What if those parents, however, had extra help from a "recovery coach," someone whose primary job was to prod and encourage them to get and complete treatment for substance abuse?
A five-year study by the University of Illinois at Urbana-Champaign, involving 1,300 parents of 1,900 children in foster care in Cook County, found that having such a coach does make a difference for a small but significant number of families.
The parents in the study who were assigned coaches "got into treatment more quickly, completed treatment at a higher rate, were more likely to get their children back, and were less likely to have a subsequent allegation of maltreatment," according to Joseph Ryan, the study's principal investigator.
Because fewer children spent less time in foster care, Ryan said, the intervention also saved the Illinois Department of Children and Family Services about $5.6 million over the five years of the study, conducted between April 2000 and June 2005.
Ryan is a professor in the Children and Family Research Center, part of the university's School of Social Work. He present his findings March 10 at the University of Chicago at a working symposium titled "Accepting the Challenge of Substance Use in Family Reunification," funded by DCFS and attended by its director, Bryan Samuels.
The findings also are part of a report prepared for DCFS, which supported the study and shared needed data as part of a decade-long agreement with the Children and Family Research Center. The study was done in connection with a federal waiver giving the state temporary authority to redirect child-welfare funds.
Almost no experimental studies have been conducted to test interventions for substance-abusing families in the child-welfare system, and the waiver made this one possible, Ryan said. Families for the study were drawn from foster-care cases opened in Chicago and suburban Cook County during the study period, by way of assessments conducted by the Juvenile Court Assessment Program.
One-third of the parents in the study were randomly assigned to a control group, which had access to substance-abuse treatment but did not have recovery coaches. Within that group, 11.6 percent were reunited with their children before the end of the study. The other two-thirds were assigned to the demonstration group; each had the services of a coach. Within that group, 15.5 percent were reunited.
The improvement is significant in research terms, in savings and for the families involved, especially since families with serious drug problems are "a really difficult population to work with," Ryan said. "The idea is to sort of chip away at solving the problem of substance abuse in child welfare. No single intervention is going to do it."
Of the mothers in the study, 64 percent had had at least one prior substance-exposed infant, meaning medical tests on the child showed evidence of substance abuse during pregnancy. Forty-two percent had had more than one.
The task is made more difficult because, for most of these parents, substance abuse is only one of the problems creating a barrier to safe reunification, Ryan said. Sixty-two percent of the families in the study were dealing with at least three major problems simultaneously, according to the records of their child-welfare caseworkers. The most common were domestic violence (30 percent), mental health (40 percent) and problems related to housing (56 percent).
The study found that the existence of those co-occurring problems, along with a lack of progress within those problem areas, appear to be the two factors limiting or obstructing the reunification process, Ryan said.
Parents who completed treatment for substance abuse, but did not make progress in other problem areas, improved their chances for reunification, but only slightly. "The ones who have multiple problems and are only making progress in substance abuse have a very low likelihood of getting their children back," Ryan said.
The rate of reunification was much higher for those who not only completed treatment, but also made progress in other areas.
Overall, 28 percent of those in the demonstration group, the group that had coaches, completed treatment for substance abuse. Those who completed treatment were significantly more likely than those who did not to achieve reunification: 28 percent versus 8 percent. The women who completed treatment were significantly less likely to then give birth to a substance-exposed child: 7.9 percent versus 18.8 percent.
What Ryan sees in the study is evidence that targeted help with other problems besides substance abuse could build upon the success found with recovery coaches. "A unique contribution of this study is that we've identified that these problems are impacting the likelihood of reunification," he said.
The prospect, which he hopes to test in any extension of this study, is that more children could eventually be reunified safely with their families, a primary goal of the child-welfare system.
Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
Published on PsychCentral.com. All rights reserved.