Combining Child Welfare and Substance Abuse Services: A Blended Model of Intervention
McAlpine, Catherine, Marshall, Cynthia Courts, Doran, Nancy Harper, Child Welfare
Montgomery County, Maryland's Child Welfare Services (CWS) and Adult Addiction Services (AAS) developed an initiative to address the requirements of the Adoption and Safe Families Act (ASFA) while meeting the needs of families and the community of providers. A blended model of intervention was determined to be the best strategy to achieve the dual mandates of CWS and alcohol and other drugs (AOD) providers. Drawing from criminal justice, systems theory, social work, and addiction treatment, the approach made use of graduated sanctions or levels of intensity in providing services, engaging client participation, and engendering motivation. This article proposes strategies at client and organizational levels to understand the process of adaptation to ASFA and to guide planning for blending services.
Parental substance abuse contributes to at least 50% of all child welfare services cases, in some parts of the United States, prevalence may be as high as 90% [National Center on Addiction and Substance Abuse (NCASA) 1999]. Substance abusing parents usually experience multiple problems that few child welfare agencies and substance abuse treatment programs are prepared to address. With the enactment of the federal Adoption and Safe Families Act of 1997 (ASFA) requiring states to file a petition to terminate parental rights if a child has been in out-- of-home care for at least 15 of the most recent 22 months, the needs of substance abusing parents have moved to the foreground. Child welfare and substance abuse treatment programs must collaborate to provide children with safe, stable homes with nurturing families as a foundation for a healthy and productive life.
Service integration is critical to working effectively with substance-abusing parents and providing intensive time-limited reunification services to children and families. Based on this premise, the local child welfare services and adult addiction services agencies in Montgomery County, Maryland, forged a relationship to integrate services across agency lines in an effort to coordinate service delivery, develop protocols to respond effectively by screening for parental substance abuse in every investigation of child maltreatment, and provide timely access and appropriate treatment for parents.
This article discusses several policy and practice issues that act as obstacles to successful implementation of ASFA and describes Montgomery County's approach to them.
ASFA created a renewed emphasis on immediate planning for children requiring child welfare services (CWS) to find more effective ways to achieve family stability. ASFA emphasizes timely decisionmaking by requiring permanency decisions for abused and neglected children within a 12-month timeline and includes mandates to terminate parental rights once a child has been placed in out-of-home care for 15 of the previous 22 months unless compelling reasons exist not to initiate termination. Attention to related problems of substance abuse and child maltreatment within families is a core element of the service delivery required on the part of CWS agencies. These mandates place a burden on CWS to ensure prompt and adequate services for parents, with an emphasis on making reasonable efforts to obtain access to resources and coordination of community services.
Child Abuse and Neglect Laws
Many state laws governing child abuse reporting, out-of-home care and termination of parental rights implicate consideration of substance abuse as a factor in child protection decisions. Most mandatory child abuse reporting laws, however, do not explicitly mention parental substance abuse, but rather speak to physical abuse, sexual abuse, and neglect. As of 1996, seven states had laws that include perinatal drug exposure due to parental substance abuse.' These laws bring children at risk of abuse and neglect to the attention of the child protection agency with an emphasis on prenatal exposure rather than on recognizing the long-term risks of living with an AOD abusing caregiver. …