7, CI=1.2, 2.4); and positive work environment (OR=1.1, CI=1.0, 1.2). DR respondents were no more likely to receive MH/SD services than respondents from comparison counties (OR=1.8, CI=0.6, 5.3). In the TI-matched sample, meeting frequency (OR=1.6, CI=1.1, 2.3) and perceptions that CPS involvement was needed (OR=1.6, CI=1.1, 2.23) were associated with service uptake. Relative to respondents from comparison counties, TI respondents in DR counties had 7.5 greater odds of receiving MH/SR services.

Conclusions

The connection between DR and service uptake may not operate solely at the family level: agency-wide attention to family engagement may benefit TI families as well, suggesting that engagement strategies are transferable to higher-risk cases not eligible for DR. Results also showed court involvement was associated with service use, but only in the lower-risk, DR-matched sample. Motivational enhancement for MH/SR services within the context of CPS practice will be discussed.