Parent Substance Use and Child Welfare Caseworker Newborn Crisis Assessments

Background/Purpose: Using qualitative focus groups, this study examined child protective service (CPS) case managers’ perceptions of the impact of parental substance use disorders (SUDs) on child safety and describes their experiences conducting newborn crisis assessments in one midwestern state. Child welfare investigators are tasked with assessing the impact of substance use on the safety and wellbeing of children. However, few studies have described how child maltreatment investigators working for CPS agencies think substance use impacts child safety or describe their experiences conducting assessments for newborns whose mothers engaged in prenatal substance use.

Methods: Qualitative focus groups were conducted with CPS case managers to discuss perceptions of parental SUDs within child welfare. Case managers’ experiences conducting newborn crisis assessments, reports in which a mothers’ prenatal substance use was reported to the agency or a child tested positive for substances at birth, emerged during the interviews. Data were collected during three focus groups (n=23) with CPS case managers within one urban district of one midwestern state. Participants were a mean of 30.7 years of age (median=29.5 years) and primarily identified as female (95.7%). Participants identified as white (56.5%), Black (39.1%), or Biracial (4.3%). Most identified as Non-Hispanic (78.3%, Hispanic 8.7%, Refused 13.0%). All participants had either an undergraduate degree (69.6%) or graduate degree (30.4%). Participants had a mean of 44 months (median=23 months) of experience in child welfare and 28.5 months (median=14 months) working in investigations. Using inductive thematic analysis, transcripts were analyzed. A codebook was developed through an iterative process of identifying key, persistent themes. Data analysis was conducted in NVivo 12.

Findings: Participants reported that the perceived impact of parental substance use varied by type of substance (marijuana, alcohol, opioids, methamphetamines) and caregiver characteristics (mental and physical health, stress coping skills, maturity). Participants also described their perceptions of parents’ motivations and engagement in assessments. Participants explained the perceived institutional, legal, and relational barriers to addressing child safety including a sense of a lack of control on the outcome of cases. Newborn crisis assessments for prenatal substance exposure were reported as a common time to engage mothers with a possible SUD. Substance type was an important factor when evaluating newborn substance exposure and determining whether or not an infant should be removed from the home. Participants also described the perceived impact of prenatal substance exposure on infants. Participants’ descriptions of parent use, perceived motivations, and attribution of blame are examined, and potential training areas are described. Participants reported concerns for parents self-medicating for mental health concerns due to a lack of behavioral health treatment.

Conclusions/Implications: Findings support the need for increased training for CPS staff on identifying, understanding, and supporting parents with a SUD. Promising approaches include practice models using a collaborative approach where SUD treatment staff support CPS case management, evaluation, and compassionate treatment of the SUD. This work also supports the need for the provision of comprehensive behavioral health care to low-income families.