Substance use treatment completion does not mediate the relationship between family treatment court participation and reunification: Results from five courts in the Southwestern U.S.

Abstract

Family treatment courts (FTC) apply judicial theory and behavioral economics to increase parent substance use treatment completion and family reunification for families in foster care due to parental substance use disorder. Dozens of quasi-experiments and case studies suggest FTC programs outperform traditional child welfare courts. However, methodological limitations in earlier research limit causal inference. The current study aimed to examine the relationship between FTC participation and family reunification, and to investigate whether substance use treatment completion mediates this relationship. Foster care, substance use treatment, and FTC administrative records from 2018 to 2022 were probabilistically linked across six counties in a Southwestern U.S. state. The final sample included 200 FTC-involved and 1367 comparison child/caregiver dyads. To address selection bias, we applied inverse probability weighting based on propensity scores. The weights balanced the treatment and control groups based on fifteen covariates, including demographic characteristics, child welfare system involvement, and novel substance use treatment metrics such as caregivers' Addiction Severity Index scores, level of care recommendation, and primary substance of choice. Applying the weight, our logistic regression model revealed that FTC-involved dyads' odds of reunification were 66 % greater compared to dyads served in traditional settings (OR = 1.66, 95 % CI: 1.14-2.40). The mediation model revealed that the effect of FTC participation on reunification was independent of treatment completion. FTC demonstrates its own treatment effect on family reunification, above and beyond substance use treatment experiences. These findings point to a "value added" for FTC participation. In an area of practice characterized by low rates of success, identifying effective, real-world interventions for families is significant.