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How is parental substance misuse associated with child protection threshold decisions made by social workers?
The findings of a retrospective cohort study.
Jessica Roy
13th April 2015
OutlineDefinitions and brief review of literature
Research design and methodology
Findings
Discussion: Risk factors and reasoning devices
Looking ahead: Implications for PhD research
Definitions and estimates‘Parental’ substance misuse
Parent or carerDrugs or alcohol
Threshold decisions as outcome measure
Probabilistic NOT deterministic causation (Palinkas, 2014)
Parental substance misuse: Why does it matter?
High prevalence of parental substance misuse in UK (Manning et al., 2009)
Parental substance misuse is associated with:Markers of child abuse (White et al., 2014)Poor developmental, educational and emotional
wellbeing outcomes (Forrester & Harwin 2011)Isolated and turbulent childhood experiences (Barnard
2007, Fraser et al., 2009, Houmoller et al., 2011)
Causal link between parental substance misuse and poor outcomes is unclear (Staton-Tindall et al., 2013, White et al., 2014)
Research QuestionsIs parental substance misuse observed to be
associated with threshold decisions made by social workers?
What factors are observed to be associated with threshold decisions made by social workers for children living with parental substance misuse?
Research DesignRetrospective cohort study
Clinical data mining of social work case files (Epstein 2010)
Purposive sample of 200 children referred to rural local authority (2012-2013)
100 children in a ‘control cohort’ and 100 children in a ‘parental substance misuse cohort’
Descriptive, bivariate (chi-square) and multivariate (logistic and multinomial regression) statistical analysis
Findings Mismatched cohorts:
Control cohort n=118/Parental substance misuse cohort n=58
Missing data n=24 96% children White British Single biggest reason for referral was domestic violence (n=70). No significant differences in demographic information between
two cohorts Children in the substance misuse cohort significantly more
likely to be exposed to domestic violence than children in the control cohort (x2 = (1) 15.46, p< 0.01)
Children in substance misuse cohort significantly more likely to be referred under category of neglect than children in the control cohort (x2= (3) 15.42, p<.01)
Chart showing substance of use
Alcohol Cannabis Heroin Cocaine Ketamine0
5
10
15
20
25
30
35
40
Substance
Num
ber
Chart showing threshold decisions
Low Tier Medium Tier High Tier0
102030405060708090
100
PSM cohort
Control cohort
Threshold decision
%
• No significant association between threshold decisions and whether a child was in the parental substance misuse cohort or not (x2=(2)5.27, p>.05)
• Multinomial logistic regression modelling indicated parental substance misuse did not have predictive effect over threshold decisions • Medium tier outcomes vs. low tier (Exp(B) 2.3,
NS)• High tier outcomes vs. low tier outcomes (Exp(B)
.78, p>.05)
Risk factorsBivariate analysis indicated following factors significantly
associated with threshold decisions:• Category of abuse, parental capacity, child’s emotional
wellbeing, parental compliance with children’s social care, housing, employment and gender of child (P< 0.05)
Logistic regression indicated three factors had predictive effect over having a high/medium tier outcome vs. case being closed after assessmentCategory of abuse (sexual/physical) (Exp(B) 15.47, p< 0.01)Concerns regarding parental capacity (Exp(B) 71.77, p<
0.01)Gender (male) (Exp(B) 7.71, p< 0.05)
LimitationsCase file research
Missing data and incomplete assessmentsValidity and reliability of data
SampleFalse positives/false negatives
Breadth not depth
Discussion – parental substance misuse
Parental substance misuse not observed to have a significant association with threshold decisions
Why?
Other factors more significantly associated with threshold decisions
Methodological choices - research design, location and sample
Normalisation/acceptability of alcohol misuse (Adamson & Templeton 2012, Devaney 2009, Forrester & Harwin 2011)
Discussion - Risk factors or reasoning devices?
Risk factors congruent with ecological models of child abuse (Belsky 1980) e.g. parental capacity, housing, employment
Other factors best understood within framework of ‘sense making devices’ (Platt & Turney 2013, Stanley et al., 2011)Specifity (category of abuse)Co-operation (parental compliance)Operational strategies (domestic violence)
Implications for future studySubstantive
Focus on children living with parental substance misuse
Change of outcome measuresThresholds decisions and child wellbeing
Analytical approachCluster analysisDecision treesStructural Equation Modelling
References ADAMSON, J. & TEMPLETON, L. 2012. Silent Voices: supporting children and young people
affected by parental alcohol misuse. London: Office of the Children's Commissioner.
BARNARD, M. 2007. Drug Addiction and Families, London, Jessica Kingsley Publishers.
BELSKY, J. 1980. Child Maltreatment: An Ecological Integration. American Psychologist, 35, 15.
DEVANEY, J. 2009. Chronic Child Abuse: The Characteristics and Careers of Children Caught in the Child Protection System. British Journal of Social Work, 39, 24-45.
EPSTEIN, I. 2010. Clinical data-mining : integrating practice and research, New York ; Oxford, Oxford University Press.
FORRESTER, D. & HARWIN, J. 2011. Parents who Misuse Drugs and Alcohol: Effective Interventions in Social Work and Child Protection, Sussex, Wiley-Blackwell.
FRASER, C., MCINTYRE, A. & MANBY, M. 2009. Exploring the Impact of Parental Drug/Alcohol Problems on Children and Parents in a Midlands County in 2005/06. British Journal of Social Work, 39, 846-866.
HINDLEY, N., RAMCHANDANI, P. & JONES, D. 2006. Risk factors for recurrence of maltreatment: a systematic review. Archives of Disease in Childhood, 91, 744-752.
References HOUMOLLER, K., BERNAYS, S., WILSON, S. & RHODES, T. 2011. Juggling harms: coping with
parental substance misuse. London: London School of Hygiene and Tropical Medicine.
MANNING, V., BEST, D., FAULKNER, N. & TITHERINGTON, E. 2009. New estimates of the number of children living with substance misusing parents: results from UK national household surveys. British Medical Council Public Health, 9.
PLATT, D. & TURNEY, D. 2013. Making Threshold Decisions in Child Protection: A conceptual analysis. British Journal of Social Work, Advanced Access, 19.
STANLEY, N., MILLER, P., RICHARDSON FOSTER, H. & THOMSON, G. 2011. A Stop–Start Response: Social Services' Interventions with Children and Families Notified following Domestic Violence Incidents. British Journal of Social Work, 41, 296-313.
STATON-TINDALL, M., SPRANG, G., CLARK, J., WALKER, R. & CRAIG, C. D. 2013. Caregiver Substance Use and Child Outcomes: A Systematic Review. Journal of Social Work Practice in the Addictions, 13, 6-31.
TAYLOR, A. & KROLL, B. 2004. Working with Parental Substance Misuse: Dilemmas for Practice. British Journal of Social Work, 34, 1115-1132
