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.