Academic journal article Child Welfare

Sobriety Treatment and Recovery Teams in Rural Appalachia: Implementation and Outcomes

Academic journal article Child Welfare

Sobriety Treatment and Recovery Teams in Rural Appalachia: Implementation and Outcomes

Article excerpt

Parental substance use and child maltreatment are complex and interconnected problems. It is estimated that more than one million parents enter treatment for substance use each year (Young, Boles, & Otero, 2007). While many of these parents will not face contact with child protective services (CPS; Scannapieco & Connell-Carrick, 2007; Smith & Testa, 2002; Street, Whitlingum, Gibson, Cairns, & Ellis, 2008), between 40% and 80% of all families referred to CPS include a parent using alcohol or drugs (Young, Gardner, & Dennis, 1998). CPS cases with parental substance use comprise up to 79% of out-of-home-care (OOHC) placements (Besinger, Garland, Litrownik, & Landsverk, 1999), and parental substance use often predicts maltreatment recurrence (Barth, Gibbons, & Guo, 2006; Fuller, Wells, & Cotton, 2001; Wolock, Sherman, Feldman, & Metzger, 2001).

Given these intersecting challenges, partnerships between child welfare and addiction treatment providers are imperative. Some recent progress has been made. Drabble (2007) outlined barriers to cross-system collaborations, and Oliveros and Kaufman (2011) described promising practices for improved addiction treatment with parents involved with CPS. However, more research and development are needed, particularly for areas like rural Appalachia, where program development is often neglected despite continued barriers to treatment utilization and access (Clark et al., 2002). Indeed, the challenges facing rural Appalachia demand innovative responses that may well provide new knowledge and strategies for cross-system collaborations serving families.

Appalachia encompasses 420 counties across 13 states and is home to over 25 million people, 42% of whom live in rural areas, compared to 20% nationally (Appalachian Regional Commission [ARC], 2014). Despite the War on Poverty and other efforts to improve key economic and health indicators, disparities persist in the Central Appalachian subregion, which includes counties within Kentucky, Tennessee, Virginia, and West Virginia. Many Central Appalachian communities have been dependent on coal mining, and the impact of this declining economic infrastructure intersects with other social, cultural, and geographic factors (Zhang et al., 2008). Lost job opportunities has forced out-migration, which has weakened social and kinship networks and contributed to social isolation (Goodrum, Wiese, & Leukefeld, 2004). Rural Appalachian counties in this subregion have poverty rates as high as twice the national average (U.S. Census Bureau, 2014), an epidemic of nonmedical prescription drug use (Hall, Leukefeld, & Havens, 2013; Leukefeld et al., 2005; Wunsch, Nuzzo, Behonick, Massello, & Walsh, 2013; Young, Havens, & Leukefeld, 2012), and annual rates of child abuse and neglect (CA/N) as high as 5.4 per 100 children (Kentucky Department for Community Based Services, 2012).

As with other regions of rural America, inequalities in treatment access and utilization in rural Appalachia stem from distance to treatment facilities (Cummings, Wen, Ko, & Druss, 2014; Fortney, Rost, Zhang, & Warren, 1999) and access to transportation (Arcury, Preisser, Gesler, & Powers, 2005). However, cultural factors may also be influential. Rural Appalachian values of individualism and self-reliance may play a role in limiting substance users' identification of a need for professional treatment (Leukefeld et al., 2005). Additionally, a long and often troubled history between local Appalachians and absentee land-owning corporations (e.g., coal, timber) are thought to have fostered a lingering skepticism of outsiders (Keefe, 1988). One innovative recent study sought to establish the impact of conjoint geographical and cultural barriers on addiction treatment outcomes (Oser & Harp, 2014). The authors found that geographic discordance-receiving treatment in a location that is both geographically and socio-culturally different-increased the odds of relapse and incarceration 12 months after treatment entry. …

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