Addressing Substance Use Disorders Among Families Involved with the Child Welfare System: A Cross-Agency Collaboration

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Community Burden Study

Caregiver Interview Guide

Background

Thank you for agreeing to participate. Today, I’ll be asking you about your experiences caring for a family member’s children (or foster children) due to the parent’s struggles with opioid/substance use. During our discussion, I’d like for you to please focus on your experiences with those children. If you’ve cared for several children whose parents have struggled with opioid/drug use, please refer to the children you’ve cared for most recently. Does that sound okay?

1. First, I’d like to learn a little about you. How long have you lived in [name] county?

2. Are you currently [or have you in the past] caring/cared for/fostering any children because of their parent’s issues with opioid/drug use?

[Note to interviewer: Use the caring for/fostering terminology moving forward based on interviewee type and response]

[If yes] are you a relative caring for these children or a non-relative foster parent?

1. If relative, what is your relationship to these children?

3. How many minor children (under 18 years of age) are you currently caring for that live in your home full time?

   1. What are their ages?

   2. How many of these children are your biological, adopted, or step children?

   3. For how many of these children are you a kinship caregiver (relative by blood or marriage)?

   4. How many of the minor children in your care are foster children?

4. Are you involved with child welfare for any of the children in your care?

   1. If yes, what is the name of the agency?

Trajectories

Now, I’d like to talk to you about how the child(ren) came into your care. Again, I’d like for you to focus on the child or children who most recently came into your care as a result of their parent’s issues with opioid/drug use.

5. What are the reasons the child(ren) were placed in your care?

   1. [If not mentioned] Do you happen to know if the child(ren) exposed to violence or other adverse experiences because of the parent’s opioid/drug use?

6. [Kinship caregivers ONLY] To the best of your knowledge, were there any issues going on in the parent’s life that may have led him/her to misuse opioids/drugs at that time?

Probe financial/relationship issues, death of a loved one, employment issues, physical pain, etc.

7. [Kinship caregivers ONLY] How were you identified as the relative who would care for the child(ren)?

   1. Did you have to make any immediate changes to your employment, finances, housing, or other arrangements in order to care for the children? What were some of the changes you had to make?

Probe safety requirements for home, obtaining or reducing employment, applying for public assistance/Medicaid, putting the child on their insurance, etc.

2. At the time, did you feel prepared to become the child(ren)’s primary caregiver? Please explain.

1. Do you expect that the children will eventually live with their parent(s) again on a permanent basis? Please explain.

   1. [If yes] When might that occur?

   2. [If no] Have you had discussions with the child welfare caseworker about you caring for the children on a permanent basis?

2. Currently, are the children regularly interacting with their parent(s)?

Probe on frequency and types of interaction (voice calls, video calls, in-person), conditions (supervised or unsupervised)

1. How do the interactions generally affect the children afterward?

Probe on how the interactions may affect the caregiver afterwards as well

10. What are some of the challenges you’ve faced with caring for child(ren) whose parent has a problem with opioids/drugs?

Probe on challenges related to impact on other children in the house, impact on the family, impact on mental and physical health, finances, etc.

1. Have you had challenges taking on a parenting role with the children?

2. How have you dealt with or overcome these challenges?

3. [If appropriate] How have these challenges affected the child(ren)?

1. To the best of your knowledge, how has parental opioid/substance use affected the children in your care? What has been the impact on them?

Probe exposure to violence and ACEs, involuntary separation from parent, children’s performance in school, anxiety/depression, etc.

Services and Supports

Next, I’d like to talk with you about the services and supports that are available to you as a caregiver/foster parent, as well as your experiences with those services and supports.

12. As a caregiver/foster parent, are you aware of the different services or supports that are available to you to assist you with caring for this child/these children? [If needed]: For example, we are interested in both formal and informal services such as those that are available through CW agencies like support groups, training classes or respite care; and more informal support such as that received from friends or family

13. Which services or supports have you utilized?

    1. How did you learn about these services and supports?

    2. How easy or difficult was it for you to access these services or supports? Please describe.

       1. What kinds of things made using services easier for you?

       2. What kinds of things made using services more challenging for you?

Probe for whether employment/working makes accessing services difficult (or easier)

3. If you have not tried to access/use some of these services, why?

Probe for stigma, time constrains, lack of awareness of services, etc.

4. How satisfied are you with the services and interactions that you received?

   1. What has been most helpful?

   2. What has been least helpful?

1. Were there any services that you needed that you either couldn’t access or didn’t know about?

2. What additional services or supports should be offered in your county?

3. [For kinship caregivers only] In your opinion, what are the biggest challenges facing families struggling with opioid/substance misuse?

4. How can agencies and organizations best spread the word about available services and supports to ensure the people who need them hear about them?

5. Is there anything else that you’d like to tell us?

Community Burden Substudy – Caregiver Interview Guide 3