Intersecting stigma of substance use and child welfare system involvement: Understanding stigma drivers, experiences, and outcomes from a socioecological perspective.

BACKGROUND

Substance use in parents is a common reason for child welfare system involvement (CWS). Stigma associated with substance use and disorders (SU/D) continues to negatively impact individuals; however, less is understood about the intersecting stigma of CWS involvement and SU/D. The current study seeks to understand parents' experiences of stigma related to SU/D and CWS involvement as well as the drivers and consequences of stigma at multiple socioecological levels using the Health Stigma and Discrimination Framework.

METHODS

Qualitative data analysis was conducted on semi-structured interviews with N = 31 Child Welfare System (CWS) personnel (90.3 % female; 96.8 % White, Non-Hispanic), N = 28 SU/D service providers (85.7 % female; 67.9 % White; 89.3 % Non-Hispanic), and N = 28 parents (89.3 % female; 78.6 % White; 89.3 % Non-Hispanic) with a current or recent CWS case due to SU/D.

RESULTS

Stigma drivers included a lack of understanding of SU/D at interpersonal, community, and organizational levels; negative stereotypes of parents with SU/D involved in CWS (seen as dishonest, unmotivated, poor parents); community neglect of SU/D; negative attitudes towards SU/D medications and harm reduction; and CWS policies unsupportive of SU/D. Parents described experiences of stigma by CWS and the healthcare system, their communities, and loved ones, leading to social isolation and hesitancy to engage in services. Consequently, stigma impacted SU/D service availability, housing/employment policies, and CWS practices, further negatively impacting parents.

CONCLUSION

Parents with SU/D and involved in CWS have unique experiences of stigmatization related to both SU/D and CWS involvement. Findings point to multiple targets for stigma reduction at different socioecological levels.