The findings of a retrospective cohort study. Jessica Roy, Bristol University

1. How is parental substance misuse
associated with child protection
threshold decisions made by social
workers? The findings of a
retrospective cohort study.
Jessica Roy
jessica.roy@bristol.ac.uk
13th April 2015

2. Outline
 Definitions and brief review of literature
 Research design and methodology
 Findings
 Discussion: Risk factors and reasoning
devices
 Looking ahead: Implications for PhD research

3. Definitions and estimates
‘Parental’ substance misuse
 Parent or carer
 Drugs or alcohol
 Threshold decisions as outcome measure
 Probabilistic NOT deterministic causation
(Palinkas, 2014)

4. Parental substance misuse: Why
does it matter?
 High prevalence of parental substance misuse in UK
(Manning et al., 2009)
 Parental substance misuse is associated with:
 Markers of child abuse (White et al., 2014)
 Poor developmental, educational and emotional
wellbeing outcomes (Forrester & Harwin 2011)
 Isolated and turbulent childhood experiences (Barnard
2007, Fraser et al., 2009, Houmoller et al., 2011)
 Causal link between parental substance misuse and poor
outcomes is unclear (Staton-Tindall et al., 2013, White et al.,
2014)

5. Research Questions
 Is parental substance misuse observed to be
associated with threshold decisions made by
social workers?
 What factors are observed to be associated
with threshold decisions made by social
workers for children living with parental
substance misuse?

6. Research Design
 Retrospective cohort study
 Clinical data mining of social work case files (Epstein
2010)
 Purposive sample of 200 children referred to rural local
authority (2012-2013)
 100 children in a ‘control cohort’ and 100 children in a
‘parental substance misuse cohort’
 Descriptive, bivariate (chi-square) and multivariate
(logistic and multinomial regression) statistical analysis

7. Findings
 Mismatched cohorts:
 Control cohort n=118/Parental substance misuse cohort n=58
 Missing data n=24
 96% children White British
 Single biggest reason for referral was domestic violence (n=70).
 No significant differences in demographic information between
two cohorts
 Children in the substance misuse cohort significantly more likely
to be exposed to domestic violence than children in the control
cohort (x2 = (1) 15.46, p< 0.01)
 Children in substance misuse cohort significantly more likely to be
referred under category of neglect than children in the control
cohort (x2= (3) 15.42, p<.01)

8. Chart showing substance of use
0
5
10
15
20
25
30
35
40
Alcohol Cannabis Heroin Cocaine Ketamine
Number
Substance

9. Chart showing threshold
decisions
0
10
20
30
40
50
60
70
80
90
100
Low Tier Medium Tier High Tier
%
Threshold decision
PSM cohort
Control
cohort

10. • No significant association between threshold
decisions and whether a child was in the
parental substance misuse cohort or not
(x2=(2)5.27, p>.05)
• Multinomial logistic regression modelling
indicated parental substance misuse did not
have predictive effect over threshold decisions
• Medium tier outcomes vs. low tier (Exp(B)
2.3, NS)
• High tier outcomes vs. low tier outcomes
(Exp(B) .78, p>.05)

11. Risk factors
 Bivariate analysis indicated following factors significantly
associated with threshold decisions:
• Category of abuse, parental capacity, child’s emotional
wellbeing, parental compliance with children’s social
care, housing, employment and gender of child (P< 0.05)
 Logistic regression indicated three factors had predictive
effect over having a high/medium tier outcome vs. case
being closed after assessment
 Category of abuse (sexual/physical) (Exp(B) 15.47, p<
0.01)
 Concerns regarding parental capacity (Exp(B) 71.77, p<
0.01)
 Gender (male) (Exp(B) 7.71, p< 0.05)

12. Limitations
 Case file research
 Missing data and incomplete assessments
 Validity and reliability of data
 Sample
 False positives/false negatives
 Breadth not depth

13. Discussion – parental substance
misuse
 Parental substance misuse not observed to have a
significant association with threshold decisions
Why?
 Other factors more significantly associated with
threshold decisions
 Methodological choices - research design, location
and sample
 Normalisation/acceptability of alcohol misuse
(Adamson & Templeton 2012, Devaney 2009,
Forrester & Harwin 2011)

14. Discussion - Risk factors or reasoning
devices?
 Risk factors congruent with ecological models of child
abuse (Belsky 1980) e.g. parental capacity, housing,
employment
 Other factors best understood within framework of
‘sense making devices’ (Platt & Turney 2013, Stanley et
al., 2011)
 Specifity (category of abuse)
 Co-operation (parental compliance)
 Operational strategies (domestic violence)

15. Implications for future study
 Substantive
 Focus on children living with parental substance
misuse
 Change of outcome measures
 Thresholds decisions and child wellbeing
 Analytical approach
 Cluster analysis
 Decision trees
 Structural Equation Modelling

16. Thank you for listening
Questions?
jessica.roy@bristol.ac.uk

17. References
 ADAMSON, J. & TEMPLETON, L. 2012. Silent Voices: supporting children and young people
affected by parental alcohol misuse. London: Office of the Children's Commissioner.
 BARNARD, M. 2007. Drug Addiction and Families, London, Jessica Kingsley Publishers.
 BELSKY, J. 1980. Child Maltreatment: An Ecological Integration. American Psychologist, 35, 15.
 DEVANEY, J. 2009. Chronic Child Abuse: The Characteristics and Careers of Children Caught in the
Child Protection System. British Journal of Social Work, 39, 24-45.
 EPSTEIN, I. 2010. Clinical data-mining : integrating practice and research, New York ; Oxford,
Oxford University Press.
 FORRESTER, D. & HARWIN, J. 2011. Parents who Misuse Drugs and Alcohol: Effective
Interventions in Social Work and Child Protection, Sussex, Wiley-Blackwell.
 FRASER, C., MCINTYRE, A. & MANBY, M. 2009. Exploring the Impact of Parental Drug/Alcohol
Problems on Children and Parents in a Midlands County in 2005/06. British Journal of Social
Work, 39, 846-866.
 HINDLEY, N., RAMCHANDANI, P. & JONES, D. 2006. Risk factors for recurrence of maltreatment: a
systematic review. Archives of Disease in Childhood, 91, 744-752.

18. References
 HOUMOLLER, K., BERNAYS, S., WILSON, S. & RHODES, T. 2011. Juggling harms: coping with
parental substance misuse. London: London School of Hygiene and Tropical Medicine.
 MANNING, V., BEST, D., FAULKNER, N. & TITHERINGTON, E. 2009. New estimates of the number of
children living with substance misusing parents: results from UK national household surveys.
British Medical Council Public Health, 9.
 PLATT, D. & TURNEY, D. 2013. Making Threshold Decisions in Child Protection: A conceptual
analysis. British Journal of Social Work, Advanced Access, 19.
 STANLEY, N., MILLER, P., RICHARDSON FOSTER, H. & THOMSON, G. 2011. A Stop–Start Response:
Social Services' Interventions with Children and Families Notified following Domestic Violence
Incidents. British Journal of Social Work, 41, 296-313.
 STATON-TINDALL, M., SPRANG, G., CLARK, J., WALKER, R. & CRAIG, C. D. 2013. Caregiver
Substance Use and Child Outcomes: A Systematic Review. Journal of Social Work Practice in the
Addictions, 13, 6-31.
 TAYLOR, A. & KROLL, B. 2004. Working with Parental Substance Misuse: Dilemmas for Practice.
British Journal of Social Work, 34, 1115-1132