Of the 4 million babies born in the United States each year around 11% have been exposed to alcohol or illicit drugs in the womb.
The National Center on Substance Abuse and Child Welfare says if they are removed from the home for their protection, these children remain in foster care longer, and the chances they will be reunited with their parents are very low.
Now a new study is suggesting that recovery coaches can significantly reduce the number of substance-exposed births as well as help reunite substance-involved families.
The study led by social work professor Joseph P. Ryan from the University of Illinois, shows that recovery coaches also saves state child-welfare systems millions of dollars in foster-care and other placement costs.
The 5 year study included 931 women in Chicago and suburban Cook County who had lost temporary custody of their children and who were chronic substance abusers, referred for alcohol and drug assessments - 69% of the women had given birth to at least one substance-exposed infant prior to enrolment in the study.
A woman's age, race, and cocaine or heroin placed certain of the women at higher risk for giving birth to a substance exposed infant and mothers who have at least one prior substance-exposed infant are significantly more likely to deliver additional substance-exposed infants.
The families were given one of two treatment conditions - the control group received traditional child-welfare and substance-abuse services while the experimental group received traditional services plus the services of a recovery coach - caseworkers with special training in addiction, relapse prevention, case management and counselling.
Their role was to get the mothers into substance-abuse treatment and keep them there by engaging in face-to-face contacts in the family home and with treatment-provider agencies and to help overcome a relapse or drop out from the program.
The recovery coach helped them re-engage with treatment and also meet the legal and other requirements associated with regaining custody of their children.
The study found that overall, mothers assigned to the recovery-coach group were more likely to access substance-abuse services, and were more likely to achieve family reunification, saving $5.5 million in foster-care and other placement costs.
Professor Ryan says reunification rates for substance-involved families are the lowest of all families involved with the child-welfare system often because they fail to address the core problem of substance abuse.
Ryan says that presents an obstacle for judges making decisions to have the children return home and he says a recovery coach increases the reunification rate by about 6%, which is a small but significant gain.
Professor Ryan says very often, substance-involved families are struggling with several major problems such as mental illness, inadequate housing, domestic violence and unemployment and it is unrealistic to think that one case worker can effectively manage such an array of problems.
Recent research by a team from St Vincent's hospital in Sydney has suggested that changes are needed in the way methadone is provided to addicted parents in order to prevent child deaths, as some children have died after being given methadone to sedate them.
The study is published in the journal Child Abuse and Neglect.