Evaluating the Impact of a Parenting Program on Reunification for Young Children Affected By Parental Substance Use: Results from a Midwestern Randomized Control Trial

Background/Purpose: Extensive research has documented that young, substance-affected children are more likely to be removed from their caregivers, be placed in foster care, and remain in out-of-home (OOH) care for longer periods of time. This study examined the impact of a randomized control trial (RCT) on the likelihood of and time to reunification for young, substance-affected children between birth and 47 months who were in OOH care. Treatment group families received child welfare services as usual plus an age adapted version of the evidence-based parenting skills intervention Strengthening Families Program (SFP); control group families received child welfare services as usual. Program participation was tracked carefully for each participant family, and the intervention developer established fidelity monitoring protocol a priori.

Methods: The impact analysis consisted of 1043 children; 673 children were allocated to the treatment condition and 370 children were allocated to control group. Cox proportional hazard models were conducted to examine a child’s likelihood of and time to reunification for three different treatment contrasts. These were: reunification rates for treatment verses control group children, reunification rates for children who received any portion of the intervention compared to all other children, and reunification rates for children who completed the intervention to fidelity compared to all other children.

Supplemental point-in-time analyses were conducted with three independent samples using complier average causal effect (CACE) to examine the probability of reunification for three different timeframes. Specifically, researchers examined the whether or not reunification had occurred within: 1) 365 days after study randomization (n=934); 2) 548 days (n=786) after randomization; and 3) 730 days (n=645) after randomization. All study analyses controlled for case and child characteristics and implementation variables. Baseline equivalence was established for all case and child demographics prior to conducting the multivariate analyses.

Results: Cox proportional hazard models revealed that children who completed the intervention to fidelity were 30% (p=.024, HR=1.31) more likely to experience reunification during the study period than all other children, while holding all covariates constant. The other two treatment indicators did not reveal statistically significant differences in reunification rates. Supplemental CACE analyses demonstrated that two-years after study randomization, children who had received any portion of the intervention were not significantly more likely to experience reunification, although this relationship was approaching significance (β=.160, p=.072). Both 365 days and 548 days after study randomization did not reveal statistically significant differences in reunification.

Conclusions/Implications: Among this young, substance-affected, child welfare involved sample, results reveal the age adapted version of SFP significantly increases a child’s likelihood of reunification for children who attended and completed the program to fidelity. The supplemental CACE analyses revealed reunification was not more likely for children who received any portion of the intervention, when compared to all other children, at 365 days, 548 days, or 730 days after study randomization, but did not receive enough of the intervention to meet fidelity guidelines. This is the first rigorous evaluation of this age adaptation of SFP, and more research is needed in order to determine effectiveness.