Substance Abuse Treatment Alone Often Not Enough to Stem Child Abuse and Neglect

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Evidence linking alcohol and other drug abuse with child maltreatment, particularly neglect, is strong. But does substance abuse cause maltreatment? In a recent article in The Future of Children volume Preventing Child Maltreatment, authors Mark Testa and Brenda Smith found that co-occurring risk factors such as parental depression, social isolation, homelessness, or domestic violence may be more directly responsible than substance abuse itself for maltreatment. Interventions to prevent substance abuse–related maltreatment, say the authors, must attend to the underlying direct causes of both.

Research on whether prevention programs reduce drug abuse or help parents control substance use and improve their parenting has had mixed results, at best. The evidence raises questions generally about the effectiveness of substance abuse services in preventing child maltreatment. Such services, for example, raise only marginally the rates at which parents are reunified with children who have been placed in foster care. The primary reason for the mixed findings is that almost all the parents face not only substance abuse problems but the co-occurring issues as well. To prevent recurring maltreatment and promote reunification, programs must ensure client progress in all problem areas.
 
At some point in the intervention process, attention must turn to the child’s permanency needs and well-being. The best evidence to date suggests that substance-abusing parents pose no greater risk to their children than do parents of other children taken into child protective custody. It may be sensible to set a six-month timetable for parents to engage in treatment and allow twelve to eighteen months for them to show sufficient progress in all identified problem areas. After that, permanency plans should be expedited to place the child with a relative caregiver or in an adoptive home.
 
Investing in parental recovery from substance abuse and dependence should not substitute for a comprehensive approach that addresses the multiple social and economic risks to child well-being beyond the harms associated with parental substance abuse.
 
Drawn from “Prevention and Drug Treatment,” by Mark Testa and Brenda Smith.
 

3 Comments

The chapter from which this excerpt is drawn is thoughtful and has much we agree with, based on our fifteen years of work with child welfare and treatment agencies and dependency courts. We agree with several of the article’s findings:
• The need for greater emphasis on co-occurring factors, especially mental illness, domestic violence, and housing/poverty issues and the case for better coordination with the services addressing these issues
• The importance of reunification and recurrence of maltreatment as appropriate benchmarks for the effectiveness of treatment for parents with substance use disorders.
• The importance of substance-exposed births as a public policy issue
• The certainty that a significant number of child welfare-referred parents with SUD will not enroll in or succeed in treatment

But we disagree profoundly with the notion that “substance-abusing parents pose no greater risk to their children than do parents of other children taken into child protective custody.” The evidence is clear that
“Substance abuse clearly pre-disposes caregivers to neglect and abuse. A large NIMH-funded study concluded that substance abusers had 3 times the odds of committing physical abuse and neglect--after controlling for social, demographic, and psychiatric variables (Chaffin, Kelleher, & Hollenberg, 1996). These findings are supportive of their earlier conclusions in which "close to half or more of abusive or neglectful parents have a lifetime prevalence substance abuse disorder" (Kelleher, Chaffin, Hollenberg, & Fischer, 1994; p. 200).” Statement of Richard P. Barth, Testimony Before the Subcommittee on Human Resources of the House Committee on Ways and Means Hearing on the Impact of Substance Abuse on Families Receiving Welfare October 28, 1997.

We also disagree that “…the permanency planning dilemma [is] whether to continue investing in the uncertain outcomes of drug recovery and family reunification or to cut the process short by terminating parental rights and proceeding with adoption or other planned permanency arrangements…” Treatment does not have to be foolproof to have better odds than termination without making an effort—and that effort is, of course, legally required by reasonable efforts language. The “uncertain outcomes of drug recovery and family reunification” is accurate as far as it goes, but as noted below, many parents do succeed in treatment if given timely access to effective treatment. California now has in place a data system among treatment providers that tracks child welfare clients and dependency drug court referrals through treatment and records how many had positive treatment outcomes—which yields initial data showing CW parents do as well or better than non-CW clients, at a rate of about one-third positive, corroborating the article’s citation of one-third. It should be noted that a majority of entering treatment clients had prior admissions and are returning for a second or more episode of treatment. Considerably higher rates of success are shown in recent evaluations of dependency drug courts linked with family treatment programs.

Finally, we disagree with the statement that “Perhaps the best course of action is to take the spotlight off of parental drug abuse and treatment completion and shine it instead on other co-factors, such as mental illness, domestic violence, and homelessness that may be more directly implicated in causing harm to a child.” It does not seem logical to us to cite these as co-occurring problems and then to suggest that one of these co-occurring factors should somehow be de-emphasized as an approach to improving child welfare outcomes. The straw man argument of child welfare agencies’ and treatment agencies’ exclusive concern with alcohol and drug issues is belied by considerable recent literature and demonstration funding from SAMHSA and other sources on the importance of comprehensive, family-based treatment. If the point is that this kind of treatment is scarcer than it should be—we agree. But severing substance abuse treatment from its co-occurring factors hardly seems a way to ensure more comprehensive treatment.

We have also found that it is helpful to frame the intersection of child maltreatment and substance abuse issues as a site of dual responsibilities:

• If we encourage parents with substance use disorders to be responsible for the effects of their lifestyles on their children, many but not all of these parents will respond positively—as long as
• “The system” also behaves responsibly by working across agency boundaries
o To identify parents’ and children’s needs,
o to make “good handoffs” that result in clients engaged in treatment,
o to improve programs’ quality, and
o to monitor whether positive outcomes are happening and take corrective action, including termination of parental rights, if they are not.

So both client and system responsibility matter in achieving the goals of the child welfare system. Framing the issue as what clients do and don’t do omits the vital dimension of what agencies do and don’t do. Both need to be in view in seeking to improve outcomes for children and families.


Sid Gardner and Dr. Nancy Young
Children and Family Futures

I think that there is a greater need for parenting skills that outweigh the drug abuse rehab need. Don't get me wrong rehab is a necessary factor in healing but, unless a parent know proper parenting techniques it will not make you a better parent once the alcohol consumption ceases.

This is clearly an important issue that must be addressed. This is why the New South Wales (Australia)Parliament is presently seeking amendments to the Children and Young Persons (Care and Protection) Act 1998; to make it mandatory for parents of children considered to be in need of care or protection (or at risk of significant harm), to enter into either a parent responsibility contract or care plan. The introduction of the proposed amendment will ensure parents take greater responsibility for their children, and further improve their parenting abilities.

If passed, family care meetings would involve parents conferencing with a Community Service caseworker to negotiate the terms on which each care plan or contract is made. During this meeting, parents would be wholly informed of all that is involved and expected of them according to the contract or care plan. Failure to attend the first meeting by either the parents or the child will result in immediate referral to the Youth Court.

“It is noted that parents are ultimately responsible for their children’s well-being” (Goward, 2010); however if the parents are not fulfilling their role, the government must step in to protect these children in need. These contracts are created to encourage parents to improve their parenting abilities; and if needed, to seek extra help that may be necessary. Parent responsibility contracts are designed by the government not only to protect children, but also to assist parents in need of support.

Although it has already been determined that such rehabilitation programs don't necessarily guarantee a reform in neither the parents or children, however the inauguration of these contracts are created to indicate to parents the exact areas they need to improve to ensure their children's safety. If the parents of these children at risk do not follow the terms on which the contract is based, then the minister of community services is to instantly refer the case over to the children's court.

Making these contracts mandatory would mean that the parents are being kept accountable for all of their actions and if no improvement has been seen within the very near future, the department of family and community services has the legal right do whatever is needed to provide these children with the care and protection needed. This not only would keep the parents accountable but also the government.

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