Executive Summary
Linking Child Welfare and Substance Abuse
Treatment: A Guide for Legislators
August 2000
A large percentage of parents who abuse, neglect or abandon their children have drug and alcohol problems. In fact, most children in foster care today were removed from their families because of maltreatment related to drug or alcohol abuse by a parent, usually the child's mother. State policymakers who seek to shorten children's stays in foster care-and to ensure the safety of such children if and when they are returned home-confront a number of challenges. These challenges include lack of appropriate treatment for women with children, inadequate coordination among agencies and courts, and the challenge of engaging and retaining women in treatment.
The challenge of parental substance abuse for child welfare agencies has become even more critical in light of recent federal policy changes that have reduced the time available to parents to complete substance abuse treatment and regain custody of children in foster care. The Adoption and Safe Families Act (ASFA) requires courts to make decisions about a child's permanent placement within 12 months after the child enters foster care and requires states to initiate proceedings to terminate parental rights if a child has been in foster care for 15 of the most recent 22 months. Observers have noted that ASFA's time frames may be in conflict with the process of recovery, which often is slow and punctuated by one or more relapses.
State lawmakers play an important role in ensuring the safety, permanency and well-being of children who are in the child welfare system because of their parents' drug and alcohol problems. State lawmakers can, among other things, initiate statewide planning processes, define desired outcomes, mandate integration of child welfare and substance abuse treatment services, fund treatment and ancillary support services, and prioritize treatment resources to ensure that parents receive the services they need to safely care for their children. This publication provides state legislators with examples of such initiatives throughout the country.
Public substance abuse treatment is financed by various state, federal and local funding streams and is administered primarily by drug and alcohol agencies in every state. In FY 1997, approximately $4 billion flowed through these agencies from various sources. Total public spending on public drug and alcohol treatment was almost $8 billion in 1996, 40 percent of which was state and local funds. Drug and alcohol treatment is a process that includes screening, assessment, referral, treatment and aftercare. Studies have shown that treatment is effective in reducing drug and alcohol use, crime, welfare dependency and health care costs. Less is known about the effectiveness of treatment on family functioning and child well-being.
Substance abuse treatment, especially for women with children, is in chronically short supply. Effective treatment for this population includes thorough assessment of both the parent's and the children's needs; a comprehensive range of community-based services to address parenting and related issues, including drug-free housing; a continuum of treatment interventions; case management and ongoing monitoring to hold clients accountable for compliance with treatment; and provision of continuing social and housing supports after treatment. Two-thirds of people in treatment report that they were physically or sexually abused as children. Accordingly, recovery from drug and alcohol dependence often requires ancillary services to address the effects of childhood trauma. Some states are funding increases in treatment for women with children with Temporary Assistance for Needy Families (TANF) funds, federal foster care funds through Title IV-E waivers and state funds. Other states require that families in the child welfare system be given priority for treatment.
Children's stays in foster care can be prolonged as a result of poor coordination and communication among courts, treatment providers and child welfare agencies. These problems are the result of differences in core values, training, funding, legal mandates, organizational cultures, timelines and attitudes about substance abuse, among other things. For example, stringent federal confidentiality rules governing the release of information about people in drug and alcohol treatment may hinder a child welfare agency's attempts to assess a client's treatment progress and readiness to resume custody of a child. Lack of accurate information makes it difficult for courts to decide on a child's permanent placement. States are employing various strategies to improve coordination and information sharing, including treatment funds that must be jointly administered by child welfare and drug treatment agencies; cross-training of child welfare workers and treatment providers; multidisciplinary teams to deliver services to drug-affected families; statewide plans and protocols for the integration of substance abuse and child welfare services; and court-based initiatives such as family drug courts and court-based assessment centers.
Engaging parents to enter and complete treatment is a major challenge for child welfare agencies. A large percentage of drug-abusing parents who come into contact with the child welfare system either do not enter treatment or drop out before completing a program. Women with children face a number of internal barriers to treatment, including fear of losing custody of their children, shame and depression. Some states are pairing clients with individuals in recovery who serve as mentors or recovery coaches. These individuals provide encouragement, arrange child care and transportation, and hold clients accountable for compliance with treatment plans. Other strategies to enhance women's motivation include drug courts, court-based assessment centers, and services that address family and parenting concerns.
Another challenge for courts and child welfare agencies is deciding when to forego reunification efforts, including substance abuse treatment, and to pursue early termination of parental rights. Some states have defined in law the circumstances under which such efforts are not required in cases involving parental substance abuse, recognizing that a court may still decide that reunification services are appropriate and consistent with the child's best interest.
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