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Impact of residential versus outpatient substance abuse treatment on child welfare outcomes: A secondary analysis of NSCAW II data


Between 40–80% of substantiated child maltreatment cases in the United States contain some

degree of parental substance abuse. After child welfare becomes involved, outcomes for

children of parents with substance abuse issues are substantially worse than for children of nonsubstance-

abusing parents. While some studies have demonstrated that substance abuse

treatment can improve child welfare outcomes, results are largely inconclusive as to whether

residential substance abuse treatment is more effective than outpatient options. Using data from

the National Survey of Child and Adolescent Well-Being II, this study evaluates the effects of

residential versus outpatient substance abuse treatment on family progress for families involved

in the child welfare system.

Using propensity score weighting to control for substance abuse severity and other variables that

may select parents into treatment, results indicate that child welfare workers were more likely

(RRR = 4.40, p = 0.026) to indicate that families had deteriorated or made no progress in cases

where parents attended residential treatment. Placement of children in out-of-home care also

increased the likelihood that workers would indicate that a family had deteriorated or made no


At the same time, results from this study indicate that child welfare workers were also more

likely (RRR = 3.77, p = 0.022) to believe that a family had made substantial progress when a

parent attended residential treatment. This finding was especially true for parents when the

caseworker assessed domestic violence as a pre-existing condition (RRR = 7.89, p = 0.044),

suggesting a moderating relationship between treatment setting and caseworker assessment.

Considering the importance of worker assessments to child welfare outcomes such as

reunification and case closure, this study’s findings have implications for treatment assignment

for child welfare involved parents. Findings from this study also provide support for the

provision of ancillary services, such as domestic violence counseling in residential programs.

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