2.5 Substance abuse treament that allows children to stay with their parents

Parental substance abuse is a serious threat to family stability and child well-being. State and local child welfare agencies estimate that up to 80 percent of the families on their caseloads have substance abuse problems – an assessment supported by 2008 national estimates that substance abuse was a factor in at least two-thirds of cases of children in foster care. [i] Research indicates that with adequate parental substance abuse treatment, parenting support, and case supervision, children may be better off with parents who have substance abuse problems than in out-of-home care.

A large body of research documents that substance abuse is a treatable public health problem with a wide range of cost-effective treatment solutions. At the same time, funding is seriously lacking for substance abuse treatment that can keep vulnerable families together. [ii] Of the 13 to 16 million Americans who need alcohol and substance abuse treatment in any given year, only 3 million receive services. Among female substance abuse treatment clients who are parents, 44 percent reported they entered substance abuse treatment in order to retain or regain custody of their children. [iii] However, a 1997 study found that child welfare agencies could provide treatment to less than one-third of parents who needed it. [iv] Forty-six percent of parents with substance abuse problems involved with the child welfare system were neither offered nor provided substance abuse services. [v]

To safely preserve families with parental substance abuse problems requires a comprehensive policy approach that supports timely access to effective treatment.

A. Timely substance abuse treatment targeted to parents involved with the child welfare system. To help ensure that parents with substance abuse problems receive timely treatment needed to retain or regain custody of their children, state policymakers can target substance abuse treatment resources to this population and take steps to ensure access. Due to enormous unmet need for substance abuse services, parents with alcohol and other drug problems often face long waiting lists for treatment. Even when treatment is available, research shows that recovery takes time. Residential treatment programs usually recommend treatment for nine months or longer, and outpatient treatment requires at least six months. Studies indicate that the longer the treatment stays, the better the outcomes. In addition, treatment is not a one-time fix. There is a high probability of relapse, and repeat treatment must be available.

At the same time, long waits for admission to substance abuse treatment programs coupled with the long-term nature of effective treatment often require more time than federally mandated timelines for termination of parental rights allow. The federal Adoption and Safe Families Act (ASFA) [vi] requires courts to make a decision regarding a child’s permanent placement within 12 months after the child enters foster care, and states must initiate proceedings to terminate parental rights after a child has been in foster care for 15 of the most recent 22 months (unless the case plan documents a compelling reason that filing a petition to terminate parental rights would not be in the best interest of the child).

Legislation in Ohio (Ohio Rev. Code Ann. Sec. 340.033) and New York (1999 N.Y. AB 7938) requires local boards and the state respectively to provide admission priority to drug, alcohol, and substance abuse treatment to parents whose children are in foster care or in jeopardy of placement.

B. Collaborative approaches to assess and facilitate access to substance abuse treatment for parents. Successful models of substance abuse treatment for parents with children at risk often hinge on collaboration among substance abuse, child welfare, and other professionals. Mental health treatment is necessary for many individuals with substance abuse problems. Others experience health problems (such as HIV/AIDS), domestic violence, and/or housing issues that require a collaborative response. [vii]

The Effective Systems section of this report includes a set of policy tools that support interagency collaboration and service delivery. (See Policy Area 15: Effective Systems, Interagency Collaboration) This section outlines policies that promote collaborative approaches to assessment of parental substance abuse problems and access to treatment.

As part of a federal Title IV-E waiver demonstration of substance abuse treatment for families involved with the child welfare system, Delaware tested the use of multidisciplinary teams and compared outcomes with families who did not have the benefit of a team approach. In each of three counties, a substance abuse liaison assisted child welfare workers to identify families in need of substance abuse services, assess their treatment needs, link them with appropriate services and provide case management. Children in participating families spent 34 percent fewer days in foster care, more cases were closed due to completion of case plans and risk reduction, and the average cost of foster care in the demonstration group was $11,736 compared to $18,149 in the control group. Over more than two years, foster care costs for families with substance abuse problems decreased by 18 percent, while costs for the control group families increased 25 percent.

In Jacksonville, Florida, alcohol and other drug counselors are stationed with child protective services investigation units to assist with assessing parents’ substance abuse problems, referring them to services, and encouraging parents to participate in treatment. [viii]

C. Residential substance abuse treatment programs that allow children to stay with their parents. Comprehensive residential programs that allow women to keep their children with them during treatment demonstrate positive outcomes for the mothers and children, and promise long term savings for taxpayers. A study of 50 federally-funded residential treatment programs that allow children to stay with their mothers reported impressive reductions in women’s use of alcohol and drugs (including crack cocaine, methamphetamine, and heroin). The findings showed that among pregnant participants, substance abuse was lower than the rates reported for U.S. women in the general population. [ix] Furthermore, the programs were able to overcome a major barrier to treatment success by engaging parents in services; almost half of the clients in residential treatment said they would not have entered treatment if they had not been able to bring their children with them. [x]

Mothers in residential treatment with their children are over five times more likely to live with all their children after discharge than women who did not co-reside with their children during treatment. [xi] Other results documented for these programs include improvements in children’s behavioral and emotional functioning, more positive family relationships, reduced parental stress, and increases in the positive social networks that provide protective factors for children. [xii] Long-term savings are predicted from avoided medical treatments, child health care, welfare, and criminal justice system involvement. [xiii]

Although some programs limit the number and ages of children co-residing with their mothers, the 50 programs in the federal study did not. When possible and appropriate, the children’s fathers were included in the treatment protocol as well. Successful programs are relatively long term (generally six to twelve months); provide gender-specific, culturally appropriate services; feature comprehensive services that are tailored to each family; and assist with transition to the community. The comprehensive array of services often includes:

· health care, including pre-natal and pediatric care, medical treatment, and nutrition services;

· mental health treatment including individual, group and family therapy, as well as play therapy and services to address children’s behavioral problems;

· parenting training, support, and supervision;

· vocational training, life skills education, and legal services;

· early care and education, on-site education or coordination with community schools, and recreation for school-aged children.

Family residential substance abuse treatment programs are one of the major activities allowable under new federal Family Connections grants, authorized through the Fostering Connections legislation. The program authorizes $15 million a year for competitive, matching grants to state, local or tribal child welfare agencies and nonprofit organizations that have experience working with children in foster care or kinship care. [xiv]

Policy Options: States can authorize and fund substance abuse services using 1, 2, or 3 of the following policies:

· Parents with a child at risk of placement or in foster care have priority for substance abuse treatment;

· State supports a team approach that includes child welfare and substance abuse professionals to identify and assess substance abuse problems of families referred for child abuse or neglect and to facilitate timely access to treatment;

· Evidence-based, in-patient substance abuse treatment that allows children to remain with their parent(s) is made available.