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CWLA 2008 Children's Legislative Agenda

Substance Abuse

Action

• Support expanded federal resources to increase substance abuse treatment capacity within the child welfare system and stimulate effective partnerships between child welfare and substance abuse agencies, including the reintroduction of the Child Protection/Alcohol Drug Partnership Act.
  
  
• Pass the Family-Based Meth Treatment Access Act (H.R. 405/S. 884).
  
  
• Support increased funding for the Substance Abuse Prevention and Treatment Block Grant.

Background

Alcohol and other drug (AOD) problems devastate the lives of hundreds of thousands of American children and their families each year. In 2001, more than 6 million children lived with at least one parent who abused or was dependent on alcohol or an illicit drug in the past year. ¹ By no means do all of these children come to the attention of the child welfare system, but a child's exposure to parental AOD use-whether through pre-natal exposure or environmental observation-undoubtedly puts him or her at risk. A parent's AOD use, abuse, and dependence can interfere with thought processes and the parenting process, leaving the parent emotionally and physically unavailable to the child, and leading to criminal activity that jeopardizes the child's health and safety. ² Unfortunately, substance abuse is estimated to be a factor in one to two-thirds of cases of children with substantiated reports of abuse and neglect and in two-thirds of cases of children in foster care. ³ Children from families with substance abuse problems tend to come to the attention of child welfare agencies younger than other children, are more likely than other children to be placed in out-of-home care, and once in out-of-home care, are likely to remain there longer. ⁴

The recent spread and increased use of methamphetamine (meth) poses an especially significant threat to our nation's children. In 2006, there were approximately 731,000 current (past-month) methamphetamine users and the National Institute of Drug Abuse has reported that both the number of emergency room visits due to and treatment admissions for methamphetamine abuse are on the rise. ⁵ As explained in testimony submitted by CWLA to the Senate Finance Committee in 2006, methamphetamine is an almost instantly addictive stimulant that produces high, intense, and fairly long levels of euphoria. ⁶ In homes overcome by methamphetamine addictions and/or containing meth labs, necessities such as food, water, supervision, shelter, and medical care may only be an afterthought-leading to pronounced and prolonged periods of neglect. Children also face hazards such as possible lab explosions and shortand long-term health implications as a result of exposure to dangerous chemicals. Because of increased caseloads with children coming from meth-involved homes, state, local, and tribal child welfare agencies have voiced greater difficulty with several responsibilities, including locating appropriate services for these children and families and recruiting foster parents willing to accept children removed from meth-involved families.

Growing up in a home plagued by AOD use and abuse poses an even greater threat to our nation's vulnerable youth because substance abuse, in addition to being a root cause of child abuse and neglect, is often cyclical and intergenerational in nature. Children with a substance-abusing parent show greater adjustment problems, as well as behavioral, conduct, and attention-deficit disorders than children without substance abusing parents. ⁷ Studies have shown these children very often choose risky behavior and develop their own AOD problems. ⁸ Youth who have been in foster care particularly have a higher rate of past year illicit drug use than youth who have never been in foster care. ⁹ For those youth who develop their own dependencies on AOD, a host of health and social issues may ensue, including mental illness, family violence, and interaction with the juvenile and/or criminal justice systems. These, in turn, can negatively influence subsequent generations and begin a new chapter of the vicious cycle.

Although AOD problems currently affect significant numbers of children and families involved with the child welfare system, appropriate, comprehensive services, including substance abuse treatment, life skills, education, job readiness, and parenting, can be effective. A congressionally-mandated five-year study on the impact of drug and alcohol treatment found that recipients of public-supported treatment programs experience a decrease in drug use, improved physical and mental health, better employment situations, and decreased criminal activity. ¹⁰ Treatment can especially do wonders for women and their children. The Center for Substance Abuse Treatment reported in 1995 that 75% of women who successfully completed its Women and Children's Branch treatment remained drug-free, and 65% of their children were returned from foster care. ¹¹ Such outcomes certainly positively impact the familial environment, keep children safe, and ideally avoid permanently breaking familial ties. If effective, treatment also reduces costs that society would otherwise be forced to bear.

Yet all too often, a shortage of effective substance abuse treatment poses a significant barrier to success. In 2006, 23.6 million persons aged 12 and older needed treatment for an illicit drug or alcohol problem, but only 2.5 million of them actually received services-leaving 21.1 million individuals unattended to. ¹² This is consistent with prior reports from the U.S. Government Accountability Office, as well as a 1997 CWLA study that found child welfare agencies were able to provide drug abuse treatment to less than one-third of parents who needed it. ¹³

Another very real factor is that the Adoption and Safe Families Act of 1997 requires decisions about children's permanent living arrangements be made on a much shortened timeframe. Securing a safe and permanent home for children has and will always be paramount, but it is noticeably difficult for child welfare agencies to-in the face of definite and life-altering deadlines-ensure that substance abusing parents are able to access comprehensive treatment and thoroughly monitor parents' progress in treatment in a timely manner. ¹⁴ Already strained child welfare agencies simply cannot stand alone in serving the complex needs of children in families struggling with substance abuse. It is vital that child welfare agencies work in collaboration with drug and alcohol agencies and non-government programs to ensure high quality, effective substance abuse treatment is provided in a timely fashion so that children's best interests are properly served. ¹⁵

Additional federal resources are necessary to facilitate this and, fortunately, some funding streams have been initiated. In 2006, when reauthorizing the Promoting Safe and Stable Families program (S.3525), Congress dedicated $145 million in mandatory funding over five years to support competitive grants for projects addressing methamphetamine and other substance abuse as it affects the child welfare system. The legislation also specifically instructs grantees to consult with state substance abuse agencies as appropriate. The funds provided by these grants are to be used to support family-based, comprehensive, long-term substance abuse treatment services, including a range of components such as early intervention and preventative services for children, counseling for children and families, mental health services, parenting skills training, and/or replication of successful models of comprehensive family treatment. The comprehensive family treatment model includes the entire family unit in treatment efforts and focuses on integrating mental health, domestic violence, sexual abuse, and family therapy counseling services.

This is a wonderful first step, but given the gravity of the substance abuse problem as it impacts child welfare, Congress must go even further to ensure that comprehensive family treatment services, including home-based, outpatient, and residential treatment programs that accept women and children, are more widely available and accessible to the child welfare population.

Avenues Forward

Child Protection/Alcohol and Drug Partnership Act
The Child Protection/Alcohol and Drug Partnership Act encompasses the comprehensive family treatment model and addresses the need for additional substance abuse treatment for caregivers involved in the child welfare system. Originally introduced in 2000 by Senator Olympia Snowe (R-ME) as S. 2435, and by Congressman Charles R. Rangel (D-NY) as H.R. 5081, this or similar legislation needs to be reintroduced in the 110th Congress.

The bill would provide five-year grants to state child welfare and alcohol and drug prevention and treatment agencies that jointly develop and increase treatment services, establish appropriate screening and assessment tools, or improve strategies to engage and retain parents with substance abuse issues who come to the attention of the child welfare system in treatment and provide aftercare support. Significant flexibility would be afforded to such collaborative efforts, thereby permitting states to develop or expand comprehensive family-serving substance abuse intervention and treatment services. These services would include early intervention services for children that address their mental, emotional, and developmental needs, as well as comprehensive home-based, outpatient, and residential treatment for parents with alcohol and drug abuse dependency. Evaluation components of the legislation would also lead to much needed improvement in data systems and strategies that identify the effectiveness of treatment.

This legislation recognizes that the best manner in which to address continuing shortfalls in actually getting substance abuse treatment to those who need it, is for child welfare and alcohol and drug prevention agencies to work together to develop and offer comprehensive, wellcoordinated, effective services. In addition, it promotes after-care support to achieve long-term child safety and family stability.

Family-Based Meth Treatment Access Act
The Family-Based Meth Treatment Access Act of 2007 (S. 884/H.R. 405), introduced in the 110th Congress by Senator Richard Durbin (D-IL) and Congresswoman Barbara Cubin (R-WY), would increase the availability of family-based substance abuse treatment and should be passed. The legislation would permit the Center for Substance Abuse Treatment (CSAT) to award funding for programs that provide comprehensive, family-based substance abuse treatment to pregnant and postpartum women that incorporates the whole families' needs, as well as mental health counseling, medical treatment, parenting, education, and legal services. Priority would be given to certain programs, including those that serve rural areas or locations forced to deal with a shortage of mental health professionals. The Secretary of HHS would also have discretion to award grants to local jails and detention facilities so that such comprehensive, family-based substance abuse treatment services could be used to assist non-violent offenders. Well-established, family- based treatment programs have proven effective. A 2001 CSAT study found that six months after family-based treatment, 60% of mothers remained alcohol and drug-free, 38% had obtained employment, and 75% had physical custody of one or more children. ¹⁶

Key Facts

• Substance abuse is a factor in one to two-thirds of cases of children with substantiated reports of abuse and neglect, and in two-thirds of cases of children in foster care. ¹⁷
  
  
• In a 1999 national survey, 85% of states reported substance abuse was one of the two major problems exhibited by families suspected for child maltreatment. ¹⁸
  
  
• Of the more than $24 billion states spend on addressing substance abuse, slightly more than 20%, or $5.3 billion, is estimated to go to child welfare costs related to substance abuse. ¹⁹
  
  
• Prenatal exposure to alcohol increases physical and mental health risks for children, including hyperactivity and attention deficit, childhood depression, memory and information processing delays, poor problem-solving skills, lower IQ scores, and difficulty with linguistic, perception, and motor development. ²⁰
  
  
• Children of alcoholics tend to exhibit greater stress and anxiety than other children, increasing the likelihood they will drink alcohol or use other substances to reduce anxiety. ²¹
  
  
• Children of substance abusers are more likely to have extensive exposure to criminal activity and the criminal justice system. ²²
  
  
• A 2005 National Survey on Drug Use and Health found that youth who have been in foster care had higher rates of illicit drug use than youth who have never been in foster care-33.6% versus 21.7%. ²³

1. Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies, National Household Survey on Drug Abuse. (2003). The NHSDA report: Children living with substance-abusing or substance-dependent parents. Available online. Washington, DC: Author. back
2. Besharov, D. (Ed.). (1992). When drug addicts have children: Reorienting child welfare's response. Washington, DC: American Enterprise Institute and Child Welfare League of America. back
3. U.S. Department of Health and Human Services (HHS). (1999). Blending perspectives and building common ground. Available online. Washington, DC: Author. back
4. Semidei, J., Radel, L.F., & Nolan, C. (2001). Substance abuse and child welfare: Clear linkages and promising responses. Child Welfare, 80(2) 109-128.. back
5. SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health. (2007). Results from the 2006 national survey on drug use and health: National findings. Available online. Washington, DC: Author; National Institute of Drug Abuse. (2006). NIDA research report series: Methamphetamine: Abuse and addiction. Available online. Rockville, MD: Author. back
6. Statement of the Child Welfare League of America submitted to the Senate Finance Committee Hearing on Methamphetamine and its Social and Economic Impact on Child Welfare, 109th Cong., 2nd Sess. (2006). Available online. Washington, DC: Author. back
7. Johnson, J.L., & Leff, M. (1999). Children of substance abusers: Overview of research findings. Pediatrics, 103(5), 1085-1099. back
8. Ibid. back
9. SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health. (2005). The NSDUH report: Substance use and need for treatment among youths who have been in foster care. Available online. Washington, DC: Author. back
10. SAMHSA, Center for Substance Abuse Treatment (CSAT). (1997). National treatment improvement evaluation study summary. Rockville, MD: Author; Mueller, M.D., & Wyman, J.R. (1997). Study sheds new light on the state of drug abuse treatment nationwide. NIDA Notes, 12(5): 1, 4-8. back
11. CSAT. (1995). Producing results. Rockville, MD: Author. back
12. SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, Results from the 2006 national survey on drug use and health: National findings. back
13. U.S. Government Accountability Office (GAO). (1997). Child protective services: Challenging practices require new strategies. (GAO/HEHS-97-115). Washington, DC: Author. Available online; GAO. (1995). Child welfare: Complex needs strain capacity to provide services. (GAO/HEHS-95-208). Available online. Washington, DC: Author; Child Welfare League of America. (1997). Alcohol and other drug survey of state child welfare agencies. Available online. Washington, DC: Author. back
14. GAO. (1998). Foster care: Agencies face challenges securing stable homes for children of substance abusers. (GAO/HEHS-98-182). Available online. Washington, DC: Author. back
15. Maluccio, A.N., & Ainsworth, F. (2003). Drug use by parents: A challenge for family reunification practice. Children and Youth Services Review, 25(7), 511-533. back
16. CSAT. (2001). Benefits of residential substance abuse treatment for pregnant and parenting women. Rockville, MD: Author. back
17. HHS, Blending perspectives and building common ground. back
18. National Center on Child Abuse Prevention Research. (2001). Current trends in child abuse prevention, reporting, and fatalities: The 1999 Fifty State Survey. Chicago: Prevent Child Abuse America. back
19. National Center on Addiction and Substance Abuse at Columbia University. (2001). Shoveling up: The impact of substance abuse on state budgets. New York: Author. back
20. Richter, L., & Richter, D.M. (2001). Exposure to parental tobacco and alcohol use: Effects on children's health and development. American Journal of Orthopsychiatry, 71(2), 182-203. back
21. Schuckit, M.A. (1994). Low level of response to alcohol as a predictor of future alcoholism. American Journal of Psychiatry, 151(2), 184-189 back
22. Austing, G., & Pendergast, M. (1991). Young children of substance abusers: Prevention research update no. 8. Portland, OR: Northwest Regional Educational Laboratory. back
23. SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, The NSDUH report: Substance use and need for treatment among youths who have been in foster care. back

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