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outcomes later in life. Prior research has found that adolescents at-risk of child welfare involvement and in foster care have a higher risk of substance misuse possibly because substance misuse serves as a coping mechanism for adolescents exposed to adversity such as child maltreatment. Although much literature has focused on parental substance use among families involved in child welfare, less is known about services and strategies to prevent foster care entry among adolescents with substance misuse who are referred to child protective services (CPS). This study explored the relationship between substance use treatment utilization, county-level deprivation, and foster care entry among adolescents referred to CPS for alleged maltreatment who misuse substances.
Methods: Data for this study came from the National Child Abuse and Neglect Data System FY 2018 and FY 2019, the American Community Survey 2015-2019, and the U.S. Opioid Dispensing Rate Maps 2015. We analyzed a cohort of 7,107 adolescents (ages 12-17) who were referred to CPS in FY 2018 and misused substances. Our main outcome variable for foster care entry during the study. Main independent variable was substance misuse treatment and measures of county deprivation such as vacant housing and unemployment rates. We conducted a multilevel logistic regression to examine the relationship between substance use treatment, other child and county factors, and foster care entry within 18 months of the initial referral.
Results: Less than one in ten adolescents (7.67%) entered foster care during the study period. In the multivariable analyses, adolescents who did not receive substance use treatment had lower odds of foster care entry (AOR = 0.30, p<.001) than adolescents who received services. For each 1-unit increase in county unemployment rate, the odds of foster care entry increased by 18% (AOR = 1.18, p<.01). sex and race/ethnicity were also significantly associated with foster care entry. Compared to adolescent males, adolescent females had 1.28 times higher odds of entry into foster care (AOR = 1.28, p<.001). Odds of foster care entry were 1.21 times higher for adolescents who self-identified as non-Hispanic Black (AOR = 1.21, p<.05) and 1.55 times higher for adolescents who self-identified as multiracial (AOR = 1.55, p<.001) when compared to adolescents who self-identified as non-Hispanic White. We also observed disparities by gender and race/ethnicity.
Conclusion: Substance use treatment increased the likelihood of foster care entry among adolescents referred to CPS with substance misuse. With the Families First Prevention Services Act of 2018, it is possible that adolescents were only provided services when risk of removal was imminent; alternatively, it is possible that our findings align with prior mental health research that has found some parents to voluntarily relinquish custody so that their children are able to access services and treatment. Future research should investigate the pathway by which substance use treatment and county-level deprivation impact foster care entry.