Mothers of children in out-of-home care: Drug treatment services can increase reunification rates
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Mothers of children in out-of-home care: Drug treatment services can increase reunification rates
听
Source:听Grella, C.E., Needell, B., Shi, Y., & Hser, Y.I. (2009). Do drug treatment services predict reunification outcomes of mothers and their children in child welfare? Journal of Substance Abuse Treatment, 36(3), 278-293.
Reviewed by:听 Sydney Duder
Parental substance abuse has been associated with high rates of
child maltreatment, and therefore a high likelihood of placement in
out-of-home care. This study of the effect of mothers鈥�
participation in substance abuse treatment on reunification with
their children was part of the California Treatment Outcome Project
(CalTOP). Data were provided by 13 counties that volunteered for
the project (out of 58 within the state).
The study sample consisted of 1,115 mothers in 43 CalTOP programs;
all had at least one child younger than 18 placed in out-of-home
care prior to her admission into substance abuse treatment.
Reunification was the binary outcome variable; a large number of
possible predictors, previously identified in the literature, were
used in the analysis:
- Mother鈥檚 demographics and scores on the Addiction Severity Index (ASI-Lite, administered at admission);
- Mother鈥檚 referral source and treatment modality (from CalTOP records);
- Type and number of services received by mothers (from a survey of program administrators);
- Child demographics and placement history (from Child Welfare Service records).
A correlational design was used; the elaborate data analysis
involved hierarchical linear modeling. Three models were tested,
all included the same mother, child and basic drug treatment
variables, but different sets of service variables: 1)
education/employment, 2) family/children, and 3) psychiatric/mental
health.
A number of mother and child variables were found to be
significant. For example, reunification was less likely for mothers
with more employment and psychiatric problems, more likely for
older children. Neither mother nor child ethnicity was a
significant predictor. More importantly, there were significant
treatment effects: completion of 90 or more days in treatment
approximately doubled the chance of reunification. Programs with a
鈥渉igh鈥� level of family-related or education/employment services
were approximately twice as likely to lead to reunification as
鈥渓ow鈥� level programs. No significant effects were found for
psychiatric/mental health services. The authors point out the range
of treatment needs for these mothers to help them achieve economic
stability and improve parenting skills; they argue that substance
abuse treatment can be a useful way to address these needs.
Methodological Notes:
Strengths of this study were the large sample, data integrated from multiple sources, extensive list of control variables, and well-planned statistical design. Also worth noting was the linking of mothers鈥� CalTOP data with their children鈥檚 child welfare records; this was accomplished by a multivariate matching procedure called probabilistic record linkage. An important finding was the effectiveness of programs that provided a range of comprehensive services (i.e., 鈥渨raparound services鈥�) in addition to the core elements of drug treatment. However, there were methodological weaknesses. The data about services offered in the various treatment programs was based on the self-report of programs administrators; it isn鈥檛 clear to what extent participants actually received the services listed. Also, in spite of the careful statistical controls, selection effects are always possible in a correlational design like this; an experimental design would have been much stronger.
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