While many parents and caregivers involved in the child welfare system suffered trauma as children, new research suggests that those with substance misuse issues as adults may have had particularly difficult childhoods.
The study found that scores assessing childhood trauma exposure among adults with substance misuse issues were 24% higher than previous estimates for other adults in the child welfare system, and 108% higher than the general population.
Not surprisingly, children in these families also have suffered more trauma. The study found that trauma scores of children aged 6-18 in families with substance misuse issues were 27% higher than scores for children involved in the juvenile justice system.
Trauma could include emotional, physical and sexual abuse, neglect, mental illness, divorce and separation, substance misuse and other issues.
"There is a difference in risk profiles between families involved in child welfare due primarily to substance misuse and those where substance misuse was not the main issue," said Elinam Dellor, lead author of the study and senior researcher at The Ohio State University College of Social Work.
"When you add substance use to an already vulnerable sample of adults, that may help explain why these adults report higher levels of trauma exposure."
The study was published online recently in the Journal of Interpersonal Violence.
Data for the study came from two Ohio-based child welfare interventions that target families that have had issues with both mistreatment of children and substance misuse. The treatment programs are Ohio START and EPIC.
The study included 402 adults, 271 children up to 5 years of age and 177 children aged 6-18 who participated in the two intervention programs.
Both interventions require trauma screening for adults and children within 30 days of enrollment.
Adults completed the Adverse Childhood Experiences questionnaire, which asks if participants experienced any of 10 traumatic experiences before they were 18 years old, including abuse and neglect and household dysfunction.
The parents and caregivers in this study had an average score of 4.2. Research suggests that adults with scores over 4.0 are at a much greater risk for a variety of health and mental health problems later in life, including heart disease and suicide.
"In the U.S., only about 16% of people have a score over 4 on this test, so you can see that adults with substance misuse issues in the child welfare system have a high burden of trauma," Dellor said.
The children in the study were screened using a standard test similar to the one used by adults, called the CTAC Trauma Screening Checklist.
In children up to 5 years old, 90% had experienced two or more traumatic experiences, while more than half (56%) had already experienced four or more. Older children in the study had an average score of 5.6 on the trauma screening test, 27% higher than scores for kids in the juvenile justice system.
"Children who live with parents who are abusing substances tend to come in with trauma issues beyond just the initial abuse or neglect issues that brought them into the system," Dellor said. "They often have already been exposed to multiple traumatic events."
The two intervention programs that provided the samples for this study started in mostly rural southern Ohio, which means most participants are white, she said. The Ohio START program has expanded into more metro areas of the state, so future research will examine racial differences in trauma.
Dellor said one important implication of this study is the need to screen all adults and children who enter the child welfare system for trauma. That hasn't been done in most systems around the country.
"We've learned in the past 20 years or so how harmful trauma exposure is, across physical, mental and behavioral health," Dellor said.
"With so many parents scoring high for trauma, their risks for all kinds of conditions skyrocket. It is important to talk about it, to address it within the child welfare system, but also give families the tools to cope when they leave."
Co-authors on the study from Ohio State's College of Social Work were Bridget Freisthler, professor, and Susan Yoon and Alicia Bunger, associate professors. Marla Himmeger from the Public Children Services Association of Ohio was also a co-author.
The work was supported by the Administration for Children and Families, part of the U.S. Department of Health and Human Services.
