Recurrent care proceedings and use of services for substance use disorder: A retrospective linked data cohort study of mothers in South London.

Abstract

In public family law cases ('care proceedings'), many mothers return to proceedings after having a child removed. Substance use disorder (SUD) is a common feature in these cases. We used a linked dataset between SUD treatment services and family court to identify: i) the prevalence and estimated time for returning to care proceedings, ii) the characteristics of mothers who returned, and iii) differences in SUD treatment service use between mothers who returned to care proceedings and those who did not. Retrospective study. South London and Maudsley NHS Mental Health Trust (SLaM) catchment area, UK. 480 mothers involved in care proceedings with SUD between 2007 and 2019. Substance use treatment records were linked to family court records. Kaplan Meier's time-to-event analysis was used to estimate the probability of returning to court and the recurrence rate. Hazard ratios (95% confidence intervals) were estimated to identify factors using Cox proportional regression analysis. Following the completion of the first care proceeding case, one-quarter of the cohort returned to proceedings (n = 119). Of returning mothers, 58.0% returned with a new baby and 52.0% had not received SUD treatment during the first proceedings. The risk of returning was highest within five years and was positively associated with younger maternal age [adjusted hazard ratio (aHR) 0.26, 95% confidence interval (CI) = 0.11-0.61], multiple children in initial proceedings (aHR 2.07, 95% CI = 1.36-3.18) and not receiving SUD treatment during initial proceedings (aHR 0.42, 95% CI = 0.29-0.61). The number of contact events with SUD treatment was not statistically significantly associated with returning to proceedings. Among mothers receiving treatment for substance use disorder and involved in care proceedings in England, nearly one in four were likely to appear in a subsequent care proceeding case.