Poster #17 - The Role of Maternal Medication for Opioid Use Disorders in Child Safety Outcomes

• In Event: Friday Poster Reception

Abstract

Background: Recent federal policy shifts have positioned medication for opioid use disorder (MOUD) as a key strategy for preventing family separation. The U.S. Administration for Children and Families (ACF) recently expanded the Title IV-E Prevention Services Clearinghouse to include three FDA-approved medications (methadone, buprenorphine, and naltrexone), authorizing states to utilize federal child welfare prevention funds for parental opioid use disorder (OUD) treatment. While the ACF encourages MOUD integration in prevention plans to reduce child maltreatment and foster care entry, the well-supported rating by the Clearinghouse is based primarily on studies focusing on adult or parental well-being outcomes. A critical knowledge gap remains regarding the direct impact of MOUD on child safety. This study bridges this gap by using linked administrative data from child welfare services (CWS) and Medicaid to examine how maternal MOUD engagement impacts child injuries, system re-reporting, and foster care duration.
Research Questions: What is the relationship between the timing of maternal MOUD engagement (relative to a CWS referral) and subsequent child safety outcomes?
Methods: We analyzed a population-based sample of 31,748 CWS referrals in Pennsylvania (2015-2019) involving Medicaid-insured mothers diagnosed with OUD. MOUD timing was categorized into four groups: (1) no MOUD, (2) before-referral only, (3) new initiation post-referral, and (4) ongoing. Outcomes assessed 91 to 365 days post-referral included injury claims, CWS re-reports, and total days in foster care. To address selection bias, we employed inverse probability weighting regression adjustment (IPWRA) via a multinomial logit model, estimating weights based on maternal history, demographics, and CWS case characteristics. We estimated the average treatment effect (ATE) for each MOUD timing relative to the non-MOUD group.
Results: Mothers were distributed across MOUD groups: No MOUD (35.4%), before-only (18.4%), new initiation (12.9%), and ongoing (33.2%). Compared to the no-MOUD group, new MOUD initiation was associated with a 3.2 percentage-point (PP) increase in the predicted probability of injury claims (95% CI: 2.1, 4.4). Ongoing MOUD was associated with a 4.1 PP increase in the probability of a new confirmed CWS case (95% CI: 2.6, 5.6). Despite the increase in re-reports, Ongoing MOUD was associated with a significant reduction in the mean number of days spent in out-of-home placement (ATE = -3.0 days; 95% CI: -4.3, -1.7).
Conclusions and Implications: This study demonstrates a nuanced relationship between MOUD timing and child safety, providing critical evidence for the implementation of Title IV-E prevention. The finding that ongoing MOUD significantly reduces the duration of out-of-home placement suggests that sustained maternal substance use treatment may facilitate more efficient reunification and stabilize vulnerable families, even when surveillance remains frequent. These findings emphasize the need for integrated, multidisciplinary support systems that monitor child safety while actively supporting maternal recovery to stabilize families.

Author

• Wan-Ting Chen, Pennsylvania State University
  Presenting Author