Substance abuse treatment and the recurrence of maltreatment among caregivers with children living at home: A propensity score analysis

Physical abuse re-reporting during the COVID-19 pandemic: The kids are not okay

BACKGROUND

Child physical abuse (PA) is a significant societal concern with limited research into predictors of re-reports.

OBJECTIVE

Our research explores correlations between sociodemographic variables and re-reported PA. Our aim was to characterize populations at higher risk and identify changes in presentation during the COVID-19 pandemic.

PARTICIPANTS AND SETTING

This retrospective descriptive study focused on 238 patients with re-reports of PA made by a pediatric hospital from January 2019 through April 2021.

METHODS

We analyzed sociodemographic information and details of reports made to child protective services (CPS) obtained from the electronic health record.

RESULTS

Females were 2.5 years older than males (mean 11.0 and 8.5 years, respectively) (p < .001, 95%CI 1.21-3.76). Males were more likely to have observable injuries (OR 2.61, p < .001) and a CPS response (OR = 2.70, p = .003). Patients categorized as "Other" races were less likely to have observable injuries (OR = 0.32, p = .006). Presentation changed during the pandemic: a quadrupling of re-reports by behavioral health clinicians caused the percentage of reports made by them to increase significantly (OR = 3.46, p < .001) and the mean age increased by 2.0 years (8.2 years before, 10.2 years during) (p = .009, 95%CI 0.5-3.5), though females remained approximately 2.2 years older than males (p = .003, 95%CI 0.8-3.7).

CONCLUSIONS

Males experienced higher rates of re-reported PA and were younger at the time of re-report. Changes to presentation during the pandemic suggest an increase in PA among older children. Future research should further explore differences in sex/race, while current prevention efforts should focus on children receiving behavioral health care.

Recurrence of Substantiated Maltreatment Reports between Low-Income Parents With Disabilities and Their Propensity-Score Matched Sample Without Disabilities

Using the Longitudinal Studies of Child Abuse and Neglect dataset, 127 low-income parents with disabilities and a propensity score matched sample of 254 parents without disabilities were compared for the rates of repeated substantiated child maltreatment allegations and potentially distinct risks for substantiated child maltreatment recurrence. The number of substantiated child maltreatment allegations was not significantly higher for low-income parents with disabilities (M = 1.17, SD = 1.83) than their matched sample (M = .93, SD = 1.44) (t = -1.29, p = .197). Findings from the negative binomial regression indicated that parental disability was also not a significant predictor for repeated substantiated child maltreatment allegations among low-income parents after controlling other risk factors (Exp(B) = 1.16, p < .353). In both groups, black parents were more likely to have repeated substantiated maltreatments than white parents. For parents with disabilities, being an older parent, receiving SNAP benefits, having a daughter, and having a child in continued out-of-home care significantly increased the risk for repeated substantiations while having a GED or higher education degree and living with a larger number of family decreased the risk. For parents without disabilities, family instability was the only additional risk factor for repeated maltreatment substantiations.

Parental substance use and home visiting programs: Implementation considerations for relationship-based treatment

Home visiting programs can provide critical support to mothers in recovery from substance use disorders (SUDs) and young children prenatally exposed to substances. However, families impacted by maternal SUDs may not benefit from traditional child-focused developmental home visiting services as much as families not impacted by SUDs, suggesting the need to adjust service provision for this population. Given the need to implement tailored services within home visiting programs for families impacted by SUDs, we sought to investigate the implementation barriers and facilitators to inform future integration of a relationship-based parenting intervention developed specifically for parents with SUDs (Mothering from the Inside Out) into home visiting programs. We conducted nine interviews and five focus groups with a racially diverse sample (N = 38) of parents and providers delivering services for families affected by SUDs in the USA. Qualitative content analysis yielded three most prominent themes related to separate implementation domains and their associated barriers and facilitators: (1) engagement, (2) training, and (3) sustainability. We concluded that the home visiting setting may mitigate the logistical barriers to access for families affected by SUDs, whereas relationship-based services may mitigate the emotional barriers that parents with SUDs experience when referred to home visiting programs.

Risk of Future Maltreatment: Examining Whether Worker Characteristics Predict Their Perception

Child welfare workers aim to promote the well-being and safety of children and are the link between the child welfare system and families. Families served by the child welfare system should expect similar service based on clinical factors, not based on their caseworker's characteristics. Using secondary data analyses of the most recent Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2008) and multilevel modeling, this study examines whether child welfare worker characteristics, such as education level and field, age, and experience predict their perception of the risk of future maltreatment. A total of 1729 case-level investigations and 419 child welfare workers were included in this study. Several one-level logistic regression and two-level logistic regression analyses were run. The best-fit model suggests that caseworkers with a Master's degree, more than 2 years of experience, and more than 18 cases were significantly more likely to perceive risk of future maltreatment. Further, the interaction between degree level and age also significantly predicted the perception of risk of future maltreatment. Results suggest that the perception of risk of future maltreatment may be influenced by caseworker factors, thus service to families may differ based on caseworker characteristics.

Examining an In-Home Behavioral Parent Training Protocol Among Parents Who Use Substances Involved Child Welfare: Effectiveness of SafeCare

Given the detrimental impact of substance use (SU) on both parent and child outcomes including child maltreatment, research and service efforts have focused on incorporating parenting resources into integrated SU treatment programs. While promising, it is imperative to examine and test parenting programs in a variety of settings. This study examined whether SU moderated the relationship between treatment condition and parenting outcomes among parents who participated in SafeCare, and parent ratings of engagement, service satisfaction, and perceived cultural competency of services. Results indicated that SU did not moderate the relationship between treatment condition and abuse potential, but did moderate this relationship for depression and parental distress such that parents with higher levels of SU reported less improvement in depression and parental distress. Results underscore that SU problems may impact the effectiveness of SC on specific risk factors, such as depression and parental distress, potentially indicating unique treatment needs and the need to adapt interventions to ensure treatment success. In addition, this study found that SafeCare was not found to be beneficial for parents with SU problems above and beyond the treatment as usual condition. Finally, results indicated that parents with SU concerns and without SU concerns engaged very similarly in SafeCare.

Cannabis legalization and cannabis-involved pregnancy hospitalizations in Colorado

The primary objective of this study was to evaluate the association between presence of recreational cannabis dispensaries and prevalence of cannabis-involved pregnancy hospitalizations in Colorado. This was a retrospective cohort study of pregnancy-related hospitalizations co-coded with cannabis diagnosis codes in the Colorado Hospital Association from January 1, 2011, through December 31, 2018 (recreational cannabis began January 1, 2014). Our primary outcome was cannabis-involved pregnancy hospitalizations per 10 k live births per county. The primary exposure measure was county variation in the number of recreational dispensaries. We controlled for counties' baseline exposure to medical cannabis dispensaries and used Poisson regression to evaluate the association between exposure to recreational cannabis and hospitalizations. During the study period, cannabis-involved pregnancy hospitalizations increased from 429 to 1210. Mean hospitalizations per county (1.7 to 4.7) and per 10 k live births (13.2 to 55.7) increased. Overall, increasing recreational dispensaries were associated with increases in hospitalizations (1.02, CI: 1.00,1.04). When comparing counties with different densities of baseline medical cannabis market, low and high exposure counties had fewer hospitalizations than those counties with no exposure (low: IRR 0.97, CI: 0.96-0.99; high: 0.98, CI: 0.96-0.99). In Colorado, there was more than a two-fold increase in cannabis-involved pregnancy hospitalizations between 2011 and 2018. Counties with no baseline exposure to medical cannabis had a greater increase than other counties, suggesting the recreational market may influence cannabis use among pregnant individuals.

Caregiver drug use in Ontario child welfare investigations: The need for coordinated intervention

BACKGROUND

Caregiver substance abuse is associated with harmful parenting behaviors, increased child welfare involvement, and negative child outcomes, and the opioid epidemic has brought increased attention to the safety and wellbeing of children living with caregivers who abuse substances.

OBJECTIVE

This paper investigates the impact of primary caregiver drug abuse concerns on child welfare investigations in Ontario, Canada and examines how different drug abuse categories impact out-of-home placements in a Canadian setting, with a focus on opioids, opiates, and morphine derivatives.

PARTICIPANTS AND SETTING

Secondary analyses of data from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018 (OIS-2018) were conducted. The OIS-2018 collected information on child welfare investigations from workers who conducted the investigations. The final unweighted sample of the OIS-2018 included 7590 investigations involving children under 18 years old.

METHODS

Descriptive and bivariate analyses were conducted as well as a logistic regression predicting out-of-home placement.

RESULTS

Investigations involving noted primary caregiver drug abuse concerns involved increased household and family risks as well as more intrusive forms of child welfare involvement. Results of the logistic regression controlling for family, child, and case characteristics revealed that investigations involving noted primary caregiver drug abuse were more likely to involve out-of-home placements, and investigations that involved caregivers who abused opioids specifically were approximately 3.5 times more likely to result in a placement.

CONCLUSIONS

A coordinated response involving the child welfare, addictions treatment, and other allied systems is warranted to support families with substance abuse concerns and provide appropriate services.

A latent class analysis of modifiable risk factors associated with child maltreatment re-reporting and recurrence

BACKGROUND

Maltreatment re-reporting and recurrence represent missed opportunities for prevention and early intervention in child welfare settings.

OBJECTIVES

This study identified latent classes of risk among families who experienced a child maltreatment re-report or maltreatment recurrence within 12-months of initial case closure.

PARTICIPANTS AND SETTING

Administrative child welfare data from a large urban county were subject to secondary analysis. Samples included children who experienced a maltreatment re-report (n = 4390), and children who experienced a second maltreatment substantiation (n = 694).

METHODS

Five modifiable risk factors (i.e., mental health, substance abuse, domestic violence, disability, parenting challenges) were extracted from the initial investigation and subject to latent class analysis. Case characteristics (i.e., age, gender, race, ethnicity, maltreatment type) were then compared across the latent classes in a post-hoc analysis.

RESULTS

Re-report classes were characterized by (1) "Few Identified Challenges" (56%, n = 2458), (2) "Mental Health and Domestic Violence Challenges" (26%, n = 1133), and (3) "Substance Abuse, Domestic Violence, Mental Health, and Parenting Challenges" (18%, n = 790). Re-report classes differed according to child age, race, ethnicity, neglect and physical abuse allegations. Recurrence classes were characterized by (1) "Domestic Violence Challenges" (48%, n = 333), (2) "Mental Health Challenges" (15%, n = 104), and (3) "Domestic Violence, Mental Health, and Parenting Challenges" (37%, n = 257). Recurrence classes differed according to child race and age.

CONCLUSIONS

Findings underscore the complex and co-occurring nature of maltreatment risk, and provide insights to strengthen assessment and intervention practices to reduce repeated contacts with child welfare systems.

Quantifying Severity of Maltreatment, Adversity, and Trauma From Child Protective Services Case Record Files

Children referred to child protective services (CPS) for allegations of abuse or neglect often have diverse experiences of maltreatment, adversity, and trauma. Severity of these experiences is associated with greater mental health impairment and increased risk of revictimization and other adversities. Although aspects of these experiences are often captured during CPS investigations and stored in case records as narrative documents, much of this information is underutilized in estimating risk and service planning. The current study extracted case record information from a randomly selected sample of 100 families, with 150 children referred to CPS during a 12-month period. The Yale-Vermont Adversity in Childhood Scale (Y-VACS) was applied to extracted information for quantifying severity of various forms of childhood maltreatment, adversity, and trauma. Study aims were to examine (a) the scope and severity of maltreatment, adversity, and trauma types and their associations; (b) linkages between severity and CPS allegation types and outcomes; and (c) the utility of severity in predicting new allegations of abuse or neglect within 12 months of referral. Results indicated feasibility in quantifying severity of maltreatment and other adversities from case record information and revealed associations between adversity severity and CPS allegation types and outcomes. Severity of psychological intimate partner violence and neglect were predictive of new allegations of abuse or neglect within 12 months of referral. Findings support moving beyond an incident-based CPS strategy to one that better incorporates case record information to assess risk.

Types of child maltreatment and child welfare involvement among opioid-using mothers involved in substance use treatment

Although there is a significant link between maternal substance use and child maltreatment risk, extant literature has not investigated this link specifically among the growing number of parents abusing opioids. Underreporting of opioid use within child welfare presents further challenges in elucidating relations between maternal opioid use and child maltreatment. The purpose of the current study is to examine the link between maternal opioid use in women in substance use treatment and self-reported rates of child maltreatment and child welfare involvement of their children. We examined maternal substance use, severity of substance use, severity and type of child maltreatment of their children, and child welfare involvement across mothers who misuse opioids and misuse other substances using self-report surveys with 89 mothers. Results suggest similarities and differences among mothers who use opioids and other substances. Mothers who use opioids endorsed more significant and prolonged involvement with child welfare than mothers who use other substances. Participants did not endorse significant differences between rates of child maltreatment, and treatment engagement across groups. Given increased awareness of significant risks associated with opioid abuse, including greater risk for child maltreatment, a better understanding of its intersection with child welfare is necessary.

Identifying children at high risk for recurrence child abuse

PURPOSE

To evaluate the characteristics of abused children, families and abusive event and to identify risk factors associated with recurrence of child abuse.

METHODS

Retrospective data from 133 children aged between 2 months to 15 years old who were diagnosed as abuse between year 2002 and 2017. Thirteen items related to characteristics of the child, families, abusive event were selected. These factors were analyzed by multivariate logistic regression model for association with repeated child abuse.

RESULTS

Total of 133 subjects with average age of 5.25 ± 4.65 years old. There were 54 cases (40.60%) reported of repeated abuse. Majority of repeated abuse type in this study was physical abuse (73.68%). Most perpetrators were child's own parents (45.10%). Factors associated with increased risk of repeated abuse were child age 1-5 years old (AOR = 4.95/95%CI = 1.06-23.05), 6-10 years old (AOR = 6.80/95%CI = 1.22-37.91) and perpetrator was child's own parent (AOR = 21.34/95%CI = 3.51-129.72). Three cases of mortality were found with single-visit children and one case in recurrence. Most of death cases were children less than 1-year-old with average age of 7 months. Causes of death were subdural hematoma with skull and ribs fracture.

CONCLUSIONS

Identifying risk factors for repeated child abuse help in recognizing child at risk to provide prompt intervention. This study found two factors associated with higher risk of abuse recurrence: child age 1-10 years old and abusive parents. Children who presented with these risk factors should be recognized and intensively monitored.

Sobriety Treatment and Recovery Teams for families with co-occurring substance use and child maltreatment: A randomized controlled trial

BACKGROUND

Co-occurring parental substance use and child maltreatment has increased in recent years and is associated with poor child welfare outcomes. The Sobriety Treatment and Recovery Teams (START) program was developed to meet the needs of these families.

OBJECTIVE

A randomized controlled trial was implemented to compare START to usual child welfare services on three outcomes: out-of-home care (OOHC) placements; reunification; and subsequent child maltreatment.

PARTICIPANTS AND SETTING

Families reported to child welfare services in Jefferson County, Kentucky, were eligible if they had a current finding of child maltreatment or services needed, substance use as a primary risk factor, a child under six years of age, and no other open child welfare cases.

METHODS

Biased coin randomization was used for a control: treatment randomization ratio of 1:2. Analyses were conducted using intent-to-treat (ITT), though a subsample of families receiving services was also analyzed. Differences were assessed using t-tests, chi-square, and risk ratios.

RESULTS

A total of 348 families including 526 children were randomized to START (n = 346) and usual services (n = 180). There were no significant differences between groups on the three outcomes in the ITT sample or the subsample that received services, though the START OOHC rate was 7 percentage points lower (relative difference: 21.6 %) and the reunification rate was 13 percentage points higher (relative difference: 27.6 %) in the subsample.

CONCLUSIONS

Although differences between groups were not significantly different, the relative differences were meaningful and this is the third study showing lower rates of OOHC among START relative to usual services. Additionally, the START reunification rate is higher than the overall U.S. average in spite of notable risk factors.

Difficult binds: A systematic review of facilitators and barriers to treatment among mothers with substance use disorders

BACKGROUND

The United States and Canada have observed sharp increases in substance use disorder among women of child-bearing or child-rearing age. Substance use disorder can have deleterious effects on children, families, and communities. Many evidence-based treatments exist, but engaging mothers in treatment is difficult. No recent review is available to help systems and providers understand the facilitators of and barriers to treatment for mothers.

OBJECTIVE

To systematically identify facilitators and barriers to substance use and mental health treatment for mothers with substance use disorder who are pregnant or parenting young children in the United States and Canada.

METHODS

We systematically searched the literature using five online databases and performed a gray literature search. We included studies published in the past two decades focused on parent or provider perspectives.

RESULTS

Our search identified 23 high-quality papers. The majority of papers qualitatively examined the perspectives of treatment-seeking pregnant women and mothers diverse in race/ethnicity, region, and treatment settings. Our synthesis of findings revealed the compelling and complex centrality of motherhood, which served as both a facilitator and barrier. Motherhood often interacted with relational (e.g., perceiving stigma vs. support from providers, family, friends, partners) and structural (e.g., time commitments, childcare) factors to both hinder and help engagement in treatment.

CONCLUSIONS

Our findings can help policy-makers and practitioners make tangible improvements to the financing and delivery of substance use treatment for mothers. Our review points to specific areas for future research, including an examination of the relationships between various structural factors and treatment outcomes.

Systematic Review of Community- and Home-Based Interventions to Support Parenting and Reduce Risk of Child Maltreatment Among Families With Substance-Exposed Newborns

Substance-exposed newborns (SENs) are at increased risk of child maltreatment, out-of-home placement, and poor health and developmental outcomes. The purpose of this systematic review is to synthesize existing research on community- and home-based interventions designed to improve parenting and reduce risk of maltreatment for families with SENs, applying a program logic framework. The review includes studies that used preexperimental, quasi-experimental, and experimental designs. Twelve interventions were identified. Of the nine studies that used more rigorous experimental or quasi-experimental designs, five showed positive effects on at least one parenting or child maltreatment outcome, although some studies showed high risk of bias. Full coherence among the intended participants, theory of change, and program components was observed for only two interventions. The findings suggest a need for more rigorous research to develop and test interventions that are grounded in theory and prior research and that address the unique needs of families with SENs.

Illicit Drug Exposures in Young Pediatric Patients Reported to the National Poison Data System, 2006-2016

This retrospective review of poison center calls found that there were 9122 illicit drug exposures reported in children <10 years of age between 2006 and 2016. Marijuana and methamphetamine were reported most frequently, with significant increases over the study period; methamphetamine was associated with the most deaths.

Risk Factors and Services to Reduce Child Sexual Abuse Recurrence

Child sexual abuse (CSA) is associated with a range of negative consequences for victims that are compounded when it recurs. We used the National Child Abuse and Neglect Data System to study a cohort of 42,036 children in 45 U.S. states with sexual abuse reports first confirmed by child protective services (CPS) during 2010 in order to identify children with increased risk for recurrence. A small proportion (3.6%) had a second confirmed sexual abuse report through 2015. In multivariate models, female gender, family hearing and vision problems, other child maltreatment, and other family violence were associated with increased risk of recurrence, while younger children, Hispanic families, and those with substance abuse tended to have less risk. One fourth of recurrence involved the same offender, usually a parent or caretaker. One fourth of cases were referred for any CPS services, which were more likely to be provided for families with poverty, drug or alcohol problems, or other violence. Only substance abuse services significantly reduced recurrence in multivariable models. Those trying to reduce CSA recurrence should recognize that certain case characteristics are associated with greater recurrence, and most CPS services do not significantly reduce CSA recurrence.

Advancing preventive interventions for pregnant women who are opioid using via the integration of addiction and mental health research

Purpose of Review

This review examines how research focused on treatment for opioid use in perinatal populations and preventive interventions for postpartum psychopathology have remained separate, despite significant overlap.

Recent Findings

Guidelines for best practice in caring for pregnant women with opioid use disorder suggest the use of medication-assisted treatment with additional comprehensive care, including behavioral and mental health interventions. However, intervention research often mutually excludes these two populations, with studies of behavioral interventions for opioid use excluding women with psychopathology and research on preventive interventions for postpartum psychopathology excluding women who are substance using.

Summary

There is a limited evidence-base to inform the selection of appropriate preventive interventions for pregnant women with opioid use disorder that can address opioid use and/or treatment adherence and concurrent mental health risks. We argue it is critical to integrate research on pregnant women who are opioid using and preventive perinatal mental health interventions to catalyze pivotal change in how we address the opioid epidemic within this growing population.

The Relationship between Parental Perception of Neighborhood Collective Efficacy and Physical Violence by Parents against Preschool Children: A Cross-Sectional Study in a County of China

Children exposed to negative neighborhood environments are at high risk of experiencing violence. This study aimed to explore the effects of parental perception of neighborhood collective efficacy on parental physical violence (PV) to their preschool children in a county of China. A total of 1337 parents from nine kindergartens were recruited by the stratified random cluster sampling method. Data about parental PV behavior toward children during the past three months, parental perception of neighborhood collective efficacy, together with their attitudes towards the use of corporal punishment to discipline children, and demographic characteristics were collected. Their relationships were investigated by applying multivariable logistic regression models. Overall, 67.5% of the parents reported at least one form of PV during the past three months. The rates of minor PV (MPV) and severe PV (SPV) were 67% and 22.8%, respectively. The results of multivariate logistic regression showed that only social cohesion was associated with lower odds of parental PV and MPV behavior after controlling for covariates. The results suggest that neighborhood collective efficacy is associated with parental PV behavior against their children to some extent, but the effects differ according to the severity level of PV. Neighborhood social cohesion may have a positive role in reducing parental PV behavior in the county surveyed at present study.

Repeat reports among cases reported for child neglect: A scoping review

BACKGROUND

In the United States (US), child welfare policy prioritizes prevention of future harm (e.g., repeat reports) after a report of maltreatment. The majority of reports include some form of child neglect, but no prior review of the recurrence literature has focused on neglect.

OBJECTIVE

This review sought to help guide future research, policy and practice by summarizing recurrence findings related to child neglect with attention to the broader ecological context in which maltreatment occurs.

PARTICIPANTS

The final review included 34 US studies of maltreatment recurrence. Twenty-eight studies compared child neglect with at least one other form of maltreatment and six studies examined recurrence among neglect cases.

METHODS

Eleven online databases were searched to locate relevant empirical studies. This review attended specifically to contextualizing findings according to other modifiable factors as well as methodological variation. A scoping review approach was used to summarize findings.

RESULTS

Of the 28 studies comparing neglect to other types of maltreatment, 14 found increased risk for neglect, 12 found no association, and two reported a lower risk. When significant, the effect size ranged from 10% to over three times higher risk for neglect. Poverty or material need was the most commonly included control (15 studies), with two thirds finding that lower resource families had higher risk.

CONCLUSION

Methodological variability across studies confounds current ability to guide practice or policy. More research is needed that can replicate and extend findings with comparable samples and model specifications that take into account the regional and policy context.

The role of co-occurring intimate partner violence, alcohol use, drug use, and depressive symptoms on disciplinary practices of mothers involved with child welfare

BACKGROUND

Evidence suggests intimate partner violence (IPV), substance use, and depression adversely affect the disciplinary practices of caregivers involved with child welfare; however, it remains uncertain whether the combined effects of these conditions are syndemic.

OBJECTIVE

The purpose of this study was to examine the (1) associations between IPV, problematic drug use, problematic alcohol use, and depressive symptoms and self-reported disciplinary practices among a sample of mothers with child welfare contact; and (2) effect of co-occurrence of these conditions on child disciplinary practices.

PARTICIPANTS AND SETTING

We used data from the second cohort of the National Survey of Child and Adolescent Well-Being (NSCAW II). The analysis focused on 965 biological mothers with children who were subjects of child abuse/neglect investigations between February 2008 and April 2009 in the United States.

METHOD

We conducted multiple linear regression analyses.

RESULTS

Our findings showed that IPV (B = .28; 95% CI = [.04, .53]) and depressive symptoms (B = .27; 95% CI = [.03, .52]) were independently associated with psychologically aggressive disciplinary practices. Also, IPV was independently associated with physically aggressive disciplinary practices (B = .64; 95% CI = [.18, 1.11]); and IPV (B = .21; 95% CI = [.06, .35]) and depressive symptoms (B = .22; 95% CI = [.07, .37]) were independently associated with neglectful parenting strategies. A significant effect was found for the interaction between problematic drug use and depressive symptoms with physically aggressive practices as the outcome. As the number of conditions caregivers had increased, so did their propensity for self-reporting each of the disciplinary practices (p <  .05).

CONCLUSIONS

The findings highlight the need for using a more holistic/multidisciplinary approach to child maltreatment prevention research, policy, and intervention.

Sociodemographic characteristics of patients with children in a methadone maintenance program: a cross-sectional study

Background

Ever-increasing numbers of opioid use disorder (OUD) in Canada has created the recent opioid crisis. One common treatment for OUD is methadone maintenance treatment (MMT). Various factors, including being a parent which entails specific stressors, may increase susceptibility to negative treatment outcomes. This study aims to investigate differences between OUD patients with and without children in socio-demographic and clinical outcomes.

Methods

Data for this study are part of a larger program. All participants are 18+ years old with OUD, provided consent, and receiving MMT. We performed a multivariable logistic regression to examine the differences between participants’ parental status, sociodemographic variables, and clinical parameters including MMT outcomes. We performed subgroup analyses on individuals with children younger than 18.

Results

A total of 1099 participants were included, with 64% having children. Participants with children were older (OR 1.06, 95% CI 1.04, 1.08), more likely to be female (OR 2.39, 95% CI 1.75, 3.27), living with a partner (OR 1.75, 95% CI 1.27, 2.41), first exposed to opioids through a prescription (OR 1.517, 95% CI 1.13, 2.04) and had lower levels of education (OR 1.86, 95% CI 1.20, 2.87). There was no significant difference in illicit opioid use patterns between groups. Same results held true in the subgroup analyses based on the age of the children except for participant age.

Conclusion

Our results demonstrate social and demographic differences between parents and non-parents receiving MMT. These differences highlight the need to understand necessary additional support for parents such as child support and other necessary therapies.

Factors associated with child protection recurrence in Australia

The aim of the current research was to advance understanding of child protection in Australia by examining the factors associated with recurrence of child protection notifications to the formal child protection system. Extant research has been primarily undertaken in the USA and it is important to understand whether similar factors associated with recurrence actually hold in the Australian context. Administrative data were obtained for a sample of 9608 children first subject to a screened-in report in 2011-12. Children were followed for 12 months. Cox Proportional Hazard models were used to measure associations between 26 independent variables and four types of recurrence: subsequent reports, subsequent investigations, subsequent substantiations, and subsequent intervention. Factors associated with recurrence in Australia were broadly similar to those identified in other jurisdictions, including reports and substantiation for neglect, younger age, prior child protection involvement in the household, and parental characteristics including drug use, mental health problems, and history of maltreatment as a child. As in previous studies, post-investigative service provision was positively associated with recurrence. In prior US research, race did not predict recurrence. However, in the present study, Indigenous Australian children were significantly more likely to be subject to all types of recurrence measured. Future research on recurrence should aim to disentangle the complex relationships between child protection recurrence, child maltreatment, and service delivery. Recurrence is not a good proxy indicator of child safety. The findings have implications for the equity of recurrence-based risk assessment tools as they are applied to indigenous populations.

Effect of a Parenting Intervention on Foster Care Reentry After Reunification Among Substance-Affected Families: A Quasi-Experimental Study

Although parental substance abuse has been identified as a risk factor for poor foster care outcomes, current research on effective interventions is limited. A few studies have shown that parenting interventions improved parenting skills and family functioning and decreased time to reunification among children in foster care due to parental substance abuse. However, more research is needed to evaluate whether these interventions positively impact reentry rates. Using propensity score analyses to establish a matched comparison group, survival analyses evaluated the relationship between participation in a parenting intervention, the Strengthening Families Program (SFP), and reentry among a sample of 493 children previously reunified with their parents. The overall reentry rate was 20.9%. Analyses indicated that there was no difference in reentry rates between the SFP (23.7%) and comparison groups (18.6%). Significant predictors of reentry were child behavior problems, family poverty, and reunification between 15 and 18 months from removal.

Predictors of substantiated re-reports in a sample of children with initial unsubstantiated reports

Many children with unsubstantiated reports of child abuse and neglect repeatedly return to the child protection system, indicating that unsubstantiated reports may represent actual child maltreatment or risk for future maltreatment. Identifying patterns of re-reporting and predictors that may be associated with later substantiated re-reporting could help to identify children who are very likely to be maltreated. This knowledge may guide the development of policies and interventions to prevent further maltreatment and the risk for re-reports. The aims of this study were to: (1) measure the period between the time of the initial reports that were not substantiated and the time of first substantiated re-reports; and (2) identify factors associated with the risk of later substantiated re-reporting. The study analyzed secondary data from the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN) through survival analysis. Of the 378 children with initially unsubstantiated reports, 81% were re-reported, of which almost two-thirds were substantiated. Children who were younger, non-white, and had caregivers with more depressive symptoms were at increased risk of a substantiated re-report. Among those that were later substantiated, 20% were substantiated within one year. Findings suggest that targeted preventative services should be developed and provided for families who are reported for the first time, even if not substantiated.

The Complex Nature of Parental Substance Use: Examining Past Year and Prior Use Behaviors as Correlates of Child Maltreatment Frequency

BACKGROUND

Child maltreatment studies predominantly have operationalized parental substance use as dichotomous variables for any use, any harmful/risky use, or any substance use disorder (SUD). This limits our understanding about how a range of use behaviors may contribute to child maltreatment.

OBJECTIVE

Build upon prior studies by incorporating a multi-faceted approach to operationalizing parental substance use.

METHODS

Cross-sectional, secondary data analyses were conducted using the National Survey of Child and Adolescent Well-being (NSCAW I). The study used weighted negative binomial regression to examine relationships between annual child maltreatment frequency and different ways of operationalizing substance use among 2,100 parents.

RESULTS

Several, inter-related behaviors (i.e., heavy drinking, illicit drug use, polysubstance use, SUD, and prior SUD < 4 years) appeared to be relevant for understanding differences in child maltreatment frequencies. A gradient effect was detected across five substance use behavior patterns: (1) lowest estimated counts were observed for nonusers, light-to-moderate drinkers, and parents with a prior (but not past year) SUD (ӯ < 7.0), (2) slightly higher estimated count was observed for heavy drinkers and/or illicit drug users (ӯ = 9.3), and (3) highest estimated count was observed for parents with past year SUD (ӯ = 17.6). Conclusions/Importance: SUD is a critical screening criteria for potential child harm. Parents reporting risky substance use behaviors may benefit from prevention or brief intervention services related to both their substance use and parenting behaviors. Administrative systems also could benefit from detailed tracking of substance use behaviors for future program evaluation and development.

Interagency collaboration: Strengthening substance abuse resources in child welfare

Supporting child welfare (CW) workers' ability to accurately assess substance abuse needs and link families to appropriate services is critical given the high prevalence of parental substance use disorders (SUD) among CW-involved cases. Several barriers hinder this process, including CW workers' lack of expertise for identifying SUD needs and scarcity of treatment resources. Drawing from theories and emergent literature on interagency collaboration, this study examined the role of collaboration in increasing the availability of resources for identifying and treating SUDs in CW agencies. Using data from the second cohort of families from the National Survey of Child and Adolescent Well-Being, study findings highlight a lack of SUD resources available to CW workers. On the other hand, the availability of SUD resources was increased when CW agencies had a memorandum of understanding, co-location of staff, and more intense collaboration with drug and alcohol service (DAS) providers. These results provide evidence to support efforts to improve collaboration between CW and DAS providers and showcase specific collaboration strategies to implement in order to improve service delivery.

Development of a prediction model for child maltreatment recurrence in Japan: A historical cohort study using data from a Child Guidance Center

To develop a prediction model for the first recurrence of child maltreatment within the first year after the initial report, we carried out a historical cohort study using administrative data from 716 incident cases of child maltreatment (physical abuse, psychological abuse, or neglect) not receiving support services, reported between April 1, 1996 through March 31, 2011 to Shiga Central Child Guidance Center, Japan. In total, 23 items related to characteristics of the child, the maltreatment, the offender, household, and other related factors were selected as predictive variables and analyzed by multivariate logistic regression model for association with first recurrence of maltreatment. According to the stepwise selection procedure six factors were identified that include 9-13year age of child (AOR=3.43/95%CI=1.52-7.72), <40year age of the offender (AOR=1.65/95%CI=1.09-2.51), offender's history of maltreatment during childhood (AOR=2.56/95%CI=1.31-4.99), household financial instability or poverty (AOR=1.64/95%CI=1.10-2.45), absence of someone in the community who could watch over the child (AOR=1.68/95%CI=1.16-2.44), and the organization as the referral source (AOR=2.21/95%CI=1.24-3.93). Using these six predictors, we generated a linear prediction model with a sensitivity and specificity of 45.2% and 82.4%, respectively. The model may be useful to assess the risk of further maltreatment and help the child and family welfare administrations to develop preventive strategies for recurrence.

Parental Criminal Justice Involvement and Children's Involvement With Child Protective Services: Do Adult Drug Treatment Courts Prevent Child Maltreatment?

BACKGROUND

In light of evidence showing reduced criminal recidivism and cost savings, adult drug treatment courts have grown in popularity. However, the potential spillover benefits to family members are understudied.

OBJECTIVES

To examine: (1) the overlap between parents who were convicted of a substance-related offense and their children's involvement with child protective services (CPS); and (2) whether parental participation in an adult drug treatment court program reduces children's risk for CPS involvement.

METHODS

Administrative data from North Carolina courts, birth records, and social services were linked at the child level. First, children of parents convicted of a substance-related offense were matched to (a) children of parents convicted of a nonsubstance-related offense and (b) those not convicted of any offense. Second, we compared children of parents who completed a DTC program with children of parents who were referred but did not enroll, who enrolled for <90 days but did not complete, and who enrolled for 90+ days but did not complete. Multivariate logistic regression was used to model group differences in the odds of being reported to CPS in the 1 to 3 years following parental criminal conviction or, alternatively, being referred to a DTC program.

RESULTS

Children of parents convicted of a substance-related offense were at greater risk of CPS involvement than children whose parents were not convicted of any charge, but DTC participation did not mitigate this risk. Conclusion/Importance: The role of specialty courts as a strategy for reducing children's risk of maltreatment should be further explored.

Risk factors for child maltreatment recurrence: An updated systematic review

OBJECTIVES

Children who have been maltreated are at increased risk of further maltreatment. Identification of those at highest risk of further maltreatment is a priority for professionals working in child protection services. The current study is intended to consolidate and expand on previous work on recurrence of child maltreatment. It has sought to identify risk factors for maltreatment recurrence in the recent literature in the expectation that this may help in the practical identification of children at risk.

METHODS

We conducted a systematic review of cohort studies published between 2003 and 2009, identifying factors associated with maltreatment recurrence in children. Studies included demonstrated differing levels of substantiation of maltreatment.

RESULTS

Fifteen studies met inclusion criteria but showed significant heterogeneity, varying in setting, recruitment of subjects, types of maltreatment considered and length of follow-up. Previous findings were replicated and expanded in the current study in relation to a range of factors, including rates of maltreatment recurrence, maltreatment types, frequency of previous episodes of maltreatment, child and family considerations, home environment and service provision. Factors were identified irrespective of level of maltreatment substantiation.

CONCLUSION

This study provides further systematic evidence of the existence of a number of factors associated with child maltreatment recurrence. It points to the possibility of practical application of its findings within the wider context of decision making in child protection services, with the ultimate aim of reducing recurrence of maltreatment in individual cases.

Examining intensity and types of interagency collaboration between child welfare and drug and alcohol service providers

The co-occurrence of child maltreatment and caregiver substance use disorders (SUDs) is a pervasive problem, with an estimated two thirds of child welfare (CW) systems cases involving SUDs. Interagency collaboration between CW and drug and alcohol service (DAS) providers shows promise in improving connections to and delivery of SUD services for CW-involved families. However, interagency collaboration between CW and DAS providers continues to be difficult to achieve and little is known about organizational characteristics and contexts that influence collaboration between these two entities. Using data from the second cohort of families from the National Survey of Child and Adolescent Well-Being, this study examined national trends in interagency collaboration between CW and DAS providers and organizational factors that influence the nature and intensity of interagency collaboration. Results indicated that collaboration intensity was greater for CW agencies that reported increased caseloads and those located in more populated counties. However, collaboration intensity decreased for CW agencies located in counties with higher child poverty. Study findings have implications for policy leaders and directors of CW agencies throughout the United States, especially because collaborating with DAS providers may increase CW agencies' organizational capacity and relieve job stress related to high caseloads. Development of strategies that spur engagement in more intense and multiple types of collaboration between CW agencies and DAS providers has the potential to relieve service burden on CW staffs and expedite service delivery to CW-involved families dealing with SUDs.

The nature and extent of child protection involvement among heroin-using mothers in treatment: high rates of reports, removals at birth and children in care

INTRODUCTION AND AIMS

A substantial proportion of women in treatment for substance use problems are mothers of dependent children, but only a small number of studies have explored the nature and extent of their child protection involvement with substance-using mothers themselves.

DESIGN AND METHODS

A large sample of mothers on the opioid treatment program (OTP) in Sydney, Australia, were interviewed. This paper describes their characteristics, the extent and nature of their involvement with the child protection system, the parenting-related interventions provided and their views of their own parenting.

RESULTS

The 171 mothers were disadvantaged and marginalised and had 302 children under the age of 16 years, 99 of whom were in out-of-home care. Nearly half the children in care (n = 42) had been removed at the time of their birth, and half (n = 49) had been removed from a mother who was on an OTP at the time. Among the younger children (age 1-2 years), higher proportions had been removed at birth than among the older children. None of the 32 mothers who had a child removed at birth and then gave birth subsequently retained care of their new baby. Women often chose to enter treatment (63.6%) for child-related reasons (35%) and attempted to shield their children from their substance use. Few health services were provided to them outside the availability of OTP.

DISCUSSION AND CONCLUSIONS

Entering treatment presents an opportunity for improving outcomes for these women and their children and to reduce future involvement with the child protection system.

A developmental approach to the risk of a first recurrence in child protective services

The objective of this study is to estimate the risk of a first recurrence over a five-year period following initial child protective services (CPS) intervention and identify the characteristics associated with the risk of recurrence for three different age groups. Recurrence is defined as the first substantiated report within the observation period after initial services have ended. The study involved a cohort of 25,897 Quebec children who received postinvestigation services for the first time and whose cases were closed between 2005 and 2009. Survival analysis was used to estimate the five-year risk of recurrence and Cox regression to model the risk of recurrence for three age groups. The covariates introduced into the regression analyses were characteristics of the child and initial services. The risk of recurrence in the five years following termination of initial CPS services was 36% for the entire cohort and varied depending on the child's age at the time of case closure. Children aged 6-11 when their cases were closed had the highest risk of recurrence. Although Aboriginal descent and prior CPS investigations have a consistent effect on the risk of recurrence in all three age groups, the effects of other covariates, such as out-of-home placement and court involvement, vary or are even reversed, depending on the child's age. These findings highlight the need to adopt a differential approach that takes into account the child's age, both in the provision of protective services and in research involving the population receiving such services.

Decision-making deficits among maltreated children

Although maltreated children involved with child welfare services are known to exhibit elevated levels of health-risking behaviors, little is known about their decision-making processes leading to such tendencies. Research findings suggest that maltreated children exhibit developmental delays in neurocognitive and emotional regulation systems that could adversely impact their abilities to make decisions under conditions of risk. Whereas prior researchers have examined risky decision making as a global construct, maltreated children's decision making was examined in two contexts in the present study: potential gains and potential losses. Comparing maltreated children (n = 25) and a nonmaltreated community group (n = 112), it was found that the maltreated children showed decision-making impairments for both domains: This impairment was especially prominent in the loss domain. The maltreated children took excessive risks and were insensitive to changes in expected value. Follow-up analyses revealed that these differences were primarily associated with insensitivity to changes in outcome magnitude for the risky option. Finally, response latency analyses indicated that the maltreated children were slower to make choices, reinforcing underlying differences in decision processes between groups. These results have implications for basic and translational science.

Mothers in methadone treatment and their involvement with the child protection system: a replication and extension study

OBJECTIVES

Although a high level of involvement with the child protection system has been identified in families where parental substance use is a feature, not all such parents abuse or neglect their children or have contact with the child protection system. Identifying parents with substance-use histories who are able to care for their children without intervention by the child protection system, and being able to target interventions to the families who need them the most is important. This study interviewed a relatively large sample of mothers about their histories, their children and their involvement with the child protection system. We hypothesized that mothers in opioid pharmacological treatment who are involved with child protection services are different in characteristics to those mothers who are not involved.

METHODS

One hundred and seventy-one women, with at least one child aged under 16 years, were interviewed at nine treatment clinics providing pharmacological treatment for opioid dependence across Sydney, Australia.

RESULTS

Just over one-third of the women were involved with child protection services at the time of interview, mostly with children in out-of-home care. Logistic regression analyses revealed that factors which significantly increased the likelihood of the mother being involved with the child protection system were: (1) having a greater number of children, (2) being on psychiatric medication, and (3) having less than daily contact with her own parents.

CONCLUSIONS

This study replicates and extends the work of Grella, Hser, and Huang (2006) and the limited literature published to date examining the factors which contribute to some substance-using mothers becoming involved with the child protection system while others do not. The finding that mental health problems and parental supports (along with the number of children) were significantly associated with child protection system involvement in this study, indicates a need for improved interventions and the provision of treatment and support services if we are to reduce the involvement of the child protection system with these families.

Impact of Intensive Case Management on Child Welfare System Involvement for Substance-Dependent Parenting Women on Public Assistance

This study examined the impact of intensive case management (ICM) on decreasing child welfare system involvement in a sample of substance-dependent parenting women who participated in a welfare demonstration study comparing ICM to usual screen-and-refer models employed in welfare settings. Previous research established the effectiveness of ICM in both increasing engagement in substance abuse treatment and in promoting abstinence, and the current study tested whether ICM had downstream impacts on child welfare outcomes not directly targeted by the intervention. The sample included 302 mothers recruited from welfare offices and their 888 minor children. Child welfare outcomes were available from administrative records for four years following study entry and included incident reports and out-of-home child placements. An initial positive effect of ICM was found on child placements, but its impact lessened over time and was likely due to the increased contact with case managers that occurred early in the study. Overall, minimal benefits of ICM were found, suggesting that while ICM was effective in the areas of treatment engagement and abstinence, there were no downstream benefits for child welfare outcomes. Implications of findings in terms of increased need for cross-system collaboration are discussed.

African American Caregivers and Substance Abuse in Child Welfare: Identification of Multiple Risk Profiles

Despite the strong correlation between caregiver substance abuse and child maltreatment, little information exists to understand the typology of African American caregivers with substance abuse problems in the child welfare system. Research shows African American caregivers contend with multiple problems stemming from substance abuse. Unfortunately, we do not yet know how to best tailor resources to be responsive to varying groups of African American caregivers. Using data from the National Survey of Child and Adolescent Well-being (NSCAW), this investigation tested for distinct multivariate profiles among a subset of African American caregivers with substance abuse problems (n=258). Latent Class Analysis (LCA) was used to classify caregivers, and five classes were identified among this high risk sample - each with distinct risk profiles. Based on these findings, we discuss implications for tailored practices to enhance the safety and stability of children involved with child welfare.

Services and recurrence after psychological maltreatment confirmed by child protective services

Recurrence rates of psychological maltreatment (PM) and the services that may reduce those rates have not been systematically evaluated. The National Child Abuse and Neglect Data System was used for 2003-2007 to study a cohort of children in 18 states with PM reports first confirmed by child protective services (CPS) during 2003. PM recurrence rates after counseling and other referrals were assessed while controlling for factors associated with service referral and other maltreatment. A total of 11,646 children had a first CPS-confirmed report with PM, and 9.2% of them had a second-confirmed PM report within 5 years. Fewer than one fourth of families were referred for services after PM, with service referrals being more likely for families with poverty, drug or alcohol problems, or other violence. Controlling for these factors, counseling referral was associated with a 54% reduction in PM recurrence, but other services were not associated with statistically significant reductions. Few families in which PM was confirmed receive any services, and most services provided were not associated with reductions in PM recurrence. Clarification of key services associated with efficacious prevention of PM is needed.

A national study of risk and protective factors for substance use among youth in the child welfare system

While child welfare services are intended, in part, to diminish maltreatment's negative impact on adolescents' development, there is evidence that receiving child welfare services affects adolescents' substance use adversely. The literature on the extent and correlates of this problem is still emerging. The present study aims to fill part of this gap by examining the association between baseline psychosocial risk and protective factors on engagement in substance use behavior over a period of 36 months for child welfare involved youth. It further compares substance use behavior between youth placed in out-of-home care and those who remained with their biological families. Data come from the National Survey of Child and Adolescent Well-Being (NSCAW), a national probability study of children and adolescents undergoing investigation for abuse or neglect. The sample for this analysis was restricted to 827 youth who were 11 years or older at baseline data collection. Key findings include a high rate of social substance use (47.7%) and illicit substance use (17.4%). There was a limited role of protective factors in mitigating risk behavior for social substance use (caregiver connectedness; OR=0.51, p<0.05). Avoiding foster care placement was a protective factor for illicit substance use (OR=0.43, p<0.05). Delinquency was a risk factor associated with both social substance use (OR=1.06, p<0.01) and hard substance use (OR=1.10, p<0.001). Given the high prevalence of substance use among child welfare involved youth, prevention efforts for this population require a better understanding of biological, psychological, and social protective factors. The child welfare system is an untapped resource that has the potential to be a gateway to and a platform for substance abuse prevention services that should be incorporated into child welfare safety and permanency interventions.

Integrated Substance Abuse and Child Welfare Services for Women: A Progress Review

A review of empirical literature reveals improvements in service utilization and outcomes for women when substance abuse and child welfare services are integrated. The increased use of substances by women involved in the child welfare system has resulted in a call for integrated, coordinated, evidence-based practices. Since the late 1990s, specific system- and service-level strategies have been developed to coordinate and integrate the provision of substance abuse and child welfare services such that women are remaining in treatment longer and are more likely to reduce substance use and be reunited with their children. The strategies reviewed provide useful guidelines for developing components of effective, evidence-based programs for substance-involved women in the child welfare system.

Household, family, and child risk factors after an investigation for suspected child maltreatment: a missed opportunity for prevention

OBJECTIVE

To determine whether a Child Protection Services investigation for suspected child maltreatment is associated with subsequent improvements in household, caregiver, and child risk factors.

DESIGN

Retrospective cohort study.

SETTING

The Longitudinal Studies of Child Abuse and Neglect, a multicenter cohort study of the antecedents and consequences of child maltreatment.

PARTICIPANTS

A total of 595 children with the same maternal caregiver responding to Longitudinal Studies of Child Abuse and Neglect surveys at ages 4 and 8 years.

MAIN EXPOSURE

Investigation for suspected child maltreatment between ages 4 and 8 years.

MAIN OUTCOME MEASURES

Adjusted differences in 7 modifiable risk factors (social support, family functioning, poverty, maternal education, maternal depressive symptoms, anxious or depressive child behaviors, and aggressive or destructive child behaviors) at age 8 years.

RESULTS

Of 595 subjects, 164 (27.6%) experienced an investigation for suspected child maltreatment between ages 4 and 8 years. At age 8 years, investigated subjects were not perceptibly different from noninvestigated subjects in social support, family functioning, poverty, maternal education, or child behavior problems after adjusting for baseline risk factors. Mothers of investigated subjects did have more depressive symptoms than mothers of noninvestigated peers at the child's age of 8 years. Substantiation of child maltreatment by Child Protective Services did not alter these findings.

CONCLUSIONS

Our finding that an investigation for suspected child maltreatment is not associated with relative improvements in common, modifiable risk factors suggests that we may be missing an opportunity for secondary prevention of maltreatment and maltreatment consequences.

Caseworker-perceived caregiver substance abuse and child protective services outcomes

The authors used data from the National Survey of Child and Adolescent Well-Being to examine associations of child protective services (CPS) caseworkers' perceptions of caregiver substance abuse with their perceptions of the severity of risk and harm a child experienced as a result of alleged maltreatment, as well as with whether a family experienced a range of CPS outcomes.The outcomes included whether the family received services from CPS, was substantiated for maltreatment, experienced child removal, and was subject to a termination of parental rights (TPR) petition. The authors also compared the magnitude of the association between caseworker-perceived caregiver substance abuse and each outcome to that of the association between other maltreatment-related risk factors and each outcome. Findings suggest that, all else equal, caseworker-perceived caregiver substance abuse is associated with increased caseworker perceptions that children have experienced severe risk and harm and also with an increased probability of each of the CPS outcomes except TPR. Moreover, these associations are equal in magnitude or larger than those between the other risk factors and the outcomes. These findings imply that CPS decisions are heavily influenced by caseworker perceptions of caregiver substance abuse, regardless of the presence of other risk factors for child maltreatment.

Estimating the "impact" of out-of-home placement on child well-being: approaching the problem of selection bias

This study used data on 2,453 children aged 4-17 from the National Survey of Child and Adolescent Well-Being and 5 analytic methods that adjust for selection factors to estimate the impact of out-of-home placement on children's cognitive skills and behavior problems. Methods included ordinary least squares (OLS) regressions and residualized change, simple change, difference-in-difference, and fixed effects models. Models were estimated using the full sample and a matched sample generated by propensity scoring. Although results from the unmatched OLS and residualized change models suggested that out-of-home placement is associated with increased child behavior problems, estimates from models that more rigorously adjust for selection bias indicated that placement has little effect on children's cognitive skills or behavior problems.

Substantiation and maltreatment rereporting: a propensity score analysis

Although it is a widely used indicator, the use of substantiation in child welfare practice and research is not without critics. Much of this criticism concerns the ability of the substantiation disposition to distinguish between child protective services (CPS) investigations in which maltreatment occurs or does not occur. This study examined the relationship between substantiation and maltreatment rereporting using an analytic technique known as propensity score matching (PSM). Children with initially substantiated maltreatment reports were at significantly higher risk for rereporting than those with initially unsubstantiated reports, even after matching the two groups on propensity scores based on several demographic and case characteristics. Although additional study using PSM on other samples is warranted, this evidence supports the predictive validity of the substantiation disposition and its continued use as one factor to consider when allocating limited post-investigation services.

Recovery coaches and substance exposed births: an experiment in child welfare

OBJECTIVES

Substance exposed infants present a major challenge to child welfare and public health systems. Prenatal substance exposure and continued substance abuse in the home are associated with a wide range of adverse social, emotional, and developmental outcomes. The objective of the current study is to evaluate the use of recovery coaches in child welfare.

METHODS

The current study is longitudinal and utilizes an experimental design. The sample includes 931 substance abusing women enrolled in a Title IV-E Waiver Demonstration, 261 in the control group, and 670 in the experimental group. Women in the experimental group received traditional services plus the services of a recovery coach. Administrative records are used to indicate substance exposure at birth.

RESULTS

Of the 931 women enrolled in the waiver demonstration, 21% of the control group and 15% of the experimental group were associated with a subsequent substantiated allegation indicating substance exposure at birth. Cox proportional hazards modeling indicates that women in the experimental group were significantly less likely to be associated with a new substance exposed birth.

CONCLUSIONS

The use of recovery coaches in child welfare significantly decreases the risk of substance exposure at birth. Integrated and comprehensive approaches are necessary for addressing the complex and co-occurring needs of families involved with child protection.

Do drug treatment services predict reunification outcomes of mothers and their children in child welfare?

The effect of mothers' participation in substance abuse treatment on reunification with their children who are in out-of-home care is an important policy issue. This article examines the predictors of child reunification among mothers who participated in a statewide treatment outcome study. Data were integrated from multiple sources to determine the contributions of characteristics of mothers (n = 1,115), their children (n = 2,299), and treatment programs (n = 43) on reunification outcomes. Hierarchical linear modeling was used to determine the fixed and random effects of mother, child, and program characteristics. Mothers with more employment and psychiatric problems were less likely to be reunified with their children; completion of 90 or more days in treatment approximately doubled their likelihood of reunification. Mothers who were treated in programs providing a "high" level of family-related or education/employment services were approximately twice as likely to reunify with their children as those who were treated in programs with "low" levels of these services.

Longitudinal analysis of repeated child abuse reporting and victimization: multistate analysis of associated factors

Most child subjects of maltreatment reports to child protective services (CPS) are involved just once, whereas other children experience repeated investigations and victimizations. This study examines individual, maltreatment, and service-related factors associated with maltreatment rereporting and substantiated rereporting in a multistate context. Case-level National Child Abuse and Neglect Data System data (505,621 children) were analyzed. Within 24 months, 22% of children were rereported, and 7% were rereported with substantiation. Younger and White and mixed race children, those with disabilities, and those whose caregivers abused alcohol were more likely to be rereported and rereported and substantiated. Service provision, including foster care placement, was associated with increased likelihood of subsequent events. When CPS agency performance is assessed using measures of reentry, separate measures may be necessary for children who receive services, so that improvements in safety can be appropriately recognized. Reentry into CPS is a complex interaction of risks to children and systemic factors tied to the intervention they receive.