Few studies directly compare child welfare clients with substance abuse problems to other child welfare clients. Analyses of the Children's Bureau's National Study of Protective, Preventive and Reunification Services conducted expressly for this report found significant differences between child welfare clients with substance abuse problems and other clients of the child welfare system. This study was based on a national sample of children with open child welfare cases in 1994 (for the report's previously published findings and a full description of the study's methodology, see HHS/CB, 1997). The 26 percent of families with identified substance abuse problems were significantly more troubled than other families in the child welfare system as measured by the frequency with which substance abuse problems were seen in tandem with a variety of other family problems. As shown in Figure 4-11, alcohol was the primary drug abused by 25 percent of substance abusing families in the child welfare system, illicit drugs were the problem for 40 percent, and in 35 percent both alcohol and drugs were abused.
Children from substance abusing households were much more likely than others to be served in foster care rather than in the home (54 percent in foster care versus 23 percent of children in non-substance abuse cases), spent longer periods of time in foster care than other children (median 11 months versus 5 months for others in foster care) and were less likely to have left foster care within a year than other children (55 percent versus 70 percent). Families with substance abuse problems were equally likely to be white or African American (47 percent), while only 6 percent were Hispanic.
Children in foster care from families with substance abuse problems were more likely than others to have a case plan of adoption (9 percent versus 3 percent) and were less likely to have a case plan of emancipation or independent living (3 percent versus 11 percent), both likely linked in part to having entered care at younger ages and being younger at the time of the study (i.e. a two-year-old is more likely than a 16-year-old to have an adoption case plan, while a 16-year old is more likely to have a plan of emancipation). Substance abusing families and others were equally likely to have a case plan goal of reunification (54 percent versus 56 percent). Children from substance abusing families were an average of 5 years old at the time of case opening, versus average age 7 for other children.
The services most commonly offered to substance abusing parents were employment training (82 percent), substance abuse treatment (70 percent), parenting training (59 percent), psychological assessment (22 percent) or household management services (22 percent). As shown in Figure 4-12, far fewer actually received the offered services -- in the case of substance abuse treatment approximately half of families with identified substance abuse problems received any substance abuse treatment services. In 23 percent of cases, substance abuse treatment services were offered but not provided, and services were not offered to another 23 percent of cases.
"Offered" services might not be delivered for a variety of reasons including clients' refusal, mismatches between available services and client needs, or ineffective referral processes. Although many of these women have multiple drug-exposed children, only 8 percent were offered family planning services. Chapter 7 includes additional information on the substance abuse treatment status of parents.
Substance abusing families were more likely than others to have had multiple caseworkers while involved with the child welfare system. Only 35 percent of families with substance abuse problems had a single caseworker, versus 59 percent of other families, and 41 percent had three or more caseworkers (versus 21 percent). This is likely due in part to the fact that cases involving substance abuse were open for longer periods of time, making multiple caseworkers more likely.
Another study, this one focusing on African American children in foster care, also found that families with substance abuse problems had more problems overall than other families, were more likely than other families to be neglectful rather than abusive, and children from these families entered care younger and stayed in care longer than other children in foster care (Walker et al, 1991; Walker et al, 1994). Researchers looking at children reported to child protective services in one California county found that 35 percent of such children were not removed from the home; 29 percent were removed from the home on an emergency basis but were returned to the parent's custody within a few days; 12 percent were removed but returned home within 18 months; and 24 percent were removed and were not expected to return home (Sagatun-Edwards et al, 1995). Ellwood and colleagues (1993) found that 25 percent of drug-exposed infants born to women on Medicaid spent most of their first two years of life in foster care, while the remainder continued in their families' care.