Child safety decisions and parental mental health problems: A new analysis of mediating factors

Abstract

Background: Our previous study showed that parents with mental health problems or substance abuse are at increased risk of having children removed from the home, primarily due to caregiving deficits, neglect, and prenatal exposure to substances, not physical abuse.

Objective: Using a larger sample and more rigorous analysis, the present study improves and expand upon the previous study, yielding more robust explanations for why these children are at increased risk of removal.

Participants and setting: The study uses a sample of 4070 Structured Decision Making® assessments conducted by San Francisco's Child Welfare provider involving parents reported for the first time from 2007 to 2015.

Methods: Using structural equation modeling, mediation models were constructed to test the indirect effects of thirteen child safety threats on safety decision.

Results: Four threats explained 95% of the effect of mental health problems on safety decision, two of which retained significance in the final model: Failure to Meet Immediate Needs (OR = 1.26, p ≤ 0.01) and Previous Maltreatment (OR = 1.24, p ≤ 0.05). Seven safety threats explained 91% of the effect of co-occurring mental health problems and substance abuse, two of which retained significance in the final model: Failure to Meet Immediate Needs (OR = 1.78, p ≤ 0.001) and Physical Harm (Drug-Exposed Infant; OR = 1.57, p ≤ 0.001).

Conclusions: As previously shown, parental mental health problems and substance abuse are not ipso facto safety threats. Rather, unmet child needs account for much of the increased risk of child removal in this population, underscoring the importance of timely resource referrals.

Keywords: Decision-making; Mental health; Structural equation modeling; Substance abuse.