Mothers in treatment for substance use: impacts on care proceedings

This project will examine the role of mothers’ substance misuse in care proceedings.

Approximately 50% of mothers receiving substance use treatment are involved with care proceedings and 50% of children in foster care are from households with a substance-using parent. Maternal and paternal substance use is considered a significant risk for child maltreatment and neglect. However, as mothers are usually the primary caregivers, they are those more likely to be involved with child protection services and to manage the effects of their substance use from their children. Many mothers who use substances also have mental health problems, and socioeconomic adversities associated with substance use (such as unstable housing and economic hardship), which place additional pressure on mothers’ ability to provide sufficient care for their children’s development. This study will raise awareness of the need for integrated policy across health and social services and aims to inform the development of substance use treatment that supports better outcomes for mothers and children.

The study will build on a previous Nuffield-funded project. It will use electronic health records from the South London and Maudsley NHS Trust (SLaM) to examine the characteristics of mothers receiving treatment for substance misuse. It will also extend a current Nuffield-funded project linking mental health records and family court data (Cafcass) at SLaM. Through data linkage with family court records, the researchers will build on this analysis to examine how substance misuse treatment impacts on outcomes for mothers and their children who are involved in care proceedings.

The first stage of the analysis will explore the prevalence and characteristics of mothers receiving community-based or residential treatment for drug and/or alcohol use. Descriptive and multivariate analysis will be used to compare the socio-demographic, psychological, patterns of substance use, and treatment characteristics between mothers and women without children, and between mothers whose children were in alternative care. The second stage will involve a qualitative investigation of how childcare issues are addressed in substance use treatment. The researchers will select a random sample of mothers receiving treatment and undertake detailed case studies, using thematic analysis to examine patterns within and across cases. The third stage of analysis will examine individual characteristics and treatment patterns associated with care proceeding outcomes (i.e. retaining, regaining or losing care of their children). Researchers will also investigate individual and treatment outcomes of the mothers one year after being involved in care proceeding according to childcare outcomes. A series of logistic regression analyses will examine the association of care proceeding outcomes with mothers’ sociodemographic, psychological and health outcomes before and after involvement in care proceedings.

This research will create recommendations to improve mothers’ engagement with substance use services and to improve parental skills while receiving substance use treatment. The findings from this research will be communicated to social workers, clinicians, policymakers, academic communities and charities and campaigning organisations. The researchers will submit four papers to academic journals in several relevant fields, as well as making presentations at key conferences and presenting key findings to policy makers.