The effect of child mental health service use on child safety and permanency in substance misusing families

Research has shown that parental substance misuse leads to a great number of adverse child protection outcomes for children including delays in reunification and reentry into out-of-home care. Although studies suggest that provision of behavioral health services for children can serve as a protective factor in this regard, empirical evidence for the beneficial effect of these services for families experiencing substance misuse is lacking. This study examined whether receipt of children’s behavioral health services mitigated the effects of parental substance misuse with regard to child safety and permanency outcomes. The study sample included all children who either entered or exited out-of-home care in Florida anytime between July 2007 and June 2010 and were enrolled in the Child Welfare-Prepaid Mental Health plan. Data were obtained from the Florida Safe Families Network (FSFN) and Medicaid claims data sets. Cox regression was used to examine time to reunification and time to reentry into care. Findings revealed that parental substance misuse was significantly negatively associated with family reunification. The presence of parental substance misuse significantly reduced the likelihood of family reunification, whether or not children received mental health services. However, children who received mental health services and were reunified with their parents were almost three times less likely to reenter out-of-home care – even in families experiencing parental substance misuse. Receipt of behavioral health services was differentially associated with time to reunification and reentry into out-of-home care. As child welfare systems strive to become more family focused, e.g. addressing parent and child needs, these findings suggest that mental health service delivery to children in foster care remains important.