Caregiver problematic substance use is a prevalent problem within the child protective services (CPS) system that is associated with negative outcomes for children. Utilizing path analysis models, this dissertation deepens our understanding of the direct and indirect (mediating and moderating) pathways from caregiver problematic substance use to indicators of child harm in two CPS populations: all families investigated for maltreatment (Aim 1) and a sub-group of families in which the children remained in the home after the investigation (Aim 2). Data for these analyses came from the National Survey of Child and Adolescent Well-Being II (NSCAW II), a landmark, longitudinal national probability study of families investigated for child maltreatment. Caregiver problematic substance use was measured in two ways. In Aim 1, caregiver problematic substance use was measured by caseworker-identified problematic drug or alcohol use. In Aim 2, caregiver problematic substance use was measured by caregiver self-report of problematic drug or alcohol use available only in this sub-group. Using the child welfare goals of safety, permanency, and well-being, child harm was operationalized as CPS referrals for services and subsequent reports of maltreatment (safety), having children removed from the home (permanency), and child levels of depression, trauma, internalizing behaviors, or externalizing behaviors (well-being). Mediators included in the models are parental monitoring, harsh discipline, emotional maltreatment, and exposure to violence. Moderators included in the models are caregiver depression, domestic violence, and criminal involvement. Among other findings, this dissertation indicates that emotional maltreatment and caregiver depression are strong pathways through which caregiver problematic substance use is associated with child harm. Bivariate analyses also indicate a need to strengthen training around caregiver problematic substance use for CPS caseworkers. By utilizing the CPS goals of safety, permanency, and well-being, the results of this dissertation have direct implications for national child welfare policies and inform how caregiver problematic substance use is addressed in CPS agencies. Emotional maltreatment and caregiver depression are risk factors that should be targeted in interventions aimed at promoting the safety, permanency, and well-being of children when caregiver problematic substance use is present.

Research has consistently shown that there is a link between caregiver substance use and child maltreatment, but less attention has been given to child trauma exposure. The co-occurrence of caregiver substance misuse and child trauma exposure is a prevailing problem that has confounded social work prevention, protection, and treatment efforts with both children and adults for years. However, there has been minimal empirical and clinical literature focusing on child trauma as an outcome of caregiver substance use. This work is designed to be the catalyst for sustained intellectual inquiry about how caregiver substance use, child maltreatment, and violence exposure can be understood in theory and practice. To this end, the research presented in this book highlights the state of the science, the impact of the phenomenon, and the policy and practice questions that must be addressed. Implications for social work practice are highlighted in order to attenuate these deleterious and pervasive problems in the future. This book was originally published as a special issue of the Journal of Social Work Practice in the Addictions.

Youth in the child welfare system experience multiple risk factors for substance use and exhibit higher rates of substance use disorder (Pecora, White, Jackson, & Wiggins, 2009). However, although early substance use (i.e., by age 13) is a known risk factor for substance use disorder (Grant & Dawson 1997, 1998), scarce research has examined early substance use in child welfare youths. In this two-part study, a developmental psychopathology perspective is applied to examine pathways to early substance use with data from the first National Survey of Child and Adolescent Well-Being (NSCAW). In part 1, the prevalence of substance use, including alcohol, marijuana, and inhalant use, among child welfare (n = 896) and general population eighth graders from the Monitoring the Future Study was compared. Second, path analysis was used to examine demographic predictors (i.e., age, gender, race/ethnicity, and out-of-home placement) of substance use among child welfare eighth graders. Part 2 used path analysis with MPLUS in a sample of 11-13 year olds at Wave 1 (n = 796) to examine the relationships between physical and sexual abuse severity and early substance use, the mediating role of internal well-being problems (i.e., internalizing behavior problems and posttraumatic stress), and gender differences. Focal measures included the child-reported Parent-Child Conflict Tactics Scale (physical abuse severity), the Trauma Symptom Checklist (posttraumatic stress), the Youth Self Report (internalizing behavior problems), and the NSCAW's caseworker-alleged abuse (sexual abuse severity) and child substance abuse module (any use of alcohol, marijuana, hard drugs, inhalants, or nonmedical prescription drugs). Findings indicated comparable or lower incidence of substances among NSCAW eighth graders overall than the general population, but higher past 30-day inhalant use among NSCAW eighth graders in out-of-home placement. Out-of-home placement was associated with higher inhalant use (lifetime and 30-day) and alcohol use (lifetime). Significant indirect effects of physical abuse severity on early substance use were found through internalizing behavior problems, but no gender differences. These findings imply the need for out-of-home caregiver education on inhalant use and demonstrate the salience of internal pathways to early substance use, indicating the need to integrate mental health and substance use services.

"The serious consequences of child abuse or maltreatment are among the most challenging things therapists encounter. This volume integrates results from the latest research showing the importance of early traumatization into a compact, practical and evidence-based guide for practitioners. This text first overviews our current knowledge of the effects of childhood maltreatment on psychiatric and psychological health, then provides diagnostic guidance, and subsequently goes on to profile promising and effective evidence-based interventions. It helps the practitioner or student to know what to look for, what questions need to be asked, how to handle the sensitive ethical implications, and what are promising avenues for effective coping."--Publisher.

This book addresses new avenues in child abuse prevention research that will expand our capacity to protect children. These new avenues result from the emergence of new research methods made possible through technologic advances, an understanding of the benefits of cross-disciplinary research and learning and the entrance of many young scholars in the field. The book explores what these avenues produce in terms of clarifying the complex problems that continue to limit our progress in addressing child maltreatment and promoting optimal child development. Specifically, the book showcases individual contributions from emerging scholars and show how these scholars use the frameworks and advanced methods to shape their work, apply their findings and define their learning communities. The book highlights the benefits of creating explicit and extended opportunities for researchers to network across disciplines and areas of interest. The primary authors are young scholars from universities across the U.S. who have worked together as Fellows of the Doris Duke Fellowships for the Promotion of Child Well-Being – seeking innovations to prevent child abuse. Through this program, the Fellows have engaged in a robust self-generating learning network designed to create the type of ongoing professional linkages and decision-making style that fosters an interdisciplinary and team planning approach to research design and policy formation.