See the newsletter issue on
Children and Substance Abuse for more coverage of this topic.
Parental substance abuse has a major impact on child welfare practice across the nation and in Illinois.
A recent survey of child welfare workers in Illinois found that 74% of their cases involved parental
substance abuse. Although recovery from alcohol and other drug abuse (AODA) is a lifetime process,
the Illinois Permanency Initiative requires that children in custody be reunified with their parents, be
made available for adoption, or have some other permanent home arrangement made within 12 months
of entering foster care. This conflict between the permanency needs of children and the recovery needs
of parents makes working with substance abusing families especially difficult.
DCFS/OASA Programs Address the Challenges
The research and program literature summarized in this newsletter issue identifies the challenges faced
by child welfare agencies as they try to keep children safe when they are in substance abusing families.
DCFS and the state Office of Alcoholism and Substance Abuse (OASA) are vigorously working to meet
these challenges. For example, the DCFS/OASA Initiative
is designed to address all the challenges
outlined in article #2, "A New Report to Congress," including cross training,
assessment, treatment delay, confidentiality, length of treatment and special efforts to get and keep
parents in treatment. The Seattle Advocacy Model discussed in article #12 is similar to the Illinois
Project SAFE, which uses a program of outpatient services supported by energetic outreach, childcare and
transportation. The DCFS/OASA Initiative and Project SAFE are both discussed below.
The Policy Guide 99.13 Substance Exposed Infants and Substance Use by Children and Youth The DCFS/OASA Initiative Integrates Services The Initiative includes these important features: Project SAFE The I AM ABLE Project Several states are using the model in various ways. The following components are usually included: The model was first used in Illinois at North Lawndale in 1996 and was transferred to the I AM ABLE
Family Development Corporation in 1998. I AM ABLE uses the Family Conference model for casework
and the family systems model for clinical treatment. Outcomes from the first demonstration project at I
AM ABLE show promise although the data are not yet clear. A second demonstration project began in
January, 2000. Child Welfare and AODA Title IV-E Waiver Eligibility - Families eligible to participate in this project will: Control Group - The demonstration project uses both control and experimental groups to which cases
are assigned randomly by an independent research firm. New Recovery Coaches - Traditionally, child welfare workers focus on children and OADA treatment
providers focus on parents. However, the Recovery Coach is a professional who does not work for either
DCFS or the AODA treatment providers, and thus sees the entire family as his or her service
responsibility. Recovery Coaches do not replace the child welfare or AODA staff, but have primary
responsibility for providing and coordinating services to the families. Coaches connect to parents
immediately (within 48 hours of referral), stay with them to the end, and are aggressive and persistent in
engaging and re-engaging them in treatment. They see parents at home regularly and can assess the
risks present in the family environment. Enhanced Services Possible - The specific enhanced services available during years 2-5 of the project
will be developed with input from various community members. They may include the following options: New Concerns: Methadone and MISA Methadone - Although studies clearly show that methadone is the best treatment available for heroin
addiction, there is an unfortunate bias against and misunderstanding about methadone among the public
and practitioners. The Office of the Inspector General is currently working to supply more methadone
maintenance treatment options for DCFS clients. See article #7 for more about methadone treatment. MISA - Professionals are becoming more aware of the number of parents who suffer from both mental
illness and substance abuse (MISA), and their special needs. However, there is still a split between the
treatment fields; drug treatment providers may not understand or serve clients who are also on mental
illness medications and mental illness treatment providers may not understand or serve clients who are
chemically dependent. OASA now has a staff person coordinating MISA programs throughout the state.
MISA topics will be covered in a future newsletter issue.
1. CASA's New Report on Substance Abuse in Child Welfare top Reid, Jeanne (Principal Investigator) (1999). No Safe Haven: Children of Substance-Abusing Parents.
The National Center on Addiction and Substance Abuse at Columbia University. 167P.
Available on the Web at
http://www.casacolumbia.org/publications1456/publications_show.htm?doc_id=7167 CASA (The National Center on Addiction and Substance Abuse at Columbia University) conducted this major 2-year study which included a survey of child welfare and court professionals, six case studies of innovative
programs, and a literature review of over 800 publications. Substance Abuse Increases Child Maltreatment Substance Abuse is a Factor in 70% of Cases Neglect is 4.2 Times More Likely Abuse is 2.7 Times More Likely Substance Abuse Increases Case Complexity More Young Children are Maltreated Six Weaknesses in Child Welfare 1. Lack of Effective Screening and Assessment will not find substance abuse because abusers may deny it or hide it. Also, because the patterns of use, abuse, or
addiction may be complex, without expertise in assessment, workers will not be able to make good decisions about
risk, treatment and other case factors. 2. Lack of Timely Access to Treatment 3. Lack of Ways to Motivate Parents 4. Lack of Criteria for Reunification 5. Lack of Preparation for Relapse 6. Lack of Standards for Reasonable Efforts to Preserve Families Innovative Programs
2. A New Report to Congress on Substance Abuse in Child Welfare top U.S. Department of Health & Human Services (1999). Blending Perspectives and Building Common Ground: A
Report to Congress on Substance Abuse and Child Protection. 179P. Available
on the Web at
http://aspe.hhs.gov/hsp/subabuse99/subabuse.htm Chapter 7: Service Delivery Models: Approaches to Addressing Joint Substance Abuse and Child
Maltreatment Problems. Child Welfare and AOD Staff Lack Training Assessment is Minimal Treatment Delay Reduces Client Motivation Confidentiality Treatment is Effective if it is Long Enough Special Efforts Get and Keep Parents in Treatment Long-Term Intervention is Needed Also, if post traumatic stress syndrome resulting from past or current physical or sexual abuse is not
treated, it may lead to continued relapse.
As of 12/1/99, the
Policy Guide 99.13 Services For DCFS Substance Affected Families
covers DCFS
procedures for identifying, assessing, referring for treatment, and coordinating the care of substance
abusing clients. Continuous assessment of risks in the family environment using the
Guide to Risk Factors for Substance Affected Families and Substance Exposed Infants
is the key to protecting children
in these families. A new
DCFS Handbook for Serving Substance Affected Families
is now being prepared.
Additional assessment and practice protocols apply when an infant is born to substance abusing parents.
See the newsletter issue on
Children and Substance Abuse
for coverage of this topic as well as substance use by children and youth.
In 1995, OASA received increased state funding to expand treatment capacity and offer faster access to
treatment for DCFS clients. The Initiative also supports improved case management and outreach,
improved communication between OASA and DCFS, and staff training in both agencies. Thirty-four
substance abuse treatment providers are involved in the Initiative services offered at 68 state locations
and 23 Project SAFE sites.
Project SAFE (Substance and Alcohol-Free Environment) began in 1986 as a Federal demonstration
project to serve substance-abusing women with children, using intensive outpatient services. A key
feature of the program is the intensive outreach to keep clients engaged in the program, which may also
include transportation to treatment and childcare during treatment. Treatment components include a
parenting curriculum, substance abuse education, individual and family counseling, specialized women's
groups, skill-building and self-help groups. Project SAFE has demonstrated its effectiveness in promoting
recovery for mothers and safety for children. There are now 21 AOD agencies and 23 treatment sites
statewide.
This project offers services to African American families, including substance-abusing families, using the
Family Group Conference model. The model originated in New Zealand as a way to involve aboriginal
Maori families in decisions about child welfare and juvenile justice, based on their traditional strong
sense of family and community.
This program is a new, five-year, Federally-funded demonstration project intended to expand the
services provided through the DCFS/OASA Initiative. The phrase, "Title IV-E Waiver," means that some
requirements of the Social Security Act are waived in order to allow development and evaluation of
innovative programs.
Two new areas of concern for child welfare agencies dealing with substance-abusing parents include
methadone maintenance treatment and clients who suffer from both mental illness and substance abuse.
In 1986 there were 1.4 million maltreated children in the U.S. In 1997 that figure had doubled to 3.0 million. Most of
the increase in child maltreatment is due to the substantial rise in substance abuse in the U.S., which was initiated
by the epidemic of crack use, but which has continued at a high level even though crack use declined during the
1990s.
Substance abuse substantially impedes our efforts to protect children. Researchers variously estimate the
percentage of total child maltreatment cases involving substance abuse at 50% to 90%. CASA estimates that 70%
of cases are caused by or aggravated by parental substance abuse. Most substance-abusing parents use alcohol
as well as other drugs. Substance abuse also drives the increase in repeated incidents of maltreatment. Child
welfare agencies must now spend more of their resources investigating reports and removing children, and have
fewer resources to provide services to families.
Child neglect is almost inevitable when parents are substance-abusers, 4.2 times more likely than in non-substance-abusing families in similar circumstances. Neglect occurs due to brief lapses in supervision as well as
extended absences from home. Parents have little time, money or energy to devote to their children due to time
spent binging, recovering from binging and trying to get money for drugs via illegal activities. Their children may be
molested by others because parents are not providing protection.
Abuse is usually triggered by a child's behavior, and drugs may increase parental violence by lowering inhibitions,
reducing thinking ability and increasing aggression, paranoia, and irritability. Parents may take children with them
on drug activities where they can be injured. Abuse is 2.7 times more likely in these families than in non-substance
abusing families in similar circumstances.
Parents, most of them women, who are now seen in child welfare cases are more troubled than ever before. Many
have multiple problems including:
Most victims of maltreatment are now under age 5. Infants are the fastest growing population in foster care, and
many are exposed to drugs during pregnancy. Exposed infants are 2 to 3 times more likely to suffer maltreatment
than other children in similar conditions.
CASA's study found six critical weaknesses in child welfare practice and family courts that compromise our efforts
to protect children.
CASA found that 42% of the professionals they surveyed either are not required to report substance abuse or don't
know if they are required to report it. Although many of those surveyed had received some training on screening
and assessment, the training was cursory. When screening is done, it is commonly just simple conversational
questions. If alcohol use is found, it may not be taken seriously. This lack of screening expertise means that
workers
Treatment and other services for substance-abusing parents are in short supply. Only 31% of substance-abusing
parents and 20% of pregnant women in the child welfare system receive treatment and the treatment offered is only
whatever happens to be available, not what is best for them. Treatment programs generally have waiting lists of 1-3
months. Most programs are designed for men, and do not meet the needs of women in the child welfare system
who may require residential treatment and aftercare, mental and physical health services, child care, pediatric
services, individual and women's group therapy, marital/family counseling, parenting education, and literacy and
job training. Studies of women receiving federally-funded treatment show it can be effective and cost effective.
In CASA's survey, 85% of respondents said their most difficult problem is motivating parents. CASA's review of
innovative programs shows that using paraprofessionals who are in recovery as home visitors shows promise in
motivating parents, and treatment programs tailored for women increase retention rates.
Child welfare practice lacks standard criteria on when children can be returned to their families. Also, without a
good understanding of substance abuse and recovery, child welfare workers are unable to make helpful decisions
about parents' progress. Federal law also discourages treatment programs from disclosing information about the
progress of parents in their programs, which hampers decision-making in these cases.
The child welfare system, lacking an expert understanding of substance abuse, generally fails to anticipate and plan
for relapse after treatment is completed. Relapse is not considered a sign of failed treatment among addiction
treatment programs, but part of the recovery process, and is most common during the first three months after
treatment. Child welfare services should spend resources on providing three months of monitoring and aftercare
services rather than on re-opening cases. These may include participation in 12-step programs, child care,
preparing a plan for assistance from friends or relatives, or using paraprofessional home visitors.
CASA's survey shows that child welfare professionals do not agree on how to help substance-abusing parents, or
on what parental behaviors should trigger moving toward termination of parental rights. Unfortunately, child welfare
professionals must negotiate two clocks: the child development clock runs quickly, while the recovery clock for their
parents runs slowly.
The report also covers innovative child welfare programs in Sacramento County, New Jersey, and Connecticut, as
well as the new family drug courts.
Child welfare workers are inadequately trained to recognize and assess substance abuse in their clients.
Alcohol and other drug (AOD) treatment staff have inadequate training to recognize and respond to child
maltreatment in their clients. Neither field has adequate knowledge or training to serve the clients that
are affected by both fields. Joint training is important to ensure that the groups will be able to collaborate
effectively. The National Center on Child Abuse and Neglect has funded 25 multi-disciplinary training
programs, and found they were effective at increasing worker awareness, increasing accuracy of
screening, improving assessment skills, and increasing knowledge of available community services.
In its survey of state child welfare agencies published in 1998, the Child Welfare League of America
found that child welfare risk assessments rarely or only briefly mention substance abuse. When risk
assessments do include substance abuse, workers may simply report that they do not have enough
information to assess this risk factor, because in court, they may be questioned about their qualifications
to make such an assessment.
Long wait times to get into treatment mean that clients will lose their motivation to cooperate, which is
highest during the crisis time when first being referred to child protection.
Child welfare workers must get consent from their clients for release of information from their AOD
treatment program at the time that clients are referred, so information about their progress can be
obtained to make decisions about the case.
Because AOD treatment programs have high drop-out rates, perhaps 50% to 80%, child welfare staff
may believe that treatment is not effective. But studies show that treatment can be effective and cost
effective. The longer the stay in treatment, the greater the improvement, and at least three months is
needed for long term results. Providing services to children of mothers in treatment has been shown to
attract and hold more mothers in treatment, as can the fear of losing custody of their children.
Results from the Illinois Project SAFE and Illinois Treatment Expansion Initiative show that by making a
persistent and intensive effort to engage substance abusing parents, the parents can make progress. Of
the first clients in the program, 81% completed treatment and 54% of their children in foster care were
reunified with parents. Read about this program in the GAO report listed on page 12.
Relapse is a process in which the recovering person becomes unable to cope with life while sober and
cannot avoid using alcohol or drugs again. During the early stage of recovery, adequate social and
recovery skills are needed to establish a sober life style and prevent relapse, and these skills can be
taught. A parent may not be able to stay sober if the negative factors in her life are not improved:
3. How to Comply With ASFA? top
Hollinshead, Dana M. (1998). "Alcohol and Other Drug Abuse and the Termination of Parental Rights: A Challenge for Implementation of the Adoption and Safe Families Act of 1997. Protecting Children v14 n3 p15-21.
The Adoption and Safe Families Act (ASFA) requires that child welfare agencies hold a permanency hearing when children have been in foster care for 12 months, and petition for terminating parental rights (TPR) when a child has been in foster care for 15 of the most recent 22 months. TPR may be avoided when 1) a child is being cared for by a relative 2) when there is a compelling reason that it is not in the child's interest, and 3) when the state has not provided the services needed to reunify the family.
ASFA Does Not Take AOD Abuse Into Account
Even though AOD abuse is a contributing factor in 40-80% of all child protection cases, the ASFA makes
almost no mention of it and how it should influence decisions made about the parents of children in care.
Both the child welfare system and AOD services are unprepared to meet the needs of these parents.
Families affected by AOD abuse are thus more likely to be referred to TRP proceedings, and may
receive unfair or ineffective treatment in the child protection system. This inequity may be intensified
because most of these families are people of color, and because child welfare practice may be culturally
insensitive.
How to Give Parents a Reasonable Chance?
The ASFA requires that parents be given a reasonable chance to recover before their parental rights are
terminated. In order to deal fairly and effectively with these parents, both child welfare and AOD
programs must address these issues:
4. Screening and Assessing Substance Abuse top
Young, Nancy, Sidney L. Gardner and Kimberly Dennis (1998). "Assessment: Bridging Child Welfare and AOD Services." Pages 111-130 in Responding to Alcohol and Other Drug Problems in Child Welfare: Weaving Together Practice and Policy. Washington, DC: CWLA Press 179P.
A new book available free from the Juvenile Justice Clearinghouse at 800-638-8736, order # ncj171669.
Always Screen For and Assess AOD Use
Child welfare services should make screening for AOD problems a standardized element of every risk
assessment. The screening must be followed by an assessment of the nature and degree of the client's
substance abuse problems. Without this assessment in addition to a screening for the existence of AOD
use, one cannot help the client connect with the most appropriate services in the AOD system. If the
AOD system is responsible for the assessment, it is less likely that all the needs of the client and her
family can be met, because AOD services are less sensitive to the needs of children and families.
Screening and Diagnostic Tools
AOD services commonly use the CAGE Questionnaire and the Substance Abuse Subtle Screening
Inventory to screen for substance abuse.
Following the screening, AOD services commonly use tools such as these to clarify the extent and nature
of AOD problems:
The Project Connect Risk Assessment Tool
Unfortunately, no standard tools exist that were designed expressly for evaluating the risk of child
maltreatment in terms of parental substance abuse. However, the Project Connect program in Rhode
Island has developed a tool for its own use. See Article 5 for more information.
Screen During Investigation of Allegations
During investigation of allegations of child maltreatment, use screening questions, such as a modified
GAGE to screen for AOD problems.
Assess Risk to the Child
As part of determining risk to children, obtain more information about the type and frequency of parental
substance abuse. The following situations may indicate greater risk of maltreatment:
Assess AOD Use Versus Abuse/Dependence
As part of determining if there is a legal basis for petition and appropriate placement, determine if the
parent's AOD involvement is substance use, abuse, or dependence. Use the Diagnostic Tools
mentioned above. If substance abuse/dependency is present, the case requires further AOD-specific
services. The placement decision should include a consideration of the parent's level of AOD
involvement.
Assess Impact of AOD on Life Functioning
As part of planning and managing the case, determine the areas of life functioning affected by the
parent's AOD use. Use this information to make decisions about the level of structure or intensity of AOD
services needed, and the areas of life functioning that need specific interventions.
5. Project Connect's Risk Assessment Tool top
Olsen, Lenore, Darlene Allen and Lenette Azzi-Lessing. (1996) "Assessing Risk in Families Affected by Substance Abuse." Child Abuse and Neglect v20 n9 p833-842.
Order a copy of the risk assessment tool from Children's Friend and Service, 153 Summer Street, Providence, RI. 401-331-2900.
Project Connect in Rhode Island developed the Risk Inventory for Substance Abuse-Affected Families to help meet the needs of their clients. They find that some parents have good parenting skills but make poor progress recovering from substance abuse, while other parents make good progress on substance abuse, but have poor parenting abilities that pose a risk to their children. The risk inventory helps workers make informed placement decisions about these families, and gives them better information about the families' service needs.
Eight Scales Are Used
The inventory includes eight scales that are evaluated with four or five descriptive statements, from no
risk to high risk, taking a trained worker only 15 minutes to complete. Families should be given a chance
to stabilize before they are evaluated.
6. Types of Alcohol and Drug Treatment top
Committee to Identify Strategies to Raise the Profile of Substance Abuse and Alcoholism Research (1997). "Treating Addictive Disorders." Pages 73-93 in Dispelling the Myths About Addiction: Strategies to Increase Understanding and Strengthen Research. Washington, DC: Institute of Medicine.
Treatment is as Effective as for Diabetes
It is a persistent myth that addiction cannot be treated. Addiction is similar to hypertension, diabetes and
asthma in that these conditions cannot be cured, but all can be treated successfully and often require re-treatment. Successful treatment for addiction is a 50% reduction in substance use after six months.
Treatment is successful for 40-70% of substance abuse patients. A longer stay in treatment is the major
predictor of treatment success. Programs addressing other needs such as housing and job training have
greater success. Success depends both on program characteristics and patient characteristics.
Three Stages of Treatment
Types of Treatment
Recommended Psychosocial Treatments
The American Psychiatric Association recommends that psychosocial treatment be a part of addiction
therapy. The following have demonstrated their effectiveness:
Treating depression, anxiety and other mental health issues at the same time may improve recovery.
Pharmacotherapy for Heroin and Opioid Drugs
Methadone is available as a non-euphoric substitute for these drugs. It is used for detoxification or
medically supervised withdrawal and is not an effective treatment by itself. Outpatient methadone
maintenance or maintenance pharmacotherapy is usually for patients who are unsuccessful with drug-free treatment, and the program includes maintenance doses, urine tests and counseling and
rehabilitation.
Naltrexone is a non-euphoric, selective opioid antagonist which has been used for narcotic dependence since 1984. It is more effective with motivated patients and when used with other non-drug therapies.
Pharmacotherapy For Alcohol and Cocaine
There are no replacement drugs such as methadone for alcohol or cocaine, but Naltrexone was
approved in 1994 for use with alcohol addiction as an opiate antagonist which reduces craving and
drinking.
Disulfiram (Antabuse) is a different type of drug which causes unpleasant and potentially life-threatening symptoms when alcohol is also taken. It may help motivated, closely monitored patients.
No drugs have yet been found to help cocaine addiction, but treating other mental health problems with appropriate drugs may be a help for both cocaine and alcohol addictions.
Coffin, Phil (1997). "Research Brief: Methadone Maintenance Treatment. The Lindesmith Center. http://www.lindesmith.org/cites_sources/brief14.html
Effective Medical Treatment of Opiate Addiction. NIH Consensus Statement 1997 Nov 17-19; 15(6):1-38. http://odp.od/nih/gov/consensus/cons/108/108_statement.htm
The Treatment of Choice for Heroin
Once individuals are addicted to heroin or other opiate drugs, opiate dependence is a true medical
condition based on a brain-related disorder. Research studies have very clearly shown that methadone
and similar drugs are the most effective and safe treatments for opiate addictions. Methadone can be
used for initial detoxification, which takes about 3 days. However, for opiates, relapse after detoxification
is almost inevitable, and the real value of methadone is in maintenance treatment.
Methadone reduces chronic narcotic craving without causing euphoria or otherwise interfering with normal functioning. The dose level and number of years of maintenance treatment must be individually determined. Numerous studies have established that using methadone as a maintenance treatment to prevent relapse has many benefits and minimal negative health consequences, even when used for 20 years or more. In the U.S., treatment is usually provided in special methadone maintenance clinics.
Treatment Has Many Benefits
The benefits of methadone maintenance treatment (MMT) are well documented, and include:
Barriers to Providing MMT
Unfortunately, the MMT capacity in the U.S. is inadequate to serve the addicted population. The public
and policy-makers often subscribe to many misconceptions or prejudices about MMT, such as:
NIH Recommendations
The expert panel convened to address the MMT issue in 1997 made these recommendations:
8. How to Do Motivational Interviewing top
Hohman, Melinda M. (1998). "Motivational Interviewing: An Intervention Tool for Child Welfare Case Workers Working with Substance-Abusing Parents." Child Welfare v77 n3 p275-289.
In the past, counselors were trained to use direct confrontation to try to break down client's defenses and denial of addiction, but this usually increases resistance. Instead, begin by trying to assess the Stage of Change that a client may be in:
Most clients seen by child welfare workers will be in the precontemplation or contemplation stages. Even with only brief contact, motivational interviewing can help increase your client's readiness and motivation to change. In your conversations, apply the six elements and the five principles of motivational interviewing listed below.
The Six FRAMES Elements
The Five Principles
Case Study: Working With Mary
When the social worker first met Mary, she claimed to be 'clean' but her shaking hands and dilated pupils
indicated this was probably untrue. She was probably in precontemplation. For the first visit they
established rapport by discussing Mary's previous addiction and treatment experiences. At the next visit,
the worker discussed Mary's family and her mother, who had been an alcoholic. By rolling with
resistance and expressing empathy about the stress Mary was experiencing, the worker made it possible
for Mary to admit her current drug use and her concerns about its affect on her child. She moved from
precontemplation to contemplation.
Clients Move Back and Forth Between Stages
Parents move back and forth through the stages of change, showing insight one day and resentful denial
the next. Relapse is possible at any of these stages, and does not indicate failure.
9. Mothers Value Caring Workers top
Akin, Becci A.and Thomas K. Gregoire (1997). Parents' Views on Child Welfare's Response to Addiction. Families in Society v78 n4 p393-404.
Substance-abusing parents are often treated punitively by the child welfare system, as if addiction were willful immoral behavior. On the other hand, their substance abuse may be ignored or seen as an unrelated issue. In order to help child welfare workers better understand the experience of substance-abusing parents, the authors interviewed 11 mothers who succeeded at recovery and regained custody of their children.
Addiction is Overwhelming
The mothers described their addictions as an omnipresent, omnipotent force that consumed their lives,
acting as both a friend and a 'living hell.' They felt shameful, guilty, and powerless. They believed that
growing up in substance-abusing families taught them that addiction is normal. Although they wanted to
quit, a life without drugs seemed desolate, and they did not know of services to help them. They were
afraid that admitting their addiction would create other problems such as the possibility of losing their
children.
The Child Welfare System Seems Uncaring
When the mothers lost custody of their children, they grieved and felt afraid, desperate, helpless and
powerless. They felt that the child welfare system was uncaring, more concerned about paperwork than
helping people, and that it did not keep its promises. They felt overwhelmed by what they were expected
to do, and that they did not get credit for what they achieved.
Caring Workers Made the Difference
Caring and supportive social workers were what helped these mothers deal with an uncaring system and
succeed. They valued the following qualities in their social workers:
10. Project Connect Uses a Generalist Approach top
Mumm, Ann Marie, Lenore J. Olsen and Darlene Allen (1998). Families Affected by Substance Abuse: Implications for Generalist Social Work Practice. Families in Society v79 n4 p384-394.
More Children are Reunified Sooner
Rhode Island's Project Connect serves substance-abusing families referred from the Department of
Children, Youth, and Families (DCYF). Sixty percent of the participants have successfully completed
Project services and reduced their risks in substance abuse, housing, health, and parenting. Project
children were more likely to be reunified with their families than non-Project children (45% versus 13%)
and within shorter time periods than non-Project children (5 months versus 11 months).
Generalists Consider Societal Problems
Project Connect believes their success is due to their generalist approach. Workers consider both
individual problems and the societal problems, such as oppression, that contribute to individual
problems.
Engaging Respectfully With Clients
Staff treat families with dignity and respect, not simply as addicts, identify their strengths, and avoid
being judgemental. They hold clients responsible for their recoveries, but not their addictions, and are
clear about their expectations and the consequences of clients' choices.
Assessment Uses Special Tools
Assessment of the family is an ongoing process. Substance abuse, parental abilities, risk of child abuse
or neglect, family strengths, and community resources are all considered. A quarterly tracking form
documents progress and the barriers to recovery. Many assessment tools are used, including
The Family Risk Scale and The Risk Inventory for Substance Abuse-Affected Families which were
developed by Project Connect.
Contracting Sessions
Contracting is based on the clients and staff agreeing they want to work together. In the first session,
problems are identified and participants agree on goals. In the next 6 sessions a service plan is
developed, usually addressing parental substance abuse, parenting skills, emotional problems,
reunification issues, financial difficulties, and housing. Clients and staff of Project Connect, DCYF and
AOD services review the contract quarterly.
Counseling Interventions
The staff use these counseling approaches:
Energetic Advocacy
The Project staff are known as 'barrier busters', providing critical advocacy to help families overcome
lack of transportation, inadequate housing, lack of child care and employment, low educational levels,
and heavy expectations from the court, child welfare and AOD systems.
Termination
Most clients stay about one year. Termination is considered when clients have achieved these goals:
11. AOD Treatment May Not Prevent Child Placement top
Dore, Martha Morrison and Joan M. Doris (1998). Preventing Child Placement in Substance-Abusing Families: Research-Informed Practice. Child Welfare v77 n4 p407-426.
The authors evaluated a voluntary program funded by the National Center on Child Abuse and Neglect, which provides services to substance-abusing families to prevent child placement. The program includes:
41% Completed Their Treatment
Forty one percent of the participants completed treatment, staying about 8 months. After 12 months,
parents had made significant progress with other areas of their lives, with the exception of domestic
violence and mental health, which the program counselors felt unqualified to address. The graduates
had these characteristics:
Predictors of Child Placement
However, completing treatment was not as strong a predictor of preventing child placement as these
variables were at predicting loss of custody:
Addiction Treatment Programs Do Not Meet Mothers' Comprehensive Needs
Substance-abusing mothers are known to avoid and drop out of addiction treatment programs.
Programs often demand that participants make sobriety their top priority, including ending relationships
with substance-abusers and moving away from drug environments.
However, these mothers may depend on substance-abusing family and friends for financial and other support, and they may be in violent domestic relationships which will escalate if they attempt to leave. Sobriety may be the least pressing of these mothers' problems, which often include dealing with childhood abuse, poverty, unsafe neighborhoods and poor health. Family preservation programs of just 6-8 weeks cannot do more than identify substance-abuse and encourage parents to enter a treatment program.
12. The Seattle Advocacy Model Helps Mothers top
Grant, Therese M., C. Ernst and Ann P. Streissguth (1996). "An Intervention With High-Risk Mothers Who Abuse Alcohol and Drugs: The Seattle Advocacy Model." American Journal of Public Health v86 n12 December p1816-1817.
The Seattle Advocacy Model uses paraprofessional advocates to work with high-risk, substance-abusing mothers who have multiple problems and who are least likely to receive preventive care. The goal is to provide a period of advocacy (three years) that is long enough to allow real change to happen. The Birth To 3 research and demonstration project is university-based and involves collaboration with existing community resources.
Advocates are Trained Paraprofessionals
The advocates working in the Birth To 3 project have past experience with high-risk populations, and
receive training on substance abuse treatment, community resources, health and family planning, child
development, and parenting skills, but are not required to have college degrees. They work with no more
than 15 clients and their families.
Program Characteristics
Results After Two Years
13. Residential Treatment Works for Mothers and Children top
Stevens, Sally J., Naya Arbiter and Robin McGrath (1997). "Women and Children: Therapeutic Community Substance Abuse Treatment." Pages 129-141 in Community as Method: Therapeutic Communities for Special Populations and Special Settings. Westport, CT: Praeger Publishers.
The Amity Center for Women and Children is a nonprofit therapeutic community in Tucson, Arizona. In 1990, Amity received a grant from the National Institute on Drug Abuse for a research project that involved 40 mothers, half of whom were randomly assigned to have their children in treatment with them.
Program Features
The Amity program shares some of the traditional assumptions of therapeutic communities:
Unlike other communities, Amity encourages family members to visit and participate, and understands that mothers must use some of their energy to be available to their children.
Characteristics of Participants
The women in the program vary in their their ages, ethnicity, education, work history, drug history, and
court involvement, but many had attempted suicide and/or were victims of sexual assault.
Better Outcomes For Mothers With Children
Preliminary data show that women accompanied by their children in treatment had better outcomes than
women without their children. They were more likely to maintain custody of their children, be employed
or receive assistance, and less likely to relapse and be arrested.
14. Some Mothers Have Better Prospects top
Carten, Alma J. (1996). Mothers in Recovery: Rebuilding Families in the Aftermath of Addiction. Social Work v41 n2 p214-223.
New York City established a Family Rehabilitation Program in 1989 for substance-abusing families as an alternative to foster care. Cases are referred to the voluntary program only if children are not at risk at home, and drug-exposed infants have priority. The program provides an average of 9 months of services.
20 Successful Mothers Had Some Positive Characteristics
The cases of 20 mothers who had completed the program and had no child protection reports for six
months were evaluated. The mothers had these successful characteristics:
Success Factors Due to the Program
Mothers Credit Caring Staff
The mothers at first felt angered by being referred to child protection, but the possibility of losing their children
motivated them to participate in the program. They valued their relationships with the non-judgemental, caring
staff, sharing decision-making using the service contracts, and being able to contact any member of their team for
help. The staff also valued working with long-term clients because they could see positive results.
Get Started at DCFS Champaign-Urbana
To begin finding Web resources on substance abuse, start with the site from the Champaign-Urbana
Field Office of the Illinois Department of Children and Family Services.
http://www.prairienet.org/dcfs/clientresources.html
Try the Yahoo Substance Abuse Page
The Yahoo web site includes many useful links.
http://dir.yahoo.com/Health/Diseases_and_Conditions/Substance_Abuse/
Link to Organization Web Sites
The National Association on Alcohol, Drugs and Disability offers this convenient list where you can link to
web sites of the major public and private organizations working in the field of substance abuse.
http://www.ncadd.org/randr.html
Improve Your Skills or Become Certified
The National Association of Alcoholism & Drug Abuse Counselors web site includes a selected reading
list for learning about substance abuse, as well as information on becoming a certified counselor.
http://www.naadac.org/how2coun.htm
Database of Alcohol Abuse Literature
The National Institute on Alcohol Abuse and Alcoholism offers a searchable database of the published
literature in this field, including abstracts,
http://etoh.niaaa.nih.gov/etohome.htm
Child Welfare League of America
Read the CWLA fact sheets and other reports on substance abuse at this location. Scroll to the bottom
of the page to see links to the various reports.
http://www.cwla.org/chemical/chemicaldependency.html
Treatment Improvement Protocol Series
Read the complete text of these protocols at this location maintained by the Center for Substance Abuse
Treatment. After you link to the site click in the first pop-up box on the page. Scroll to the bottom of the
list and highlight SAMHSA/CSAT Treatment Improvement Protocols then press the Select button.
http://text.nlm.nih.gov/
Mental Illness and Substance Abuse
This Dual Diagnosis Web Site offers a wealth of information to help clients with both mental illness and
substance abuse problems.
http://www.erols.com/ksciacca/
Manual: Protecting Children in Substance-Abusing Families (1994)
Read the complete text of this manual offered by the National Center on Child Abuse and Neglect.
Covers assessment of parents and children, court issues, and types of treatment programs.
http://www.calib.com/nccanch/pubs/usermanuals/subabuse/index.htm
GAO Report on Foster Care & Substance Abuse
This 1998 report discusses how substance abuse impedes foster care services in Illinois and California.
http://www.gao.gov/AIndexFY98/abstracts/he98182.htm
DHHS Report on Treatment Outcomes
This 1997 study found that treatment programs were cost effective in reducing substance abuse,
although they did not improve employment or welfare status.
http://aspe.os.dhhs.gov/hsp/caldrug/calfin97.htm
Chicago Treatment for Opiate Dependencies
The Center for the Investigation and Treatment of Addiction offers a program located at the U of I
Chicago to treat opiate dependencies.
http://www.CITA1.com/official/default.htm
List of Illinois Treatment Programs
The Illinois Alcoholism and Drug Dependence Association member organizations are listed here. They
offer services for alcohol and drug prevention, intervention and treatment.
http://www.iadda.org/Providers.htm
National Database of Treatment Programs
This searchable database of Federal, State, and local treatment and prevention programs is provided by
the Substance Abuse and Mental Health Services Administration.
http://wwwdasis.samhsa.gov/98dir/default.htm
Interested in Listservs?
This site includes a list of e-mail discussion groups and listservs on topics related to substance abuse.
http://www.gwcinc.com/lists.htm