Service Utilization and Reunification: A National Study of Disparities By Race/Ethnicity

Background: Reunification, or return to a primary caregiver, is the priority case goal for children in foster care. Reunification often occurs when parental risk factors are addressed and reduced, such as seeking substance use treatment for parents with substance misuse disorders. Indeed, targeted service utilization increases the odds of reunification. Although some recent research has found racial/ethnic disparities in reunification rates, few studies have examined the link between racial/ethnic disparities in service utilization and subsequent reunification. Utilizing national data, this study examined the relationship between service utilization and reunification among diverse racial/ethnic groups.

Methods: We combined two national datasets: The Adoption and Foster Care Analysis System (AFCARS) and the National Child Abuse and Neglect Data System (NCANDS). AFCARS is an annually collected database containing the population of children in care for each fiscal year and NCANDS is an annually collected database of referrals to child protective services (CPS). The analytic sample consisted of all children who were referred to CPS and entered care in 2015 and who had valid data about service utilization (n=30,238). These children were followed for two subsequent years (FY 2015-FY2017) to compare those who reunified to those who did not. The main independent variable was service utilization, which included three family preservation services, six basic needs services, three clinical services, and two legal services. Multivariate survival analyses were conducted to examine time to reunification based on the number and type of services used, while controlling for child race/ethnicity, age, and parental risk factors. Average treatment effects for each service were calculated among each racial/ethnic group. All analyses were conducted using Stata version 16.

Results: Less than half of the sample (n=13,056; 43.18%) reunified during the study period. Families used an average of 1.29 services. There were racial/ethnic disparities in utilization rates of each service. Families that utilized one (HR=1.13, p<.001) or two (HR=1.22, p<.001) family preservation services had higher odds of reunification than those who did not use any. However, utilization of basic needs services and clinical services reduced the odds of reunification. The treatment effects of each service varied by race/ethnicity; for example, legal services increased the odds of reunification for White and Multi-racial families but decreased the odds of reunification for Hispanic children. Home-based services increased reunification among Black, Hispanic, and Multi-racial children, but decreased the likelihood among Native American children.

Conclusions and implications: Racial disparities are present in service utilization and subsequent reunification. While family preservation services consistently improved the odds of reunification, basic needs services and clinical services (e.g., substance use treatment, mental health services) decreased the likelihood. It is possible that these services reflect more chronic issues that require a longer period to reunify. Furthermore, the different impacts of service utilization on reunification among racial/ethnic groups warrants further study to understand why this occurs, how to make services more culturally responsive, and better serve families of color.