Substance abuse and serious child mistreatment: Prevalence, risk, and outcome in a court sample

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Abstract

This study examined the prevalence and specific types of substance abuse in a sample of 206 cases of serious child abuse or neglect brought before a metropolitan juvenile court on care and protection petitions. In 43% of the cases, at least one of the parents had a documented problem with either alcohol or drugs, a figure which rose to 50% when alleged instances of substance abuse were included. Alcohol, cocaine, and heroin were the three most frequently mentioned abused substances. Parents with documented substance abuse were significantly more likely than nonsubstance-abusing parents to have been referred previously to child protective agencies, to be rated by court investigators as presenting high risk to their children, to reject court-ordered services, and to have their children permanently removed. When the two factors of court investigator high risk ratings and presence of parental substance abuse were combined, it was possible to obtain even higher levels of prediction of which parents would reject services and have their children permanently removed. Results suggest (1) the importance of increased screening, evaluation, and treatment of parental substance abuse in cases of serious child mistreatment; and (2) the possibility of adopting a predictive approach as to which families will be able to respond to court-ordered treatment requests and have their children returned.

Résumé

Cette étude examine la prévalence et les types spécifiques de toxicomanies dans un échantillon de 206 cas de mauvais traitements ou de négligence grave d'enfants portés devant un Tribunal de la Jeunesse métropolitain pour demande de protection et de prise en charge. Pour 43%, il existait un problème avéré d'alcool ou de drogue chez au moins un des parents, une incidence qui montait à 50% lorsqu'on incluait la suspicion d'une toxicomanie. L'alcool, la cocaine et l'héröine étaient les trois drogues les plus fréquemment citées. Les parents toxicomanes avérés avaient significativement plus de risque que les parents non toxicomanes d'avoir été signalés antérieurement aux instances de protection de la jeunesse, d'être considérés par les enquêteurs judiciaires comme à haut risque pour leurs enfants, de refuser les guidances imposées par le Tribunal et de voir leurs enfants leur être enlevés de manière permanente. Le rejet de guidance par les parents et l'éloignement permanent des enfants étaient encore plus prévisibles lorsque la toxicomanie coëxistait avec l'évaluation à haut risque par les enquêteurs judiciaires. Ces résultats suggèrent (1) l'importance d'un dépistage, d'une évaluation et d'un traitement renforcés de la toxicomanie parentale dans les cas de mauvais traitements graves aux enfants et (2) la possibilité de développer une approche prédictive permettant d'établir quelles familles se révèleront aptes à répondre aux traitements imposés par le Tribunal et à recupérer leurs enfants.

Resumen

Esta investigación examinó la prevalencia y las formas específicas de abuso del alcohol y las drogas en una muestra de 206 casos de abuso o negligencia grave al menor que fueron conducidos ante una corte juvenil metropolitana con peticiones de Cuidado y Protección. En 43% de los casos, por lo menos uno de los padres tenía un problema documentado con el alcohol ó las drogas, una cifra que subió a 50% cuando se incluyeron denuncias de abuso de sustancias. El alcohol, la cocaína y la heroína fueron las très sustancias más frecuentemente mencionadas. Los padres con abuso de sustancias documentados tenían una probabilidad significativamente mayor que los padres que no abusaban de sustancias de haber sido referidos previamente a las agencias de protección a la infancia, de ser evaluados por los investigadores del tribunal como de alto riesgo para sus hijos, de rechazar las recomendaciones de tratamiento del tribunal, y de que sus hijos fueran permanentemente alejados del hogar. Cuando se combinaban los dos factores de evaluación de los investigadores de la corte como de alto riesgo y la presencia de abuso de sustancias en los padres, fue posible obtener nivelés aún más altos de predicción acerca de cu'ales padres rechazarían las recomendaciones de tratamiento del tribunal y tendrían sus hijos removidos del hogar. Los resultados sugieren: (1) la importancia de la investigación, evaluación y tratamiento del abuso de sustancias en los casos graves de abuso al niño, y (2) la posibilidad de adoptar un enfoque predictivo acerca de cuáles familias serán capaces de adoptar las recomendaciones de tratamiento del tribunal y que les devuelvan sus hijos al hogar.

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      Worldwide, studies have suggested that parental substance abuse is a concern in approximately 11% to 40% of investigated reports of child maltreatment (Dolan, Casanueva, Smith, Lloyd, & Ringeisen 2012; Sun, Shillington, Hohman, & Jones, 2001; Testa & Smith, 2009). Among children placed in the US foster care system, estimates range from 16 to 79% (Anthony, Austin, & Cormier, 2010; Taplin & Mattick, 2015 Murphy et al., 1991; U.S. General Accounting Office, 1994), although many of these findings are decades old and relied on inconsistent measurements of parental substance abuse. Research on the effects of prenatal exposure to illicit drugs and alcohol has produced mixed results, yet has suggested that maternal substance use during pregnancy can cause direct health concerns, such as low birth weight (Anthony et al., 2010; Kelly et al., 2002; Pan & Yi, 2013; Patrick et al., 2012), preterm birth (Barth, 2001; Kelly et al., 2002; O’Donnell et al., 2009), hypoxia due to maternal malnutrition or drug-affected placental functioning (Behnke & Smith, 2013), congenital and neurological abnormalities (Behnke & Smith, 2013; Burns, Mattick, & Cooke, 2006; Pan & Yi, 2013), heart problems, and seizures resulting from neonatal abstinence or withdrawal (Burns et al., 2006; Pan & Yi, 2013).

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    This study was made possible by grants from the Massachusetts Department of Social Services and the Cabot Family Foundation.

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