Parent substance abuse, child welfare Parent substance abuse, child welfare and children's mental health: and children's mental health:

Parent methamphetamine abuse in Parent methamphetamine abuse in rural Illinoisrural Illinois

December 13, 2006December 13, 2006

Wendy Haight, PhDWendy Haight, PhD

This research is in collaboration with the Charleston Field Office of the Illinois This research is in collaboration with the Charleston Field Office of the Illinois Department of Children and Family Services and was supported by funding from an Department of Children and Family Services and was supported by funding from an Arnold O. Beckman UIUC Research Board, and a development grant from the Arnold O. Beckman UIUC Research Board, and a development grant from the Center for Children and Family Research. Center for Children and Family Research. Co-PIs are Teresa Ostler, PhD and Co-PIs are Teresa Ostler, PhD and James Black, MD PhD, and Linda Kingery, MSW.James Black, MD PhD, and Linda Kingery, MSW.

Parent substance abuseParent substance abuse

Places strain on child welfare systemsPlaces strain on child welfare systems

One of leading causes for children’s entry into state One of leading causes for children’s entry into state care in US and Canada. care in US and Canada. ((e.g., Suchman et al., 2006)e.g., Suchman et al., 2006)

Significant obstacle to family reunification. Significant obstacle to family reunification. ((Ryan, 2006)Ryan, 2006)

Risk factor for children’s development of mental health Risk factor for children’s development of mental health and substance abuse disorders. and substance abuse disorders. ((Cretzmeyer, et a;., 2003)Cretzmeyer, et a;., 2003)

Parent abuse of illicit drugsParent abuse of illicit drugs Children may be exposed to:Children may be exposed to:

Drugs prenatally Drugs prenatally (Merikangas et al., 1996;Etz et al., 1996)(Merikangas et al., 1996;Etz et al., 1996)

Environmental risks Environmental risks (Johnson et al., 1998, Hawkins et al, 1992;Kumpfer et al., 1996)(Johnson et al., 1998, Hawkins et al, 1992;Kumpfer et al., 1996)

Compromised parenting Compromised parenting (Hawkins et al., 1992; Dishion & McMahon, 1996)(Hawkins et al., 1992; Dishion & McMahon, 1996)

Maltreatment Maltreatment (CASA, 1999)(CASA, 1999)

Stigma Stigma (Klee, 1998; Hans, 2002)(Klee, 1998; Hans, 2002)

Children whose parents abuse illicit substances are more likely Children whose parents abuse illicit substances are more likely to:to: Abuse substances Abuse substances Experience mental health problemsExperience mental health problems Drop out of schoolDrop out of school Experience early pregnancyExperience early pregnancy Become involved in criminal or other anti social behaviorBecome involved in criminal or other anti social behavior(See Cretzmeyer et al., 2003; Millar & Stermac, 2000)(See Cretzmeyer et al., 2003; Millar & Stermac, 2000)

What is methamphetamine?What is methamphetamine? Powerful, highly addictive central nervous system Powerful, highly addictive central nervous system

stimulant stimulant Less expensive and more easily available than cocaine Less expensive and more easily available than cocaine

with a much longer lasting “high.”with a much longer lasting “high.” User experiences:User experiences:

initial rush, euphoria initial rush, euphoria decreased fatigue and appetite decreased fatigue and appetite increased energy, alertness & libido increased energy, alertness & libido

““Tweaking” followed by sleep for several days.Tweaking” followed by sleep for several days. Highest rates of use occur among 20-29 year olds who Highest rates of use occur among 20-29 year olds who

often have children. often have children. (see, e.g., Anglin et al., 2000; Rawson et al., 2002; Bauer & Olson, 2006, West & Stuntz, (see, e.g., Anglin et al., 2000; Rawson et al., 2002; Bauer & Olson, 2006, West & Stuntz,

2000)2000)

Health problems to the userHealth problems to the user

““Dopamine depletion syndrome.”Dopamine depletion syndrome.” Other damage to brain Other damage to brain Severe dental problems, “meth mouth.”Severe dental problems, “meth mouth.” Secondary health damage to lungs, heart, and Secondary health damage to lungs, heart, and

kidneys may be what physically kills. kidneys may be what physically kills.

(See Anglin et al., 2000; Maxwell, 2005; Rawson et al., 2002; SAMHSA, 2002; (See Anglin et al., 2000; Maxwell, 2005; Rawson et al., 2002; SAMHSA, 2002; Thompson et al., 2004; Wermuth, 2000)Thompson et al., 2004; Wermuth, 2000)

Psychiatric effectsPsychiatric effects

Psychiatric symptoms: psychosis, depression, rapid mood Psychiatric symptoms: psychosis, depression, rapid mood changes, irritability and out-of-control rages and violent changes, irritability and out-of-control rages and violent behavior. behavior.

Psychotic symptoms may persists for months or years after use Psychotic symptoms may persists for months or years after use has ceased.has ceased.

Interpersonal violence extensive. PTSDInterpersonal violence extensive. PTSD

(Anglin et al., 2000; Cohen et al., 2005; Cretzmeyer et al., 2003; McGregor et al, 2005; (Anglin et al., 2000; Cohen et al., 2005; Cretzmeyer et al., 2003; McGregor et al, 2005; SAMHSA, 2002 )SAMHSA, 2002 )

Why are we concerned about parent Why are we concerned about parent abuse of methamphetamine per se?abuse of methamphetamine per se?

Characteristics of methamphetamine:Characteristics of methamphetamine: highly addictive highly addictive parents rapidly disabled both physically & mentallyparents rapidly disabled both physically & mentally

Produced in and around home.Produced in and around home. Long term separation from parents who are Long term separation from parents who are

serving long prison terms, ill or dead.serving long prison terms, ill or dead. Rural problem: Assess and cultural issuesRural problem: Assess and cultural issues Urgent and growing problem in the USUrgent and growing problem in the US

Mixed methods researchMixed methods research What are the contexts in What are the contexts in

which children whose parents which children whose parents abuse methamphetamine are abuse methamphetamine are reared?reared?

How are children doing How are children doing psychologically?psychologically?

What are the implications for What are the implications for intervention?intervention?

How effective is intervention?How effective is intervention?

East central IllinoisEast central Illinois

East central IllinoisEast central Illinois

Rural: Covers 3,492 square miles, pop 160,284Rural: Covers 3,492 square miles, pop 160,284 Ethnically homogeneous. 95% white.Ethnically homogeneous. 95% white. Working class: Median yearly income range from Working class: Median yearly income range from

$37,313 - $40,084.$37,313 - $40,084. Percentage population graduated from college ranges Percentage population graduated from college ranges

from 10% - 21%.from 10% - 21%. Facing a serious and growing drug problem.Facing a serious and growing drug problem. Growing pessimism and fear in community.Growing pessimism and fear in community. Response: increase penalties, decrease access to Response: increase penalties, decrease access to

precursors.precursors.

ParticipantsParticipants DCFS professionals in CFO. (18 )DCFS professionals in CFO. (18 )

Other knowledgeable community professionals: Other knowledgeable community professionals: educators, law enforcement, substance abuse educators, law enforcement, substance abuse treatment providers (10 )treatment providers (10 )Caregivers (foster parents, extended family Caregivers (foster parents, extended family members, meth abusing parents) (10)members, meth abusing parents) (10)Children (22)Children (22)

ProceduresProcedures

Interviews: Interviews: adults and childrenadults and children Standardized assessments Standardized assessments of children’s of children’s

development, behavior, experience of trauma development, behavior, experience of trauma and attitudes towards substance abuse. and attitudes towards substance abuse.

Participant observationParticipant observation of DCFS of DCFS investigations and supervision, court cases. investigations and supervision, court cases.

Record reviewRecord review of newspaper articles and of newspaper articles and other documentation of meth abuse in rural IL.other documentation of meth abuse in rural IL.

ResultsResultsCommon Experiences of children Common Experiences of children

Perspectives of adults and childrenPerspectives of adults and children

Exposure to criminalityExposure to criminality

Exposure to violenceExposure to violence

Exposure to adult substance abuseExposure to adult substance abuse

Violence intertwined with substance abuseViolence intertwined with substance abuse

Common Experiences of ChildrenCommon Experiences of ChildrenAdult perspectivesAdult perspectives

Environmental danger, chaosEnvironmental danger, chaos

NeglectNeglect

AbuseAbuse

Common Experiences of ChildrenCommon Experiences of Children Child perspectivesChild perspectives

Separation/LossSeparation/Loss

How are the children doing psychologically?How are the children doing psychologically?(Standardized assessments)(Standardized assessments)

Range of scores on the PPVT, but mostly Range of scores on the PPVT, but mostly average.average.

65% of children evidenced a pattern of trauma 65% of children evidenced a pattern of trauma symptoms. (TSCC, CBCL)symptoms. (TSCC, CBCL)

57% other emotional and behavioral problems 57% other emotional and behavioral problems (CBCL).(CBCL).

How are the children doing psychologically?How are the children doing psychologically?(Child report)(Child report)

Emotional pain in relation to familyEmotional pain in relation to family Few social resources for coping with emotional Few social resources for coping with emotional

painpain Passive strategies for copingPassive strategies for coping Talking about parents’ meth abuse is taboo.Talking about parents’ meth abuse is taboo.

Individual variation in children’s Individual variation in children’s experiences, perspectives experiences, perspectives

& mental health functioning& mental health functioning

Knowledge about methamphetamine.Knowledge about methamphetamine. Stances towards parents’ antisocial behaviorStances towards parents’ antisocial behavior Stances towards child welfare and legal Stances towards child welfare and legal

intervention: e.g., Denial, defiance, rejection of intervention: e.g., Denial, defiance, rejection of parents, sad/conflicted.parents, sad/conflicted.

Mental health functioningMental health functioning

Protective factors that may buffer children’s Protective factors that may buffer children’s experience of parent methamphetamine abuseexperience of parent methamphetamine abuse

Child’s age when parent becomes disabledChild’s age when parent becomes disabled Family resourcesFamily resources Community resourcesCommunity resources

Leadership roles for social workers Leadership roles for social workers

Help parents get into treatment.Help parents get into treatment.

Recruit and educate foster care parents.Recruit and educate foster care parents.

Develop, implement and assess mental health Develop, implement and assess mental health services targeted at children of meth abusers. services targeted at children of meth abusers.

Life story intervention for rural childrenLife story intervention for rural childrenChild componentChild component

Primacy of the relationship.Primacy of the relationship. Telling the story. Telling the story. Termination and transition to relationships with other, Termination and transition to relationships with other,

supportive adults or therapist.supportive adults or therapist.

Foster parent componentFoster parent component Support from foster parent is necessary.Support from foster parent is necessary. Regular contact and communication.Regular contact and communication. Psycho education as needed.Psycho education as needed.

Assessing life story therapyAssessing life story therapy

School –aged children entering foster care School –aged children entering foster care because of parent methamphetamine abuse.because of parent methamphetamine abuse.

Longitudinal, experimental design (cross-over or Longitudinal, experimental design (cross-over or wait list design).wait list design).

Intervention and wait list control groups.Intervention and wait list control groups. Assessed at 3 time points over one year period Assessed at 3 time points over one year period

using standardized assessments and clinical using standardized assessments and clinical interviews; and throughout intervention.interviews; and throughout intervention.

ReferencesReferences Black, J., Haight, W. & Ostler, T. (in press). Mental health Black, J., Haight, W. & Ostler, T. (in press). Mental health

issues of children of methamphetamine abusers. issues of children of methamphetamine abusers. Psychiatric Psychiatric Times.Times.

Haight, W., Ostler, T., Black, et al. (2006). A child’s eye view of Haight, W., Ostler, T., Black, et al. (2006). A child’s eye view of parent methamphetamine abuse: Implications for helping foster parent methamphetamine abuse: Implications for helping foster families to succeed. families to succeed. Children and Youth Services Review. Children and Youth Services Review. (Available on line)(Available on line)

Haight, W., Jacobsen, T., Black, et al. (2005). “In these bleak Haight, W., Jacobsen, T., Black, et al. (2005). “In these bleak days:” Parent methamphetamine abuse and child welfare in the days:” Parent methamphetamine abuse and child welfare in the rural Midwest. rural Midwest. Children and Youth Services Review, 27Children and Youth Services Review, 27, 949-, 949-971. 971. (Also available on line)(Also available on line)

Ostler, T., Haight , W. & Black, J., et al. (in press) Mental health Ostler, T., Haight , W. & Black, J., et al. (in press) Mental health needs and perspectives of rural children reared by parents who needs and perspectives of rural children reared by parents who abuse methamphetamine. abuse methamphetamine. Journal of American Academy of Journal of American Academy of Child and Adolescent Psychiatry.Child and Adolescent Psychiatry.

Questions or comments?Questions or comments?