Intersecting stigma of substance use and child welfare system involvement: Understanding stigma drivers, experiences, and outcomes from a socioecological perspective

Intergenerational Trauma: The Relationship Between Residential Schools and the Child Welfare System Among Young People Who Use Drugs in Vancouver, Canada

Characteristics and precipitating circumstances of suicide among youth involved with the U.S. child welfare system

As the opioid epidemic continues to push children into the child welfare system, child protection agencies and courts are forced to grapple with the topic of parental substance use treatment. One mechanism for improving treatment retention and effectiveness is understanding the parents’ perspectives on their own substance use, including its impact on their parenting, before and during child welfare system involvement. In-depth interviews with 17 currently or recently-involved parents in a Midwestern family treatment court, which are specialized child welfare dockets designed to address substance use, were conducted and analyzed using constant comparative coding. Seven themes reflecting parents’ views on their substance use over their life course emerged. Parents described early and easy access to substances, which normalized substance taking. Parents described non-linear trajectories over time that culminated in child welfare involvement. Parents viewed substances as both helping and hurting their ability to parent, took precautions to protect their children while also exposing their children to substance-related risks, and experienced a strong desire to stop using while simultaneously continuing to use. Parents with substance use disorders who enter the child welfare system have long histories of trauma, cyclical and worsening substance use trajectories, and easy access to substances in their immediate social surroundings. These parents also have several strengths upon which to capitalize, including efforts to protect their children from their addictions, earlier periods of sobriety, and substantial awareness of their own experiences. Working effectively with these parents requires attention to the full scope of their perspectives and experiences.

The WHO defines child maltreatment as any form of neglect, exploitation, and physical, emotional, or sexual abuse, committed against children under the age of 18. Youth involved in the child welfare system report more maltreatment experiences and environmental turbulence (e.g., number of moves, caseworkers), placing them at greater risk for poorer physical and mental health. The International Classification of Functioning, Disability, and Health (ICF) provides a framework to describe health conditions and severity of disabilities for an individual and/or group in the context of environmental factors. The Maltreatment and Adolescent Pathways (MAP) study is a longitudinal study, assessing self-reports on variables (e.g., child maltreatment history, trauma symptoms, dating violence, and substance use) of youth in an urban child protection service system. This study focuses on 11 of the 24 MAP publications that pertain to health and functioning, which can be considered applicable to the ICF framework, following established linking rules. The purpose of this study is to analyze these MAP sub-studies, with maltreatment and involvement in the child welfare system as environmental factors that impact the functioning of child welfare-involved youth. Findings indicate significant relationships across environmental factors (i.e., child maltreatment histories, child welfare system involvement), health conditions (i.e., trauma symptomatology, psychological distress, intellectual disabilities), and functioning problems (i.e., substance use, adolescent dating violence, sexual risk-taking, coping motives, sleep problems). The interrelated nature of these factors in the MAP sub-studies suggests the value of the ICF model to a holistic health view of use to practitioners supporting system-involved youth, clarifying unattended environmental factors in guiding service provision for foster care and/or maltreated youth.

Risk of Child Welfare System Involvement Among Mothers With Substance Use Disorder.

Health, social and legal outcomes of individuals with diagnosed or at risk for fetal alcohol spectrum disorder: Canadian example

Brief report: Growth in polysubstance use among youth in the child welfare system

Parental substance use is a primary driver of child welfare system involvement, and child welfare services primarily seek to address caregiver challenges, including connecting parents to treatment. Although research highlights that formal child welfare services connect children to health care professionals, less is known about how the system affects caregivers' substance use treatment. To examine the prevalence of maternal substance use disorder (SUD) in the Pennsylvania child welfare system and the association between formal child welfare system response and mothers' take-up of SUD treatment. This cohort study used linked Medicaid claims and child welfare system records for mothers enrolled in Medicaid and involved in the Pennsylvania child welfare system between 2015 and 2018, followed by 12 months postsystem contact. The study applied a difference-in-differences framework to estimate associations between child welfare system intervention and maternal SUD treatment utilization. Data were analyzed from January to September 2024. Child welfare system intervention was defined in 3 categories: no formal services, in-home services, and foster care services. Maternal SUD was defined by International Classification of Diseases, Ninth Revision or Tenth Revision diagnosis codes. Dependent variables were mothers' monthly and cumulative use of inpatient and outpatient SUD treatment, defined by procedure and service location codes. Among 46 484 mothers, the prevalence of maternal SUD was estimated at 62% within the child welfare system population, predominantly involving opioid and polysubstance use. Compared with mothers who did not receive a formal child welfare system response, those who received a formal intervention had a statistically significant higher probability of monthly outpatient (in-home services: 24%; 95% CI, 18%-28%; foster care: 63%; 95% CI, 55%-75%) and inpatient (in-home services: 36%; 95% CI, 23%-48%; foster care: 130%; 95% CI, 103%-156%) SUD treatment in the 12 months after referral. This cohort study demonstrates that formal child welfare services can facilitate substance use treatment for caregivers. As states seek to reduce the role of formal child welfare system responses in responding to parental substance use, alternative strategies to engage and retain parents in treatment are needed.

Housing circumstances of disabled parents within the child welfare system

Objective: Children in the Child Welfare System (CWS) are at high risk for multiple adverse outcomes. Since involvement in CWS and having a chronic medical condition are both risk factors for poor academic achievement, a logical view is that the combination is additive, increasing the odds of poor performance. However, several factors may complicate such an association. This study explores negative and positive factors that could affect academic achievement in children in CWS with chronic medical conditions.Method: In a secondary data analysis of a nationally representative, longitudinal sample of children in CWS (N = 5,501), subjects were divided into three groups based on chronic medical condition: High Prevalence, Low Severity (HPLS; asthma, eczema, allergy, diabetes), Other (OTH; all other chronic conditions, including those with primary central nervous system involvement), and NONE (children with no chronic condition). Using weighted analyses, hierarchical logistic regression models addressed factors associated with academic achievement. Predictor variables included chronic condition group, sex, income level, case substantiation, home placement, and school engagement. Intelligence quotient was a covariate. Outcome variables were strong performances for reading and math, defined by standard score ≥85.Results: In TOTAL group, 80% had strong reading; more in HPLS (85%) vs. NONE (79%) and OTH (80%), adjusted F = 433, p < 0.001. In TOTAL group, 67% had strong math; more in NONE (68%) and HPLS (68%) vs. OTH (60%), adjusted F = 1,278, p < 0.001. Models predicting to strong reading and math achievement were significant, R2 = 0.51, p < 0.001 and R2 = 0.43, p < 0.001, respectively. HPLS had increased odds of strong reading achievement (aOR 1.3, 95% CI 1.3–1.4); both HPLS and OTH had lower odds of strong math achievement (aOR 0.87 and 0.76), p < 0.001, respectively. Male sex had lower odds of strong reading (aOR 0.44) and math achievement (aOR 0.62); positive school engagement had higher odds of strong reading (aOR 1.18) and math achievement (aOR 2.04), all p < 0.001.Conclusion: If true, our findings challenge the general belief that chronic illness can only be associated with negative outcomes and that cumulative adversities are simply additive in terms of risk. Increased contact with the medical system may provide an opportunity for improving reading achievement for children in CWS and promoting positive school engagement.

This study examined the predictors of financial assets (e.g., savings and retirement assets) at early midlife in a sample of 1,092 individuals (93.7% Black American) who grew up in low-income neighborhoods. Data were drawn from the Chicago Longitudinal Study, which has tracked participants from early childhood to midlife and consists of participant, parent, teacher surveys, and administrative records. The main outcomes were savings in 2019 dollars (log) and savings in the top quartile of the study sample, both self-reported at age 35-37. Hierarchical linear and binary logistic regression analyses identified many significant (p < .05 or p < .01) predictors of assets, including: involvement in child welfare system by age 5 (b = -1.55), Child-Parent Center preschool participation (b = 0.77), early math achievement (b = 0.05), socio-emotional adjustment (0.18), grade retention (b = -1.14), school quality (b = 1.50), and juvenile arrest (b = -2.17). The strongest alterable predictors in the full model were involvement in child welfare system, socio-emotional adjustment, grade retention, school quality, and juvenile arrest. The full model also indicated that males had greater savings and Black participants fewer savings. Parent expectations and involvement as well as school quality also predicted top quartile savings status. Implications for future research and practice are discussed. The contribution of school experiences in early and middle childhood suggests greater investments in programs that promote socio-emotional learning and academic success.

* Abbreviation: MAT — : medication-assisted treatment The United States is experiencing unprecedented rates of drug overdose deaths and drug-related problems. This epidemic is driven primarily by opioids. Although most responses to this opioid epidemic are focused on preventing harm to adults, there are at least 5 pathways by which opioid-related problems can spill over and affect child health and safety: 1. child or adolescent poisoning and overdose: this could happen because of intentional misuse or accidental ingestion of prescription drugs by young children; 2. opioid misuse in pregnancy: opioid misuse in pregnancy is associated with inadequate prenatal care, preterm birth, low birth weight, respiratory depression, and neonatal abstinence syndrome1; 3. impaired parenting and attachment: parents’ opioid misuse may impair their ability to adequately supervise, bond with, and care for their children; 4. material deprivation: money spent on drugs may come out of family finances needed to care for children; and 5. extended separation from parents: children may be separated from a parent with an opioid-related problem because of a parent’s incarceration, residential psychiatric or drug treatment, or death or because of a child’s placement in foster care. Indeed, quantitative and qualitative studies suggest that increases in parental opioid misuse and overdose death have resulted in concomitant increases in these adverse childhood experiences and that many children are ending up in … Address correspondence to Kenneth A. Feder, Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Hampton House Room 782, 624 N. Broadway, Baltimore, MD 21205. E-mail: kfeder1{at}jhu.edu

Factors related to the disproportionate involvement of children of color in the child welfare system: a review and emerging themes

A life course perspective of victimization, child welfare involvement, cumulative stress and mental health for mothers on probation and parole.

Research ObjectiveFamily drug courts (FDCs) and other multi‐system strategies are increasingly used to address the needs of families involved in the child welfare system who are affected by substance use disorders. Ohio’s Statewide System Improvement Program (SSIP) was established to expand the scale and service scope of existing FDCs and coordinating care across court, child welfare, and behavioral health systems. This study was conducted to evaluate the impact of SSIP on family stability and recover outcomes over time.Study DesignPropensity Score Matching was applied to compare outcomes for eligible families with and without exposure to SSIP and identify characteristics of families most likely to enroll in FDC. Logistic and linear regression analyses were conducted to identify differences in temporal trends among the SSIP intervention and matched comparison groups.Population StudiedAdministrative data from state agencies and local FDCs were linked using a deterministic linkage process. Statewide Automated Child Welfare Information System (SACWIS) data were gathered to identify cases of child maltreatment[i] where substance use was a contributing factor[ii] and to assess family stability (eg, out‐of‐home placement, subsequent maltreatment, and reunification). Medicaid administrative data provided information about clinical diagnoses and treatment. Behavioral health treatment episode data provided information related to social determinants of health (eg, employment).Principal FindingsThe SSIP FDC participants demonstrated significant improvement (reduction) over time in out‐of‐home placement (2015‐2017), while there was no improvement over time in the comparison group (OR = 1.70, P &lt; .05). Counties that implemented SSIP demonstrated improvement over time (2014‐2017) relative to the comparison group in the following areas: behavioral health treatment retention (β = 0.26, P &lt; .01); medication‐assisted treatment retention (β = 0.45, P &lt; .05); length‐of‐stay in out‐of‐home placement (OR = 1.15, P &lt; .05); and placement with kin (OR = 1.22, P &lt; .01).Among 1,695 family case episodes eligible for FDC, only 15.6% were enrolled in a FDC. Standardized differences scores revealed family characteristics associated with FDC enrollment including: white race (P &lt; .001), history of child maltreatment (P &lt; .001), and parent with mental illness (P &lt; .001).ConclusionsThis finding suggests that SSIP program elements that focus on coordination of behavioral health services and judicial involvement to monitor participation may have had a significant positive impact over time, as the key elements of the model were put into practice.Implications for Policy or PracticeWhile FDCs are showing promising results in the counties where the programs are in place, more work is needed to ensure equal access to FDCs and identify effective practices to be spread. Linked administrative datasets can be used to measure the impact of child welfare interventions on individual‐ and family‐level outcomes across systems of care with minimal data collection burden. Future work could include a cost‐benefit analysis as costs were not the primary endpoints in this analysis. Child maltreatment defined by child abuse or neglect based on Ohio's Comprehensive Assessment Planning Model‐Interim Solution Policy Manual and includes admission of by the person(s) responsible; adjudication; other forms of confirmation; circumstantial or isolated indicators; or a determination by a caseworker based upon assessment/investigation. Substance use involvement identified by report of substance use on the intake record, family assessment, or placement file. Primary Funding SourceUnited States Department of Justice Office of Juvenile Justice and Delinquency Prevention and the Ohio Supreme Court.