Adolescents with substance use referred to child protective services: Does substance use treatment prevent foster care entry?

Adolescent substance use has been linked to several negative outcomes, which can be exacerbated by exposure to adversity such as child maltreatment. However, few studies have examined the intersection of adolescent substance use and child protective service (CPS) involvement. This study examined the relationship between substance use treatment and entries into foster care among adolescents referred to CPS for maltreatment. Data for this study came from the National Child Abuse and Neglect Data System (NCANDS), an annually reported database that contains information on all CPS reports screened for investigation. NCANDS was merged with county-level data from the American Community Survey to explore the relationship between treatment and foster care entry while adjusting for contextual factors. Our sample included 2326 adolescents who were referred to CPS in fiscal year (FY) 2018 and were followed until FY 2019 to examine correlates of foster care entry. A series of multilevel logistic regressions were conducted. Approximately 1 in 20 adolescents entered foster care during the study period and 1 in 10 used treatment services prior to foster care entry. Substance use treatment increased the odds of foster care entry (adjusted odds ratios = 2.30, p < 0.05), while adolescents residing in counties with higher percentages of non-Hispanic White residents had lower odds of foster care entry (adjusted odds ratios = 0.67, p < 0.05). Among adolescents with substance use referred to CPS, substance use treatment increases the likelihood of foster care entry. This may highlight the need to provide services earlier and to ensure that adolescents can access treatment without entering state custody. Future research should explore these relationships in more depth.