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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?. Previous Research: Community and Child Maltreatment Studies . Community bas
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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