A Call for Social Change from Mothers in the Child Welfare System with Substance Use

Background

Incidence of babies born with opioid exposure increased by 82% nationally between 2010 and 2017. Rates of involvement with the child welfare system (CWS) and consequences of parental-child separation are likewise estimated to have risen. In the location of the current study, parental substance use was associated with 49.6% of the children entering out-of-home care between July 2019 and June 2020 (i.e., the most frequently cited reason for removal statewide). Given prevalence rates and consequences, this study sought to better understand the experiences of mothers with infant removal due to parental substance use when navigating the agencies and systems involved in their lives, including emphasis on how their experiences relate to recovery and relapse.

Methods

A qualitative participatory action design was applied with photovoice methodology to engage, understand, and prioritize the voice of mothers in the research process. Through documentary photography, narrative descriptions, and critical dialogue, photovoice facilitates ways for participant voices to be heard and received by the stakeholders they identify as important. This project is the first known use of photovoice methodology with mothers in the CWS and seeks to give mothers a platform for advocacy and social change. Thirteen mothers were given digital cameras to create photographs that represent their experiences with agencies and systems of care. They then participated in multiple sessions of critical dialogue to share photographs, reflect on their experiences, identify community needs, and discuss and codify themes and shared priorities as co-researchers in the study. Each mother in the sample had a child under age five, involvement with the CWS in the last 18 months, and was active in recovery support services. The sample size exceeds most published photovoice studies with female participants included in a recent scoping review in 2019.

Results

Findings reveal that mothers characterize the CWS as both easy to fail and hard to succeed and describe three key subthemes: (1) disempowerment, (2) incongruent design, and (3) the need for empathetic and competent caseworkers and supportive relationships. Numerous barriers impeding recovery and reunification were emphasized, including missed opportunities for destigmatized and accessible early intervention and experiences of feeling unheard, uninformed, and devalued in system interactions. Each subtheme will be presented in detail and the presentation of data will prioritize the words of mothers with photographs and corresponding narratives. Congruent with photovoice methodology, a core deliverable in the form of a social action statement will also be presented. It is composed of ‘I need” expressions by mothers that specify recommendations for caseworkers, multi-professional stakeholders, the CWS system, and the community.

Conclusions

Implications of this study focus on strategies to achieve empowerment and improve programmatic and system practices to better align with the needs and experiences of mothers in recovery. Emphasis is placed on the role and support of caseworkers as central influencers, networks of support, strengths-based and coordinated care, and opportunities for early intervention. Collectively, findings inform how community stakeholders may support mothers across the multiple systems they interact with and how mothers themselves define the need for social change.