Pathways from Caregiver Problematic Substance Use to Child Harm: A Secondary Data Analysis of the National Survey of Child and Adolescent Well-Being II

Caregiver problematic substance use is a prevalent problem within the child protective services (CPS) system that is associated with negative outcomes for children. Utilizing path analysis models, this dissertation deepens our understanding of the direct and indirect (mediating and moderating) pathways from caregiver problematic substance use to indicators of child harm in two CPS populations: all families investigated for maltreatment (Aim 1) and a sub-group of families in which the children remained in the home after the investigation (Aim 2). Data for these analyses came from the National Survey of Child and Adolescent Well-Being II (NSCAW II), a landmark, longitudinal national probability study of families investigated for child maltreatment. Caregiver problematic substance use was measured in two ways. In Aim 1, caregiver problematic substance use was measured by caseworker-identified problematic drug or alcohol use. In Aim 2, caregiver problematic substance use was measured by caregiver self-report of problematic drug or alcohol use available only in this sub-group. Using the child welfare goals of safety, permanency, and well-being, child harm was operationalized as CPS referrals for services and subsequent reports of maltreatment (safety), having children removed from the home (permanency), and child levels of depression, trauma, internalizing behaviors, or externalizing behaviors (well-being). Mediators included in the models are parental monitoring, harsh discipline, emotional maltreatment, and exposure to violence. Moderators included in the models are caregiver depression, domestic violence, and criminal involvement. Among other findings, this dissertation indicates that emotional maltreatment and caregiver depression are strong pathways through which caregiver problematic substance use is associated with child harm. Bivariate analyses also indicate a need to strengthen training around caregiver problematic substance use for CPS caseworkers. By utilizing the CPS goals of safety, permanency, and well-being, the results of this dissertation have direct implications for national child welfare policies and inform how caregiver problematic substance use is addressed in CPS agencies. Emotional maltreatment and caregiver depression are risk factors that should be targeted in interventions aimed at promoting the safety, permanency, and well-being of children when caregiver problematic substance use is present