Digging Deeper: Examining the Substance Use Patterns and Treatment Experiences of Foster Care Involved, Substance Use Affected Families

Background/Purpose: A wealth of research has demonstrated parental substance misuse as a risk factor for child maltreatment. Children removed due to parental substance misuse remain in foster care (FC) for longer durations and are less likely to experience reunification. Additionally, research suggests that a caregiver’s substance type affects a child’s likelihood of reunification (i.e., Lloyd & Akin, 2014), There remains a dearth of information available regarding substance use patterns and treatment experiences (e.g., substance choice, route of administration, frequency of use, number of treatment episodes, etc.) of foster care involved caregivers. This study sought to describe the patterns, prevalence, and treatment characteristics among caregivers with young children (0-47 months) in FC due to parental substance use.

Methods: The sample included caregivers with young, substance-affected children in FC with a case plan goal of reunification in one Midwestern state. All caregivers were randomly selected to receive a parenting-skills intervention and consented to allow access to their substance use treatment records. Substance use treatment and service data, following CFR-42 confidentiality requirements, was obtained from 2005 through 2018. Only caregivers with matched treatment records (N=216) were included in the study. Univariate and bivariate analyses were conducted to examine case and treatment characteristics. For individuals with multiple treatment records, variables were combined to look at substance use behaviors across multiple treatment episodes.

Results: Caregivers were primarily White (75.9%), non-Hispanic/Latino (86.1%) females (71.8%) with a mean age of 28.3 (SD=6.1) years. The majority reported having a high school diploma/GED or higher education (62.8%), being single (45.1%), unemployed (45.6%), and an annual income of $0 - $9,999 (65.1%) at the time of enrollment. Treatment episodes ranges from 1 – 12 treatment records for the given period: 42% had 1 treatment episode, 22% had 2 treatment episodes, 18.5% had three treatment episodes, and 17.5% had 4 or more treatment episodes when compared to individuals with 1 treatment episode. Individuals with 2 or more treatment records experienced greater unemployment rates (50.0% versus 39.6%), were more likely to be between the ages of 26-29 years old (31.2% versus 17.6%), and less likely to be single (35.5% versus 58.2%).

Examining caregivers’ first treatment episode, the most commonly reported primary substance of abuse was marijuana (37.5%), followed by methamphetamine (35.6%) and alcohol (13.0%). Smoking was the most common form of marijuana/hashish (n=78, 96.3%) and methamphetamine (n=55, 71.4%) consumption. Additionally, most participants received ambulatory non-intensive outpatient substance use treatment (n = 96, 44.4%) and 72.2% (n = 156) reported a co-occurring mental health issue.

Conclusion/Implications: Results illustrate that among caregivers seeking reunification, the majority have experienced multiple treatment episodes and reported co-occurring mental health issues, which may be further complicated with conditions associated with unemployment, single-parenthood, and low income. Many participants received less intensive services as their first service experience, which may indicate lack of accessible intensive services. More research is needed into these experiences in order to shed light on how they may influence child reunification.