The opioid crisis has left an indelible mark on countless families across the United States. With over 108,000 drug overdose deaths, the majority involving opioids, the epidemic has profound implications not only for public health but also for child welfare systems.
This article explores the crossover between parental opioid use and child welfare involvement, the impact of opioid use disorder on families, and the critical role that evidence-based interventions like Multisystemic Therapy (MST) can play in addressing these systemic challenges.
The Opioid Crisis and Its Impact on Families
Opioid use disorder severely impairs a parent's ability to care for their children. They can face numerous challenges, some of which include, but are certainly not limited to:
- Neglect and Abuse: Parents may become incapable of prioritizing their children's needs, leading to neglect and potential abuse.
- Prenatal Exposure: Babies born with neonatal opioid withdrawal syndrome face significant health issues, including low birth weight, respiratory difficulties, and seizures.
- Family Disruption: Addiction can lead to family separation, either through parental incarceration or the involvement of child protective services. Out-of-home placement of the child is not uncommon.
The Child Welfare League of America (CWLA) reports that overdose and drug-related hospitalizations correlate with higher rates of child abuse reports, substantiated cases of neglect, and increased foster care placements, particularly in regions like Appalachia and parts of the Pacific Northwest.
Nearly 9,000 U.S. children and adolescents died from opioid poisoning between 1999 and 2016, with the rate of opioid-related deaths among younger children steadily increasing ever since.
The Child Welfare System's Response to Parental Opioid Use
The child welfare system often struggles to respond effectively to cases involving parental opioid use due to several systemic challenges, such as limited resources, coordination challenges, and an overreliance on drug testing.
Firstly, the availability of family-friendly treatment options that support parenting across a wide range of functions (e.g., individual therapy, family therapy, childcare, and parenting classes) is limited, making it difficult for affected families to receive the necessary support they deserve. This limitation is particularly challenging in rural areas.
Collaboration between child welfare agencies, courts, and substance use treatment programs often stalls due to differing approaches and priorities. Casey Family Programs reports challenges associated with collaboration are further compounded due to difficulties in sharing programmatic data and client information across agencies.
Additionally, the child welfare system upholds an overreliance on drug testing, which can lead to punitive measures rather than supportive interventions. Prioritizing punitive measures over holistic support can exacerbate the trauma experienced by families, leading to additional challenges in their present and future. These consequences are particularly true for Native American and Black mothers, who are statistically more likely to be reported to a child welfare agency.
On top of these pervasive challenges, many more barriers exist within the child welfare system's response to cases involving parental opioid use: overwhelmed child welfare workers with high caseloads, biased reporting, lack of understanding when it comes to reporting criteria, and policies that can often contradict the length of time parents need to recover.
How Multisystemic Therapy Can Improve Child Welfare's Response
To better address the wide-ranging, intersecting complexities of parental opioid use, the child welfare system needs to:
- Improve coordination between various agencies to provide a unified, supportive approach.
- Expand the availability of holistic, family-centered treatment options that address substance misuse and the underlying causes.
- Shift from punitive measures to supportive interventions that promote family stability and recovery. Updating policy to align with the amount of time required to allow interventions to be successfully implemented is also critical.
Evidence-Based Insights, Practices, and Research
Robust research indicates that MST and the MST adaptation (MST-BSF) and MST for Child Abuse and Neglect (MST-CAN) are highly effective for addressing parental behaviors related to child maltreatment and improving child welfare outcomes. The multisystemic approach of these interventions significantly reduces parental substance misuse while improving parent and child mental health and parenting practices and decreasing the likelihood of child abuse and neglect.
The success of these programs underscores the need for broader implementation of such evidence-based, integrative treatment models within the child welfare system to better support families affected by substance misuse.
MST-BSF and MST-CAN can enhance the child welfare system's response to cases involving opioid use by addressing the multifaceted needs of families, reducing out-of-home placements, and facilitating family cohesion.
MST for Child Abuse and Neglect (MST-CAN)
MST-CAN is an evidence-based intervention targeting children aged 6-17 and their families who are involved with CPS due to physical abuse and/or neglect. Approximately 20%-30% of MST-CAN cases also include treatment for parental substance misuse.
The program typically ranges from six to nine months, and its structure is robust, involving a dedicated clinical team that includes:
- Three full-time therapists, each managing a caseload of a maximum of four families
- A full-time supervisor
- A family resource specialist for case management
- A part-time psychiatrist or psychiatric nurse practitioner.
- A collaborative relationship with CPS
This team composition ensures intensive and personalized care for each family.
The small average caseload of no more than four families per therapist allows deep engagement and tailored interventions. Practitioners have the bandwidth to address specific family dynamics and individual needs, such as parent and child mental health difficulties, parenting behaviors, child and adult trauma, and much more. Families receive approximately three sessions per week and have the availability of team on-call services to help manage crises. Research shows that the MST-CAN model significantly improves natural social supports for parents.
The annual cost of implementing an MST-CAN program is approximately $500,000 to $700,000, which includes staff salaries, psychiatry services, training, ongoing support, and quality assurance oversight.
Despite the initial investment, MST-CAN is financially beneficial long-term:
- In the U.K., a 2015 program evaluation, which included a cost-benefit analysis, indicated a financial savings of £66,150.43, with a return rate of £1.04 for every pound spent.
- In Switzerland, research found costs ranged 16-50% lower than the costs of contingency plans.
- In the United States, preliminary findings from a randomized controlled effectiveness study showed a cost savings of $3.31 for every dollar spent, underscoring the program's economic viability.
By addressing the root causes of abuse and neglect, MST-CAN helps children and young people safely remain with their families. It reduces the likelihood of out-of-home placements and keeps families together long-term—all while saving long-term funds for the regions implementing the program.
MST-Building Stronger Families
MST-BSF, an MST-based model, is specifically designed for families experiencing co-occurring child physical abuse and/or neglect plus serious parental substance misuse. MST-BSF provides a specific evidence-based treatment for adult substance misuse called Reinforcement Based Therapy. In addition, intensive family safety planning, family problem-solving and communication, trauma treatment for children and adults, and family healing related to the adult taking responsibility for the maltreatment are critical parts of the model. Similar to MST-CAN, the MST-BSF model involves a robust team to offer holistic support:
- One supervisor
- One family resource specialist focusing on case management
- Three therapists with a caseload of a maximum of our families are available on-call to families 24 hours a day//7days a week
- Psychiatry is available at 10-20% time
- Close working relationship with Child Protective Services
- A brief in an inpatient detoxification facility may be needed at the onset of treatment for parents with substance dependency (e.g., opioids, alcohol, fentanyl)
A quasi-experimental study funded by the Annie E. Casey Foundation revealed significant positive outcomes for MST-BSF. The program boasts a treatment completion rate of 93%, with only 1.46% of cases discharged due to lack of engagement. This high level of completion indicates a strong family commitment to change once in the program and effectiveness in addressing substance misuse (and its corresponding impact on families).
Additional outcomes include:
- A significant decrease in drug and alcohol use, depression, and psychological aggression in parenting among mothers
- 80% of caregivers had no reported maltreatment across 24 months
- Decreased anxiety symptoms in children and young people
A 5-year Randomized Controlled Effectiveness trial funded by the National Institue on Drug Abuse showed:
- Significant reductions in alcohol, opioid, and cocaine use
- A significant reduction in child neglect
The MST-BSF model has been disseminated across six regions in Connecticut, showcasing its scalability and adaptability to different community settings. It is also Title IV-E Funding-eligible through the Family First Prevention Services Act. MST-BSF is rated as "well-supported by research evidence" to significantly reduce the likelihood of young people entering the child welfare system.
Role of Child Welfare Agencies and Professionals
By collaborating and implementing evidence-based practices such as MST-BSF and MST-CAN, child welfare agencies and service providers can enhance their response to the opioid crisis and provide better support to affected families.
Key strategies include:
- Early Engagement and Treatment: Engaging families early and providing necessary assessments and treatments to assure safety and prevent crises and family separations.
- Collaborative Efforts: Promoting collaboration among Child Protective Services and the MST treatment team.
- Reducing Stigma and Barriers: Offering home-based services and focusing on family strengths to reduce stigma and barriers to accessing treatment, making it easier for families to engage and benefit from interventions.
These MST-based programs can be implemented successfully in any community, helping child welfare systems improve their response to opioid-related cases and providing services that address underlying concerns related to the root causes of opioid misuse and addiction.
Fight the Opioid Epidemic & Build Stronger Families with MST
MST Services is at the forefront of addressing the devastating impact the opioid crisis has on families and the systems that interact with them (like child welfare systems). By applying multisystemic therapy-based programs, particularly MST-BSF and MST-CAN, MST Services transforms the approach to the pervasive challenges that communities, agencies, and families face.
If you or someone you know is interested in learning more about Multisystemic Therapy-based program (MST-BSF and MST-CAN), contact MST Services here.
MST is an evidence-based alternative to incarceration or severe system consequences due to serious externalizing, anti-social, and criminal behaviors. MST effectively treats young people and their families by utilizing a built-in suite of interventions within the home, school, and community settings. Treatment is tailored to the family and individual strengths and needs, which could include but is not limited to the following types of therapies: Family Therapy, Cognitive Behavioral Therapy, Drug and Alcohol Treatment, Mental Health Services, Peer Ecology Assessment and Intervention, Trauma-informed treatment, and Educational/ Vocational Support.
