Substance Abuse-Affected Families in the Child Welfare System: New Challenges, New Alliances
Azzi-Lessing, Lenette, Olsen, Lenore J., Social Work
During the past decade an unprecedented number of single-parent families entered the child welfare system because the mother had an identified substance abuse problem. Affecting as many as 80 percent of all cases of substantiated abuse and neglect (Child Welfare League of America, 1990), substance abuse is now cited as one of the three most common reasons for children entering care, along with abuse and neglect and economic stress (Children's Defense Fund, 1992). Substance abuse is regarded as a key factor in the recent growth of out-of-home placements (Child Welfare League of America, 1990). These trends have forced the child welfare field and substance abuse treatment providers to take a new look at the needs of parents with problems of chemical dependence and their children. As Halfon so aptly noted, this has meant "treading into an area that has been an incredible morass of conflicting policies and inadequate services" (cited in Child Welfare League of America, 1990, p. 24).
This article examines these conflicts and problems in service delivery, looking first at the mandate framing child welfare practice and at issues in substance abuse treatment that affect this population. The article discusses specific practice and policy issues that must be addressed if the problem of chemical dependency is to be dealt with effectively and recommends ways to strengthen the delivery of services to this client population.
Child Welfare Mandate
Current child welfare practice is driven to a large extent by the Adoption Assistance and Child Welfare Act of 1980 (P.L. 98-617), which mandated that families be strengthened through services to prevent placement and, when placement was necessary, reunified as quickly as possible. It required that child welfare agencies make reasonable efforts to support families and to keep them together. The law builds in timelines for decision making through six-month case reviews and 18-month dispositional reviews.
At the same time, child welfare agencies are also required through federal and state law to protect children from harm and ensure their safety. Thus, child welfare professionals must constantly struggle to find ways to strengthen families while also protecting children. When chemical dependency enters the picture, these mandates become difficult to balance, for the cycle of recovery does not always mesh with the child's needs or the timelines for child welfare decision making. To complicate matters further, these mandates must be met within a service delivery system that is woefully underfunded and where families' needs often extend far beyond the scope of what service providers can offer.
Substance Abuse Treatment
When mothers are referred by the child welfare system for substance abuse treatment, they are referred to a system that has historically focused on treating individual problems and that has been dominated by treatment models favoring the needs of men. Although gains have been made in the availability of services, still less than 1 percent of federal antidrug money is targeted toward drug treatment for women and even less toward pregnant and parenting women (Child Welfare League of America, 1990). The Alcohol, Drug Abuse, and Mental Health Services Block Grant program currently sets aside only 10 percent of its funds for the treatment of women (Child Welfare League of America, 1992). Treatment slots for pregnant women are virtually nonexistent in many communities (Gustavsson, 1991). Residential treatment programs, which are a necessary component of any comprehensive service delivery system (Barth, 1993; Child Welfare League of America, 1992; DeLeon & Jainchill, 1991; Straussner, 1989), pose special challenges for women with primary child care responsibilities and are equally scarce.
To effectively serve chemically dependent women, experts have called for nothing less than a paradigm shift that would refocus services on the needs of the family and on the broader social and economic needs of women in treatment (Child Welfare League of America, 1990, 1992; Daghestani, 1988; Finkelstein, 1994; Reed, 1987; Zimmerman, 1988). …