Half of the Time It's Them That Makes Me Wanna Go Get a Drink': Perceptions of Child Welfare Involvement Among Parents with Substance Use Disorder

Background and Purpose. Parental substance use disorder (SUD) is linked to profound adverse impact on children and families, including a higher risk of child maltreatment and child welfare system involvement. Relatively little research has explored the experiences of parents with SUD who ultimately became involved with state child welfare agencies. Given the stigma that often surrounds SUD, particularly among parents, more research is needed to examine how they may experience their interactions with child welfare workers. The purpose of the present study was to explore the perceptions and experiences related to child welfare involvement among parents who received treatment for SUD in the past year.

Methods. The current study included 46 parents of children under the age of 18 (73% females; 55% Black or Hispanic) residing in one Northeastern state in the US. Participants were recruited from agencies providing outpatient substance use treatment and harm reduction services; those who met eligibility criteria completed a brief demographic survey and an individual interview. The survey focused predominantly on basic demographics, patterns of substance use, and access to relevant services; the interview inquired about participants’ child welfare involvement, their interactions with child welfare workers, and their suggestions for improving services for parents with SUD. Interview transcripts were analyzed using reflexive thematic analysis.

Results. Of the 46 study participants, 29 reported past or current child welfare involvement for any of their children (e.g., reports, investigations, in-home services, child removals). Thematic analysis revealed participants’ varied experiences with the child welfare system. Some described their interactions as beneficial – i.e., leading them to receive substance use treatment services or other needed resources. Others viewed their interactions with the system as ineffective, and sometimes harmful. Participants emphasized the importance of targeted efforts to reunite with their children, while acknowledging the tremendous variability among caseworkers. Participants also described feeling judged and stigmatized by workers based on their histories of substance use. Many indicated that the worker-client power dynamics often felt punitive, coercive, or inappropriate. These power imbalances generated fear that the system will permanently remove their children, and sometimes functioned as barriers to seeking additional support.

Conclusion and Implications. Participants offered numerous recommendations for improving child welfare services. A key theme was the importance of workers treating parents with dignity and respect, through demonstrations of empathy and provision of supportive services. Participants also recommended that child welfare services could be improved through incorporating peers with lived experiences, de-emphasizing punitive approaches, more education on substance use and harm reduction, and an emphasis on collaboration with parents. Findings suggest that there is a need for greater understanding of substance use, harm reduction, and recovery processes among child welfare workers, as well as a need for a trauma-informed approach to working with parents who misuse alcohol or drugs.