The Relationship between SUDs and Child Welfare Services

The Fourth National Incidence Study of Child Abuse and Neglect (NIS-4) found that SUD use accounted for 11 percent of child maltreatment cases investigated by CPS (Sedlak et al., 2010). It is also estimated that 700,000 children in Child Welfare Services (CWS) had parents with SUD problems (Young & Gardner, 2009). According to the Child Welfare Information Gateway (2014), 295,000 parents who received treatment for a SUD had one or more children removed by CPS. 

Consequences of Child Maltreatment in the Context of Alcohol and Other Drugs

As stated, parental SUD is a risk factor for child maltreatment. Repercussions of child maltreatment, displayed in childhood and into adulthood, can cause severe impairment in intrapersonal, interpersonal, academic, and occupational domains of life. Children who experience maltreatment are more prone to develop emotional and behavioral problems, including emotional dysregulation, trauma symptoms, and externalizing and internalizing problem behavior such as anxiety and aggression (Shipman, Edwards, Brown, Swisher, & Jennings, 2005; Dunn, McLaughlin, Slopen, Rosand, & Smoller, 2013; Oshri, Rogosch, & Cicchetti, 2013; Holmes, Yoon, Voith, Kobulsky, & Steigerwald, 2015; Font & Berger, 2015). 

Exposure to SUD within the family exacerbates the adverse consequences of maltreatment, since SUD as well as behaviors associated with SUDs comes with various co-occurring problems, such as poverty, domestic violence, and involvement in criminal activities such as drug dealing, prostitution, or theft (Taylor, 2011). In addition to societal misfortunes, parents with SUD struggle with co-occurring mental and health issues that include depression, anxiety, HIV/AIDS, and others (Taylor, 2011). 

The Characteristics of Families in the CPS System

Even though families with SUD issues are greatly represented in child welfare services, not every family with SUD problems enter the system. Research suggests that women who are involved in CPS are, on average: two years younger; have more children; are arrested more often; are more likely to be mandated to receive treatment; have more treatment failure; and are more likely to be referred to other treatment programs at discharge than women who are not involved in CPS (Shillington, Hohman, & Jones, 2001). These women are also more likely to have attended SUD outpatient or day treatment rather than residential treatment. Being on psychiatric medication for coexisting mental health problems and receiving less parental support are also risk factors for women to be involved in CPS (Taplin & Mattick, 2013). 

“Unsuccessful” SUD treatment outcomes and a continuation of substance use increase the likelihood that families reenter the child welfare system after reunification. According to Brook and McDonald (2009), children whose caregivers use both alcohol and other drugs are more likely to enter the system than children whose parents do not use any alcohol and drugs. Children whose primary caregivers have drug only or alcohol only problems are also at heightened risk for reentry (Brook & McDonald, 2009). Other risk factors include high-risk potential for caretaker criminal behavior, absence of law enforcement involvement during the initial investigation, and being a single African American woman (Fuller & Wells, 2003). 

In 1997, The Adoption and Safe Families Act (ASFA) was enacted to reduce the length of time children spend in foster care, prevent future parental abuse by promoting adoption, and make timely permanency decisions to avoid further harm (Harris-McKoy et al., 2014). The major goal of AFSA is to make decisions based on the best interest of the child, which conventionally has been interpreted as preventing further harm to children by unfit parents (Harris-McKoy et al., 2014). 

Recommendations for Practice, Research, and Policy

Since SUD problems in families are multifaceted, the prevention and intervention strategies should also be multifaceted, addressing micro-, meso-, and macro-level components of the issue. These strategies should aim to reduce the frequency of entrance into the CWS, to enhance chances of reunification once in the system, and to improve mental and physical health. Professional therapists might consider these approaches when working with families, all the while keeping in mind the individual needs and strengths of their clients and families. The risk and protective factors for SUDs, as well as for placement into the system, mentioned in this paper should be addressed at the earliest opportunity. SUD treatment providers should identify barriers to treatment such as lack of provision of childcare, support services, and culturally specific services (Shillington et al., 2001). Too often, treatment facilities do not offer accommodations for the entire family, which deters mothers from seeking treatment. A family-centered approach might resolve some of these barriers for families with SUD problems. Where appropriate, families could receive services at home, thus avoiding the removal of children for extended periods. Adding services that allow for in-home treatment gives the parent an incentive to seek help, as it decreases the fear of having the children removed or of the family unit disintegrating. 

At the macro-level, therapists and treatment leaders can advocate for policies that consider both the children’s best interests and the nature of substance abuse and its treatment. Treatment should be viewed from a holistic framework to address physical and mental health issues, as well as housing, employment, and poverty. More public and private treatment facilities that provide evidence-based practice and that are accessible to patients with children is crucial to addressing this problem. Advocating for additional funding to create treatment facilities that encompass the entire family, or to reformat current facilities’ budgets to incorporate space for families, is recommended to help increase motivation towards treatment, which will in turn increase the number of successful recoveries.

When addressing mental health, treatment facilities may find the need for an eclectic approach, which combines different treatment modalities in order to reach each individual and family in the best possible way. Treatment modalities might include, but are not limited to traditional Twelve Step programs, family therapy, cognitive behavioral therapy, and if necessary, medication (Taylor, 2011). The family-oriented therapeutic community model is another promising method of comprehensive rehabilitation, which takes into consideration the impact that SUD has on each family member, as well as the family as a whole system. In this model, instead of separating the family while the parent seeks treatment, with children being placed into foster care, the family is gathered in a stable treatment setting for eighteen and twenty-four months with care and assistance from a health care team including a psychologist, physician, substance use specialist, childcare worker, and others (Taylor, 2011). SUD treatment should screen for and treat illicit drug use, and this may include methadone management or other medication-assisted treatment, as well as timely entry into residential care or other appropriate treatment programs (Lloyd & Akin, 2014). These facilities would do well to intentionally coordinate their services and communicate regularly with CWS. 

In conclusion, there is much room for improvement and further research in the treatment of SUD in family systems. A focus on rehabilitation, collaboration with child welfare services, and holistic treatment for the entire family is necessary in order to strengthen families and reduce the multigenerational impact of SUD in families.