Abstract
Introduction
The use of illicit substances, including opioids, is a serious public health issue in the United States. While there are reports of the impact of the ongoing opioid crisis on adults, a new focus has emerged on how parental substance misuse (PSM) affects children. This study explored existing screening and assessment practices and services for children and families affected by PSM across different service sectors in one state. The purpose of the study was to identify opportunities for training, policy development, and practice improvement related to identifying PSM and linking children and parents to services.
Methods
Interviews (n = 15) with professionals from five service sectors (mental health, primary care, schools, community programs, and law enforcement) were used to inform development of a state-wide survey of the same groups (n = 498) to assess current practices, attitudes, knowledge, and training needs related to child screening of PSM. The survey was piloted using cognitive interviewing (n = 9) before it was distributed.
Results
Fewer than 20% of survey respondents reported using standardized tools specific to screening PSM. Informal assessment practices predominate, though 60% of respondents saw value in adopting more standardized PSM screening. Attitudes about PSM and screening varied among sectors but interest in training was high.
Discussion
Results indicate a need for more systematic PSM screening, cross-sector training and practice discussions, and policies to support early identification of children affected by PSM. Ramifications of these findings and recommendations are discussed.
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References
Aarons, G. A. (2004). Mental health provider attitudes toward adoption of evidence-based practice: The Evidence-Based Practice Attitude Scale (EBPAS). Mental Health Services Research, 6(2), 61–74
amfAR. (n.d.). Opioid & health indicators, New Hampshire. Retrieved January 21, 2020, from https://opioid.amfar.org/NH
Bradley, E. H., Curry, L. A., & Devers, K. J. (2007). Qualitative data analysis for health services research: Developing taxonomy, themes, and theory. Health Research and Educational Trust. https://doi.org/10.1111/j.1475-6773.2006.00684.x
Cochran, G., Field, C., Lawson, K., & Erickson, C. (2013). Pharmacists’ knowledge, attitudes and beliefs regarding screening and brief intervention for prescription opioid abuse: A survey of Utah and Texas pharmacists. Journal of Pharmaceutical Health Services Research, 4(2), 71–79. https://doi.org/10.1111/jphs.12013
Drabble, L. (2011). Advancing collaborative practice between substance abuse treatment and child welfare fields: What helps and hinders the process? Administration in Social Work, 35(1), 88–106. https://doi.org/10.1080/03643107.2011.533625
New Hampshire Drug Monitoring Initiative. (2019). 2019 overview report (Report No.2020-4381)
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8
Garg, A., Nelson, C. S., Burrell, L., Duggan, A. K., & Sia, C. (2010). Association of substance use discussion by pediatric providers with the parent-provider relationship and maternal behavior change. Clinical Pediatrics, 49(3), 240–248. https://doi.org/10.1177/0009922809334351
Ghertner, R., Waters, A., Radel, L., & Crouse, G. (2019). The role of substance use in child welfare caseloads. Children and Youth Services Review, 90, 83–93. https://doi.org/10.1016/j.childyouth.2018.05.015
Hostage, J. C., Brock, J., Craig, W., & Sepulveda, D. (2020). Integrating screening, brief intervention and referral to treatment (SBIRT) for substance use into prenatal care. Maternal and Child Health Journal, 24(4), 412–418. https://doi.org/10.1007/s10995-020-02892-9
Kroll, B., & Taylor, A. (2003). Parental substance misuse and child welfare. Jessica Kingsley Publishers Ltd.
Lane, W. G., Dubowitz, H., Feigelman, S., Kim, J., Prescott, L., Meyer, W., & Tracy, J. K. (2007). Screening for parental substance abuse in pediatric primary care. Ambulatory Pediatrics, 7(6), 458–462. https://doi.org/10.1016/j.ambp.2007.07.007
Lipari, R., & Van Horn, S. L. (2017). Children living with parents who have a substance use disorder. Th CBHSQ Report. Rockvill, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/sites/default/files/report_3223/ShortReport-3223.html
Meinhofer, A., & Anglero-Diaz, Y. (2019). Trends in foster care entry among children removed from their homes because of parental drug use, 2000 to 2017. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2019.1738
Monnat, S. M., & Rigg, K. K. (2018). The opioid crisis in rural and small town America. University of New Hampshire, Carsey Research. https://carsey.unh.edu/publication/opioid-rural-smalltown-us
Morton, C., & Wells, M. (2017). Behavioral and substance use outcomes for older youth living with a parental opioid misuse: A literature review to inform child welfare practice and policy. Journal of Public Child Welfare. https://doi.org/10.1080/15548732.2017.1355866
Niccols, A., Milligan, K., Sword, W., Thabane, L., Henderson, J., & Smith, A. (2012). Integrated programs for mothers with substance abuse issues: A systematic review of studies reporting on parenting outcomes. Harm Reduction Journal, 9(14), 1–11
Radcliffe, P., Chandler, A., Martin, F., & Whittaker, A. (2019). Parents and substance use. International Journal of Drug Policy, 68, 97–100
Radel, L., Baldwin, M., Crouse, G., Ghertner, R., & Waters, A. (2018). Substance use, the opioid epidemic, and the child welfare system: Key findings from a mixed methods study. U.S. Department of Health and Humans Services, ASPE Research Brief. https://aspe.hhs.gov/system/files/pdf/258836/SubstanceUseChildWelfareOverview.pdf
Smith, V. C., & Wilson, C. R. (2016). Families affected by parental substance use. Pediatrics, 138(2), e20161575–e20161575. https://doi.org/10.1542/peds.2016-1575
Spehr, M. K., Coddington, J., Ahmed, A. H., & Jones, E. (2017). Parental opioid abuse: Barriers to care, policy, and implications for primary care pediatric providers. Journal of Pediatric Health Care, 31(6), 695–702. https://doi.org/10.1016/j.pedhc.2017.05.007
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(1), 6–31. https://doi.org/10.1080/1533256X.2013.752272
Steele, M., Zayed, R., Davidson, B., Stretch, N., Nadeau, L., Fleisher, W., Doey, T., Spenser, H. R., Abidi, S., Auclair, G., Callanan, T. S., Duncan, D., Ferguson, G., Flynn, R., Hope-Ross, L., Khalid-Khan, S., Lazier, L., Liashko, V., Lipton, H., … St John, K. (2012). Referral patterns and training needs in psychiatry among primary care physicians in Canadian rural/remote areas. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 21(2), 111–123
Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on drug use and health (HHS Publication No. PEP19-5068, NSDUH Series H-54)
The Council of Economic Advisers. (2017). The underestimated cost of the opioid crisis (Issue November). https://static.politico.com/1d/33/4822776641cfbac67f9bc7dbd9c8/the-underestimated-cost-of-the-opioid-crisis-embargoed.pdf
Young-Wolff, K. C., Tucker, L. Y., Armstrong, M. A., Conway, A., Weisner, C., & Goler, N. (2020). Correlates of pregnant women’s participation in a substance use assessment and counseling intervention integrated into prenatal care. Maternal and Child Health Journal, 24(4), 423–431. https://doi.org/10.1007/s10995-020-02897-4
Zellman, G. L., Bell, R. M., Archie, C., DuPlessis, H., Hoube, J., & Miu, A. (1999). Physician response to prenatal substance exposure. Maternal and Child Health Journal, 3(1), 29–38. https://doi.org/10.1023/A:1021810129171
Acknowledgements
This work was supported by Grant No. #90C01099 from the Administration for Children and Families, Children’s Bureau. The authors wish to acknowledge the providers and stakeholders across the state who participated in this study.
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Knight, E., Butcher, R.L. & Jankowski, M.K. Toward Improved Identification of Parental Substance Misuse: An Examination of Current Practices and Gaps in One US State. Matern Child Health J 25, 1353–1360 (2021). https://doi.org/10.1007/s10995-021-03138-y
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DOI: https://doi.org/10.1007/s10995-021-03138-y