Responding to Alcohol and Other Drug Problems in Child Welfare: Weaving Together Practice and Policy Nancy K. Young Sidney L. Gardner Kimberly Dennis Office of Juvenile Justice and Delinquency Prevention CWLA Press • Washington, DC CWLA Press is an imprint of the Child Welfare League of America. The Child Welfare League of America (CWLA) is a privately supported, non profit, membership-based organization committed to preserving, protecting, and promoting the well-being of all children and their families. Believing that children are our most valuable resource, CWLA, through its member ship, advocates for high standards, sound public policies, and quality ser vices for children in need and their families. © 1998 by the Child Welfare League of America, Inc. All rights reserved. Neither this book nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher. For information on this or other CWLA publications, contact the CWLA Publications De partment at the address below. CHILD WELFARE LEAGUE OF AMERICA, INC. 440 First Street, NW, Third Floor, Washington, DC 20001-2085 e-mail: [email protected] CURRENT PRINTING (last digit) 10 9 8 7 6 5 4 3 2 1 Cover design by Shelley Furgason Printed in the United States of America ISBN # 0–87868-736-X This project was supported by Grant No. 98-JN-FX-K001 from the Office of Juvenile Justice and Delinquency Preven tion, Office of Justice Programs, U.S. Department of Justice. Points of view or opinions in this document are those of the authors and do not necessarily represent the official posi tion or policies of the U.S. Department of Justice. Contents Preface ................................................................................v Acknowledgments ............................................................. vii Introduction .......................................................................ix 1 Facing the Problem ....................................................... 1 2 Seeking Solutions ........................................................ 27 3 Lessons of the Models ................................................. 51 4 Treating AOD Problems: Practices, Innovations, and Effectiveness ......................................................... 77 5 Assessment: Bridging Child Welfare and AOD Services ............................................................ 111 6 Beyond the Boundaries of Child Welfare: Connecting with Welfare, Juvenile Justice, Family Violence, and Mental Health Systems ........................ 131 7 Building the Future: Recommendations..................... 149 Appendix A: Collaborative Values Inventory .................... 163 Appendix B: A Dialogue on Practice and Policy............... 167 Appendix C: Review Panel .............................................. 173 Appendix D: CWLA’s Chemical Dependency and Child Welfare Task Force ............................................. 175 About the Authors .......................................................... 179 iii iv Responding to Alcohol and Other Drug Problems List of Tables Table 1. Paths of Exposure to Alcohol and Other Drug Use .... 3 Table 2. Model Strategies and the Policy Framework ........... 28 Table 3. Results of Adjusting Intensity and Severity of Treatment ............................................. 80 Table 4. Therapeutic Approaches to AOD Treatment ........... 82 Table 5. Phases in the Change Process ................................. 87 Table 6. Comparison of Length of Stay in Treatment ........... 92 Table 7. Sources of Referral .................................................. 92 Table 8. Drugs Used by Women in Study ............................. 92 Table 9. Critical Variables Affecting Treatment Outcomes.....98 Table 10. Adolescent Program Model .................................. 104 Table 11. The Phases of the Screening and Assessment Process ................................................................. 119 Table 12. Assessment Processes with AOD Considerations ... 126 Table 13. Similarities and Differences in Approaches to Family Violence and AOD Problems ...................... 142 Table 14. Recommendations for Policy and Practice Changes ............................................................... 150 Table 15. Proposed Training Agendas .................................. 154 Preface The epidemic of drug and alcohol abuse that threatens our nation has many economic and social costs, but its cost to families is our greatest national deficit. Increasing numbers of Americans are living on the outskirts of hope and opportunity, with hundreds of thousands of children and adolescents feeling the devastating effects of abuse and neglect, homelessness, violence, and economic erosion. The widespread use of alcohol and other drugs by parents and other family members intensifies these social ills. Families should be on the front line of defense in the nation’s war on drugs, but in many cases, alcohol and other drugs have broken through the line. Many children and youth stand unprotected. The child welfare community cannot carry out its mandate to protect children unless there is a dialogue among profes sionals and caregivers from such disciplines as child welfare, substance abuse prevention and treatment, mental health, juvenile justice, pub lic assistance, and domestic violence. It is through collaboration that effective innovations in policies, programs, and practices evolve. The Child Welfare League of America is especially grateful for the energy, talent, vision, and commitment of Nancy Young, Sid Gardner, and Kimberley Dennis, the authors of this guidebook. We believe that Responding to Alcohol and Other Drug Problems in Child Welfare: Weaving Together Practice and Policy will be a valuable resource to guide the important work that must be done to protect children and strengthen families. David S. Liederman CWLA Executive Director v Acknowledgments This report is based upon the work of an extraordinary group of people who have designed and staffed the innovative model projects that we have summarized. They are the real pioneers in this field, working on behalf of children and families in areas where there are few well-blazed trails. Some of them have taken risks; all of them have made a differ ence. Among them we would like to single out Toni Moore from Sac ramento County and Katherine Wingfield of the CWLA staff. We would like to offer special thanks to two people without whom this guidebook could never have been completed: Dr. Robert Caulk of Sacramento and Angela Young of Irvine. It was Bob’s vision of CWS-AOD links and his deep commitment to doing something about AOD issues that created the Sacramento model. And it has been our niece Angela’s generous caring for our two youngest children that made it possible for us to devote the intensive time that this project has required. We would also like to acknowledge support from the following organizations in the compilation of materials from which this guide book was developed: The Annie E. Casey Foundation, the Edna McConnell Clark Foundation, the Stuart Foundation, and the Center for Collaboration for Children of California State University, Fullerton. We are especially grateful to the federal Office of Juvenile Justice and Delinquency Prevention, whose generous support helped to make this publication possible. We extend our deep appreciation to Shay Bilchik, Ellen Shields-Fletcher, and Gina Wood of the Office of Juve nile Justice and Delinquency Prevention, as well as staff from the Of fice of National Drug Control Policy and the Center for Substance Abuse Prevention of the U.S. Department of Health and Human Ser vices for their continued commitment to improve the quality of life for vulnerable children and their families. vii Introduction Many parents coming into contact with the child welfare system are users and abusers of alcohol and other drugs (AOD), the effects of which impair their parenting skills and threaten the safety of their children. (This guidebook cites estimates of 40 to 80% of all the fami lies in the child welfare system as AOD users/abusers.) In addition to problems with substance abuse, these parents also face difficulties due to their status in the Temporary Assistance for Needy Families (TANF) program (or welfare system), the behavior of their adolescent chil dren, family violence, and mental health issues. As a result, a paradox is driving the future of the child welfare system: decisions and re sources outside the child welfare system will determine how well that system can serve some of its most important clients—those who are in the caseloads of other agencies, as well as child welfare. Drawing on the experience of several models of child welfare prac tice, this guidebook sets forth a policy framework that can assist child welfare agencies in responding to these overlapping problems. Throughout the guidebook, the experience of the Sacramento County Alcohol and Other Drug Treatment Initiative is used as a case study of building bridges between the child welfare and substance abuse treatment systems. The policy framework focuses on the underlying values of these systems of services, the daily practices of workers in these systems, training, budget issues, outcomes and information systems, and ser vice delivery methods. The guidebook describes several barriers that constrain cooperation between child welfare and AOD treatment agen cies, including timing barriers that are summarized as “the four clocks”: child welfare deadlines for permanency planning, TANF time limits, the different timetable for AOD treatment and recovery (“one day at a time for the rest of your life”), and the developmental timetables that affect younger children as they bond with adults. ix x Responding to Alcohol and Other Drug Problems Within daily practice, the most important recommendation—the keystone in the bridge needed between child welfare and substance abuse treatment agencies—is the assessment used by agencies to iden tify the needs and monitor the treatment of these parents with mul tiple problems served by multiple systems. We present options for blending assessment instruments that are now administered separately by each set of agencies, resulting in “layered assessments” that make the tasks of line workers more difficult and that force clients to go through repeated, overlapping assessment of their problems. This guidebook also makes a case for screening and assessment of AOD problems in much greater depth within the child welfare system, so that resources from the AOD treatment system can be matched with the known needs of parents. We describe several models where agencies have been able to de velop effective ways of linking child welfare services and AOD treat ment and set forth the pros and cons of these models with a matrix that summarizes all nine models. The text reviews innovative prac tices in both the child welfare and substance abuse treatment fields, including changes in approaches to families, in interviewing techniques, in community partnerships, and in using treatment outcomes to de termine which programs are most effective for which clients. The guidebook reviews evidence of the demonstrated effective ness of treatment for parents in the child welfare system, and makes a case that treatment has a significant payoff in costs that can be avoided if only a portion of the parents are able to reunify with their children. The report discusses the differences between parents who can be treated successfully after one episode of treatment, those who return for ad ditional treatment episodes and eventually succeed, and those who do not succeed in treatment. Because of the co-occurrence of AOD problems with clients af fected by welfare reform, juvenile justice, family violence, and mental health, the report asserts that the CWS-AOD linkage is not enough, and goes on to describe models of stronger connections between child welfare clients and these other populations.
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