Identification of Domestic Violence Service Needs Among Child Welfare–Involved Parents With Substance Use Disorders: A Gender-Stratified Analysis

Abstract

The current study examined the prevalence and associations of a need for domestic violence services among child welfare–involved mothers and fathers with substance use disorders. Data were drawn from 2,231 child welfare–involved parents in Illinois with an identified substance use disorder. Approximately 42% of mothers and 33% of fathers with a substance use disorder had a concurrent need for domestic violence services. The sample was stratified by gender and logistic regression models were fit to determine the adjusted odds of an identified need for domestic violence services. For both mothers and fathers, the strongest association was an additional need for mental health services. Age, education status, alcohol use, marijuana use, and a reported history of physical violence victimization were also associated with a need for domestic violence services among mothers, while race, age, marital status, annual income, alcohol use, cocaine use, and a reported history of physical violence perpetration were associated with a need for domestic violence services among fathers. The findings of this study make clear that domestic violence is a commonly co-occurring service need for child welfare–involved parents with identified substance use disorders, and that associations with this need vary by gender.

Keywords

drugs and alcohol intimate partner violence child welfare gender differences co-occurring service needs

Introduction

Attention is increasingly being paid to the complex, co-occurring service needs of child welfare–involved families (Simon & Brooks, 2017). Recognizing that problems rarely occur in isolation, scholars have attempted to identify the patterns and prevalence of co-occurring needs for mothers and fathers at various stages of child welfare practice (Flanagan, Sullivan, & Connell, 2015; Jarpe-Ratner, Bellamy, Yang, & Smithgall, 2015). This research can help child welfare workers anticipate specialized service needs and build capacity to link families with tailored interventions.

Considering issues of co-occurrence is particularly important with respect to parental substance misuse and adult domestic violence, defined here as a pattern of abuse designed to maintain power and control over an intimate partner. Parental substance use can impair parenting capacity (Barnard & McKeganey, 2004; Famularo, Kinscherff, & Fenton, 1992; Osborne & Berger, 2009) and has frequently been associated with child neglect (Besinger, Garland, Litrownik, & Landsverk, 1999). This behavior has also been consistently associated with poorer foster care outcomes including reduced rates of family reunification and higher rates of reentry (Brook & McDonald, 2009; Brook, McDonald, Gregoire, Press, & Hindman, 2010; Mowbray, Victor, Ryan, Moore, & Perron, 2017). Modest improvements in these outcomes are observed when parents are connected with treatment for substance misuse (Choi, Huang, & Ryan, 2012; Ryan, Perron, Moore, Victor, & Park, 2017). However, certain co-occurring problems—including domestic violence—have the potential to complicate substance use treatment and thereby temper the sought-after improvement in outcomes (Choi & Ryan, 2006).

A considerable body of evidence indicates that domestic violence frequently co-occurs with parental substance misuse and can detrimentally affect substance use treatment (Dong et al., 2004; Murphy & O’Farrell, 1994; Rice et al., 2001; Walton, Chermack, & Blow, 2002). Reported rates of past-year physical domestic violence among those seeking treatment for substance misuse have ranged from 40% to 60% (Chermack, Fuller, & Blow, 2000; Chermack et al., 2008; O’Farrell & Murphy, 1995). In terms of impact on substance use treatment, women who are victims of domestic violence are more likely to drop out of substance use treatment programs, while men who perpetrate domestic violence are more likely to relapse (Lipsky et al., 2010). Substance misuse has also been associated with treatment dropout among men and women enrolled in batterer intervention programs (Dalton, 2001; Jewell & Wormith, 2010). In recognition of the detrimental impact that domestic violence can have, practitioners and researchers have sought innovations to mitigate these effects, including the integration of violence interventions into substance use treatment (Chermack et al., 2017; Easton et al., 2007; Stover, Carlson, & Patel, 2017).

Prior studies have identified associations of domestic violence among those seeking substance use treatment to help providers identify and respond to these co-occurring issues (Chase, O’Farrell, Murphy, Fals-Stewart, & Murphy, 2003; Chermack, Walton, Fuller, & Blow, 2001). However, no research to date has examined these associations in parents involved with the child welfare system. This gap in research limits our understanding of domestic violence service needs among child welfare–involved parents with substance use disorders. Failure to account for domestic violence may in turn interfere with the efficacy of substance use treatment, and limit the impact of treatment toward improving child welfare outcomes.

Background

Complex Service Needs of Child Welfare–Involved Families

A number of studies have used person-centered analysis (e.g., latent class analysis) to assess patterns of co-occurring needs in child welfare–involved families (Flanagan et al., 2015; Kohl & Macy, 2008). When focusing on parents with children in foster care, substance misuse emerges as a common service need that often co-occurs with domestic violence and mental health issues. For instance, Jarpe-Ratner et al. (2015) examined assessment data collected from 4,089 families (3,847 mothers, 2,521 fathers) at intake into foster care to classify parents based on similar needs profiles including mental health, substance misuse, and domestic violence (no distinction made between perpetration and victimization). The largest class of mothers (40% of the sample) was characterized by high rates of substance misuse (53%) and mental health needs (46%), along with moderate rates of domestic violence (31%). When assessing for co-occurring needs among fathers, the largest class (48% of the sample) was characterized by low levels of service needs, while the second largest class (30% of the sample) was distinguished by high rates of substance misuse (86%) and moderate rates of domestic violence (39%) and mental health needs (25%). Thus, co-occurring substance misuse, domestic violence, and mental health needs were prevalent for both men and women seeking to be reunified with their children placed in foster care.

Associations of Domestic Violence Among Those With Substance Use Disorders

Associations of domestic violence have not been examined specifically among child welfare–involved parents with substance use disorders. However, prior research has assessed for these associations in individuals at large who are seeking substance use treatment. Sociodemographic and behavioral factors such as age, race, socioeconomic status, mental health, and substance misuse (substance, frequency, and severity) have consistently been associated with domestic violence victimization and perpetration in those seeking treatment for substance misuse with some important gender differences. For example, Chermack et al. (2001) found that younger age and more frequent use of cocaine were associated with both domestic violence perpetration and victimization, while more frequent use of marijuana was predictive only of perpetration. Race interacted with domestic violence severity, as non-White participants were more likely than White participants to report either no violence or severe violence. Meanwhile, women consistently reported higher levels of psychological distress than men within the subgroups of those who perpetrated violence and those who were victimized. Chase et al. (2003) examined associations of domestic violence in a sample of 103 women seeking couples-based treatment for alcohol. Based on self-reports from these women, the authors found that lower annual income and levels of education were associated with women’s use of physical violence against their male partners, while more frequent alcohol use by men was linked to men’s use of physical violence against their female partners.

It should be noted that the primary instrument for measuring domestic violence in these correlational studies was the original Conflict Tactics Scale (CTS; Straus, 1979). The result of using the CTS is that domestic violence is operationalized as individual acts of physical aggression, a more limited definition than conceptualizing domestic violence as a pattern of abuse over time designed to obtain coercive control (Johnson, 2005; Stark, 2007). That is, the original version of the CTS focuses exclusively on discrete incidents of physical violence and does not account for forms of psychological, sexual, and financial abuse, and the coercive use of children that are now commonly included within more expansive definitions of domestic violence (Beeble, Bybee, & Sullivan, 2007; Cook & Goodman, 2006; O’Leary, 1999; Stark, 2007). Scholars have also noted additional limitations of relying on the CTS, including an inability to identify the context and motivations of violence that often vary by gender (DeKeseredy & Schwartz, 1998; Kernsmith, 2005; Kimmel, 2002).

The Current Study

The current study focuses on a caseworker-perceived need for domestic violence services among child welfare–involved parents with identified substance use disorders. This approach goes beyond identifying discrete incidents of physical violence and operationalizes domestic violence using a definition that includes coercive control and multiple forms of abuse. The two objectives of this study are to (a) estimate rates of domestic violence service needs among child welfare parents with substance use disorders and (b) identify gender-specific associations of domestic violence service needs among child welfare parents with substance use disorders. The sociodemographic and behavioral associations examined were selected based on the prior research and a consideration of the information that is likely to be available to child welfare workers as they engage in service planning.

Method

The current study uses a subset of data from a Title IV-E waiver demonstration project in Illinois that provides recovery coaches to child welfare–involved parents with an identified substance use disorder (see Ryan, Choi, Hong, Hernandez, & Larrison, 2008, for a detailed overview). First authorized by Congress in 1994 (Public Law 103-432), Title IV-E waivers permit states to use federal funding to test innovations in the delivery of child welfare services (Murray & Gesiriech, 2004). These demonstration projects are authorized by the Children’s Bureau (part of the U.S. Department of Health and Human Services) and require rigorous evaluation and cost neutrality, meaning the expenses of the project cannot exceed the level of funding allocated for services as usual.

For the demonstration project in the current study, the state of Illinois sought a Title-IV E waiver to test the ability of a recovery coach model to improve child welfare outcomes for families in which at least one parent had an identified substance use disorder. Recovery coaches serve as specialized case managers who use comprehensive clinical assessments, advocacy, service planning, and outreach to help keep parents engaged in substance use treatment and improve child welfare outcomes. Recovery coaches work with parents in the family homes, serve as providers at treatment agencies, and accompany child welfare caseworkers and substance abuse treatment staff on home visits.

The sample includes custodial parents who were assigned to the treatment group and provided a recovery coach on or after April 28, 2000 in Chicago and suburban Cook County. To be eligible for assignment, parents were required to (a) have a child removed from the home by child protective services, (b) be classified as being in need of substance misuse services based on the criteria established by the American Society of Addiction Medicine (ASAM; Mee-Lee, 2013), and (c) not currently be in receipt of services for substance misuse. Eligibility was determined by the Juvenile Court Assessment Project (JCAP) where juvenile court judges or child welfare caseworkers refer parents suspected of substance use at the time of their temporary custody hearing or at any time within 90 days of the hearing. JCAP employs certified clinicians who carry out the necessary screenings to determine if a parent meets criteria for a recommendation of substance misuse treatment using ASAM guidelines. Under ASAM guidelines, those who meet the diagnostic criteria for a substance use disorder are assigned to one the following four levels of care: outpatient, intensive outpatient and partial hospitalization, medically monitored inpatient (residential treatment), and medically managed intensive inpatient treatment (O’Toole et al., 2004).

Data Sources

The current study utilizes two sets of administrative records compiled for the demonstration project. First, information collected during the initial JCAP assessment provides records related to demographic and family characteristics at the time of first screening. JCAP records also provide detailed information on parents’ substance use including type, frequency, and amount collected by self-report to trained interviewers. The second set of records is drawn from the Treatment Record and Continuing Care System (TRACCS) developed for the demonstration project. Measures of co-occurring problems and matched services are taken from the recovery coaches’ TRACCS reports that were completed during monthly meetings with assigned parents. At these meetings, recovery coaches screen for a number of service needs including legal services, transportation, housing, child care, domestic violence services, and mental health services, and then record whether parents have received services for an identified need.

Sample

To be included in the study sample, parents were required to (a) be screened for eligibility in the Title IV-E demonstration project from April 2000 through December 2014, (b) be assigned to the treatment group of the project, and (c) have at least one TRACCS form completed, as this was the administrative record containing information related to service needs. Of the 2,479 parents assigned to the treatment group during the observation period, TRACCS forms were available for 2,231 parents (90% of those eligible).

Measures

Domestic violence service need

The primary variable of interest in this study, domestic violence service need, reflects whether a recovery coach identified a parental need for domestic violence services—related to either victimization or perpetration—during monthly meetings. The Illinois Department of Children and Family Services (2010), referencing Ganley and Schechter (1996), defines domestic violence in its child protective services manual as “the establishment of power and control through a pattern of coercive behaviors that include physical, sexual, verbal, and emotional assaults perpetrated by one intimate partner against another.” This definition was operationalized for recovery coaches through the development of a screening tool to identify domestic violence and determine whether a current need for services was present. The screening tool—developed by the Department—included a set of nine indicators of a potential need for domestic violence services including (a) self-reported incident of domestic violence, (b) third-party reports of domestic violence, (c) visible physical injuries (e.g., black eye, bruises), (d) observation that one partner seeks to control everything (e.g., always answers questions addressed to other partner), (e) property damage in the home (e.g., phone ripped from wall, holes punched in wall), (f) use of the children by one partner to control the actions of the other, (g) prior or current police involvement for domestic violence, (h) an existing order of protection, and/or (i) a history of receiving domestic violence services. If any of these indicators were present then the recovery coach was instructed to directly ask a set of four questions related to social isolation, threats, physical violence, and use of children (e.g., “Has your partner ever tried to keep you away from your family, friends, work or neighbors?”; “Has your partner ever threatened to use the children to control you in any way?”).

Recovery coaches—in consultation with their supervisors—used the information gathered from the screening tool to determine the presence or absence of a need for domestic violence services. Domestic violence service need was coded dichotomously for this study (present or absent). Recovery coaches did not distinguish between a perceived need for perpetration-based services (e.g., batterer intervention) or victim-based services (e.g., survivor advocacy). This limitation is reviewed in the “Discussion” section of this article.

Mental health service need

Mental health service need was coded dichotomously (present or absent). Evidence of active psychosis or suicidality was an immediate indicator of a mental health service need. Otherwise, recovery coaches indicated such a need when a parent reported both distress and impairment in functioning related to thoughts and/or emotions. Mental health service need was included in the current study due to substantial literature on the association of mental health issues with both substance use (Kessler, Chiu, Demler, & Walters, 2005; Regier et al., 1990) and domestic violence (Shorey, Febres, Brasfield, & Stuart, 2012; Tolman & Rosen, 2001; Trevillion, Oram, Feder, & Howard, 2012), along with the high rates of co-occurrence described earlier.

Reported substance use

Recovery coaches asked participants about their drug use during each monthly meeting. Binary variables were constructed to indicate whether or not the parent reported use of each of the following substances (yes or no) at some point after enrollment in the demonstration project: alcohol, cocaine, marijuana, and opioids.

Reported history of violence

Parents were asked at intake to report a lifetime history of physical violence victimization and/or perpetration. The item for victimization read, “Have you ever experienced anyone being violent toward you?” and the item for perpetration read, “Have you ever been violent toward another person?” No distinction was made based on the parent’s relationship to the perpetrator or victim. Reported history of violence was coded as one of four values: perpetration only, victimization only, both perpetration and victimization, or no history of perpetration or victimization.

Parent sociodemographics

Parents’ sociodemographics were drawn from the JCAP assessment forms completed at the time of intake. These include gender (male or female), race (Black, White, Hispanic, or parents of another race), age at intake to the demonstration project, and education level (less than high school, high school or general education diploma [GED], and post–high school education). Marital status was coded as never married, currently married, or formerly married, with the latter consisting of both divorced and widowed parents due to small cell sizes. Annual income was recorded in an interval format on the JCAP intake assessments as one of three categories: less than US$7,401, US$7,401 to US$19,644, and more than US$19,644. Due to small cell sizes, the intervals US$7,401 to US$19,644 and more than US$19,644 were collapsed into a single category and the income variable was dichotomized as greater or less than US$7,400.

Analytic Plan

Initial analyses used univariate and bivariate statistics to examine the distribution of sociodemographic and service need variables by gender. Bivariate analyses were conducted using chi-square and t tests to assess for differences between parents with an identified need for domestic violence services and those without a need for such services. Effect sizes were then derived to assess the strength of significant bivariate associations using Cohen’s (1988) heuristics (0.10 = small effect, 0.30 = medium effect, 0.50 = large effect). Logistic regression models were then fit to determine adjusted odds of being identified by a recovery coach as in need of domestic violence services. All data cleaning and analysis was conducted in the statistical programming language R (R Core Team, 2016).

Results

Summary Statistics

A summary of parents’ sociodemographic and service need characteristics is presented in Table 1. Women comprised approximately two thirds (64%) of the overall sample, and a similar proportion identified their race as Black (68%). The mean age for parents was 32.7 years with a range from 17.1 to 65.8. Slightly more than half of parents (52%) did not complete high school, and 74% of parents reported never having been married. A considerable share (88%) indicated annual income of less than US$7,400 when asked during intake into the demonstration project. A third of parents were identified as having a concurrent need for mental health services, while more than two thirds (67%) reported no history of physical violence perpetration or victimization. Alcohol (57%) and cocaine (55%) were the most frequently used substances.

Table 1.

Summary Statistics for Parents With Substance Use Disorders.

Variable	OverallN = 2,231N (%)	MenN = 802N (%)	WomenN = 1,426N (%)	Test Statistic
Race
Black	1,505 (67.5)	548 (68.3)	957 (67.2)	χ²(df = 3) = 22.2* V = 0.09
White	475 (21.3)	140 (17.5)	333 (23.4)
Hispanic	188 (8.4)	92 (11.5)	96 (6.7)
Other	61 (2.7)	114 (14.2)	39 (2.7)
Age M (SD)	32.7 (8.5)	35.1 (9.9)	31.4 (7.3)	t = −9.1 (df = 1301)* d = 0.43
Marital status
Never married	1,647 (74.0)	554 (69.1)	1,092 (76.8)	χ²(df = 2) = 16.3* V = 0.09
Currently married	256 (11.5)	112 (14.0)	143 (10.1)
Formerly married	322 (14.5)	136 (17.0)	186 (13.1)
Annual income
Less than US$7,401	1,931 (87.9)	621 (78.5)	1,309 (93.3)	χ²(df = 2) = 103.2* V = 0.22
More than US$7,400	265 (12.1)	170 (21.5)	94 (6.7)	χ²(df = 2) = 103.2* V = 0.22
Education level
Less than HS	1,154 (52.1)	370 (46.4)	782 (55.2)	χ²(df = 2) = 25.6* V = 0.11
High school/GED	786 (35.5)	338 (42.4)	448 (31.6)
Post-HS education	277 (12.5)	90 (11.3)	186 (13.1)
Reported use of
Alcohol
No	950 (43.4)	302 (37.7)	647 (45.4)	χ²(df = 1) = 12.3* V = 0.07
Yes	1,280 (57.4)	500 (62.3)	778 (54.6)	χ²(df = 1) = 12.3* V = 0.07
Cocaine
No	1,006 (45.1)	477 (59.5)	527 (37.0)	χ²(df = 1) = 104.0*
Yes	1,224 (54.9)	325 (40.5)	898 (63.0)	V = 0.22
Marijuana
No	1,013 (45.4)	302 (37.7)	710 (49.8)	χ²(df = 1) = 30.2* V = 0.12
Yes	1,217 (54.6)	500 (62.3)	715 (50.2)	χ²(df = 1) = 30.2* V = 0.12
Opioids
No	1,476 (66.6)	580 (72.3)	896 (62.8)	χ²(df = 1) = 20.2*
Yes	754 (33.8)	222 (27.7)	530 (37.2)	V = 0.09
Reported history of physical violence
No violence	1,466 (69.2)	581 (76.6)	884 (65.2)	χ²(df = 3) = 116.6* V = 0.23
Victimization only	408 (19.3)	62 (8.2)	345 (25.4)
Perpetration only	106 (5.0)	66 (8.7)	40 (2.9)
Both	137 (6.5)	49 (6.5)	87 (6.4)
Mental health service need
No	1,485 (66.6)	650 (81.0)	835 (58.6)	χ²(df = 1) = 115.8* V = 0.23
Yes	746 (33.4)	152 (19.0)	591 (41.4)	χ²(df = 1) = 115.8* V = 0.23
Domestic violence service need
No	1,378 (61.8)	834 (67.6)	834 (58.5)	χ²(df = 1) = 17.6* V = 0.09
Yes	853 (38.2)	592 (32.4)	592 (41.5)	χ²(df = 1) = 17.6* V = 0.09

Note. Bolded effects sizes are those that meet Cohen’s (1988) threshold for a small effect (i.e., effect size ≥ .10). V = Cramer’s V; d = Cohen’s d; GED = General Education Development.

p < .05.

Men and women differed from one another across all variables, although not all effect sizes reached the threshold of 0.10 (see Table 1). The strongest effect was observed on age (d = 0.43), with women 3.7 years younger than men on average. Women reported lower levels of annual income (V = 0.11), were more likely to be identified as in need of mental health services (V = 0.23), and were overrepresented among those who did not finish high school (V = 0.11). In terms of reported history of physical violence (V = 0.23), men more often reported perpetration only, and women more often reported victimization only. Men were more likely to report marijuana use (V = 0.12), while women were more likely to report cocaine use (V = 0.22).

Comparison of Need for Domestic Violence Servicesby Gender

Differences between those with an identified need for domestic violence services and those without such a need are presented in Table 2, stratified by gender. At the bivariate level, men with an identified need for domestic violence services were more often white and Hispanic (V = 0.14) and more likely to have an additional need for mental health services (V = 0.21). Men with domestic violence service needs were also more likely to report a history of either physical violence perpetration alone, or both perpetration and victimization (V = 0.15) than men without a need for domestic violence services. Women were overrepresented among those with a need for domestic violence services if they were younger (d = 0.18), had an additional need for mental health services (V = 0.27), and/or reported a history of physical violence victimization or both perpetration and victimization (V = 0.21).

Table 2.

Comparison of Identified Need for Domestic Violence Services by Gender.

Variable	Men		Test Statistic	Women		Test Statistic
	Identified Domestic Violence Service Need			Identified Domestic Violence Service Need
	No(N = 542)N (%)	Yes(N = 260)N (%)		No(N = 834)N (%)	Yes(N = 592)N (%)
Race
Black	394 (72.7)	154 (59.2)	χ²(df = 3) = 14.7* V = 0.14	586 (70.3)	371 (62.7)	χ²(df = 2) = 9.8* V = 0.08
White	82 (15.1)	58 (22.3)		173 (20.8)	160 (27.0)
Hispanic	53 (9.8)	39 (15.0)		54 (6.5)	42 (7.1)
Other	13 (2.4)	9 (3.5)		20 (2.4)	19 (3.2)
Age M (SD)	35.5 (10.3)	34.2 (8.9)	t = 1.8 (df = 580)	32.0 (7.4)	30.7 (7.1)	t = 3.4 (df = 1297)* d = 0.18
Marital status
Never married	384 (70.8)	170 (65.4)	χ²(df = 2) = 6.5* V = 0.09	658 (79.4)	434 (73.3)	χ²(df = 2) = 7.4* V = 0.07
Currently married	64 (11.8)	48 (16.2)		72 (8.7)	71 (12.0)
Formerly married	94 (17.3)	42 (18.5)		99 (11.9)	87 (14.7)
Annual income
Less than US$7,401	433 (80.8)	188 (73.7)	χ²(df = 2) = 4.7* V = 0.08	765 (93.6)	544 (92.8)	χ²(df = 2) = 0.2
More than US$7,400	103 (19.2)	67 (26.3)	χ²(df = 2) = 4.7* V = 0.08	52 (6.4)	42 (7.2)	χ²(df = 2) = 0.2
Education level
Less than HS	250 (46.4)	120 (46.3)	χ²(df = 2) = 0.0	447 (53.9)	335 (57.1)	χ²(df = 2) = 2.1
High school/GED	228 (42.3)	110 (42.5)		265 (32.0)	183 (31.2)
Post-HS education	61 (11.3)	29 (11.2)		117 (14.1)	69 (11.8)
Reported use of
Alcohol
No	227 (41.9)	75 (28.8)	χ²(df = 1) = 12.2* V = 0.12	404 (48.5)	243 (41.0)	χ²(df = 1) = 7.5* V = 0.07
Yes	315 (58.1)	185 (71.2)	χ²(df = 1) = 12.2* V = 0.12	429 (51.5)	349 (59.0)	χ²(df = 1) = 7.5* V = 0.07
Cocaine
No	340 (62.7)	137 (52.7)	χ²(df = 1) = 6.9* V = 0.09	310 (37.2)	217 (36.7)	χ²(df = 1) = 0.0
Yes	202 (37.3)	123 (47.3)	χ²(df = 1) = 6.9* V = 0.09	523 (62.8)	375 (63.3)	χ²(df = 1) = 0.0
Marijuana
No	207 (38.2)	95 (36.5)	χ²(df = 1) = 0.1	451 (54.1)	259 (43.8)	χ²(df = 1) = 14.5* V = 0.10
Yes	335 (61.8)	165 (63.5)	χ²(df = 1) = 0.1	382 (45.9)	333 (56.2)	χ²(df = 1) = 14.5* V = 0.10
Opioids
No	397 (73.2)	183 (70.4)	χ²(df = 1) = 0.6	518 (62.1)	378 (63.9)	χ²(df = 1) = 0.4
Yes	145 (26.8)	77 (29.6)	χ²(df = 1) = 0.6	316 (37.9)	378 (63.9)	214 (36.1)
Mental health service need
No	471 (86.9)	179 (68.8)	χ²(df = 1) = 36.1* V = 0.21	581 (69.7)	254 (42.9)	χ²(df = 1) = 101.0* V = 0.27
Yes	71 (13.1)	81 (31.2)	χ²(df = 1) = 36.1* V = 0.21	253 (30.3)	338 (57.1)	χ²(df = 1) = 101.0* V = 0.27
Reported history of physical violence
No violence	418 (80.9)	163 (67.6)	χ²(df = 3) = 17.5* V = 0.15	577 (72.6)	307 (58.3)	χ²(df = 3) = 58.6* V = 0.21
Victimization only	38 (7.4)	24 (10.0)		161 (20.3)	184 (32.8)
Perpetration only	34 (6.6)	32 (13.3)		27 (3.4)	13 (2.3)
Both	27 (5.2)	22 (9.1)		30 (3.8)	57 (10.2)

Note. Bolded effects sizes are those that meet Cohen’s (1988) threshold for a small effect (i.e., effect size ≥ .10). V = Cramer’s V; d = Cohen’s d; GED = General Education Development.

p < .05.

Multivariate Logistic Regression Models

Table 3 provides a summary of the logistic regression models used to test the association between study variables and an identified need for domestic violence services. With the exception of age and an identified mental health need, men and women differed across each of the sociodemographic and behavioral associations examined. Marital status, income, alcohol use, cocaine use, and physical violence perpetration were associated with a domestic violence service need for men, while education, marijuana use, and physical violence victimization were associated with a domestic violence service need for women.

Table 3.

Adjusted Odds of an Identified Need for Domestic Violence Services.

Variable	Men		Women
Variable	Adjusted OR	95% CI	Adjusted OR	95% CI
Race
Black	Ref	—	Ref	—
White	1.07	[0.66, 1.71]	0.99	[0.73, 1.35]
Hispanic	1.66	[0.99, 2.76]	1.08	[0.67, 1.73]
Other	1.81	[0.64, 4.80]	1.19	[0.58, 2.42]
Age	0.97	[0.95, 0.99]	0.97	[0.96, 0.99]
Marital status
Never married	Ref	—	Ref	—
Currently married	1.98	[1.22, 3.19]	1.49	[0.99, 2.25]
Formerly married	0.96	[0.57, 1.59]	1.31	[0.91, 1.88]
Annual income
Less than US$7,401	Ref	—	Ref	—
More than US$7,400	1.63	[1.09, 2.42]	1.01	[0.62, 1.64]
Education level
Less than HS	Ref	—	Ref	—
High school/GED	0.90	[0.62, 1.28]	0.89	[0.68, 1.16]
Post-HS education	0.98	[0.56, 1.71]	0.67	[0.46, 0.98]
Reported use of
Alcohol
No	Ref	—	Ref	—
Yes	1.97	[1.37, 2.87]	1.27	[0.99, 1.65]
Cocaine
No	Ref	—	Ref	—
Yes	1.52	[1.07, 2.18]	1.18	[0.90, 1.54]
Marijuana
No	Ref	—	Ref	—
Yes	1.05	[0.72, 1.54]	1.31	[1.01, 1.69]
Opioids
No	Ref	—	Ref	—
Yes	1.11	[0.75, 1.64]	1.08	[0.84, 1.39]
Mental health service need
No	Ref	—	Ref	—
Yes	2.64	[1.76, 3.97]	2.50	[1.97, 3.19]
Reported history of physical violence
No violence	Ref	—	Ref	—
Victimization only	1.39	[0.75, 2.51]	1.86	[1.42, 2.45]
Perpetration only	1.90	[1.08, 3.34]	0.73	[0.35, 1.46]
Both	1.57	[0.80, 3.03]	2.45	[1.49, 4.11]

Note. Bold values represent a p < .05 as determined by a 95% confidence interval that does not include 1. GED = General Education Development. OR = odds ratio; CI = confidence interval.

Men

When compared with men who had never married, currently married men were more likely to be identified as in need of domestic violence services, Adjusted odds ratio (AOR) = 1.98, 95% confidence interval (CI) = [1.22, 3.19], as were those men with an annual income greater than US$7,400 (AOR = 1.63, 95% CI = [1.09, 2.42]). Identification of a concurrent need for mental health services for men was associated with nearly 3 times the odds of being identified as in need of domestic violence services (AOR = 2.64, 95% CI = [1.76, 3.97]). A reported history of physical violence perpetration was associated with nearly twice the odds of an identified need for domestic violence services (AOR = 1.90, 95% CI = [1.08, 3.34]). Men who reported alcohol use (AOR = 1.97, 95% CI = [1.37, 2.87]) and cocaine use (AOR = 1.52, 95% CI = [1.07, 2.18]) were also more likely to have an identified need for domestic violence services.

Women

Older women were less likely to be identified by a recovery coach as in need of domestic violence services (AOR = 0.97, 95% CI = [0.96, 0.99]), as were women with some education beyond high school (AOR = 0.67, 95% CI = [0.46, 0.98]). The odds of being identified as in need of domestic violence services were also greater for women with a concurrent need for mental health services (AOR = 2.50, 95% CI = [1.97, 3.19]) and for those women who reported either physical violence victimization (AOR = 1.86, 95% CI = [1.42, 2.45]) or both physical violence victimization and perpetration (AOR = 2.45, 95% CI = [1.49, 4.11]). Women who reported marijuana use (AOR = 1.31, 95% CI = [1.01, 1.69]) were also more likely to have an identified need for domestic violence services.

Discussion

The identification of co-occurring domestic violence service needs in child welfare–involved parents with substance use disorders has importance beyond establishing a list of issues to be remedied. Substance use treatment is a key element in achieving stable reunification for these families, and the co-occurrence of domestic violence may inhibit effective substance use interventions. Child welfare caseworkers, therefore, have an incentive to identify these co-occurring needs so that referrals can be made to the appropriate services when available. To help build knowledge that can guide caseworkers in identifying these needs, the current study limited its sample to a set of parents with an identified substance use disorder and a child placed into foster care, and used a gender-stratified analytic approach to examine (a) rates of a co-occurring domestic violence service need and (b) gender-specific associations with this need.

The current study showed that a co-occurring need for domestic violence services was common among both mothers (42%) and fathers (32%) with a substance use disorder. Thus, a substantial proportion of substance misusing families must contend with the additional challenges that domestic violence can pose to (stable) family reunification. Prior research on the association between domestic violence and family reunification is mixed with some studies showing a decreased likelihood in reunification for families experiencing domestic violence (Cheng, 2010; Farmer, Southerland, Mustillo, & Burns, 2009), whereas others did not observe a significant relationship between domestic violence and reunification (Ogbonnaya & Pohle, 2013). Victor et al. (2016) reported that domestic violence was associated with an increased likelihood of reentry to foster care for children who had previously been reunified with their primary caregivers.

The rates of domestic violence and substance misuse co-occurrence also suggest that domestic violence is a prevalent concern for effectively treating substance misuse in child welfare–involved families. Promisingly, for these families, integrated treatment approaches have demonstrated effectiveness in addressing co-occurring substance misuse and domestic violence needs (Easton, Crane, & Mandel, 2018; Satyanarayana et al., 2016). For example, Easton et al. (2018) conducted a randomized controlled trial to test a manualized cognitive behavioral therapy (CBT) approach designed to simultaneously address domestic violence perpetration and substance misuse. When compared with those who received substance use counseling as usual, participants who received the integrated CBT approach perpetrated less physical violence and had fewer positive screens for cocaine and alcohol 3 months posttreatment. Unfortunately, such integrated treatments are not universally available to child welfare–involved families. Child welfare workers must therefore work strategically in tailoring service plans and consider informing parents about the potential impact of domestic violence on substance use treatment outcomes.

The associations of this co-occurring need for domestic violence services among child welfare–involved parents with substance use disorders generally differed between men and women. Although distinctions could not be made as to whether a recovery coach identified a need for services based on domestic violence perpetration or victimization, the multivariate findings offer some evidence that men are likely identified more often as perpetrators and women as victims. For instance, a lifetime history of physical violence was associated with a need for domestic violence services for both men and women, but in different ways. Men who reported perpetrating physical violence were twice as likely to have an identified need for services, while women were twice as likely to have an identified need for services when they reported physical violence victimization or both victimization and perpetration. This finding is in line with prior research that has shown that men most often initiate physical violence against intimate partners, and that women’s use of force is generally a response to ongoing abuse (Jacobson et al., 1994; Larance & Miller, 2017).

Other differences were observed with respect to marital status, annual income, and education. Married men and men who earned more annually were more likely to be identified as needing domestic violence services, while women with less education had greater odds of identification. Although these demographic associations can assist child welfare workers in identifying parents with domestic violence service needs, the impact of these differences on substance use treatment outcomes is unclear. Prior studies have found mixed results for each of these demographic factors in relation to substance use treatment outcomes (Adamson, Sellman, & Frampton, 2009; McKay & Weiss, 2001).

The strongest association of a domestic violence service need for both men and women was a concurrent need for mental health services. This is in accordance with the findings of Jarpe-Ratner et al. (2015) who identified classes of parents with frequently co-occurring substance misuse, domestic violence, and mental health needs. Given the prevalence with which these three needs co-occur in child welfare–involved families (Jarpe-Ratner et al., 2015), the association of each with child maltreatment (Barth, 2009), and their ability to complicate intervention (Lipsky et al., 2010), substance misuse, domestic violence, and mental health might rightly be thought of as a child welfare syndemic (see Meyer, Springer, & Altice, 2011, for a discussion of the substance abuse, domestic violence, and HIV/AIDS [i.e., SAVA] syndemic among women). Synergistic relationships between these needs might require the further integration of service delivery beyond existing approaches to the co-occurring disorders of substance use and mental health, and the inclusion of violence interventions in substance use treatment. Future research is also needed to help child welfare workers determine whether and how to order the receipt of services when substance misuse, domestic violence, and mental health supports are all indicated but integrated treatments are not available.

Limitations

A number of limitations in the current study should be noted. For example, a distinction was not made between a domestic violence service need for perpetration versus victimization. Such a distinction is certainly important for referral to domestic violence services and may also be important when referring to substance misuse services. More research is needed to understand the specific dimensions of domestic violence that pose challenges to substance use treatment, with attention given to differences between perpetration and victimization. Other limitations with respect to measurement include the self-report nature of the data on substance misuse and domestic violence. In addition, the sample in this study was drawn from a Midwestern urban county, which might limit the generalizability of the findings. Finally, although a strength of this study was the heterogeneity of the substances used by parents, regional variations in substance use could produce different results.

Conclusion

The findings of this study make clear that domestic violence is a commonly co-occurring service need for child welfare–involved parents with identified substance use disorders. This co-occurrence presents distinct challenges for successful substance use treatment, an important outcome for achieving child welfare objectives such as stable family reunification. Although caseworkers must consider the available information in each individual investigation when determining service needs, the associations established here can aid in identifying families at heightened risk for co-occurring domestic violence service needs among those with established substance use disorders. More broadly, the strong association of mental health needs with the co-occurrence of parental substance misuse and domestic violence for both mothers and fathers raises the possibility of additional challenges to effective substance use treatment when all three service needs are present. Further research is needed to understand the symbiotic nature of these factors and to develop effective interventions for these parents.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the Illinois Department of Children and Family Services as part of the Alcohol & Other Drug Abuse (AODA) IV—E Waiver Project Evaluation.

Author Biographies

Bryan G. Victor is a postdoctoral research fellow with the Child and Adolescent Data Lab at the University of Michigan School of Social Work.

Stella M. Resko is an associate professor of social work at Wayne State University with a joint appointment at the Merrill Palmer Skillman Institute for Child and Family Development.

Joseph P. Ryan is an associate professor of social work at the University of Michigan–Ann Arbor, and codirector of the Child and Adolescent Data Lab.

Brian E. Perron is a professor of social work at the University of Michigan–Ann Arbor, and codirector of the Child and Adolescent Data Lab.

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