Spotlight on Disproportionality and Disparities among Families in Child Welfare and Substance Use Treatment

Families of color and other diverse groups affected by child abuse or neglect and substance use disorders (SUDs) often face a complex set of challenges. The prevalence of SUD 1 and challenges associated with disproportionality and disparities in service systems varies by gender, 2, 3 race and ethnicity, 4, 5, 6 socioeconomic status, 7 as well as among other important groups.

Disproportionality is the underrepresentation or overrepresentation of a group compared to its percentage in the total population, 4, 5, 6 socioeconomic status, 8 such as the overrepresentation of racial or ethnic groups in child welfare.

Disparity is defined as “all things being equal—including need, eligibility, and preferences—one group systematically fares worse than another.” 9 For instance, the rate of opioid misuse among Blacks is similar to the general population and yet drug overdose deaths between 2015–2016 among Blacks increased by 40%, compared to the general population increase of 21%; and, exceeded all other racial and ethnic groups. 10 Contributing factors include substantially lower access to SUD treatment 11 and limited access to medication-assisted treatment for opioid use disorders. 12

Both disproportionality and disparities exist at each of the decision points across the child welfare service continuum. 13 In 2018, Black children composed approximately 23% of children in foster care, while they were approximately 14% of the total U.S. child population. 14 In the same year, American Indian/Alaska Native children accounted for over 2% of children in foster care, while composing less than 1% of the total U.S. child population. 15 Racial and ethnic minority children are:

  • More likely to experience lengthier placement in out-of-home care
  • More likely to experience group placement
  • Less likely to reunify 16

Assessing risk to child safety and well-being in the context of socioeconomic factors—such as housing and financial insecurity—has been a long-standing challenge in the child welfare system. Families with low socioeconomic status are more likely to be referred to child welfare services for severe neglect and have a higher unmet need for housing services and medical care. 17 A cross-system collaborative approach that is attuned to and actively addresses institutional inequities in services and differences among populations is necessary to meet the complex needs of families.

  • Highlighted Resource

    • Interactive Bibliography Search

      National Center on Substance Abuse and Child Welfare, 2021

      Access research on the topics of diversity, equity, and inclusion using the Interactive Bibliography. The Interactive Bibliography is a searchable platform for publications on cross-system issues involving child welfare, substance use disorders, family treatment, and dependency courts.

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1 National Institute on Drug Abuse. (2003). Drug use among racial/ethnic minorities. https://archives.drugabuse.gov/sites/default/files/minorities03_1.pdf

2 Greenfield, S. F., Back, S. E., Lawson, K., Brady, K. T. (2010). Substance abuse in women. Psychiatic Clinic of North America, 33(2), 339-355. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124962/

3 Grigsby, T. J., Howard, K. & Howard, J. T. (2021). Comparison of past year substance use estimates by age, sex, and race/ethnicity between two representative samples of the U.S. adult population. Population Research Policy Review. doi:10.1007/s11113-021-09645-8

4 Wu, L. T., Woody, G. E., Yang, C., Pan, J. J., & Blazer, D. G. (2011). Racial/ethnic variations in substance-related disorders among adolescents in the United States. Arch Gen Psychiatry, 68(11):1176-1185. doi:10.1001/archgenpsychiatry.2011.120

5 McCabe, S.E., Morales, M. Cranford, J.A., Delva, J., McPherson, M.D., & Boyd, C.J. (2007). Race/ethnicity and gender differences in drug use and abuse among college students. J Ethn Subst Abuse, 6(2): 75–95

6 Evans, E., Spear, S. E., Huang, Y. C., & Hser, Y. I. (2006). Outcomes of drug and alcohol treatment programs among American Indians in California. American Journal of Public Health, 96(5), 889-896. doi:10.2105/ajph.2004.055871

7 Cummings, J. R., Wen, H., KoO, M., & Dross, B. G. (2014). Race/ethnicity and geographic access to Medicaid substance use disorder treatment facilities in the United States. JAMA Psychiatry, 71(2), 190-196. doi:10.1001/jamapsychiatry.2013.3575

8 U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau, Child Welfare Information Gateway. (2016). Racial Disproportionality and Disparity in Child Welfare. https://www.childwelfare.gov/pubPDFs/racial_disproportionality.pdf

9 Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Authors: McDaniel, Marla, Tyler Woods, Eleanor Pratt, and Margaret C. Simms. (2017). OPRE Report #2017-69, Identifying Racial and Ethnic Disparities in Human Services: A Conceptual Framework and Literature Review. https://www.acf.hhs.gov/opre/report/identifying-racial-and-ethnic-disparities-human-services-conceptual-framework-and

10 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Behavioral Health Equity. (2020). The Opioid Crisis and the Black/African American Population: An Urgent Issue. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-05-02-001_508%20Final.pdf

11 Substance Abuse and Mental Health Services Administration. (2020). Double jeopardy: COVID-19 and behavioral health disparities for black and latino communities in the U.S. https://www.samhsa.gov/sites/default/files/covid19-behavioral-health-disparities-black-latino-communities.pdf

12 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Behavioral Health Equity. (2020). The Opioid Crisis and the Black/African American Population: An Urgent Issue. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-05-02-001_508%20Final.pdf

13 Casey-CSSP Alliance for Racial Equity in the Child Welfare System; Hill, R. B. (2006). Synthesis of research on disproportionality in child welfare: An update. https://assets.aecf.org/m/resourcedoc/aecf-CFS-SynthesisOfResearchOnDisproportionalityInChildWelfareAnUpdate-2006.pdf

14 National Conference of State Legislatures. (2021). Disproportionality and race equity in child welfare. https://www.ncsl.org/research/human-services/disproportionality-and-race-equity-in-child-welfare.aspx

15 National Conference of State Legislatures. (2021). Disproportionality and race equity in child welfare. https://www.ncsl.org/research/human-services/disproportionality-and-race-equity-in-child-welfare.aspx

16 National Conference of State Legislatures. (2021). Disproportionality and race equity in child welfare. https://www.ncsl.org/research/human-services/disproportionality-and-race-equity-in-child-welfare.aspx

17 Marcenko, M. O., Hook, J. L., Reich, J. L., & Lee, J. S. (2012). Multiple jeopardy: Poor, economically, disconnected and child welfare involved. Child Maltreatment, 17(3), 195-206. doi:10.1177/ 1077559512456737