1. Substance Abuse and Child Welfare Services: Research Update and Needs Presented at the National Center on Substance Abuse and Child Welfare Researcher’s Forum December 10, 2003, Washington, DC The research for this presentation was funded by the Administration on Children, Youth, and Families of the U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation (RWJF).. Points of view or opinions in this presentation and accompanying documents are those of the presenter and do not necessarily represent the official position or policies of the U.S. DHHS or the RWJF. Results are preliminary. Contact information: rbarth@unc.edu Richard P. Barth School of Social Work, University of North Carolina

3. Study Measures Risk Assessment at Baseline – Asks whether the caregiver was “actively abusing alcohol at the time of the investigation” or was “actively abusing drugs at the time of the investigation” Composite International Diagnostic Interview Short Form (CIDI-SF) – Alcohol Dependence in last 12 months – Drug Dependence in last 12 months – Screening questions Services questions at 12 and 18 month follow-up

4. Caregiver Report of Alcohol and Drug Use and Dependence CIDI-SF% Alcohol Screen7.3 Drug Screen18.3 Alcohol or Drug Screen23.9 Alcohol Dependence2.2 Drug Dependence2.8 Alcohol or Drug Dependence 3.9

5. CWW Report of Alcohol and Drug Problems Primary Caregiver% Alcohol Abuse8.2 Drug Abuse9.2 Alcohol or Drug Abuse13.8 Secondary Caregiver Alcohol Abuse11.9 Drug Abuse8.9 Alcohol or Drug Abuse16.6

6. CWW Report by Child Setting TotalIn-home no CWS In-home CWS Out-of- home Alcohol abuse** 8.23.312.628.7 Drug abuse** 9.23.512.137.4 Alcohol or drug abuse** 13.86.020.346.1 ** p <.001

7. Findings The prevalence of AOD problems among in-home caregivers is much lower than previously reported (although no known studies of AOD problems among only in- home caregivers) Prevalence of AOD problems among out- of-home caregivers is lower than many previous reports

8. Agreement between Caregiver and CWW report (%) Sensitivity ^Specificity ^^ Alcohol dependence29.494.8 Drug dependence27.494.8 Alcohol or drug dependence41.597.5 Alcohol screen14.195.5 Drug screen13.096.5 Alcohol or drug screen18.594.2 ^ Sensitivity is correct classification of dependence ^^ Specificity is correct classification of non dependence

9. Agreement between Caregiver and CWW report SensitivitySpecificity In-home, no services In-home, services In-home, no services In-home, services Alcohol dependence 22.246.797.188.4 Drug dependence 16.552.196.889.2 Alcohol or drug dependence 30.764.494.882.0

10. Agreement between Caregiver and CWW Report SensitivitySpecificity In-home, no services In-home, services In-home, no services In-home, services Alcohol screen 10.625.297.889.4 Drug screen 8.123.197.892.6 Alcohol or drug screen 12.632.596.687.1

11. CWW Identification of Substance Abuse Of the caregivers who are alcohol dependent, 71% are classified by the CWW as not having an alcohol problem Of the caregivers who are drug dependent, 73% are classified by the CWW as not having a drug problem Of the caregivers who met alcohol screen, 86% are classified by the CWW as not having an alcohol problem Of the caregivers who met drug screen, 87% are classified by the CWW as not having a drug problem

12. Findings CWW’s misclassify caregivers who are AOD dependent the majority of the time CWW’s are even more likely to miss potential AOD problems among caregivers who use substances, but are not dependent CWW’s are about twice as likely to identify an AOD problem when a case is opened

13. Caregiver Characteristics and Alcohol or Drug Use (%) AOD Dependent AOD ScreenNeither Caregiver Race Black332225 White515451 Hispanic71618 Other987 Caregiver age (years) 3132 Child age (years) 677

14. Caregiver Demographics AOD DependentAOD ScreenNeither Married (%)182831 Prior report (%)455148 Prior CWS (%)282628 Poverty (mean)*.99*1.3 Caregiver education (%) None.5.01.2 H.S. diploma807774 Assoc. degree202325 BA/ RN/MA+-- Other-- * p <.05

15. AOD Dependence and Risk Factors AOD DependentAOD ScreenNeither Active D.Violence*51312 Recent arrest*19158 High stress in family605148 Another supportive caregiver present** 354150 Low social support322927 Trouble paying for basic necessities 302320 CG history of CAN172119 * p <.05; ** p <.01

16. Relationship Between Alcohol/Drug Problems and Child Behavior AOD DependentAOD ScreenNeither Total CBCL a,b 63.658.4**56.6** Externalizing a,b 62.958.9*56.6** Internalizing b,c 58.355.1*53.3** Total TRF56.555.655.5 Externalizing59.358.457.0 Internalizing54.954.154.4 a= Dependent higher than neither; b= dependent is higher than screen; and c=screen is higher than neither. * p <.05; ** p <.01

17. Relationship Between Alcohol/drug Problems and Child Well-being AOD DependentAOD ScreenNeither BDI43.440.541.2 Vineland 0-295.598.496.4 3-584.092.4*87.4 6-1095.799.599.1 PLS-391.190.587.5 SSRS (11+)86.490.592.5 * p <.05

18. Findings Differences in demographic characteristics between dependent, screened, and no AOD  Poverty (higher)  Recent Arrest (more often)  Another supportive caregiver present (less) Differences in child well-beingscores:  Problem Behavior (more)  Developmental scores (no differences)

19. Maltreatment Type and Substance Abuse Physical Abuse Sexual Abuse Failure to Supervise Failure to provide Alcohol dependence- CIDI -.01 -.04 <.05.00.04 <.05 Drug dependence- CIDI -.05.02.07 <.0001 -.005 CWW indicates need for alcohol services -.09 <.0001.01.031.07 <.001 CWW indicates need for drug services -.19 <.0001 -.06 <.01.08 <.0001.15 <.0001 Risk assessment indicates alcohol abuse -.11 <.0001 -.04 <.01.01.12 <.0001 Risk assessment indicates drug abuse -.11 <.0001 -.05 <.001.05 <.001.12 <.0001

20. AOD Service Receipt at Baseline No CWSCWS Alcohol or drug dependent 11**40 Alcohol or drug screen 2**6 Alcohol dependent4*40 Alcohol screen--4 Drug dependent15*46 Drug screen2*7 * p <.05; ** p <.01

21. AOD Service Receipt for Dependent Caregivers at Baseline Alcohol and drug use was most clearly associated with failure to provide and least associated with physical abuse Overall, 80% of caregivers self-reported to be dependent on alcohol or drugs did not receive services Overall, 85% of caregivers identified by the CWW as having an alcohol or drug problem did not receive services

22. AOD Service Referral and Receipt at 12 Months Referred (%)Received services (%) Alcohol or drug dependent2716 Alcohol or drug screen28<1 Alcohol dependent--9 Alcohol screen12<1 Drug dependent3024 Drug screen32<1

23. Findings Caregivers with AOD problems are much more likely to receive AOD services at baseline if their case is open The majority of caregivers who have an AOD problem and did not receive services at baseline are not referred in the next 12 months Very few caregivers who did not receive services at baseline receive AOD services in the next 12 months

24. Limitations CIDI-SF likely misses some cases of dependency Risk assessment may miss some cases of AOD problems that the CWW identified We do not know whether the CWW inquired about AOD problems at intake No measure of abuse Small cell sizes among 12-month follow-up questions

25. Implications Confirms that substance abuse is a significant issue among the child welfare population Confirms that a consistent response to substance abuse is not in operation as part of CWS CWW’s need training regarding substance abuse detection Risk assessment should routinely include structured, brief substance abuse assessments

26. Future Research Detailed examination of which caregivers received services over 18 months Determine whether AOD services affect likelihood of re-reports Multivariate analyses of contribution of case characteristics, AOD services, and CWS to parent and child functioning

27. Epidemiology of CWS and SA Which CWS-involved families are also substance involved? – Ages of children – Race of caregivers – Urbanicity

28. CWS and SAT Processes CWS and SAT and processes: – What contributes to timely entry into SAT for CWS involved caregivers – What contributes to completion of SAT for CWS involved caregivers Is entry into and completion of SAT related to mandated CWS services – Is completion of SAT associated with CWS case status (i.e., placement, reunification, TPRR)

29. Child welfare and substance abuse services and processes: – What contributes to safety outcomes for children of substance-involved (SI) caregivers

30. Child welfare and substance abuse services and processes: – What contributes to safety outcomes for children of substance-involved (SI) caregivers

31. Child welfare and substance abuse services and processes: – What contributes to safety outcomes for children of substance-involved (SI) caregivers