CHAMPAIGN, Ill. - A new study by researchers at the University of Illinois indicates that mothers with chronic substance abuse problems are more likely to make progress in recovering from addiction - and to reunite with their children in state custody - if they receive residential treatment plus community-based transitional services.
The three-year study examined treatment progress and family reunification rates among 160 mothers who had given birth to substance-exposed infants in Cook County in Illinois. Eighty percent of the mothers involved in the study had given birth to two or more substance-exposed infants. At some point, all of the mothers had lost temporary custody of their children to the Illinois Department of Children and Family Services and had been referred by the court for alcohol- and drug-treatment services.
Prior studies have indicated that 10 to 11 percent of all newborns in the U.S. are exposed to illicit drugs or alcohol in the womb, and mothers who bear a substance-exposed infant are significantly more likely to deliver additional substance-exposed infants. They also are likely to continue abusing substances during their children's early years and subsequently be associated with a child maltreatment or neglect allegation. Once removed from parental custody, their children stay in foster care longer and reunification rates are much lower than other families'.
Hui Huang, a doctoral student in the School of Social Work at Illinois, and co-author Joseph Ryan, a professor of social work at Illinois who specializes in child welfare and substance abuse/recovery issues, examined quarterly reports by case workers, treatment records and reunification records in the IDCFS database to determine if specific types of substance abuse treatment were associated with mothers' likelihood of making treatment progress and being reunited with their children.
The researchers looked at three categories of treatment services: residential treatment alone, nonresidential treatment alone and residential treatment combined with transitional components.
Huang and Ryan found that mothers who received combined services were more than nine times more likely to make treatment progress, and they were reunited with their children more quickly than mothers who received residential or nonresidential treatment alone.
After 18 months, nearly 10 percent of the mothers who received combined services achieved reunification with their children.
By the two-year mark, more than 21 percent of them had their children back, versus less than 13 percent of mothers in the nonresidential treatment group and 4 percent of the mothers who received residential treatment alone.
"What we found is that if people receive both residential and transitional services they are more likely to achieve treatment progress, and if they achieve treatment progress, they are more likely to achieve family reunification," Huang said.
"Transitional services offer addicts the opportunity to practice what they learned in the residential care environment with some supports still in place," once they're back home, Ryan said. "It's almost like getting booster shots from an outpatient clinic that help them reinforce, discuss and process what they're experiencing once they're back in their family home and the environment where their addictions initially developed."
Residential substance abuse services provided alone - without components such as outpatient treatment to provide support as the women reintegrated with society - had no significant impact on the women's treatment progress, even when the researchers controlled for characteristics such as mental health problems, drug of choice and ethnicity.
Because residential treatment programs are high-cost services, funding for them and other pricey human services are often targeted for reduction when state legislators are slashing budgetary expenditures. However, there are both financial costs and human costs to be considered because ineffective treatment programs result in people struggling with their addictions longer and their children staying in the child welfare system for significantly longer periods of time, Ryan said.
"This is a chronic, difficult-to-serve population in child welfare," Ryan said. "But it appears that providing even short-term residential services along with appropriate scaffolding into the community makes sense in terms of treatment effectiveness. This would be a cost effective way to go."
The study was published in the February 2011 issue of the journal Children and Youth Services Review.
The findings corroborated Ryan's previous studies on substance exposed births and treatment services, which indicated that use of recovery coaches - caseworkers specially trained in addiction counseling and relapse prevention - could significantly impact substance-involved mothers' recovery and family reunification rates, saving state child-welfare systems millions of dollars in foster care and other placement costs.