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Home > Practice Areas > Alcohol and Other Drugs > Alcohol and Other Drug Survey of State Child Welfare Agencies - 1997

 
 

Alcohol and Other Drug Survey of State Child Welfare Agencies

February, 1997

Introduction

Children and families who are alcohol and other drug (AOD) involved are challenging the capacity of the child welfare system. Every day hundreds of thousands of young people suffer the effects of family dysfunction, violence, homelessness, crime and poverty that result from living in an AOD involved household. Although it is difficult to quantify a causal relationship between AOD use and child maltreatment, experts agree there is a strong, frequently occurring correlation between parental chemical dependency and child abuse and neglect. Of the nearly one million children found to be confirmed or "substantiated" victims of maltreatment in 1996 alone, at least 50% had chemically involved caregivers. Eighty percent of states report that parental substance abuse and poverty are the top two problems among child protective caseloads.1

Because the child welfare system is deeply involved with chemically affected children and families, it is imperative that policy and decision makers have accurate information about the numbers of children and families affected by alcohol and drug related problems, the services that can improve their health and well-being, and the policies and resources necessary to support these services. In early 1997, the Child Welfare League of America (CWLA), conducted a survey of the state public child welfare agencies to obtain a baseline measure of the types of policies, programs, and data collection efforts currently in place to support chemically involved children and families, with a special emphasis on children and youth in out-of-home care.

Methodology

After field testing the survey instrument, each state child welfare agency and the District of Columbia were sent the survey instrument. Forty-seven of the 51 surveys were returned, for a response rate of 92%.2

The 76-question survey queried the states on a number of topics: assessment policy, types of services and programs available to clients, staff training, financial resources, permanency planning, demographics of the chemically-involved client population, barriers to effective service delivery and recommendations. States with written AOD policies were asked to send them to CWLA.

Recommendations at the end of each section of this report are drawn from CWLA's North American Commission on Chemical Dependency and Child Welfare publication, Children at the Front: A Different View of the War on Alcohol and Drugs and developed with the guidance of CWLA's national task force on Chemical Dependency and Child Welfare.

Demographics

Very few state child welfare agencies have information management systems that track substance abuse data on the children and families they serve.

When asked to provide the number of children and adolescents in out-of-home care who were placed there in part due to parental substance abuse, 83% (39 of 47) of the respondents were unable to answer the question.3
  • Of the 8 states that could respond:

     
    # of children & adolescents
    Average
    2,065
    Range
    338-5,400


  • Less than 7% (3 of 47) of the states were able to provide the number of children and adolescents in out-of-home care who themselves have a substance abuse problem.

     

    # of children & adolescents

    % of children & adolescents

    Average

    434

    8%

    Range

    83 - 1,000

    1%-20%



  • 23% of states reported that the number of young people with their own substance abuse problems had increased over the last ten years.


  •   children in out-of-home care
    with a history of AOD abuse themselves
    Increased

    10 of 47

    Decreased

    0

    Remained the same

    1 of 47

    Do not know

    36 of 47




      children in out-of-home care
    for whom parental abuse of AOD is a reason for removal


    Increased

    13 of 47

    Decreased

    0

    Remained the same

    0

    Do not know

    34 of 47




    67% of respondents believe that AOD involved families are "much more likely" or "more likely" to re-enter the child welfare system over a five year period compared to a families for whom AOD is not an issue.


Recommendations
  1. Child welfare agencies should encourage and support state and local efforts to establish reporting and tracking systems so that national data related to the impact of chemical dependency on children, youth, and families can be collected.

  2. The federal government should make funding available through Title IV-B and IV-E or other programs to assure that state and local child welfare agencies have the resources to comply with the data collection mandates.

Assessment Policy

When a child welfare agency receives a report of maltreatment, a child protective services (CPS) caseworker may be dispatched to the family's home to investigate and determine if there is evidence to substantiate the abuse/neglect charge. A risk assessment protocol guides CPS workers' actions during the investigation. CWLA found:
  • 18 of 47 state risk assessment protocols do not address parental drug abuse;

  • 19 of 47 state risk assessment protocols do not address parental abuse of alcohol;

  • 35 of 47 states do not explore alcohol and/or drug use by the children and youth themselves.
When it is determined that it is in the best interest of a child to be removed from the home and placed into foster care, it is incumbent upon the state as "parent" to provide for the child's physical, emotional, and psychological needs. An assessment is therefore conducted to ascertain what types of health and mental health services the youth requires.
  • Only 8 of 47 of the states employ an assessment protocol that investigates AOD use by those entering out-of-home care.

  • Only 7 of 47 of the states report that they have a written policy that mandates staff to routinely inquire about AOD abuse in pregnant adolescents requiring out-of-home care.
CWLA found that there is a major gap in written policy regarding reporting a young person's substance abuse:
  • 39 of 47 of the agencies do not have a written policy requiring foster care parents/kinship care providers to report a child's AOD abuse to the agency.
Recommendations
  1. Child welfare agencies should develop and routinely utilize standardized questions regarding AOD use/abuse in all intakes and investigations of child maltreatment.

  2. All young people should receive a comprehensive health and mental health assessment which includes screening for alcohol and other drug use within three days of entering out-of-home care.

  3. Child welfare agencies should develop standard protocols to routinely inform and educate both male and female adolescents and pregnant women of all ages about the dangers associated with AOD use during pregnancy.

  4. Child welfare agencies should require through written policy that all direct caregivers (foster parents, kinship care providers, group residential staff) report to the foster care social worker a child's AOD use so that a treatment plan can be developed and implemented. This policy should also be outlined during foster parent/kinship caregiver orientation programs.

Services and Programs

In order to assure that children and families are provided the services necessary to enhance family functioning and healthy development, child welfare workers frequently coordinate the efforts of multiple agencies by assuming the role of case managers. When asked if the child welfare agency takes primary responsibility for case management of AOD problems and treatment when such problems exist in substantiated child abuse and neglect cases respondents replied:



Percent Number
Yes, for all parties, including parents

47%

22 of 47

No

36%

17 of 47

Yes, for children and youth only

4%

2 of 47

Do not know

4%

2 of 47

Missing

9%

4 of 47




Prevention
A comprehensive body of literature documents how consistent exposure to parental abuse of AOD may contribute to the development of a child's own substance abuse problems. Therefore it is critical that children and youth of chemically dependent parents receive developmentally appropriate AOD prevention services. The survey found that:
  • 91% (43 of 47) of the states responded that they do not provide special AOD support groups for children in family foster care.

  • 64% (35 of 47) report that they have not developed specialized AOD support groups for youngsters in group residential care.

  • 34% of agencies (16 of 47) do not provide any form of AOD prevention services to youth in out-of-home care.

  • Almost half of the states, 43% (20 of 47), rely primarily on the AOD prevention education programming administered by the school system.



Treatment
Child welfare agencies are constantly struggling to meet the AOD needs of thousands of clients each day. States were asked to estimate, for the following populations involved with the child welfare system, what percentage required AOD treatment services, and of each group, what percentage the agency the capacity to serve through direct or contracted services.

  % Needing Services Of those needing services,
% Agency can serve

n

Parents

67%

31%

11

Children & Adolescents

43%

29%

7

Pregnant women

35%

20%

5



The following chart describes the states' estimation of the waiting period children and families typically experience before they receive AOD services through the child welfare agency.

 

Percent

Number

There is no problem; all can be served within one month

2%

(1 of 47)

Fewer than 10% cannot be treated in a timely manner (1 month or less)

9%

(4 of 47)

Fewer than 25% cannot be treated in a timely manner

2%

(1 of 47)

Fewer than 50% cannot be treated in a timely manner

2%

(1 of 47)

50% or more cannot be treated in a timely manner

28%

(13 of 47)

Do not know/ missing

57%

(27 of 47)




Recommendations
  1. Because many youth change schools due to multiple foster care placements or return home to their family of origin which may be in another school district, there is a high likelihood that a significant portion of youth in out-of-home care may never complete a school-based substance abuse prevention education program. Therefore all child welfare agencies should develop and integrate into their continuum of services AOD prevention programming for youth in out-of-home care.

  2. Child welfare agencies should support and facilitate intra- and inter-agency collaboration, including joint training and program development and resource sharing among the child welfare system, the AOD community, the courts, and other health service agencies.

  3. Child welfare and AOD treatment providers and health care professionals should establish or participate in ongoing interagency, interdisciplinary teams for the care and case management of AOD-involved infants, children, and families in the child welfare system.

Staff Training

Because it is the responsibility of the child welfare agency to determine the degree to which parental substance abuse poses a risk to the child, it is imperative that workers not only be able to assess and document the impact of AOD on parenting, but also to assess substance abuse within the larger context of family functioning and behavior, including parental use of support systems, availability of community resources, parental desire and capacity to parent, the child's attachment to the family, the child's special medical/developmental problems, and the likelihood that in-home services can reduce risk. Therefore CWLA asked respondents if workers received training during their first year of service on recognizing and dealing with AOD problems.

Staffs

training in recognizing AOD problems

 

yes

no

do not know

Child Protective Services

37 of 47

3 of 47

7 of 47

Family Preservation

26 of 47

5 of 47

16 of 47

Foster Care Staff

29 of 47

5 of 47

13 of 47

Group/Residential Care

11 of 47

12 of 47

24 of 47

 

Staffs

training in dealing with AOD problems

 

yes

no

do not know

Child Protective Services

32 of 47

5 of 47

10 of 47

Family Preservation

21 of 47

5 of 47

21 of 47

Foster Care Staff

26 of 47

4 of 47

17 of 47

Group/Residential Care

12 of 47

10 of 47

25 of 47

 

Due in part to the enormous volume of children and families requiring child welfare services, it has become standard practice for public agencies to contract with community-based private agencies to provide such services. When asked if the contracts stipulate that the private agency's staff be trained in recognizing and dealing with AOD problems, a majority of the respondents did not know if private agency staffs were so equipped.


Recognizing AOD problems:

 

Percent

Number

Yes

13%

6 of 47

No

32%

15 of 47

Do not know

55%

26 of 47



Dealing with AOD problems:

 

Percent

Number

Yes

17%

8 of 47

No

34%

16 of 47

Do not know

49%

23 of 47







Recommendations
  1. As part of a mandatory orientation program, child welfare agencies should provide all new employees AOD training in recognizing and dealing with AOD problems.

  2. Agencies should also develop and provide periodic in-service trainings or refresher courses on AOD problem identification and management.

Direct Care Providers

As the direct caregivers to young people removed from their homes, family foster care parents and kinship care providers are critical players on the child welfare team. Because they spend the most time with the young people, they are often in the best position to help identify problems (such as AOD abuse) and assist in ameliorating them.

The following charts show the number and percentage of state child welfare agencies that provide AOD training to foster care parents and kinship care providers.

Caregivers

training in recognizing AOD problems

 

yes

no

do not know/missing

Family Foster Care Parents

22 of 47

10 of 47

15 of 47

Kinship Care Providers

9 of 47

20 of 47

18 of 47



 

Caregivers

training in dealing with AOD problems

 

yes

no

do not know/missing

Family Foster Care Parents

22 of 47

8 of 47

17 of 47

Kinship Care Providers

11 of 47

14 of 47

22 of 47




Given the enormous responsibility associated with caring for a child, child welfare agencies have developed screening protocols in order to determine if potential substitute caregivers are suitable.
  • 66% (31 of 47) state that foster parents and kinship care providers are assessed for their own AOD use/abuse.

  • 66% (31 of 47) rely on foster parents/kinship care providers self-reporting alcohol and other drug abuse.

  • 21% (10 of 47) do not assess a potential foster parent or kinship care provider's AOD use/abuse.4

  • 4% (2 of 47) utilize toxicology screens to determine AOD abuse.


Because of the medical and developmental problems children prenatally exposed to AOD often have, it is imperative that these caregivers understand the level of responsibility involved caring for such a child and possess the skills and abilities to meet those needs.

Approximately 40% (19 of 47) of states report that they recruit foster care parents and kinship care providers specifically to care for children prenatally exposed to AOD.


State agencies frequently provide additional support and benefits to caregivers who take on the responsibility of caring for an AOD exposed child. These benefits are of at least five types:

 

Percent

Number

More money

61%

(28 of 47)

Respite care

48%

(22 of 47)

Additional training

39%

(18 of 47)

Transportation services

28%

(13 of 47)

Support groups

19%

(9 of 47)

Other

15%

(7 of 47)

None

15%

(7 of 47)

Do not know/missing

11%

(5 of 47)





Recommendations
  1. Child welfare agencies should provide AOD training to all caregivers as part of their pre-service and in-service training to ensure that they understand AOD issues and the impact AOD abuse has on family functioning.

  2. All direct care staff should be trained to develop the skills necessary to recognize and appropriately respond to AOD problems in the children and families they serve.

  3. Agencies should question kinship care providers and family foster parents about their own AOD involvement as part of the initial screening and assessment process.

  4. State child welfare services should support foster parents and kinship caregivers through ongoing consultation and other appropriate services including respite care, transportation, and child day care.

  5. Agencies can encourage participation of foster parents and kinship care providers in AOD training by reimbursing them for costs associated with transportation, child care, and other related expenses.

Resources

Increasing numbers of children and families struggling with chemical dependency problems are flooding the child welfare system. In order to provide AOD prevention and treatment services, child welfare agencies tap into these funding sources:



Source

Percent

Number

Medicaid

62%

(29 of 47)

General funds

41%

(19 of 47)

IV-B

28%

(13 of 47)

Health department

23%

(11 of 47)

Other*

38%

(18 of 47)

Do not know/missing

19%

(9 of 47)

No funds

2%

(1 of 47)

*Other funding sources include Title IV-E, special grants, and state alcohol & drug departments.

When asked how much money is allocated from the child welfare budget for AOD services for children and families:
  • Only 22 of the 47 states were able to provide the dollar figure allocated for AOD services.

  • 10 of the 22 states responded that no money was earmarked for AOD services.

  • Of the 12 states that did appropriate resources for substance abuse services:
 

Dollar Amount

Percent of Total Budget

average:

$919,182

0.33%

range:

$10,000 - $8,500,000

0% - 2%



Recommendations
  1. Increase treatment options for families by allowing IV-E dollars to be used for the care of a child (who otherwise would be placed into out-of-home care) with a parent in a residential treatment facility, when the permanency plan is the child's reunification with his/her family.

Permanency Planning

Forty-one states (87%) could not report how many children of substance abusing parents had been reunited with their biological parents. In the six states that did respond, an average of 54.2% of children of substance abusers were reunited with their parents. Of the six respondents, only two states could also report how many of those children were subsequently re-abused and removed once again. On average, 30% of those children were maltreated again and the state regained custody.


Recommendations
  1. Child welfare workers should establish and maintain ongoing contact with AOD treatment providers who work with chemically involved parents. AOD providers should keep child welfare agencies informed about treatment progress, episodes of relapse, and/or unplanned discharges. Child welfare agencies should use such information to assure that the parent's treatment plan is consistent with the child's case plan.

  2. Child welfare workers should not make success or failure of the parent in AOD treatment the sole factor in reunification decision making because relapse is a part of the recovery process. Decisions must also include the parent's ability to resume caregiving and assure the safety and well-being of the child and the presence or absence of back-up caregivers in the attended family.

  3. Specifically, agencies should carefully assess such factors as: past history of abandonment or inability to locate the parents, prior parental history of child maltreatment, placement of other children in foster care; prior efforts at reunification; history of drug-exposed births; level of motivation to parent a child; and the nature of impairment imposed by any continuing AOD use.

Conclusion

The abuse of alcohol and other drugs has had and continues to have a profound impact on the lives of millions of children and their families. Rising demand for treatment, combined with limited financial resources have created a child welfare system under great stress. To meet the challenges posed by AOD problems, the child welfare system should begin a dialogue with professionals and caregivers from many different disciplines, which will lead to innovations in policies, programs and practices at the local level. Collaborative, coordinated, culturally competent, community-based services are more likely to emerge when the professionals and caregivers in a community possess a common base of knowledge about child welfare concerns and AOD problems.



(1) National Committee to Prevent Child Abuse. (1997). Current trends in child abuse reporting and fatalities: NCPCA's 1996 annual fifty state survey. Washington, DC: author.


(2) Surveys were not received from Montana, North Dakota, South Dakota, and Tennessee.


(3) Nearly 58% of the states unable to answer this question reported however that they had fixed plans to begin collecting this data within the next two years.


(4) 13% (6 of 47) did not know if substitute caregivers were assessed for AOD abuse/use or they left the question blank.

© Child Welfare League of America. The content of these publications may not be reproduced in any way, including posting on the Internet, without the permission of CWLA. For permission to use material from CWLA's website or publications, contact us using our website assistance form.


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