Drug using mothers: retaining care of their children

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1 Drug using mothers: factors associated with retaining care of their children Gail Gilchrist 1 and Avril Taylor 2 1 L'Institut Municipal d'investigació Mèdica, Barcelona, Spain p g,, p 2 University of the West of Scotland, UK

2 Do drug users retain the care of their children? Of women entering methadone treatment that had children, 51% (3463/6845) were living apart from their children (Lundgren et al., 2003) 62% of IDU parents in a community sample did not have any of their children under age 14 living with them (Pilowsky et al., 2001) 47% of mothers in substance abuse treatment 47% of mothers in substance abuse treatment had received child welfare services in past 6 months (Grella et al., 2006)

3 Factors associated with drug users not retaining care of their children? Younger age Heroin use, stimulant use, daily alcohol use Injecting Having two or more children Having other children in foster care Depression Unstable living conditions Living with other drug users Living alone or with strangers Not having health insurance Criminal justice involvement HIV +ve with clinical symptoms Not receiving methadone (Nair et al., 1997 (US); Pilowsky et al., 2001 (US); Lundgren et al., 2003 (US); Meier et al., 2004 (UK))

4 How many drug users have children? About one child for every problem drug user in UK (ACMD, 2003) Just over half the drug users in treatment in UK with dependent children (53%) did not live with their children, 9% had children in care (Meier et al., 2004) 5.5% of population < 16 years in Glasgow affected by parental substance misuse In Scotland, 40% of cases in the Child Protection Review involved parental substance misuse

5 Rationale A significant number of children of substance users do not reside with their mother, what characteristics predict this? Previous studies conducted in drug users attending treatment or in criminal justice system We know very little about these children [children of drug users] in particular we do not know who are caring for them when the mother is not caring for them (Hay et al., 2005; p.28)

6 Sample, setting and aims 185 female drug users who had ever given birth from a study of psychiatric morbidity among female drug users attending a drugs crisis i centre (n=59), drop-in for street sex workers (n=65) and from specialist GP led service for opiate users (n=61) (Gilchrist et al., 2007) To describe the living arrangements of female drug users children To describe the variables associated with female drug users not living with any of their children

7 Glasgow Greater Glasgow covers an urban population of over 900,000 Largest city in Scotland

8 Deprivation Glasgow has the highest rate of lone Glasgow has the highest rate of lone parents and unemployment in Scotland

9 Deprivation Glasgow has 50% of the most deprived Glasgow has 50% of the most deprived postcode sectors in Scotland

10 Questionnaire Illicit Drug Use (Diagnostic Interview Schedule, Robins et al., 1981), injecting behaviour and treatment Emotional, physical & sexual abuse (EuropASI-X, Oberg and Sallmen, 2002) Deliberate self harm and suicide attempts (ONS, Singleton et al., 1998) Past treatment for psychological/ emotional problems (ONS, Singleton et al., 1998) Revised Clinical Interview Schedule (CIS-R, Lewis & Pelosi, 1992) measures 14 current neurotic symptoms

11 Analysis the dichotomy of having at least one child versus no children living with the mother as the response variable as it was considered that retaining at least one child was a positive outcome for a population at risk for parenting difficulties (Pilowsky et al., 2001) Stepwise forward logistic regression analyses were performed to ascertain the variables associated with participants not having their child/ren living with them Variables significant in other research studies and those with moderate level of association in univariate logistic regression analyses (p<0.2) in the current study were entered into the model Lemeshow goodness-of-fit test was applied to ascertain the fit of the model (The fit of the model is considered good when p>0.05)

12 Participation rate Convenience sample Sex worker drop-in centre 43% (96/222) Drugs crisis centre 32% (91/284) Consecutive sample Specialist medical led service 81% (79/98)

13 Pregnancies and childbirth 83% (221/266) had been pregnant and of them, 84% (185/221) had given birth to a total of 327 children The mean number of times these 185 participants had given birth was 1.8 (sd. 1.2; range 1-7 times) Majority had given birth to one child (110/185; 60%); 21% (38/185) to two children; 11% (20/185) to three children and 9% (17/185) to more than 3 children

14 Demographics Polydrug users, majority heroin dependentd mean age years (sd. 6.06, ) 58% (107/185) were single; 29% (53/185) were cohabiting 17% (31/185) were currently homeless or living in homeless accommodation; 74% (136/185) had ever been homeless 47% (86/184) lived with someone who used drugs

15 Where are their children? n=297^ (%) Mother s care 87 (29.3) With mother and father who live together 40 (13.5) With mother and father (joint custody) 5 (1.7) Father s care 28 (9.4) Care of a family member 78 (26.3) Foster care 41 (13.8) Adopted 14 (4.7) Children s home 4 (1.3) ^Missing data for living arrangements for one child and excludes participants adult children who currently lived on their own (n=18), were in prison (n=1) or who had died (n=10).

16 Unadjusted associations between at least one child living i with their mother and substance use ^Denominators vary owing to missing data At least one child lives w/ mother No child/ren live/s with mother OR (95% CI) n=92 (%)^ n=87 (%)^ Ever injected drugs 71 (77.2) 80 (92.0) 3.38 ( ) Treatment in last 12 months 84 (91.3 ) 66 (75.9) 0.30 ( ) Prescribed methadone in 66 (71.7) 7) 41 (47.1) 035( ( ) last month Ever accidentally 27 (29.3) 46 (52.9) 2.70 ( ) overdosed on drugs Cocaine use 27 (29.3) 41 (47.1) 2.15 ( ) Hazardous drinking 17 (18.5) 26 (29.9) 1.88 ( )

17 Unadjusted associations between at least one child living with their mother and current neurotic symptoms (CIS-R) Moderate to high severity current neurotic symptoms At least one child lives with mother No child/ren live/s with mother OR (95% CI) n=92 (%)^ n=87 (%)^ Depression 47 (51.1) 70 (80.5) 3.94 ( ) Depressive ideas 52 (56.5) 67 (77.0) 2.58 ( ) Obsessions 38 (41.3) 53 (60.9) 2.22 ( ) Somatic symptoms 36 (39.1) 50 (57.5) 2.10 ( ) ^Denominators vary owing to missing data

18 Unadjusted associations between at least one child living with their mother and mothers childhood experiences At least one child lives with mother No child/ren live/s with mother OR (95% CI) n=92 (%)^ n=87 (%)^ Residential home 9 (9.8) 21 (24.1) 2.93 ( ) Local authority care 20 (21.7) 30 (34.5) 1.90( ) Physical abuse 22 (24.2) 31 (37.3) 1.87 ( ) Emotional abuse 29 (31.9) 35 (42.2) 1.56 ( ) Sexual abuse 21 (23.3) 3) 26 (31.3) 3) 1.50( ) ^Denominators vary owing to missing data

19 Unadjusted associations between at least one child living with their mother and adulthood experiences At least one No child/ren OR (95% CI) child lives live/s with w/ mother mother n=92 (%)^ n=87 (%)^ Ever been homeless 55 (59.8) 76 (87.4) 4.65 ( ) Sex work ever 48 (52.2) 70 (80.5) 3.78 ( ) Ever in prison 33 (35.9) 50 (57.5) 5) 242( ( ) 41) Live with drug user 34 (37.0) 50 (58.1) 2.37 ( ) Physical abuse 41 (45.1) 48 (57.1) 163( ( ) Emotional abuse 49 (53.8) 55 (65.5) 1.63 ( ) Sexual abuse 20 (22.0) 26 (31.0) 159( ( ) ^Denominators vary owing to missing data

20 Factors associated with participants p children not living with them (multivariate analysis) OR (95% CI) Current depressive symptoms ( ) Ever worked as a prostitute 3.12 ( ) Live with a drug user 2.71 ( ) Ever been homeless 2.96 ( ) Been in prison 2.47 ( ) n=167, Hosmer and Lemeshow Test p = 0.613

21 Comparison by service for risk factors identified for participants living with none of their children Current depressive symptoms Ever involved in prostitution Crisis centre n=59 (%)^ Drop-in n=65 (%)^ Specialist service n=61 (%)^ 47 (79.7) 46 (70.8) 30 (49.2) (64.4) 64 (98.5) 21 (34.4) <0.001 p Live with a drug 25 (43.1) 39 (60.0) 0) 22 (36.1) user Ever been homeless 48 (81.4) 51 (78.5) 37 (60.7) Ever been in prison 28 (47.5) 36 (55.4) 21 (34.4) ^Denominators vary ^Denominators owing vary missing owing data to missing data

22 Conclusions Majority of female drug users have children Less than half of participants children lived with them Involvement in prostitution, homelessness, imprisonment, depressive symptoms and living with a drug user predicted female drug users living with none of their children Differences between services- does not imply py treatment is a protective factor

23 A dysfunctional family system in which the parent child interaction ti is embedded d provides the context t for the transmission i of neglect across generations (Dunn et al., 2002) Substance use/ mental health problems Poor parenting Child placed in local l authority care

24 Recommendations Identify female drug users at early stage in career Treatment services should: address the needs of drug users with children, tailor treatment to women s needs to increase access and retention in treatment address high levels of mental health develop methods, such as parenting classes, to help mothers retain care of their children where possible R h d d t d t i t f i t ti Research needed to determine types of interventions that are effective

25 Acknowledgements Royal Society of Edinburgh International Exchange Programme Greater Glasgow NHS Board Dr Laurence Gruer, NHS Health Scotland and Professor Jacqueline Atkinson, The University of Glasgow Staff and attenders of the services in the study

26 Publication Gilchrist, G. & Taylor, A. Drug using mothers: factors associated with retaining care of their children. Drug and Alcohol Review (in press) i i

Deposited on: 15 May 2008 Glasgow eprints Service

Deposited on: 15 May 2008 Glasgow eprints Service Gilchrist, G. and Gruer, L. and Atkinson, J. (2005) Comparison of drug use and psychiatric morbidity between prostitute and non-prostitute female drug users in Glasgow, Scotland. Addictive Behaviors 30(5):pp.