In Utero Exposure to Opioids: An Observational Study of Mothers Involved in the Child Welfare System

Gregory Bushman, Bryan G. Victor, Joseph P. Ryan, Brian E. Perron

Background: Women are underrepresented in the current substance abuse research; however, women are a particularly vulnerable population when it comes to opioid use and abuse. Pregnant women are even more so, because of the potential that exists for in utero exposure (IUE) to substances. Objectives: To identify trends in IUE to opioids in order to ensure that resources are allocated effectively to address the current opioid epidemic and to assist the populations most affected by it. Methods: This study draws on 15 years’ worth of clinical assessment data collected from 3598 child welfare-involved mothers to assess for trends in IUE to substances over time. Data from the last 5 year period (N = 852) are then analyzed to identify recent demographic correlates associated with IUE to opioid substances. Results: A substantial increase in the rates of IUE to opioids over the past 15 years is observed among child welfare-involved mothers. Moreover, we find that race is a significant correlate of IUE to opioids. Conclusion: Study findings are consistent with other recent research that demonstrates racial differences in the populations that are most affected by the opioid epidemic; however, more research is needed to determine how these racial differences in rates of IUE to opioids affect child welfare outcomes.

Bushman, G., Ryan, J.P., Victor, B.G., & Perron, B.E. (2017). In utero exposure to opioids: An observational study of mothers involved in the child welfare system. Substance Use & Misuse, 1-8.

Disparities at Adjudication in the Juvenile Justice System: An Examination of Race, Gender, and Age

Michael Evangelist, Joseph P. Ryan, Bryan G. Victor, Andrew Moore, Brian E. Perron

Black and male youths are overrepresented at every stage of juvenile justice processing. The current study investigated racial, gender, and age disparities in the probability of a formal adjudication using administrative data (N = 12,070) from a large, urban county in the Midwest. The authors extend previous work by considering the joint effect of race, gender, and age on formal adjudications in the juvenile justice system. The findings indicate that being black, male, and in the middle of the juvenile court’s age jurisdiction were associated with an increase in the probability of receiving a formal adjudication, after controlling for prior referrals and the type and severity of the underlying offense. The magnitude of racial and gender disparities differed across age and was greatest for the least serious offenses. Through the application of graphical analyses, the authors identify youths most at risk of disparate treatment.

Evangelist, M., Ryan, J.P., Victor, B.G., Moore, A., & Perron, B.E. (2017). Disparities at adjudication in the juvenile justice system: An examination of race, gender, and age. Social Work Research, 41, 199-212.

Parental Substance Use and Foster Care Reentry

Orion Mowbray, Bryan G. Victor, Joseph P. Ryan, Andrew Moore, Brian E. Perron

Foster care involvement due to parental substance use is a common problem with many challenges associated with service delivery. Using administrative data from a Midwestern state between the years 2009 and 2015 (= 17,420), this study examines characteristics of substance-abusing families at the time of entry into the foster care system and estimates the risk of reentry subsequent to reunification. Bivariate findings and survival analysis for reentry suggests substance-using parents are more likely to be involved in additional allegations associated with foster care involvement. These results highlight the need for improved services integration and coordinated delivery among service systems.

Mowbray, O., Victor, B.G., Ryan, J.P.,  Moore, A., & Perron, B.E. (2017). Parental substance use and foster care reentry. Journal of Social Work Practice in the Addictions, 352-373.

Timing Matters: A Randomized Control Trial of Recovery Coaches in Foster Care

Joseph P. Ryan, Brian E. Perron, Andrew Moore, Bryan G. Victor, Keunhye Park

Substance use disorders are a major problem for child welfare systems. The abuse of and dependence on alcohol and drugs by parents increases the risk of child maltreatment and interferes with efforts to locate a permanent home for children in foster care. The current study focuses on an intervention designed to increase the probability of reunification for foster children associated with substance using families. We focus specific attention on the timing of the intervention, in particular the timing of comprehensive screening and access to substance abuse services in relation to the temporary custody hearing. A diverse group of children (n = 3440) that were placed in foster care and associated with a parent diagnosed with a substance use disorder were randomly assigned to either a control (services as usual) or experimental group (services as usual plus a recovery coach for parents). Binomial logistic regression models indicated that early access to substance use services matters (within two months of the temporary custody hearing) but only when parents were connected with a recovery coach. Additional findings indicated that the recovery coach model eliminated racial disparities in reunification. The implications of these findings are discussed.

Ryan, J.P., Perron, B.E., Moore, A., Victor, B.G., & Park, K. (2017). Timing matters: A randomized control trial of recovery coaches in foster care. Journal of Substance Abuse Treatment, 77, 178-184.

Longitudinal Trends in Substance Use and Mental Health Service Needs in Child Welfare

Orion Mowbray, Joseph P. Ryan, Bryan G. Victor, Gregory Bushman, Clayton Yochum, Brian E. Perron

Caregiver substance use and mental health problems have long been discussed as concerns in promoting positive child welfare outcomes. Yet the absence of longitudinal data focused on racial/ethnic differences in service needs and substance use has limited child welfare systems in their ability to address potential disparities. This study examines racial/ethnic trends in service needs and patterns of substances used among child welfare-involved caregivers over a 15-year period (2000–2015) from a large, urban county located in the Midwestern United States. Substance use service needs showed an increase over time among White non-Hispanic individuals, and declined over time for all racial/ethnic minority groups. Mental health service needs increased over time, with White non-Hispanic individuals experiencing the largest increase. Co-occurring service needs showed a moderate increase for all groups. Trends associated with service needs across the lifespan were relatively similar across racial and ethnic groups, with needs peaking between ages 30 and 35. When examining specific substances used, cocaine use decreased over time for all individuals. However, marijuana use increased substantially for Black/African American individuals, while opioid use increased substantially for White non-Hispanic individuals. These results highlight key areas where trends among child welfare-involved caregivers differ from population-based trends and suggest that improved coordination between child welfare agencies, mental health and substance use treatment providers may be a key step in reducing the disparities observed.

Mowbray, O., Ryan, J.P., Victor, B.G., Bushman, G., Yochum, C., & Perron, B.E. (2017). Longitudinal trends in substance use and mental health service needs in child welfareChildren and Youth Services Review, 73, 1-8.

Recovery Coaches and the Stability of Reunification for Substance Abusing Families in Child Welfare

Joseph P. Ryan, Bryan G. Victor, Andrew Moore, Orion Mowbray, Brian E. Perron

Substance abuse is a long-standing challenge for child welfare systems. Parental substance abuse disrupts family stability, family cohesion, and jeopardizes the well-being of children. In the current study we test an intervention to improve child welfare outcomes for substance abusing families, specifically the probability of families achieving a stable (at least 12 months) reunification. The intervention was an integrated case management model where recovery coaches were appointed to substance abusing parents associated with an open foster care placement. A diverse group of families (n = 1623) were randomly assigned to either a control group (services as usual) or an experimental group (services as usual plus a recovery coach). Multinomial logistic regression indicated that substance abusing parents associated with a recovery coach were significantly more likely to achieve a stable reunification as compared with similar families in the control group.

Ryan, J.P., Victor, B.G., Moore, A., Mowbray, O., & Perron, B.E. (2016). Recovery coaches and the stability of reunification for substance abusing families in child welfare. Children and Youth Services Review, 70, 357-363.

Foster Home Licensing and Risk of Reentry to Out-of-home Care Following Family Reunification

Bryan G. Victor, Joseph P. Ryan, Andrew Moore, Orion Mowbray, Michael Evangelist, Brian E. Perron

Family reunification without subsequent reentry is the primary permanency goal for children placed in foster care. While a number of placement-level factors have been examined for their effect on subsequent reentry to care, no study to date has considered foster care licensing. The current study uses statewide administrative data to construct a cohort of foster care youth who entered care between 2009 and 2012 and were reunified by the start of 2013 (N = 7752) to investigate the association between types of foster care and the probability of reentry to foster care up to two years following reunification. We focus specifically on the licensing status of foster homes, and employ propensity score analysis to address selection bias in placement type. A propensity-weighted cox proportional hazard model revealed that youth placed in licensed relative care (LRC) homes and licensed non-relative care (LNC) homes were more likely to reenter foster care than those youth placed in unlicensed relative care (URC) homes during their first spell of foster care.

Victor, B.G., Ryan, J.P., Moore, A., Mowbray, O., Evangelist, M., & Perron, B.E. (2016). Foster home licensing and risk of reentry to out-of-home care following family reunification. Children and Youth Services Review, 70, 112-119.

Foster Home Placements and the Probability of Family Reunification: Does Licensing Matter?

Joseph P. Ryan, Brian E. Perron, Andrew Moore, Bryan Victor, Michael Evangelist

The concept of foster care has been widely studied in child welfare. The literature is well developed with regard to the risk of initial placement, length of stay in care, placement stability, exits to permanency, and emancipation. Yet, the literature is woefully underdeveloped when it comes to understanding if variations in the types and characteristics of foster homes impact important child welfare outcomes. The current study utilizes entry cohorts pulled from statewide administrative data (N = 17,960) to investigate the association between types of foster care and the probability of reunification. We focus specifically on the licensing status of foster homes. Reflecting federal benchmarks, we examined the odds of reunification at one- and two-year intervals. Propensity score analysis was used to reduce selection bias. Adjusted logistic regression models revealed that youth placed in licensed relative care (LRC) homes were the least likely to achieve reunification compared with youth placed in licensed non-relative care (LNC) homes and unlicensed relative care (URC) homes. Conversely, youth placed in URC homes were more likely to achieve reunification as compared with youth placed in LRC and LNC homes. These findings will help states to efficiently target scarce resources to specific types of foster homes that may be impacting federal reunification benchmarks.

Ryan, J.P., Perron, B.E., Moore, A., Victor, B.G., & Evangelist, M. (2016). Foster home placements and the probability of family reunification: Does licensing matter? Child Abuse & Neglect, 59, 88-89.