We Need to Reach Addicted Parents Through the Child Welfare System
Although some substance use disorders (SUDs) can go away without therapy, getting help boosts one’s chances of abstinence and recovery significantly. Only around 10% of those who have a substance use disorder (SUD) obtain treatment each year.
The system must discover ways to take advantage of opportunities to assess for substance use disorder (SUD), and offer and facilitate treatment entry when indicated, in order to help more sober living people get into recovery, and do so more rapidly.
WHAT IS THE PROBLEM THAT THIS STUDY TRIES TO SOLVE?
Traube et al. reported the Child Protection Substance Abuse Initiative (CPSAI), a New Jersey program that targets parents involved in the Division of Child Protection and Permanence, which is part of the state’s child welfare system. In other words, these parents were referred to state services after it was established (e.g., by a professional) that their sober living child’s safety was in jeopardy due to factors such as abuse or neglect. The authors also looked into the elements that contributed to people finishing substance use disorder (SUD) therapy after it was started by this method.
HOW WAS THIS RESEARCH DONE?
This study outlined a novel program that aimed to: assess and facilitate treatment engagement for parents being evaluated by the child welfare system to document proportions of parents who received a specialized assessment, were referred to treatment and completed treatment and addiction recovery to examine sober living individual factors that predicted successful treatment completion for those who were referred to treatment to examine sober living individual factors that predicted the effective completion of treatment for individuals referred to treatment
In terms of program practicalities, the Division of Child Protection identifies clients who may have a substance use disorder (SUD) and sends them to trained drug and alcohol counselors in their office. The counselor attempts communication with the sober living client multiple times, including at least three times in 30 days (e.g., mail, phone, or hand-delivered letters).
Counselors then conduct a clinical and service needs assessment, identify state-contracted SUD treatment programs, refer clients to these programs as needed, and assist clients in entering treatment at the appropriate level of care (e.g., inpatient or outpatient).
The counselor continues to assist with case management for up to 30 days after referring the client, or until the client undergoes substance use disorder (SUD) treatment. The proportions of sober living clients who were referred to and engaged in therapy can be found in the section below under “What did this study find.” The initiative also enhanced financing for referral source SUD programs to handle the inflow of clients from the child protection system and their unique requirements (e.g., programs offered groups on parenting).
From October 2009 to September 2010, around 14,000 individuals (18 years or older) were accepted into the program. Only the most recent referral was chosen for monitoring if there were multiple referrals.
The following were the primary outcomes:
- Referral for, and receipt of, a substance abuse evaluation,
- Receiving any type of SUD treatment.
- Treatment for SUD is now complete.
Age, gender, race/ethnicity, employment, and legal status were also explored to see if any of these factors predicted treatment completion for people who were referred.
WHAT WERE THE RESULTS OF THIS RESEARCH
1,282 of the 13,829 sober living people referred to the program completed treatment for substance use disorder (SUD) (9 percent ).
The number of sober living clients who participated in each phase, as well as the percentages of those who had finished the previous step, are shown in the figure (e.g., the proportion enrolled in treatment of those who were referred by the program)
It’s worth noting that some of the clients were still in therapy when the analysis cut-off was set. As a result, the number of people who completed therapy may be larger than shown in the figure.
The researchers did not conduct any analysis to see if disparities in these steps varied significantly depending on the participants’ demographic characteristics. However, there were some potentially significant discrepancies in terms of description.
Hispanics had the lowest referral to treatment of those who were examined in terms of ethnicity (White, 63 percent; African American, 60 percent; Hispanic, 50 percent ). Hispanics had the highest completion rates among those who entered treatment, while African Americans had the lowest (Hispanic, 59 percent; White, 56 percent; African American, 48 percent ). While minority clients were significantly more likely to complete therapy after being referred, it is possible that African Americans were less capable of completing treatment once they began. This is in line with findings from large-scale substance use disorder (SUD) treatment studies conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA). These findings suggest that African Americans are more likely than other ethnic/racial groups to seek treatment for substance abuse (15 percent vs. 10 percent; see here). African American and Hispanic patients, on the other hand, may be less likely than Whites to complete substance use disorder (SUD) treatment once they begin it (see here).
In other words, while Whites are less likely to follow up on a referral to treatment, minorities, particularly African Americans, appear to be more difficult to keep in care after they are enrolled.
The actual reasons for this are unclear, and they require further examination. One theory is that minorities face more psychosocial difficulties than whites (e.g., lower-income, transportation barriers, housing instability). Recovery capital refers to the resources that can make it easier to start and maintain recovery, and which ongoing abstinence/remission can help to improve. Younger people, in comparison to older people, may have been more prone to drop out of therapy prematurely, according to other studies. This is most likely due to the prevalence of drinking and other drug use among young individuals, as well as young adults’ lower levels of motivation to begin and maintain recovery compared to older adults.
In terms of age, the youngest parents had the highest rates of treatment referrals (Younger than 20, 64 percent; 21-30, 60 percent; 31-40, 58 percent; 40 or older, 55 percent ). The youngest parents, on the other hand, were the least likely to complete treatment (Younger than 20, 44 percent; 21-30, 52 percent, 31-40, 56 percent, 40 or older, 60 percent ).
More study is needed, but this is a promising first step in demonstrating that using the child welfare system as a major referral source may help to boost treatment involvement and recovery rates.
WHY IS THIS RESEARCH SO IMPORTANT
About 12% of children under the age of 18 live with a parent who has a substance abuse problem (SUD). Misuse of drugs or alcohol is a significant risk factor for child abuse (see here).
Parents who abuse drugs or alcohol may be referred to the child welfare system if they are unable to appropriately care for or respect their children’s rights. This provides an opportunity for them to participate in treatment.
- This program evaluation study has significant shortcomings. For starters, participants were not assigned to the program at random. As a result, we can’t be positive if the program’s initiatives led to people seeking treatment.
- Second, because the study was limited to a single state, it’s uncertain whether the findings can be applied to child welfare systems in other jurisdictions.
- Third, despite the fact that an assessment was completed and therapy referrals were made if needed, there was no information on the clinical characteristics of the participants. As a result, we can’t say how serious the participants’ substance abuse was or whether they satisfied formal clinical diagnostic criteria for substance use disorder (SUD) (i.e., based on the DSM-IV-TR; Diagnostic and statistical handbook of mental illnesses). This makes it even more difficult to say whether these findings apply to other people in child welfare programs across the country.
- Fourth, it appeared that addiction recovery individuals were referred to numerous programs, but the program characteristics were not explained in-depth (e.g., level of care and services offered). Some programs may have been more effective at keeping people than others; however, this type of analysis is impossible due to a lack of data on program type.
- Finally, while it is known whether a person completed treatment, no information on actual substance use outcomes was supplied. As a result, even with this small sample of clients, the full impact of the program is unknown.
Individuals with suspected substance abuse are directed to an addiction expert counselor for a substance use disorder (SUD) assessment directly inside the Division of Child Protection under the Child Protection Substance Abuse Initiative, a pilot program in New Jersey. This research is significant because it will shed light on the potential utility of a joint program like this, and the approach might be replicated in other states.
THE NEXT STEP
- Research that randomly assigns child welfare clients to receive the comprehensive assessment and treatment linkage intervention described here or to be placed on a waitlist, then compares substance use outcomes, could assist better determine the strategy’s genuine effectiveness.
- If this unique strategy is demonstrated to be beneficial utilizing this type of study design, it will be a stronger argument to expand it to other states. As part of this more comprehensive study, it would be interesting to see if recovery coaching during treatment (rather than just connecting people to treatment) could help address any unique barriers that minorities face, thereby increasing the likelihood that they will complete treatment successfully.
- Finally, future studies might look into whether children with older children/adolescents have better psychosocial outcomes as a result of their parents obtaining substance use disorder (SUD) therapy (e.g., improved academic performance and decreased aggressive behavior).
- Individuals and families seeking recovery should consider the following resources: You might be able to get into treatment and rehabilitation through the child welfare system, but more research is needed to figure out how to increase your chances of success.
- For the benefit of scientists: The effectiveness of this intervention was difficult to assess due to various methodological flaws in this study. However, given the need for novel techniques to involve more people in therapy, this fascinating study implies that more research is needed.
- For policymakers to consider: Using the child welfare system to assist people with substance use disorders in getting help Treatment could be a cost-effective and unique strategy to address the impact of substance use disorder (SUD) on communities and families, particularly children. However, much more research is required to determine the best successful techniques for doing so.
- Professionals in the field of treatment and treatment systems should be aware of the following: Individuals may first come into contact with your treatment program/system through the child welfare system. Although further research is needed, this study describes a possible technique to help promote this therapy entrance. One interesting discovery is that African American patients are less likely to complete treatment. Peer recovery coaches, for example, could help overcome hurdles to treatment retention, although additional research is needed to confirm this theory.
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- Traube, D. E., He, A. S., Zhu, L., Scalise, C., & Richardson, T. (2015). Predictors of Substance Abuse Assessment and Treatment Completion for Parents Involved with Child Welfare: One State’s Experience in Matching across Systems. Child Welfare, 94(5), 45-66.
- Recovery Research Institute. 2017. “Using the Child Welfare System to Engage Parents with Substance Use Disorders.” Research. https://www.recoveryanswers.org/research-post/using-the-child-welfare-system-to-engage-parents-with-substance-use-disorders/.