Child maltreatment

Family Protective Factors and Child Behavioral Health in Families Affected by Parental Substance Use Disorder and Child Maltreatment

Stanek, C., Chang, Y., Radney, A., Himmeger, M., McClellan, J., Lee, J. Y., Dellor, E., & Yoon, S. (2025)

Child maltreatment is a widescale public health crisis impacting approximately 600,000 children annually (U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, 2024). The presence of parental substance use disorder (PSUD) is a known risk factor for the occurrence of child maltreatment (Walsh et al., 2003). PSUD has also been identified as a significant risk factor for child internalizing and externalizing behaviors (Seay, 2020). Family resources such as social support, concrete resources, parenting knowledge, parent-child relationship, and family adaptive functioning may play a protective role in mitigating child internalizing and externalizing behaviors in the face of adversity (Formoso et al., 2000; Ozer et al., 2017; Pérez-González et al., 2017). However, little is known about the association between family resources and child behaviors in the context of family environments with co-occurring PSUD and child maltreatment. This topic is important to address to inform practice and policy efforts that can strengthen family resources promoting resilience among children facing both child maltreatment and PSUD.

The aim of this study was to 1) explore levels of protective factors for families with substance use disorder and 2) examine associations between family protective factors and child behaviors. Families (N=124) were recruited from Ohio START. A hierarchical linear regression model revealed that higher levels of family functioning (p=.029) and parenting knowledge (p<.001) were significantly associated with lower levels of child externalizing behaviors. Higher levels of family functioning (p=.012) and parenting knowledge (p<.001) were also associated with lower levels of internalizing behaviors.

Findings suggest that family-level factors may play a salient role in mitigating poor behavioral outcomes for children who have experienced child maltreatment and have a parent with SUD. As such, it is crucial that child needs are addressed alongside PSUD treatment, and that family functioning and parental education are targeted as points of intervention when addressing co-occurring PSUD and child maltreatment. Policymakers can increase funding allocation to support the development of more family-based interventions for PSUD across broader child welfare populations, with the inclusion of peer recovery supporters, to optimize parent and child health outcomes.

References

Formoso, D., Gonzales, N. A., & Aiken, L. S. (2000). Family Conflict and Children’s Internalizing and Externalizing Behavior: Protective Factors. American Journal of Community Psychology, 28(2), 175–199. https://doi.org/10.1023/A:1005135217449

Ozer, E. J., Lavi, I., Douglas, L., & Wolf, J. P. (2017). Protective Factors for Youth Exposed to Violence in Their Communities: A Review of Family, School, and Community Moderators. Journal of Clinical Child & Adolescent Psychology, 46(3), 353–378. https://doi.org/10.1080/15374416.2015.1046178

Pérez-González, A., Guilera, G., Pereda, N., & Jarne, A. (2017). Protective factors promoting resilience in the relation between child sexual victimization and internalizing and externalizing symptoms. Child Abuse & Neglect, 72, 393–403. https://doi.org/10.1016/j.chiabu.2017.09.006

Seay, K. D. (2020). Pathways From Parental Substance Use to Child Internalizing and Externalizing Behaviors in a Child Protective Services Sample. Child Maltreatment, 25(4), 446–456. https://doi.org/10.1177/1077559520913638

U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2024). Child Maltreatment 2022. U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. https://www.acf.hhs.gov/cb/data-research/child-maltreatment

Walsh, C., MacMillan, H. L., & Jamieson, E. (2003). The relationship between parental substance abuse and child maltreatment: Findings from the Ontario Health Supplement. Child Abuse & Neglect, 27(12), 1409–1425. https://doi.org/10.1016/j.chiabu.2003.07.002

Yoon, S., Ploss, A., Hutzel, M., Webb, R., Hatfield, A., Lee, J. Y., Munshi, A., Radney, A., & McClellan, J. (2024). Parenting attitudes and behaviors among parents involved with the child welfare system and affected by substance use disorders. Child abuse & neglect, 149, 106657. https://doi.org/10.1016/j.chiabu.2024.106657

Substance use among parents is a complex issue that poses serious issues including child maltreatment. Parents affected by substance use disorder (SUD) and involved in child welfare systems may experience difficulties in creating a safe and nurturing environment for their children due to substance use and multiple challenges they face, such as poverty, limited access to resources, and other systemic inequities and barriers. Parental substance use has been linked to less optimal parenting and child welfare outcomes, such as parentification, corporal punishment, child maltreatment, extended durations in out-of-home placements, and lower rates of family reunification. The implementation of the Sobriety Treatment and Recovery Teams (START) model in Ohio has allowed parents with at least one minor child to engage in SUD treatment services. START has successfully shown to improve rates of family reunification and reduce rates of child neglect while also helping parents reduce substance use.

Telephone surveys and qualitative interviews were utilized to explore parents’ perceptions of their parenting attitudes before and after participation in Ohio START (Sobriety, Treatment and Reducing Trauma). The survey data found that parenting attitudes towards appropriate family roles, parents’ level of proper expectations of children, and acknowledgment of children’s power and independence improved on their post-test. Qualitative interviews revealed themes including being present for children, engaging in activities with children, enjoyment in providing care to children, maintaining employment for financial stability, emotional regulation, stress management, and a sense of pride. Parents reported being involved in new activities with their children following participation in Ohio START. Findings from the study indicate positive changes in parenting attitudes and practices among parents who participate in Ohio START.