The Opioid Epidemic and Child Maltreatment: The Importance of Macro-Level Context for Child Outcomes

Background & Purpose:

Concerns have been raised that the opioid epidemic has caused increases in child maltreatment and thus, increased child protective system (CPS) caseloads (Lynch et al., 2018). Understanding the specific impact of the opioid crisis on the child welfare system is a current priority for researchers and policymakers. Yet, research is routinely limited by available measures of the opioid epidemic, maltreatment, or both. Studies often rely on out-of-home placements to measure maltreatment and prescription rates to measure the opioid epidemic. While informative, prescription rates may not capture the full range of morbidity/mortality associated with the type or level of severity of opioid use that warrants CPS involvement, and focusing on out-of-home placements limits our understanding of impacts on a more varied range of possible CPS outcomes. Research analyzing broader aspects of maltreatment and the opioid epidemic can improve our understanding of this link, informing decisions about how to target child welfare resources to improve child outcomes. Thus, the purpose of this study was to examine the longitudinal associations between county-level opioid overdose rates and four indicators child maltreatment.

Methods:

Publicly available data on several county-level indicators, including opioid use, were linked to hospitalization and CPS records for one state in the Northwest from 2000-2017. Indicators of child maltreatment (intakes, substantiations, out-of-home placements, and maltreatment-related hospitalizations) were aggregated to the county-level based on the county’s child population per year. The opioid epidemic was operationalized as opioid overdose-related hospitalizations and deaths as reported by the Department of Health. Analyses included Spearman correlations and Bayesian Model Averaging (BMA) to identify measures for inclusion in multivariate models. Building on the BMA results, panel data analysis was used to examine the link between opioid overdose and the four outcomes within and across time while accounting for several county-level covariates (e.g., unemployment, crime).

Results:

Each of the child maltreatment indicators, except substantiations, were positively correlated with opioid overdose at the county-level. Correlations ranged from 0.10 (placement) to 0.15 (intakes). Results from the panel analysis demonstrated that as counties experienced increased problems with the opioid epidemic, maltreatment allegation substantiations (coefficient: -4.08, standard error: 1.73, p = 0.018) and out-of-home placements (coefficient: -1.55, standard error: 0.70, p < .05) declined. No significant trends were identified for CPS intakes or maltreatment-related hospitalizations.

Conclusions:

As counties experienced increased problems with the opioid epidemic, substantiations and out-of-home placements declined; meanwhile, associations between opioid overdose rates and CPS intakes and hospitalizations disappeared after accounting for other county-level factors. Findings point to the saliency of broader macro-level contexts – including states’ child welfare policies and economic environments – for understanding the link between the opioid epidemic and child maltreatment. For example, factors relevant to our findings include the state’s reduction of CPS staff due to financial burden during the study time period; that substance abuse is not explicitly included in the state’s definition of maltreatment as it is in other states; and the implied discretion given to CPS workers through state laws. Implications for policy, practice, and research will be discussed.