Substance Abuse among Caregivers Involved with Child Welfare Services: Prevalence and Identification by Child Welfare Wo

2. Significance How much does substance abuse influence involvement in Child Welfare Services (CWS)? How informed is the identification and response to substance abuse by child welfare workers? How equitable is the response?

3. Previous Research: Community and Child Maltreatment Studies Community based samples Epidemiological Catchment Area Study (1996) Substance abuse treatment samples Black and Mayer (1980) Child maltreatment samples Pierce and Pierce (1985) CWLA (1992) Study of Child Maltreatment in Alcohol Abusing Families (1993)

4. Previous Research Child Welfare Research Children at risk of being placed in foster care Caregivers of children in foster care Children in dependency caseloads Primarily urban samples Other Human Services Research Substance abuse among TANF recipients Murphy and colleagues (1991) Famularo and colleagues (1986, 1992) Murphy and colleagues (1991) Famularo and colleagues (1986, 1992)Murphy and colleagues (1991) Famularo and colleagues (1986, 1992) Murphy and colleagues (1991) Famularo and colleagues (1986, 1992)

5. Limitations of Previous Research Lack standardized measures of substance abuse Limited generalizability Sample size Urban Prevalence among in-home caregivers Agreement between caregiver and CWW report

6. Study Questions: Prevalence Among in-home caregivers, what is the prevalence of substance abuse according to the: Caregiver? Child Welfare Worker? Both the caregiver and child welfare worker?

7. Study Questions: Agreement What is the agreement between caregiver self-report and child welfare worker report of substance abuse? What is the average caregiver self-report score according to the child welfare worker report?

8. National Survey of Child and Adolescent Well-Being (NSCAW) Funded by PRWORA 1996 Longitudinal Nationally representative sample of 5,504 children Subjects of investigation for child abuse or neglect by CPS between October 1999 and December 2000 Wave 4 is 36 month follow-up. Wave 4 is 36 month follow-up.

10. Substance Abuse Measures: Risk Assessment Child welfare worker report Asks whether the caregiver was: �actively abusing alcohol at the time of the investigation� �actively abusing drugs at the time of the investigation�

11. Composite International Diagnostic Interview Short Form (CIDI-SF) Caregiver self-report (ACASI) Alcohol dependence in last 12 months Drug dependence in last 12 months

12. DSM-IV Criteria for Dependence Tolerance Withdrawal Taking substance in larger amounts or for longer period than intended Unsuccessful attempts to decrease or cease use Time Giving up other activities Continuing to use even after recognizing problem

13. Scoring the CIDI-SF Screen Alcohol: 4 or more drinks in a day in past 12 months Drugs: Use of any illegal drug or inappropriate use of prescription drug Dichotomous Sum the seven questions 3 or higher is considered dependent Continuous Average the seven questions

14. Descriptive Statistics of Sample: Child Characteristics

15. Descriptive Statistics: Child

16. Descriptive Statistics: Caregiver

17. Prevalence of substance abuse among in-home caregivers

18. Prevalence of CG reported substance abuse, open vs. closed cases No significant differences in CG report of dependence by open/closed case status.No significant differences in CG report of dependence by open/closed case status.

19. Prevalence of CWW reported substance abuse, open vs. closed cases **p<.0001**p<.0001

20. Findings Prevalence of substance abuse problems among in-home caregivers is much lower than previously reported Open cases are much more likely to have CWW-reported substance abuse problems than closed cases

21. Agreement between Caregiver and CWW report (Kappa statistic)

22. CWW identification of self-reported substance �abuse�

23. CWW Recognition of Alcohol or Drug �Abuse� CIDI +

24. CWW identification of self-reported substance dependence

25. CWW Recognition of Alcohol or Drug Dependency

26. Service Receipt Among Closed Cases with Substance Dependency

27. Average CIDI-SF Score by Risk Assessment Status

28. Findings Overall, 40% of cases of alcohol or drug dependency were identified by CWW CWWs missed 47,055 cases of alcohol/drug dependent in-home caregivers, 37,322 of those were closed Alcohol or drug dependence is more likely to be identified among open cases (or, dependent CGs are more likely to have cases opened?)

29. Limitations Risk assessment Broadly defines substance abuse Not all risk assessment tools include substance abuse Not a perfect measure of CWW knowledge CIDI-SF Measures dependence (very strict criteria) Self-report Kappa is an unweighted measure

30. Implications Substance abuse is a significant issue CWW�s need better training Risk assessment should include structured, brief substance abuse assessments

31. Ongoing Research Who has substance abuse problems? Who receives substance abuse treatment? What is the effect of substance abuse treatment receipt on re-reports? What is the effect of substance abuse AND child welfare services on parent and child functioning?

33. CWW report by in-home vs. out-of-home