Illicit Substance Use and Child Support: An Exploratory Study

June 2019

aspe.hhs.gov

Office of the Assistant Secretary for Planning and Evaluation

U.S. Department of Health and Human Services

OFFICE OF HUMAN SERVICES POLICY

Illicit Substance Use and Child

Support: An Exploratory Study

Authors: Lauren Antelo and Annette Waters, PhD

_________________________________________________________

KEY FINDINGS

 There is limited research addressing illicit substance use

among noncustodial parents.

 Programs that include noncustodial parents may serve

noncustodial parents with substance use disorders, but rarely

do they focus specifically on this population.

 Child support programs do not systematically identify parents

with substance use disorders or use formal substance use

assessments. When such problems are identified it is most

often because parents voluntarily disclose substance use, or

child support caseworkers notice signs of substance use

problems.

 Substance use disorders may make maintaining employment

and meeting child support obligations more difficult,

particularly as individuals experience waves of relapse and

recovery.

 Problem solving courts, fatherhood/parenting programs, and

enhanced case management hold promise for addressing

child support and substance use issues simultaneously.

________________________________________________________

Introduction

For noncustodial parents in the formal child support

program, having a substance use disorder (SUD)

including opioid use disorder (OUD), might affect their

ability to access and maintain employment, and

consistently pay child support. Many child support

agencies acknowledge that there has been a rise in illicit

substance use among noncustodial parents. Yet there has

been scant research looking specifically at how substance

use among noncustodial parents affects the formal

payment of child support. This research begins to address

this gap. Through an environmental scan and discussions

with experts in four states, we investigate the prevalence of

illicit substance use (with a particular emphasis on opioid

misuse) among noncustodial parents. We study the

potential influence that SUDs have on child support

payments. We explore how child support enforcement

programs approach substance use and opioid misuse.

Finally, we investigate how and in what ways SUD

treatment can be integrated into child support programs.

Our principle research question is: What is the effect of

having a substance use disorder on child support

outcomes, such as the payment of formal child support?

Methodology

This study combined an environmental scan of

published literature with interviews with experts. We

conducted an environmental scan of literature published in

the last ten years, including peer-reviewed studies,

government reports, and gray literature.

The goal of the

scan was to identify what is known about the prevalence of

SUDs (with a particular emphasis on opioid misuse) among

noncustodial parents, the potential influence these

disorders have on child support payments, and how child

support enforcement programs approach substance use

and opioid misuse. See Appendix A for additional

information on the methodology including search terms

used for the environmental scan.

To complement the environment scan, we conducted

interviews with experts. The eighteen experts who

participated in the study included a mixture of federal and

nonfederal individuals with expertise in the child support, substance use disorders, and/or legal

fields. We intentionally selected a number of experts from the same states with the objective of

triangulating our findings. We recruited multiple experts from Indiana, Kentucky, Ohio, Vermont,

West Virginia, and Wyoming. Questions were also tailored to correspond with the experts’ area

of expertise. See Appendix B for additional information on the methodology.

Substance use disorder is defined as relying on illicit drugs such as marijuana, cocaine, crack, heroin and other illicit opioids,

hallucinogens, inhalants, methamphetamines (including crystal methamphetamine) and the misuse of psychotherapeutics such

as prescription opioids—OxyContin and its analogs. For this brief, substance use disorder does not include alcohol or tobacco.

See https://www.samhsa.gov/data/sites/default/files/cbhsq-

reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.htm#tab1-1B.

Gray literature is defined as reports, books, working papers, government documents, and evaluations that are generated

outside of the academia and peer-reviewed journals.

What is the Child Support

Program?

The child support program

(referred to as the IV-D program) is

open to any parent or person with

custody of a child that needs help

establishing paternity, a child

support order, a medical support

order, or to collect child support

payments. Noncustodial parent is

the term most often used to refer to

the parent that has a legal

obligation to pay child support. It

does not include the legal physical

custody of a child, as that process

is generally separate from child

support for never-married families.

The child support program serves

mostly lower income families.

• Approximately 34% of families

and 42% of children in the IV-D

program were poor in 2015.

• Nearly half (48%) of all children

who lived in poverty in 2015 were

eligible for child support services.

• Custodial parents who participate

in the IV-D program are much

more likely to be poor, never

married, under the age of 30

years old, and have limited

education than custodial parents

outside the IV-D program.

See, “Characteristics of Families Served

by the Child Support (IV-D) Program:

2016 U.S. Census Survey Results.”

Limited Research on Intersection between Child Support and SUDs

There is limited research on the intersection between child support orders and substance

use disorders and the literature contained little information on the prevalence of SUDs

among noncustodial parents. Although several sources noted some overlap between owing

child support and having a SUD, few documented prevalence rates. One source that discussed

low-income fathers in a child support program mentioned that “many” participants may also have

a SUD, but did not provide any further details (Sorensen 2010). In another source, authors noted

that in their sample of 50 fathers receiving methadone in an opioid treatment program, 32

percent reported a court-mandated child support order (Williams 2014). Another source,

examining non-cash support from nonresidential fathers, found that 14 percent of the fathers in

the study were currently misusing drugs and/or alcohol (Kane et al. 2015).

Having a substance use disorder is a factor that might contribute to a person’s inability to retain

employment. Many employers require successful applicants to pass a drug test and those with a

SUD are not able to pass drug tests. In addition, individuals with a SUD oftentimes have criminal

records and therefore are banned from certain types of jobs. Insufficient employment is also

clearly identified in the literature as an important factor in a noncustodial parent’s ability to pay

child support (Thomason et al. 2017). However, the link between the two topics was never

explicitly examined. For example, one source examined the relationship between child support-

related wage garnishment, such as income withholding, and criminal recidivism among a male

reentry population (Roman and Link 2015). This article acknowledged that SUDs are likely an

issue for this population; however, it did not examine the role of SUDs in noncustodial parents’

ability to meet their child support obligations.

While our review did not identify many studies focusing specifically on the intersection of SUD

and child support, the federal Office of Child Support Enforcement (OCSE) within the

Administration of Children and Families has identified this as an important issue. SUDs were

frequently mentioned in OCSE’s monthly newsletter, the Child Support Report, which highlights

child support news from across the nation. We found that SUDs and the ability to pay child

support were often addressed in parallel by programs or agencies, but the two were rarely linked

(OFA 2017; ACF 2014, 2017; OCSE 2009, 2012, 2016; McKay et al. 2016; Bonnie et al. 2014;

Fontaine et al. 2017; D’Amico et al. 2018; DOJ 2013). Additionally, in many of these instances,

the research or programs targeting SUDs focused on a broader population that may have

included parents owing child support, but did not focus on this particular group.

Likewise, research and programs targeting child support rarely focused specifically on parents

with SUDs. These broader populations include those served by fatherhood programs, programs

for incarcerated or previously incarcerated individuals, and programs for veterans, drug courts,

child support courts (McKay et al. 2016; Fontaine et al. 2017; D’Amico et al. 2018; OCSE 2009,

2012, 2016; Skinner and Whitter 2009; Paulsell et al. 2015). It is possible that noncustodial

parents with SUDs may be served by these programs or included in research, but subgroup

analyses were not provided. Therefore, we found little information about the actual overlap of

noncustodial parents with SUD who owe child support within these populations.

Similarly, few sources contained information on the relationship between SUDs and payment of

child support. In a study of non-cash support among nonresident fathers, the authors observed

fathers currently misusing drugs and/or alcohol provided less formal ($29 versus $57), informal

($39 versus $41), and non-cash support ($28 vs. $65) than those without current drug/alcohol

misuse disorders (Kane et al. 2015). An evaluation of one jail-based reentry program, for men

diagnosed with substance dependency and who have minor children, found that child support

compliance was higher among the treatment group (Miller et al. 2016). However, the sample size

was small and only included a volunteer comparison group.

A general link between child support and SUD was observed in some sources. The literature

involving drug courts or problem-solving courts included some mention of issues relating to child

support and SUD (OCSE 2008, 2017; Hora 2011). Consistent across these sources was the

need for agency collaborations, for example, between the drug court and child support offices.

Results from Qualitative Interviews

We classified the key findings from the qualitative interviews into six categories:

1) Prevalence of SUD among noncustodial parents and demographic differences;

2) Impact of SUDs

3) Discovery of SUDs in the noncustodial parent population;

4) Child support procedures in cases of noncustodial parents with SUDs;

5) Policy, judicial, and legal changes; and

6) Child support practices to help noncustodial parents with SUDs increase their

compliance with their child support obligations.

Demographics and Trends in Substance Use Among Noncustodial Parents

Most experts did not have data on the prevalence of SUDs among the noncustodial parent

population. Most did not collect specific data on SUD prevalence among noncustodial parents,

but some gave anecdotal estimates that ranged between 15 to 40 percent. Experts also believed

there to be an increase in SUDs among noncustodial parents over the past 5 to 10 years. Most

experts spoke about general trends they observed, since the information is not routinely

collected. One child support expert’s county agency has conducted several research projects

that captured some self-reported data from noncustodial parents on SUDs. From this research,

this expert reported substance use ranged from 3 to 30 percent—the wide range reflects the lack

of concrete information on SUD prevalence. Experts noted the types of substances used by

noncustodial parents varied, but some mentioned observing opioids (both heroin and

prescriptions) and methamphetamines usage. Several mentioned that recent restrictions on

prescription opioids seemed to lead noncustodial parents to use heroin, though some research

suggests this may not be driving large scale increases in heroin use (Compton and Jones, 2016;

Ali et al 2017), and there is no systematic evidence that this is taking place among noncustodial

parents.

In general, experts did not have data on specific demographic trends related to SUDs and

noncustodial parents. However, several reported seeing an increase in female noncustodial

parents and an increase in the percentage of those female noncustodial parents with SUDs.

Many experts noted that SUDs were observed across all income levels, but were most prevalent

in the lower income groups. These experts believed that this low-income population often had

co-occurring mental illnesses, a history of incarceration, a poor employment record, and/or low

educational attainment.

Impact of having an SUD

Having a SUD can lead to economic challenges

that in turn, affect the payment of child support

and trigger counterproductive enforcement

actions.

Most experts agreed that substance use is a barrier

to employment that, in turn, makes it more difficult

for noncustodial parents to meet their child support

obligations. Several experts believed substance

use tends to have a negative impact on a

noncustodial parent’s ability to retain a job more

than to obtain one. Experts reported that many

noncustodial parents with SUDs have some job

skills and are able to get “clean enough” to do well

in a job interview. However, frequent drug testing

and the cycle of relapse and recovery make it hard

for noncustodial parents to retain employment.

These relapse and recovery cycles coincide with

waves of employment resulting in temporary

employment and employment in under-the-table

jobs. As a result, these noncustodial parents cannot

file for unemployment and the child support agency

may encounter challenges establishing income

withholding orders. Experts indicated that

noncustodial parents with SUDs also tended to

have lower monthly child support obligations that

they were struggling to meet. They also had higher

child support debt, referred to as arrears. Reasons

for lower obligations included having a lower

income and lengthier periods of unemployment

than noncustodial parents without SUDs. This is

consistent with research that has established that

individuals out of work and with lower incomes are more likely to have SUDs (Jones et al, 2015).

Experts expressed the belief that both of these economic conditions were exacerbated by the

cycle of relapse and recovery commonly associated with substance use disorder. The extent to

which difficulties in making payments are due to SUDs or economic circumstances is not well

understood. However, experts stated that during relapse, the noncustodial parent may struggle

to maintain employment, thus making child support payment compliance more difficult. While a

noncustodial parent may regain employment during recovery, the past-due child support and

potentially any interest will have accumulated. Having more arrears has a significant negative

effect on noncustodial parent’s employment and child support payments (Cancian et al 2013).

Experts also noted that noncustodial parents with SUDs may lose their driver’s licenses if

substance use results in failure to meet child support obligations. Driver’s license suspension is

an available administrative enforcement action for child support agencies and states are required

by federal law to have procedures to suspend for nonpayment of child support.

States have

flexibility to determine for which child support cases this action is used and some states have

practices in place to address the disparate impact on low-income individuals.

However, the

action can lead to the loss of a noncustodial parent’s primary mode of transportation, which is a

Federal law 42 USC 666(a)(16) requires that state child support programs have processes to withhold, suspend, or restrict

licenses for noncompliance with child support.

See GAO report on License Suspension for Nondriving Offenses at http://www.gao.gov/new.items/d10217.pdf.

Evidence-Based SUD Treatment

Noncustodial parents with SUDs can

benefit from a number of evidence-based

treatments for SUD. The Evidence-Based

Practices Resource Center at the

Substance Abuse and Mental Health

Services Administration (SAMHSA)

provides communities, clinicians and

others in the field with information and

tools to incorporate evidence-based

practices into their communities or clinical

settings.

For example, to address OUD, research

supports medication assisted treatment

(MAT), combining one of three approved

medications in combination with

psychosocial supports. SAMHSA has

issued clinical guidelines and best

practices for treating OUD in vulnerable

populations, such as pregnant or

parenting women and justice-involved

individuals.

See https://www.samhsa.gov/ebp-

resource-center for more examples of

evidence-based treatment approaches.

barrier to employment.

Driver’s license suspension is also a barrier to obtaining SUD treatment.

Although some form of public transportation generally is available in urban areas, the lack of

public transportation in suburban and rural areas, and on Tribal land, may make it difficult for

noncustodial parents to get to treatment facilities.

Discovery of SUDs in the Noncustodial Parent Population

There is no formal screening process for substance use amongst noncustodial parents in

the child support program. Experts knew of no formal screening as part of regular child

support processes, such as order establishment or enforcement, to determine whether a

noncustodial parent had a substance use disorder. A noncustodial parent’s SUD is typically not

disclosed during the establishment of an order, in large part because noncustodial parents’ in-

person appearances are not common in the states represented by this study. Information on

parents’ substance use is not typically collected in the documentation to determine the order

amount. Experts acknowledged that child support agencies are most likely unable, or

unprepared, to do anything about a noncustodial parent’s SUD if it is disclosed. Nevertheless,

child support offices, the courts, and other community organizations that provide wrap-around or

employment services to noncustodial parents could become aware of the parent’s SUD through

a variety of pathways.

Child support caseworkers can learn that a noncustodial parent has a SUD when custodial

parents disclose it. This disclosure may take place during the enforcement stage when child

support caseworkers are seeking to identify the reason for non-compliance of payment. Experts

observed that child support caseworkers with a smaller caseload and a more intensive case

management strategy were more likely to notice signs of a SUD than those with larger

caseloads. Caseworkers from child support and other service provider organizations could

suspect that a noncustodial parent has a SUD based on the noncustodial parent’s behavior.

However, most often there is not a formal mechanism to verify a noncustodial parent’s SUD,

such as a validated substance use assessment.

Child Support Procedures in cases of Noncustodial Parents with SUDs

The majority of the child support experts indicated that there is no difference in protocols

for noncustodial parents with and without SUDs. Experts generally agreed that child support

enforcement protocols did not differ for noncustodial parents with and without SUDs. Some noted

that courts in their jurisdiction do not have the authority to mandate noncustodial parents to

undergo a substance use assessment. Courts also cannot mandate that they receive substance

use treatment unless the noncustodial parent is seeking parenting time. Parenting time, often

referred to as “access and visitation”, is addressed in a different court setting for never-married

parents and therefore it is not a part of child support proceedings in the majority of states. If

having a SUD is interfering with a noncustodial parent’s ability to meet his or her child support

obligation, the court or the child support agency may help the noncustodial parent file for a

modification of the child support order amount. However, the impetus and onus is generally on

the noncustodial parent to initiate and follow through with the process. Applying for a modification

can be difficult for noncustodial parents who are struggling with relapse, recovery, or are

currently incarcerated. The process requires submission of various financial documents and

often-lengthy paperwork, some of which may be complex and challenging to complete.

See https://oewd.org/sites/default/files/FileCenter/Documents/759-4c%20-%20Driver's%20License%20Suspensions.pdf.

See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995852/.

Farrell, Mary, Caitlin Anzelone, Dan Cullinan, and Jessica Wille (2014). Taking the First Step: Using Behavioral Economics to

Help Incarcerated Parents Apply for Child Support Order Modifications. OPRE Report 2014-37. Washington, DC: Office of

Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services

When modifications do occur, it is often based on the noncustodial parent’s change in financial

status, not directly related to a SUD. Several experts stated that if a noncustodial parent is

seeking treatment, their agencies have the option to provide a temporary modification of a child

support order or a continuation, which lowers the order amount, and to potentially suspend the

accumulation of arrears for a set period of time. These legal procedures ensure that no

administrative enforcement actions are taken. However, the experts reported that the temporary

modification does not always occur due to large caseloads, full dockets, and SUD treatment

concluding before a set court date. In some jurisdictions, court dates for child support

modifications are set ninety to one hundred and twenty days out from the submission of the

modification request, or may be delayed due to large dockets.

Select counties in Ohio and Wisconsin, and Georgia through their Parent Accountability Court

(located in 45 of the state’s 49 judicial districts), have reviewed license suspension policies and

created programs to help noncustodial parents with reinstatement when deemed appropriate.

More recently, child support agencies have used license reinstatement as an incentive for

participating in an employment intervention. Respondents were not aware of this same model

being explored for noncustodial parents participating in SUD treatment.

Targeted child support arrears compromise or forgiveness programs for completion of treatment

are not common. Experts noted that a judge may grant arrears forgiveness of state-owed child

support debt in some states, but often does not have the ability to forgive arrears owed to the

custodial parent. In some states, custodial parents can forgive child support arrears owed to

them. Child support agencies have experimented with targeted arrears reduction initiatives for

specific populations of noncustodial parents, such as those participating in employment services,

but not specifically those with SUDs.

A few experts indicated they have referrals to treatment providers, yet these are provided as part

of a broader case management strategy for noncustodial parents behind in their child support

obligations, not specifically for noncustodial parents with SUDs.

Policy, Judicial and Legal Changes

Recent changes to child support enforcement policy and practice hold promise to

improve how child support agencies work with noncustodial parents with SUD. Federal

and state policies on child support can influence how agencies work with noncustodial parents

with SUDs. States were at various stages of implementing the provisions of the 2016 Flexibility,

Efficiency, and Modernization in Child Support Enforcement Programs Final Rule issued by the

federal Office of Child Support Enforcement. Specifically, Section §303.6(c)(4) on civil contempt

procedures now require states to have adequate screening processes to determine a parent’s

“actual and present” ability to pay their child support obligation. Some experts noted these new

procedures may uncover a noncustodial parent’s SUD, though were not aware of any agencies

yet using it for this purpose. If states design their screening process to identify SUD, they may

also want to develop approaches for addressing the noncustodial parent’s SUD. For example,

an agency may establish a formal referral process with a treatment facility or they may create

procedures for child support order establishment and enforcement that take into account the

noncustodial parent’s participation in treatment. The federal rule also directs states to

automatically modify child support orders for noncustodial parents incarcerated for 180 days or

more, or notify the parties they are eligible for such a modification. This may result in a

suspended child support order, or a minimum order, or in some cases, a zero-dollar order. The

same approach could be considered for noncustodial parents with SUDs entering treatment,

thereby supporting treatment success and potentially increasing child support compliance.

and Office of Child Support Enforcement May 2018 Child Support Report, Ohio- New Approach Increases Modification

Request.

Apart from federal requirements, states have flexibility to design policies that can encourage

noncustodial parents with SUD to meet their child support obligations while also getting

treatment. Respondents from Ohio shared that their updated child support guidelines included a

self-support reserve for those noncustodial parents that are low-income. This provision in a

state’s child support guideline calculation sets aside an income amount the noncustodial parent

must retain prior to paying child support. The intention is to enable low-income noncustodial

parents to have sufficient resources to meet their basic needs and incentivize continued

employment. This may also enable noncustodial parents with limited income due to participation

in treatment to maintain basic needs and work towards increased employment and stability.

Apart from policy changes, experts reported changes in the general mentality and practices in

regard to noncustodial parents with SUDs. For example, legal experts in one state indicated that

SUDs are now treated as an illness or disease by many courts rather than a moral failing.

Another expert mentioned seeing a culture change in terms of how enforcement agencies

approach noncustodial parents. Many agencies now emphasize the importance of assisting

noncustodial parents to address their broader needs so that they can be in a better position to

meet child support obligations. Other experts noted that courts are reducing counterproductive

actions against noncustodial parents with SUDs, such as limiting driver’s license suspensions

and incarceration for failing to meet support orders.

Child Support Practices to help

Noncustodial Parents with SUDs increase

their Compliance with their Child Support

Obligations

There are no federal or state requirements related

to child support practices for those in SUD

treatment, but there are emerging ideas about how

to help these families.

Experts identified two current practices that assist

noncustodial parents with SUDs to obtain employment

which can lead to child support compliance: 1) helping

noncustodial parents sign up for Medicaid so that they

can access treatment, which reduces the barrier to

work, and 2) utilizing employment programs with

tiered approaches that allow parents to work part-time

while seeking treatment. In study states that

expanded Medicaid, child support agencies were able

to provide information, a referral, or help noncustodial

parents apply for health insurance. Once the

noncustodial parent was receiving Medicaid, they

were able to access more treatment options. In the

second strategy, experts cited partnerships with

community-based organizations that specialized in

workforce services for populations with barriers to

employment, such as SUD. For example, Goodwill

Industries was a partner that experts believed had

shown success in serving noncustodial parents with

multiple barriers.

Child support agencies might

consider several emerging practices

when working with noncustodial

parents with SUD, including:

• Review child support orders for a potential

modification when a noncustodial parent is

in treatment;

• Suspend arrears accumulation while a

noncustodial parent is in treatment;

• Partner with an employment program that

has a tiered approach;

• Help noncustodial parents sign up for

Medicaid to access treatment;

• Partner with a community-based

organization with expertise in working with

individuals with SUDs;

• Work with a medical-legal partnership;

• Consider how license suspension and

reinstatement is used in the context of

treatment;

• Train staff on how to interact with parents

with SUDs.

Child support agencies rarely have formalized partnerships with other organizations that

can support noncustodial parents with SUDs.

While experts acknowledge the importance of partnerships to provide appropriate services to this

population, they stated that child support agencies do not usually have formally established

partnerships with organizations that can assist noncustodial parents with SUDs in meeting their

child support obligations. However, some experts indicated that child support agencies have

informal partnerships that can include SUD treatment providers, legal aid, and employment

organizations. These informal partnerships may be at the very basic level of being a referral

source for the child support program. In the context of this study, experts were asked to reflect

on their agency-level partnerships that most often resulted in referrals or service provision for

shared customers with SUDs. Although many legal and SUD treatment experts stated that their

organizations did collaborate in some way with others in the community, they indicated a general

lack of formal partnerships with child support agencies. Child support, substance use disorder

and legal experts all indicated the main barriers to collaboration were funding constraints that

limited the number of individuals they could serve, large caseloads for staff at child support

agencies, treatment centers and legal aid providers, and a lack of knowledge about child support

agencies as a potential referral sources for customers.

In the cases where collaboration occurred with the child support agency, representatives of legal

aid and employment organizations generally initiated it. One promising example of such a

collaboration is Medical Legal Partnerships (MLPs). In the MLP model, attorneys join medical

providers, social workers and other community providers to holistically address the needs of an

individual. In Indiana, the MLP attorneys often assist noncustodial parents with child support

issues that may arise during the recovery process.

Although several experts from child support agencies directly informed noncustodial parents with

SUDs about treatment resources, most did not have formal relationships with SUD treatment

centers. The majority of child support experts collaborated in some way with other community

resources, such as employment services providers or fatherhood programs. Nevertheless,

experts all agreed that agency collaboration with treatment providers was critical for noncustodial

parents with a SUD to succeed and become compliant with their child support obligations.

Finally, experts discussed being more intentional about the inclusion of child support services in

the creation of a “one-stop shop” of social services, ranging from food, to clothing for

employment, to adult education for noncustodial parents with a substance use disorder, all

housed in the same location to facilitate collaboration.

Promising Programs Identified through the Environmental Scan

and Expert Discussions

Through the environmental scan and expert discussions a selection of promising programs and

practices were identified. These included problem-solving courts, fatherhood programs, and

strategic partnerships with child support agencies. Table 1 provides a brief description of the

programs and practices. None of the programs or practices identified were designed specifically

for noncustodial parents with SUDs. These programs or practices were frequently mentioned by

the experts, in the literature, or a combination of both. This does not represent a comprehensive

list of all relevant programs and practices.

In particular, experts discussed the potential value of problem solving courts,

fatherhood/parenting programs, enhanced case management, and integrated programs or

strategic partnerships with child support. Limited information was identified on specific

programmatic approaches, or on the efficacy of these programs in supporting noncustodial

parents with SUDs in meeting child support obligations

Table 1. Summary of program and practices identified by scan and experts

Program/practice

Description

Problem-solving

courts

Drug treatment courts were the most commonly mentioned venues for

addressing treatment and relapse for noncustodial parents, and family

courts for addressing custody issues. While there are few problem-

solving courts that focus specifically on child support, drug treatment

courts have the potential to work with the comprehensive needs of

noncustodial parents with SUDs, including their child support obligations.

Substantial evidence

exists on the effectiveness of drug courts in

helping parents through treatment. No information was identified on the

efficacy of these programs in supporting noncustodial parents with SUDs

in meeting child support obligations.

Fatherhood/parenting

programs

Generally, these programs are implemented by multiservice

organizations that frequently offer both parenting/fatherhood and

employment services. Some have partnerships with child support and

SUD treatment programs. These programs are often privately funded or

receive grants through other government organizations (e.g., Office of

Family Assistance). By helping address SUD barriers to family

relationships among noncustodial parents, these programs may also

increase the likelihood they meet their child support obligations. No

information was identified on the efficacy of these programs in supporting

noncustodial parents with SUDs in meeting child support obligations.

Enhanced case

management

Enhancements to traditional case management for noncustodial parents

can support both SUD treatment and recovery, as well as child support

compliance. Enhanced approaches can be applicable both to child

support case managers, as well as those working in SUD treatment and

employment. Enhancements included additional behavioral health

assessments, training in new behavioral/therapeutic techniques,

increased communication between the noncustodial parent and case

manager, attending legal proceedings, and formation of case

management teams. No information was identified on the efficacy of

these programs in supporting noncustodial parents with SUDs in meeting

child support obligations. However, the federal Office of Child Support

Enforcement’s (OCSE) Procedural Justice-Informed Alternatives to

Contempt grants, which include enhanced case management, are part of

a rigorous evaluation with forthcoming findings.

Integrated programs

or strategic

partnerships with

child support

Strategic partnerships were operated by either the child support agency

or another agency/organization that included a specific partnership with

the state or local office of child support. Several of these programs were

mentioned above in another context (for example, OCSE’s Procedural

Justice-Informed Alternatives to Contempt grants), but other types of

programs were also mentioned. These included integrated employment

programs that provide child support and SUD services through

formalized partnerships and child support integration with the court

system. No information was identified on the efficacy of these programs

in supporting noncustodial parents with SUDs in meeting child support

obligations.

There was general consensus among the experts that more integrated programming that

included partnerships with child support agencies, drug treatment providers, and other supportive

Lloyd MH. Family Drug Courts: Conceptual Frameworks, Empirical Evidence, and Implications for Social Work. Families in

Society. 2015 Jan 1;96 (1):49–57. Shaffer, Deborah Koetzle. "Looking inside the black box of drug courts: A meta‐analytic

review." Justice Quarterly 28.3 (2011): 493-521.

services was needed. Experts suggested the creation of a child support/drug treatment problem-

solving court as a program with promise. Some believed the team-based approach of problem-

solving courts would be especially beneficial to noncustodial parents with SUDs, as had been

experienced with veterans in the same court setting. In addition, experts suggested increased

staff training on how substance use influences a person’s decision-making could, amongst other

things, potentially increase child support compliance. One respondent noted positive impacts on

caseworker interactions with noncustodial parents following such training, which ultimately

improved compliance.

Directions for Future Work

This study is exploratory and limited to a few states and a select group of experts. However, key

themes emerged from both the environmental scan and expert interviews that lay the

groundwork for future research and policy work. The majority of experts expressed the belief that

the intersection of substance use and child support was a salient issue that deserved further

research. One expert stated, “It’s a serious enough problem that it warrants having a special

focus. The goal is to try and get noncustodial parents to financially and emotionally support their

child, and substance use is a huge barrier to be able to do that.”

Several knowledge gaps that have implications for both policy and practice emerge from this

study. First, there is a need for descriptive research on the population of noncustodial parents

with SUDs and the prevalence of SUD among noncustodial parents generally. Issues associated

with SUD may compound a noncustodial parent’s difficulty in meeting their financial obligations,

such as polysubstance use, co-occurring mental health conditions, and inability to access

treatment. Understanding how these other factors compound barriers to paying child support is

key to designing policies and interventions that combine SUD treatment and child support

services. New interventions should be evidence based, where possible, to increase the odds that

they can be replicated and scaled.

This study identified several ways traditional child support enforcement may present barriers to

payment by noncustodial parents receiving treatment for SUD. These include lack of screening

to identify SUDs, a siloed approach to case management, and sanctions such as driver’s license

suspensions that impede accessing SUD treatment. More needs to be understood as to how

these barriers manifest themselves, and how child support compliance efforts interact with SUD

treatment. In particular, research can explore how collaborations across organizations can

increase the likelihood of positive treatment outcomes, and subsequently increase the likelihood

of making payments. For example, parents are very unlikely to be asked by treatment providers

whether or not they have a child support obligation. Longer standing partners, such as prisons

and fatherhood programs in some jurisdictions, now routinely ask. Future efforts could target the

establishment of partnerships between child support agencies and treatment providers, and

include training for treatment provider staff on the child support program.

This study signals the need to better understand how child support enforcement intersects with

substance use disorder among noncustodial parents. Greater evidence can help policymakers

and practitioners design and deliver programs that better serve families struggling with SUD and

move them to self-sufficiency.

Acknowledgments

This research would not have been possible without the voices from the field. We thank

everyone who participated in the study. Your perspectives and knowledge were invaluable.

We also thank Daniel Friend, Nellie Garlow, and Amanda Lee from Mathematica Policy

Research for their data collection efforts and Jacqueline DeAnda, an Archer Fellow, for her work

in the early stages of the project.

Appendix A – Environmental Scan Methodology

Search methods. The search strategy sought to identify sources that addressed the intersection

of child support and substance use. Therefore, for each database, the search was set up to

identify any source that mentioned both the child support and substance use search terms.

Exhibit I.1 shows the search terms used.

Exhibit I.1. Search terms used

Library staff searched Medline, PAIS Index, ERIC, PsycINFO, Academic Search Premier,

Education Research Complete, SocINDEX, and Scopus databases for peer-reviewed literature.

In addition, library staff searched several databases known to include government reports and

other gray literature: Social Science Resource Network (SSRN), JSTOR, the Rutgers Law

Library Gray Literature Database, Westlaw, the National Criminal Justice Reference Services

(NCJRS), and Google Custom Search Engine (GCSE).

The results of the search are shown below in Exhibit I.2. Across all sources, the search identified

1,152 results. All of the identified peer-reviewed literature, the sources identified through NCJRS,

and 100 of each of the sources identified through SSRN, JSTOR, GCSE, and Westlaw were

screened. A random sample of the Westlaw results (which had no discernable order), and the

first 100 results from the other databases were used because these items were sorted by

relevance.

Screening methods. To screen articles, the title, abstracts, and executive summaries for both

child support and substance use search terms were examined. If those components of the

source were not included, the entire source was read. In addition to looking for the relevant

terms, the general content of the source was reviewed for relevance. For example, a source may

have identified child support and/or substance use in an introduction section, but the main

purpose of the article was describing or researching a topic or population different from the focus

of our scan. 77 results were initially screened and 50 sources were determined to be included

for this scan. All of the screened-in sources from the peer-reviewed databases, SSRN, JSTOR,

and NCJRS were included. For GCSE, 24 most recent sources were included. No Westlaw

sources were included.

Exhibit I.2: Search and screening results

Database

Number

returned

Number

screened

Number initially

screened in

Number coded

Peer-reviewed

databases

SSRN

173

100

JSTOR

169

100

Rutgers

Child support-related terms: child support, child support enforcement, child support orders, child

support payments, noncustodial parents

and

Substance use-related: substance use disorders, opioid use disorders, substance abuse, opioid

abuse, prescription opioids, heroin, methamphetamines, poly-substance use, illicit drugs

GCSE

169

100

Westlaw

543

100

NCJRS

Total

1152

498

Nearly half (48 percent) of the sources were screened out because the topic was not relevant. In

most of these instances, both sets of relevant words were found, but the topic was not of interest

to the scan. For example, the source may have been primarily about substance use recovery

and briefly mentioned that a single parent may owe child support. In other instances, the topics

of child support/noncustodial parent and substance use disorder did not intersect. This

disconnect was found frequently for topics concerning incarcerated or justice-involved

populations, particularly in government reports that broadly discussed services provided by

government agencies. An additional 31 percent of sources focused on one but not both topics.

Twenty percent of sources focused on substance use disorder only and 11 percent on child

support only. Finally, 12 percent of articles were out of date (for example, the source was

reprinted within our time frame, but the original publication was prior to 2008), 5 percent were

international, and 4 percent could not be screened because a sufficient preview or full-text

version was not available.

The vast majority (78 of 100) of the Westlaw cases were not reviewed. Although words from both

sets of topics were found, the underlying case was not about policies or programs directly related

to noncustodial parents and their substance use. The cases were about a range of issues

including welfare fraud, homicide, and property claims. The majority were about whether a

person was entitled to social security benefits due to substance use disorder issues. Ultimately,

no Westlaw articles were coded due to limited information of promising practices and programs.

For simplicity, they are included in the “not relevant” category below.

Exhibit I.3: Reasons for screen-out

Reason

Percentage

Not relevant

Neither child support nor noncustodial

Out of date

No substance use disorder

International

Could not screen

Coding. The following information was examined in each article:

 Child support characteristics (for example, average payment amount, number of

support orders)

 Substance use disorder (SUD) or opioid use disorder (OUD) characteristics (e.g.,

prevalence or type of substances)

 Demographic characteristics of noncustodial parents with SUD (for example, age,

gender, race/ethnicity)

 Region and location

 Promising programs and practices

 Research outcomes (for example, changes in child support compliance following

participation in a program)

 Agencies that focused on providing support for noncustodial parents with SUD

 Other interactions (that is, noting any other ways that substance use and child

support interact or influence each other)

 Summary (that is, a brief synthesis of each article, noting the major points and

relevance of the article)

 Year and type of reference

Appendix B – Qualitative Interviews

Recruiting experts. Semi-structured conversations were conducted with eighteen experts with

expertise in the areas of child support, substance use disorder, and/or legal services. A number

of experts from the same states were intentionally selected with the objective of triangulating

findings. Multiple experts were recruited from Indiana, Kentucky, Ohio, Vermont, West Virginia,

and Wyoming. Stakeholder recruitment took place over a four-week time period and included

both email and phone outreach. Nonresponsive experts received at least three varied outreach

attempts before they were no longer considered viable participants. In more than half of the

cases where a stakeholder declined participation, he or she provided an additional potential

stakeholder who might be better suited to participate in a discussion. With these additional

recommendations, a total of 46 experts were contacted before concluding recruitment. Experts in

the legal field were more willing to participate in interviews, while experts in the substance use

field were the least likely to respond. 18 interviews with 21 experts were scheduled and met the

goal to include experts who represented a mixture of federal and nonfederal positions and who

were experts in all three fields. Additionally, multiple experts were recruited from Indiana, Ohio,

and Wyoming, which was one of the initial recruitment goals.

Conducting and coding interviews. Stakeholder discussions took place over a two-month

period. Each interview lasted between 45 minutes to one hour, with one interviewer and one

note-taker facilitating each call. For coding, key themes raised by multiple experts were

highlighted.

Exhibit I.4

Name and organization

Area of

expertise

State

Office of Child Support

Child Support

Wyoming

Office of Child Support Enforcement

Child support

South Dakota

Office of Child Support, Indiana

Child support

Indiana

Administration for Children and Families

Child support

National

Georgia Office of Child Support

Child support

Georgia

Natrona County Child Support

Enforcement Department

Child support

Wyoming

Fatherhood Program, Montgomery

County, Ohio

Child support

Ohio

Workforce Development in Kenosha

County, Wisconsin

Child support

Wisconsin

Center for Policy Research

Child support

National

Office of Child Support, Stark County,

Ohio

Child support

Ohio

River Valley Resources

Substance use

Indiana

SAMHSA

Substance use

National

Communicare Kentucky

Substance use

Kentucky

Indiana Family Law

Legal

Indiana

Medical Legal Partnerships, Indiana

Legal

Indiana

Legal Action Center

Legal

New York

Vermont courts

Legal

Vermont

Ohio State Legal Services Association

Legal

Ohio

West Virginia Sixth Circuit Family Court

Legal

West Virginia

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