Academic journal article Child Welfare

Co-Occurrence of Parental Substance Abuse and Child Serious Emotional Disturbance: Understanding Multiple Pathways to Improve Child and Family Outcomes

Academic journal article Child Welfare

Co-Occurrence of Parental Substance Abuse and Child Serious Emotional Disturbance: Understanding Multiple Pathways to Improve Child and Family Outcomes

Article excerpt

Families who become involved with the child welfare system because of child maltreatment face multiple and complex needs that must be addressed prior to successful reunification. Children who experience maltreatment frequently enter the child welfare system with distinct issues, including serious emotional disturbance (SED). SED is defined by federal regulations as a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified in the Diagnostic Statistical Manual that results in functional impairment that substantially interferes with family, school, or community activities. An early study found that 72% of children with open child protective service cases were "statistically indistinguishable" from children in intensive mental health treatment programs (Trupin, Tarico, Low, Jemelka, & McClellan, 1993, p. 345), suggesting that the occurrence of child mental health issues, including SED, is widespread among families involved with child welfare.

Because children with an SED exhibit challenging behaviors, literature suggests that effectively parenting children with an SED requires increased parenting skills, capacities, and resources, which may be beyond the capabilities of parents who are high functioning (Pickrel, 2002). Unfortunately, nearly all families under child protection surveillance comprise caregivers with complex service needs themselves, including a sizable proportion with untreated substance abuse. Studies have estimated that up to 80% of families with a child in foster care have a parent with substance abuse as well (Testa & Smith, 2009). Importantly, great variety exists in the definition of substance abuse across studies. The vast majority of studies rely on child welfare administrative records and caseworker assessment rather than relying on a clinical assessment or diagnosis of substance use disorder. As described below, this study designated foster care cases as substance abuse-affected based on child welfare workers' assessments and child protection services' investigation results.

Despite knowledge that children's SED (e.g., Akin, 2011) and parental substance abuse (e.g., Brook, McDonald, Gregoire, Press, & Hindman, 2010) represent stand-alone, well-established barriers to permanency, little has been written about the co-occurrence of child SED and parental substance abuse among families involved with child welfare or these families' service needs upon their child entering foster care. This study presents findings from a sub-study within a federal demonstration project aimed at improving permanency outcomes for families that encounter the most significant barriers to permanency. Our aim was to begin uncovering knowledge about the role, scope, and influence of parental substance abuse among the foster care population of children with an SED. More knowledge is needed regarding the overlap and interplay between these two risk factors and their collective impact on the achievement of positive outcomes for these highly vulnerable subpopulations within the larger child welfare system.

Children's Mental Health

Children's mental health issues place families at risk for involvement with the child welfare system, and once in the system, children's mental health issues can be a barrier to stability and permanency. Up to 80% of children in foster care have significant mental health challenges, most commonly externalizing disorders (Kerker & Dore, 2006). The etiologies of these mental health problems include the experience of maltreatment and trauma associated with removal from the home (Kerker & Dore, 2006). Other risk factors for SED include child, parent, and family-level variables, such as children with poor physical health, parental substance abuse, and poverty (Kerker & Dore, 2006).

The impact of SED on children's experiences in the child welfare system is profound. Children in care with an SED have less stable placements (e. …

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