Risk of Child Welfare System Involvement Among Mothers With Substance Use Disorder

Introduction

This paper aimed to examine the factors associated with child welfare system involvement among mothers receiving public substance use treatment services.

Methods

This was a cohort study using 2015–2023 linked data from Allegheny County, Pennsylvania, on residents’ interactions across public service systems. Independent variables, measured within 3 months of study inclusion, included family characteristics, public benefit receipt, jail release, and substance use disorder diagnoses. The data, captured over the subsequent 21 months, included any child welfare interaction, active case, and out-of-home placement. The data were analyzed in 2024–2025.

Results

Younger maternal age, having multiple children, and having an infant or a young child were all associated with an increased risk of any child welfare system involvement; having an infant was also associated with a risk of out-of-home placement (adjusted hazard ratio=2.54, 95% CI=1.80, 3.59). Although all substance use disorder diagnoses were associated with an increased risk of all types of child welfare system involvement, for out-of-home placements, the strongest associations were observed for stimulant (adjusted hazard ratio=2.35, 95% CI=1.64, 3.36) and opioid (adjusted hazard ratio=2.18, 95% CI=1.60, 2.96) use disorders. Receipt of certain public benefits, such as Temporary Assistance for Needy Families, was also associated with higher risks of any child welfare system interaction, an active case, and out-of-home placements (adjusted hazard ratio=1.93, 95% CI=1.41, 2.65).

Conclusions

Enhanced support is particularly needed for mothers of infants and for those with opioid or stimulant use disorders. Receipt of certain public benefits underscores economic vulnerability as a key pathway to child welfare system involvement among mothers with substance use disorder.