Children and Family

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Children and Family
Research Center
Substance Abuse and Child Welfare Understanding
the Problem and Testing a Response
Joseph P. Ryan, Ph.D. November 2, 2006 Child
Advocacy Program Harvard University
School of Social Work
University of Illinois at Urbana-Champaign
TM
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Outline

• Estimates and reasons for concern
• Testing at birth
• Once identified then what?
• Assumptions regarding substance abuse and child
  welfare
• Experimenting with innovative strategies

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Estimates of Substance Abuse

• 11 of children (8.3 million) live with at least
  one parent who is either alcoholic or in need of
  treatment for the abuse of illicit drugs
• 3.8 million live with a parent who is alcoholic
• 2.1 million live with a parent whose primary
  problem is with illicit drugs
• 2.4 million live with a parent who abuses
  alcohol and illicit drugs in combination
• National Survey on Drug Use and Health

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Estimates of Substance Abuse and Pregnancy

• 3.4 (134,110/year) - illegal drugs
• 17.6 (694,220/year) tobacco
• 13.8 (544,330/year) alcohol
• 32 of pregnant women who use illicit drugs also
  use alcohol and tobacco placing the number of
  children exposed to legal or illegal drugs in
  utero per year at gt1 million

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Concern for Substance Abuse in Child Welfare

• Parenting Practices
• Compromises appropriate parenting practice
• Significantly increases the risk of physical
  abuse and child neglect (3 times more likely)
• Child Development
• Alcohol abuse associated with learning deficits,
  behavioral problems, poor academic performance,
  and adult alcohol problems
• Research on Illicit drug abuse is less conclusive
• What happens in the home is the MOST important

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Substance Abuse and Child Welfare Placements

• Scope of the Problem
• 14 of foster care placements result primarily to
  substance abuse (McNichol Tash, 2001)
• 70 of foster care case openings involve parental
  substance abuse (GAO, 1998)
• 79 of children in foster care have parents that
  abuse alcohol and/or drugs (Besinger, Garland,
  Litrownik Landsverk, 1999).

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Drug Testing at Birth

• No federal policy that guides testing for
  substances at birth.
• The only provisions that exist require states to
  have in place a protocol for responding to SEIs.
• Specific testing policies and practices are left
  to the hospitals

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Drug Testing at Birth

• National Study of Testing Practices
• 89 of hospitals conduct assessments to identify
  which patients to test
• Triggers include prenatal care, history of drug
  use, and general suspicion
• 83 of hospitals inform mothers about the test
• 41 report that consent is not required
• There is no systematic data collection efforts
• National Abandoned Infants Resource Center, UC
  Berkeley

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Potential Problems with this Approach

• Study in Illinois between 1997 and 2000
• African American babies account for 78 of
  Illinois infants identified as drug exposed in
  1998, yet account for 20 of births
• 5,851 African American drug exposed babies
  identified
• 39 were taken into foster care
• 1,035 white drug exposed babies identified
• 27 were taken into care

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Once identified.then what?

• Intact Family Recovery
• Testing positive for substances at birth does not
  automatically result in temporary custody
• Rationale is that a single drug test is not
  sufficient evidence of inadequate parenting
  skills or risk of maltreatment
• New Haven example in Nobodys Children get
  families into treatment and use the threat of
  temporary custody
• Study using NSCAW data in home services with
  substance abusing caregivers

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Is Traditional Response Working?

• Outcomes in Child Welfare
• Approximately 26,000 placements in 2004
  (California)
• 38 of these children are reunified within 12
  months
• 70 are no longer in substitute care after 24
  months
• So how about substance exposed infants?
• Only 14 of all substance exposed infants
  entering care in 1994 achieved reunification by
  2001 (Illinois)
• POSSIBLE EXPLANATIONS?

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Substance Abuse and Child Welfare Assumptions

• Families are unable to access necessary treatment
  services long waiting lists and/or insufficient
  bed space
• The system is designed with many yet few sticks.
  What might happen with caregivers that lost
  custody of their children?
• Once parents recover from alcohol and drug abuse
  reunification can be achieved without the risk
  of compromising developmental outcomes.

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Illinois AODA Waiver Demonstration

• Primary Objectives of Illinois AODA Waiver
  Increase timely access to substance abuse
  treatment and thus speed up time to family
  reunification
• How Can this be Accomplished Recovery Coaches
• Contract with an independent agency
• Work in collaboration with caseworker not a
  replacement
• Assigned to family for the life of a case
• Provide assertive outreach, engagement, and
  re-engagement
• Coordinate AOD planning efforts

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Evaluation of the Demonstration
Eligibility (1) foster care cases opened after
April 2000, and (2) parents must be assessed at
the Juvenile Court Assessment Program (JCAP)
within 90 days of the temporary custody
hearing Assignment Substance abusing caregivers
were randomly assigned to either the control
(regular services) or demonstration
group Treatment Parents in the demonstration
group received regular services plus intensive
case management in the form of a Recovery Coach
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Evaluation of the Demonstration Research Questions

• Are parents in the demonstration group more
  likely to access AODA treatment services compared
  with parents in the control group?
• Do parents in the demonstration group access AODA
  treatment services more quickly compared with
  parents in the control group?
• Are families in the demonstration group more
  likely to achieve family reunification compared
  with families in the control group?

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Evaluation of the Demonstration Sample April
2000 June 2004
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Treatment Access
Control 46 Demonstration 70
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Time to First Treatment Episode
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Family Reunification and Permanence
Group Assignment by Permanency Status (child
level) as of December 31, 2006
plt.05
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What Else is Occurring?

• Two Reasons for Program Failure
• Intervention Simply Does not Work
• families fail to access services in timely manner
  (not true)
• Faulty Program Assumptions
• facilitate timely access
• facilitate higher treatment completion rates
• yet satisfactory reunification rates still not
  achieved
• WHAT COULD EXPLAIN RATES OF REUNIFICATION?

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Families with Co-occurring Problems
Substance Abuse (SA)
56 Housing
30 Mental Health
30 Domestic Vlnce.
62 report SA and at least 2 additional
problems 27 report SA and all 3 additional
problems
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Co-occurring Problems and Reunification The
Problems and the Progress are Important
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Co-occurring Problems and Reunification The
Problems and the Progress are Important
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Co-occurring Problems and Reunification The
Problems and the Progress are Important
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• Conclusions
• Testing for substances at birth is problematic
• The outcomes for children associated with
  substance abusing caregivers is concerning
• Innovative strategies increase the likelihood of
  family reunification but effects are small
• Substance abusing families report a variety of
  co-occurring problems and these problems decrease
  the likelihood of reunification.
• Progress in these co-occurring areas increases
  reunification

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• Questions that Remain Unanswered
• Should testing be universal?
• How much time should child welfare agencies spend
  working with substance abusing families before
  moving aggressively towards the termination of
  parental rights?
• What is the role of the court? How can we
  provide judges with enough information to make an
  informed decision? Are some courts simply
  reluctant to return children to substance abusing
  families?