Prevention of Ongoing Child Welfare Involvement: Addressing Comorbid Needs of Mothers with Substance Use

Families of children involved in the child welfare system (CWS) with complications of maternal substance use disorders (SUD) are at increased risk for family disruption and short- and long-term parent and child deleterious outcomes, including repeated involvement in the CWS. Only 10-22% of mothers involved in the CWS complete SUD treatment, compared to 46-62% of women in need of treatment from the general population. CWS involved families also are referred to a number of services in order to complete their child welfare treatment plan including parenting classes and additional ancillary services (e.g., housing, employment, anger management). Competing service provider schedules and low resources have been shown to contribute to low treatment completion for this population.

Drawing on evidence-based behavioral strategies to address substance use and parenting needs, antisocial and other mental health disorders, an intensive community-based integrated treatment was developed (i.e., the FAIR program). Mothers involved with child welfare for hard substance use (94% methamphetamine; 6% opiates; 45% IV users; 7% HIV positive) and child neglect were referred. Treatment sessions involved frequent urinalysis (UAs), an individually tailored reinforcement system, parent training, 24/7 support, assistance with key ancillary needs (mental health, housing, employment, education, finding primary care), and an integrated framework of the interplay between substance use and parenting. Additional supports were integrated including skills coaching for older children of the mothers, couples treatment, and a Resource Builder who provided information related to ancillary needs and building a “store” of tangible incentives.

Outcomes from a small feasibility pilot (N = 31; 13 TAU; 18 FAIR) are promising. At baseline, 24 of the mothers (77%) reported their children currently were removed from the home and most reported having more than one child. The majority of mothers randomized to FAIR engaged in (94%; n =17) and completed treatment (87%; n =16). They showed significant reductions in substance use and cravings, and in psychosocial correlates (e.g., depression and trauma symptoms). FAIR mothers showed significant changes in parenting including parental stress, child abuse potential, parenting efficacy, and stability (housing, employment). In addition, significant positive relationships between indicators of substance use and parenting and mental health symptoms indicated that as substance use decreased, so did problematic symptoms.

Outcomes will be discussed in relation to what intervention components were provided to successfully engage mothers and lessons learned for future larger research trials of FAIR and other programs in the CWS.