Substance-affected families are frequently cited as the most challenging families to serve within the child welfare context, particularly in rural settings where treatment services may be few and far between. Growing evidence suggests that family treatment courts (FTCs) may be more effective than their traditional counterpart at achieving key child welfare goals; however, prior studies have been limited in their methodological rigour. This study used treatment and matched comparison data to test foster care exit patterns of families with children in foster care due to parental substance use. Treatment group data were collected on a sample of 91 children with open dependency cases in an integrated FTC in a rural Midwestern town. Propensity score nearest neighbour one-to-two matching was used to identify a comparison group of 146 children. Findings suggest that FTC participation significantly influenced foster care exits. Survival analyses revealed that FTC children were 170% more likely to reunify, and 58% more likely to achieve permanency, than comparison cases. The effect of FTC participation on likelihood of reunification and likelihood of permanency was stronger when models estimated outcomes from FTC start date, rather than child removal date. Implications for social work practice, research, and education are discussed. K E Y W O R D S child welfare system, family treatment court, parental substance use disorder, permanency, survival analysis 1 | INTRODUCTION Families in the foster care system due to parental substance use disorder (SUD) are frequently cited as the most challenging families to serve within the child welfare system (CWS). These families often struggle with multiple co-occurring issues such as domestic violence, poverty, homelessness and mental illness (Child Welfare Information Gateway, 2014; Testa & Smith, 2009). The National Survey on Drug Use and Health (NSDUH) reveals that almost half (48%) of adults who reported a past year SUD also reported a co-occurring mental illness in the past year (Substance Abuse and Mental Health Services Administration [SAMHSA], 2019). Compared with other children in child welfare, children affected by substance use face worse child welfare-related outcomes compared with children in the CWS for other reasons (Barth et al., 2006). These children have longer stays in foster care (Vanderploeg et al., 2007), are less likely to reunify (Lloyd & Akin, 2014) and are more likely to face termination of parental rights (TPR) (Connell et al., 2007) compared with children without substance-related removals. This is unfortunate given that removals due to parental drug use have increased nearly 150% between 2000 and 2017, while entries for other removal reasons mostly declined (Meinhofer & Angleró-Díaz, 2019). In 2018, nearly a quarter of a million children were in foster care due to parent drug use (Children's Bureau, 2019).
