Parental substance use and foster care entrance : trends, geographic variation, and predictors of reunification




Stritzel, Haley

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Parental substance use is a major risk factor for a child’s entrance into foster care and, in the context of the opioid epidemic, has contributed to an increasing proportion of foster care entrances. However, parental substance use exists on a spectrum of severity and risk to a child’s safety and well-being. Whether or not a child with substance-using parent(s) is removed to foster care and returns to their parents’ home following foster care depends on the extent to which professionals, caseworkers, judges, and other authorities perceive parental substance use as maltreatment and whether it can be reconciled with a child’s safety and wellbeing. Decision-making in the child welfare system largely depends on the personal judgments of caseworkers, judges, and other child welfare workers, which are in turn influenced by external factors varying over time and place. Regarding time, the primary narrative regarding substance abuse has shifted dramatically from one emphasizing criminality and the need for punishment during the 1980s crack cocaine epidemic to one emphasizing public health and the need for treatment during the current opioid crisis. How this new narrative is reflected in child welfare decision-making, however, has not been adequately explored. Regarding place, the policies, availability of services, and more general sociodemographic and health environment of counties and states are known factors in child welfare decision-making, but have yet to be applied specifically to cases involving parental substance use. This dissertation links data from the Adoption and Foster Care Analysis and Reporting System with various county- and state-level data sources to address these gaps in the literature. The first study shows how sociodemographic variation in substance use-associated foster care entry rates over time reveal changes in where and for whom the child welfare system allocates resources. The second study demonstrates how county-level policy, health, and sociodemographic characteristics explain geographic variation in these rates. In the third study, I show how Medicaid expansion and program generosity interact in nuanced ways to predict reunification among children removed from the home due to parental substance use. All three studies illustrate the ongoing connections between the opioid epidemic and child welfare.



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