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Journal Issue: Preventing Child Maltreatment Volume 19 Number 2 Fall 2009

Prevention and Drug Treatment
Authors: Mark F. Testa Brenda Smith

Is It Possible to Target AODA Families for Treatment?

Indicated prevention35 involves screening abuse and neglect cases for signs of parental substance abuse to promote sobriety and prevent the recurrence of maltreatment. To date, usual caseworker practices have not proved effective in identifying AODA problems among families in the child welfare system or in preventing subsequent maltreatment allegations once families are investigated for child maltreatment. An analysis using data collected on families reported for child maltreatment as part of the National Survey of Child and Adolescent Well-Being (NSCAW) found that among at-home caregivers who screened positive for past-year alcohol abuse or illicit drug use, only 18 percent were identified by caseworkers as having a substance abuse problem. Among at-home caregivers meeting criteria for alcohol or drug dependency, caseworkers identified a substance abuse problem for only 39 percent.36 Such findings are consistent with other research indicating that child welfare caseworkers are ill-equipped to identify substance abuse problems.37

When substance abuse is indicated, evidence also casts doubt that CPS is effective in linking parents to substance abuse services and treatment. A study focusing on parents with substance abuse problems involved with child welfare services found that about half received substance abuse treatment; 23 percent were offered treatment but did not receive it; and 23 percent were not offered treatment.38

Shares of parents completing treatment are similarly low. An Oregon-based study found that both before and after implementation of the Adoption and Safe Families Act of 1997, about one-third of mothers involved with the child welfare system who entered substance abuse treatment completed their first treatment episode; about half completed any treatment episode within a three-year observation window.39 A more recent study found that among parents with substance abuse problems and children in foster care, only 22 percent completed treatment.40

To upgrade identification of substance abuse problems and improve treatment access for parents in the child welfare system, service organizations in both child welfare and substance abuse treatment have increasingly adopted programs or policies that encourage or mandate inter-agency collaboration. For example, child welfare caseworkers are sometimes required to involve substance abuse treatment providers in service planning, or substance abuse treatment counselors may be required to enlist child welfare caseworkers in client engagement. Nevertheless, inter-agency collaboration in child welfare and substance abuse treatment has proven difficult to achieve.41 Organizational policies promoting collaboration have not always been sufficient to establish widespread changes in staff collaborative practices.42

One such collaborative approach is a “cooperative interagency relationship” implemented in Montgomery County, Maryland, during the late 1990s. The collaboration between county child welfare and substance abuse services involved information sharing, cross-training and internal supports, new service standards to assure quality, and new protocols and standards for assessment, referral, and follow-up. A key aspect of the effort was the co-location of a substance abuse specialist at the county’s central child welfare office. The substance abuse liaison consulted with child welfare staff on substance abuse cases, helped intervene with substance abuse cases, and facilitated substance abuse referrals for child welfare clients. After three years, evaluation measures indicated that child welfare workers had increased their consultation with and involvement of substance abuse specialists in their cases.43

Another intervention emphasizing inter-agency collaboration is the Engaging Moms Program, which promotes treatment entry and engagement among low-income mothers who used crack cocaine.44 In one evaluation, mothers of infants were randomly assigned to Engaging Moms or to regular services. The evaluation found that mothers in Engaging Moms were more likely than those receiving regular services both to enter treatment (88 percent, as against 46 percent) and to stay in treatment for at least four weeks (67 percent, as against 38 percent). After 90 days, however, rates for the two groups had become more similar (39 percent of the Engaging Moms group were still in treatment, compared with 35 percent of the regular services group). Whether the Engaging Moms Program, which was run by university researchers, could be transferred to community practice settings is uncertain, but the evaluation illustrates the program’s promise for promoting treatment entry and short-term retention while underscoring the challenges associated with long-term treatment retention among mothers of young children.

As states and localities work to promote collaboration among child welfare and substance abuse services, evidence suggests that adopting organizational policies or rules regarding collaboration may result in uneven implementation among front-line staff.45 Given individual influences on the implementation of organizational dictates, states and localities adopting pro-collaboration policies and programs should communicate their goals effectively and convince front-line staff of their value.