Mothers receiving substance use treatment involved in care proceedings: A record linkage cohort study

Background: Maternal substance use is a common feature in care proceedings (Family Courts) and is associated with a heightened risk of children being removed from the home. Not all mothers who use substances neglect/abuse their children and require care proceedings. Those who have lost the right to care for their children often have multiple and complex needs. Substantial barriers to developing evidence-based practices that address the needs of substance using mothers involved in care proceedings exist. Identifying maternal substance use can be challenging, possibly due to substance using mothers being hard to reach and include in research. This study uses a novel linked data resource to describe: i) who the mothers involved in care proceedings are, ii) what factors are associated with out-of-home placement of their children, and iii) the individual and treatment characteristics of mothers that returned to subsequent set of care proceedings. 
 
Methods: Records of 1587 mothers of children (<18 years old) attending addiction services in South East London between 2007 and 2019 were extracted. Records of 480 mothers (30%) were linked to family court records. 
 
Results: The number of care proceeding cases decreased during the study period. Most mothers involved in care proceedings (79%) were known to substance use treatment services before care proceedings began. Mothers involved in care proceeding presented a distinctive profile from those mothers not involved in care proceedings: younger age, non-white background, social deprivation, housing problems, lifetime history of domestic violence and poor mental health. 82% of mothers had care for their child terminated by the court. Mothers’ younger age, housing problems and poorer quality of life increased the odds of the child being removed. The participation of the child’s father in the proceedings was a protective factor for maintaining care of the child for those mothers that were receiving substance use treatment at the time of the proceedings. Attending treatment for substance use during the proceedings was not associated with the child placement outcome. Almost three in every four mothers involved in care proceedings was likely to reappear in a subsequent set of proceedings within ten years after the completion of the first case. Of the mothers who do return to court, 53% do so with the same child from the previous case.
 
Conclusion: Findings highlight that substance use treatment services are not designed to support mothers retain the care of their children. Understanding and addressing the range of needs of these mothers has implications for both substance use treatment and child welfare.