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The Missing Link to Child Safety, Permanency, and Well-Being: Addressing Substance Misuse in Child Welfare

October 2012
Social Work Research 36(2):83-87

October 2012
36(2):83-87

DOI:10.1093/swr/svs043

Authors:

Dorian Traube

University of Southern California

Estimates of Substance Misuse among Child Welfare-involved Families

…

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GUEST EDITORIAL

The Missing Link to Child Safety, Permanency,

and Well-Being: Addressing Substance Misuse

in Child Welfare

Dorian E. Traube

Parental substance misuse places families at

risk for involvement in Child Welfare Ser-

vices (CWS) (Barth, Gibbons, & Guo,

2006). Furthermore, maltreated children of

parents who misuse substances are more likely to

misuse substances in adulthood than are maltreat-

ed children of parents who do not misuse sub-

stances (Schuck & Widom, 2001). More than 10%

of all children in the United States live with a

parent who misuses or is addicted to alcohol or

drugs (Substance Abuse and Mental Health Ser-

vices Administration, Ofﬁce of Applied Studies,

2008). These children are disproportionately at

risk for both poor developmental outcomes

(Osborne & Berger, 2009) and being abused or

neglected (Walsh, MacMillan, & Jamieson, 2003).

They are also at risk for becoming involved with

Child Protective Services and, potentially, for

being removed from home and placed in substi-

tute care if their home environment is deemed a

threat to their safety. The child welfare system

may be the locus of a vicious circle of intergener-

ational substance use. Maltreated children of

parents who misuse substances will themselves be

comparatively likely to misuse substances in adult-

hood (Schuck & Widom, 2001). Although CWS

are intended, in part, to diminish maltreatment’s

negative impact on adolescents’substance use, there

is evidence that receiving CWS affects adolescents’

substance use adversely. Furthermore, experience in

foster care or other out-of-home placement has

been associated with substance misuse in adulthood

(Zlotnick, Tam, & Robertson, 2004).

There is a dearth of literature on the extent

and correlates of substance misuse among CWS-

involved families, and the literature on prevention

and treatment services is even more limited. Con-

tributing to this gap in the literature is the fact

that many child welfare journals fail to identify

the role of substance abuse in child maltreatment.

Furthermore, maltreated children continue to be a

hidden population within the substance abuse lit-

erature. Scientists and practitioners interested in this

area must sift through these two huge bodies of liter-

ature to ﬁnd relevant studies. It is in this veritable

Tower of Babel that social work can keep this

crucial determinant of child safety, permanency, and

well-being from becoming confounded.

There is arguably no profession in the United

States more closely identiﬁed with the ﬁeld of

child welfare than social work. Child welfare has

even been referred to as a specialized ﬁeld within

social work, implying the professional preemi-

nence, if not the exclusivity, of social work in

delivering CWS (Lieberman, 1988). In addition,

social workers play a huge role in substance abuse

treatment and service delivery (Burke & Clapp,

1997). Therefore, social work may be one of the

few professions to afford a comprehensive under-

standing of the interdisciplinary determinants,

treatments, and prevention needs of families af-

fected by substance misuse within the child

welfare system. Social work has been criticized for

many years as a profession that “cherry picks”

theory and practice from allied ﬁelds, including

psychology and sociology. Taking leadership in

this area will allow the ﬁeld of social work to dem-

onstrate professional preeminence in an interdisci-

plinary area commonly overlooked by its critics.

The following is an overview of the current state of

the ﬁeld of substance misuse and child welfare, fol-

lowed by recommendations for epidemiological and

social work services research inquiry.

PREVALENCE OF SUBSTANCE MISUSE AND

CHILD WELFARE INVOLVEMENT

Although studies suggest that a sizable majority of

families involved in CWS are affected by

Social Work Research Advance Access published September 17, 2012

substance use, estimates of prevalence among

parents and children vary widely. In its report to

Congress in 1999, the U.S. Department of Health

and Human Services (HHS) stated that between

one-third and two-thirds of children in CWS

were affected by substance misuse. To date, this is

the only federally documented statistic related to

substance use and CWS. Estimates of parental

substance misuse are affected by factors such as in-

tensity of CWS involvement, how substance

misuse is deﬁned and measured, and who provides

the substance use data (Young, Boles, & Otero,

2007). Estimates of substance use among child

welfare–involved youths can vary depending on

how use is measured and by sample age (Young

et al., 2007). The varied prevalence estimates of

substance misuse for the child welfare population

are detailed in Table 1.

RISK FACTORS FOR SUBSTANCE USE

DISORDERS AND CHILD WELFARE

INVOLVEMENT

There are many mechanisms that explain how pa-

rental substance misuse might contribute to child

maltreatment. Researchers have observed that in

utero exposure to alcohol, cocaine, and other

drugs can lead to congenital deﬁcits in a child,

which may make the child more difﬁcult to care

for and, therefore, more prone to child maltreat-

ment (Magura & Laudet, 1996;Young et al.,

2007). Studies also have shown that parenting skills

can suffer among substance-abusing parents. For

example, there is evidence that substance-abusing

parents are less responsive to their infants (Magura

& Laudet, 1996) and that drug use interferes with

a parent’s ability to provide basic needs, including

food, clothing, hygiene, and medical care (Magura

& Laudet, 1996). Finally, it has been reported that

violence is more likely in homes where drugs and

alcohol are used (Magura & Laudet, 1996). Addi-

tional evidence suggests that, on average, children

of substance-abusing parents enter CWS at signiﬁ-

cantly younger ages than do other children, are

victims of more severe maltreatment, come from

families with greater numbers of presenting prob-

lems, and are more likely to be rereported for mal-

treatment than are other CWS-involved children

(Berger, Slack, Waldfogel, & Bruch, 2010). The

former are also more likely to be placed in foster

care and, once there, to remain in care longer and

experience greater numbers of placements (Barth

et al., 2006). Parental substance misuse is dispro-

portionately represented among the CWS popula-

tion (Pilowsky & Wu, 2006) and has a profound

impact on the development of some of the most

vulnerable members of society.

Risk factors for substance misuse among child

welfare–involved youths are unclear. Previous

studies have identiﬁed demographic, psychosocial,

and contextual risk factors for substance use

among youths in child welfare, including gender,

age, history of abuse, and mental health difﬁculties

(Aarons et al., 2008;Vaughn, Ollie, McMillen,

Scott, & Munson, 2007); lower levels of caregiver

monitoring (Wall & Kohl, 2007); and deviant

peer networks (Thompson & Auslander, 2007).

RECOMMENDATIONS FOR SUBSTANCE MISUSE

EPIDEMIOLOGICAL RESEARCH IN CHILD

WELFARE POPULATIONS

Although estimates could beneﬁt from better reli-

ability, a clear burden of illness and health disparity

exists for families involved in CWS. Prevention

efforts for this population require a better under-

standing of the scope, unique risk factors, and pro-

tective factors for substance misuse among youths

and their caregivers in the child welfare system.

Prior efforts to understand the biological, psycho-

logical, and social factors that are necessary to

address for substance misuse prevention have been

limited by the use of small regional samples of

CWS-involved families. The use of nationally

representative samples of CWS teenagers and care-

givers will be required to obtain an accurate longi-

tudinal understanding of the nature of substance

misuse and maltreatment among caregivers and the

impact that maltreatment and child welfare place-

ment has on the development of substance misuse

and sexual risk taking among teenagers.

SUBSTANCE ABUSE SERVICE POINTS OF ENTRY

AND USE PATTERNS AMONG CWS-INVOLVED

FAMILIES

CWS has the potential to serve as a gateway to

substance abuse prevention and treatment services.

An estimated $258 million is spent per day on

child maltreatment services (HHS, Administration

on Children, Youth, and Families, 2007), with

60% directed toward neglect, 70% of which is

linked to parental substance misuse (Gaudin,

1993). A primary goal of the coordination of child

welfare and substance abuse services is to ensure

2Social Work Research

that families have access to treatment and preven-

tion programs. From a child welfare perspective,

integration of services should encourage the safety,

permanency, and well-being of the child, and

from a substance abuse treatment perspective, this

approach should maximize the likelihood of pro-

viding caregivers with the opportunity for recov-

ery (Barth et al., 2006). In 65% to 74% of

investigated child protective cases, parents require

treatment for dependence on alcohol or other

drugs (Child Welfare League of America, 1997;

U.S. General Accounting Ofﬁce, 1998). A shortage

of publicly subsidized substance misuse treatment

services means that fewer than one-third of afﬂicted

individuals receive services (Child Welfare League

of America, 1997). Furthermore, those substance-

abusing youths and parents in the child welfare

system who do begin treatment tend not to com-

plete it (U.S. General Accounting Ofﬁce, 1998).

There is a paucity of information about characteris-

tics associated with receipt of substance abuse treat-

ment among CWS-involved families. In the general

population, factors including ethnic minority status,

having multiple children (McMahon, Winkel,

Suchman, & Luthar, 2002), having a low education

level (Knight, Logan, & Simpson, 2001), and unem-

ployment (Weisner, Mertens, Tam, & Moore,

2001) are predictors of failure to receive substance

abuse treatment services. Obstacles to treatment for

CWS-involved families include poor substance

abuse detection within CWS; the use of substance

abuse treatment approaches with weak evidence

bases; and poor coordination of substance abuse,

child welfare, and mental health services (Barth

et al., 2006).

SUBSTANCE ABUSE SERVICES RESEARCH

RECOMMENDATIONS FOR CWS-INVOLVED

FAMILIES

Little is known about access to services, efﬁcacy of

substance abuse treatment, and prevention efforts

related to substance misuse for this population.

This is likely because the child welfare system

most frequently takes a clinical approach to sub-

stance abuse treatment. In a clinical approach, the

child or caregiver with signiﬁcant substance

Table 1: Estimates of Substance Misuse among Child Welfare–involved Families

Population Estimate (%) Date Author

Parents in Boston 43 1991 Murphy et al.

Parents 50 1997 Child Welfare League of America

Parents in California 65 1998 U.S. General Accounting Office

Parents in Illinois 74 1998 U.S. General Accounting Office

Urban parents with children in foster

care

79 1999 Besinger, Garland, Litrownik, and Landsverk

Parents and caregivers 33–66 1999 U.S. Department of Health and Human Services

Kinship caregivers 11.2 2000 Rittner and Davenport

Parents with children placed in specialized

foster care

14 2001 McNichol and Tash

Biological mothers 68 2004 Jones

Hispanic caregivers 6.1 2007 Libby, Orton, Barth, and Burns

American Indian caregivers 7.5 2006 Libby et al.

Caucasian caregivers 13.2 2006 Libby et al.

African American caregivers 11.3 2006 Libby et al.

Parents 16–61 (varying by state) 2007 Young, Boles, and Otero

Teenagers 11 (substance disorder

in last year)

2008 Aarons et al.

Teenagers 19.2 (lifetime substance

disorder)

2008 Aarons et al.

17-year-olds in Midwest 7.3 (drug abuse); 14

(alcohol abuse)

2004 Courtney, Terao, and Bost

17-year-olds in Missouri 35 2007 Vaughn et al.

11–15-year-olds nationally 9 2007 Wall and Kohl

12–17-year-olds nationally 2.0 (drug abuse); 3.3

(alcohol abuse)

2007 Vaughn et al.

Traube / The Missing Link to Child Safety, Permanency, and Well-Being: Addressing Substance Misuse in Child Welfare 3

misuse problems is sent to a substance abuse treat-

ment program outside of the child welfare system

to be “ﬁxed.”Furthermore, CWS-involved fami-

lies receive clinical services through multiple spe-

cialty and nonspecialty service sectors or “systems

of care,”including child welfare, juvenile justice,

mental health, educational, health, vocational,

recreational, substance abuse, and social services

(Garland, Hough, Landsverk, & Brown, 2001).

The nature of the overlap between these

service sectors perpetuates the challenges involved

in responding to the issue of substance misuse

among CWS-involved families because each has

its own focus, procedures, and linkages between

systems. This is a result of the fact that within

these systems of care models, there is often

overlap in the populations receiving services across

multiple sectors, but there are also important dif-

ferences in the service populations (Burns,

Angold, & Costello, 1992). The prevalence, type,

and severity of substance misuse; the reasons for

entry into services (including the extent to which

familial or extrafamilial pressures drive use); and

the demographic proﬁles of service users—includ-

ing age, gender, race or ethnicity, and socioeco-

nomic status distribution—all differ across sectors

(Burns et al., 1992). It is these differences in

service sector demographics that could allow us to

speculate about longitudinal patterns of service

use (Burns et al., 1992).

A better understanding of the typical patterns

of service use might identify suggested targets for

intervention to change ineffective or undesirable

service use patterns. Investigation of system-level

factors across sectors may provide a more complex

and realistic conceptual framework for modeling

multiple-sector public systems of care than that

provided in cross-sectional models of systems of

care organization (Burns et al., 1992). Greater un-

derstanding of the patterns of the development of

different types of needs across service sectors

might help guide the appropriate targeting of in-

terventions. Yet, to date, no studies that I am

aware of have described patterns of care related to

substance abuse services for CWS-involved fami-

lies. To develop strong prevention and interven-

tion programs for this population, we must know

the typology of families who overlap systems, the

constellation of services that best meet the needs

of these families, and the contextual factors that

aid access and use of prevention services.

CONCLUSIONS

The ﬁeld of social work can and should take the

lead in developing research on the child welfare

system as an untapped resource with the potential

to be a gateway to and a platform for substance

abuse treatment and prevention services. As a

gateway to preventive mental health and substance

abuse services for many families, formal substance

abuse services can be part of the child welfare

safety and permanency intervention, allowing for

better coordination of substance abuse and child

welfare services. Likewise, there is the potential

for mounting prevention services directly onto

the platform of the CWS system. This approach

has been successfully implemented with evidence-

based prevention programs to address externaliz-

ing behaviors in teenagers (Price et al., 2008).

One of the most novel aspects of approaching

substance abuse treatment and prevention through

child welfare is that it allows social work research-

ers to address primary, secondary, and tertiary

levels (Gordon, 1983) of prevention simultane-

ously. For child welfare–involved youths, the aim

would be to use evidence-based primary preven-

tion measures to impede the development of sub-

stance misuse. Secondary prevention measures can

be used with teenagers who have developed

problems related to substance use and misuse after

having been exposed to the same risk factors that

placed their caregivers in the ranks of child

welfare involvement. Finally, tertiary prevention is

required for CWS-involved caregivers who are

already suffering and disabled by substance misuse

to mitigate further deterioration while engaged in

childwelfareandsubstanceabuseservices.Thisisan

untapped area of both the literature and federally

funded inquiry. As a gatekeeper of the ﬁeld of child

welfareandakeyserviceproviderintheﬁeld of

substance misuse, social work is primed to take the

lead in addressing the safety, permanency, and well-

being of one of the most high-risk populations in

the United States—families affected by substance

misuse and child welfare involvement.

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traube@usc.edu.

Traube / The Missing Link to Child Safety, Permanency, and Well-Being: Addressing Substance Misuse in Child Welfare 5

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Nov 2023
J CHILD ADOLES SUBST

Research shows that young people in foster care experience high levels of behavioral health problems that may lead to life obstacles, including legal system involvement (LSI) during the transition to adulthood. However, few longitudinal studies have examined LSI among foster youth from a behavioral health perspective during the transition to adulthood. To understand adolescent behavioral health conditions associated with adult LSI, we used longitudinal survey data of young people in foster care (n = 540) to compare the prevalence of different behavioral health disorders (age 17) between youth who later reported LSI and those who did not (ages 19–21). We also examined associations between adolescent behavioral health disorders and adult LSI, accounting for other covariates. We find that compared to those who did not, youth who reported later LSI in early adulthood had significantly higher rates of four behavioral health disorders at age 17: alcohol use, drug use, conduct disorder, and oppositional defiant disorder. Regression results showed drug use disorder at age 17 to be a particularly strong predictor of later LSI after accounting for other covariates. Many individuals experience various risk factors for LSI, including behavioral health needs. We discuss implications for practice, policy, and research in the child welfare context.

Mandatory reporting of child abuse/neglect among substance use counselors

Article

Oct 2021

Substance use counselors are in a unique position to intervene when exposed to suspected abuse of children. However, mandatory reporting habits of substance use counselors have seen little attention in empirical research. The purpose of this study was to quantify the frequency of mandatory reports of child abuse and/or neglect among substance use counselors. Further, binary and ordinal regression models were used to determine if personal and/or professional characteristics are predictive of reporting frequency. A total of 241 substance use counselors were recruited from national addiction organizations. Results from both the ordinal and binary logistic regressions identified dual-licensure status as a significant positive predictor and a lack of knowledge of the symptoms of child abuse and neglect as a significant negative predictor of reporting behaviors. Given the relationship between reporting habits and knowledge of abuse/neglect, substance use counselors must increase declarative, procedural, and conditional knowledge in order to increase adherence to mandated reporting.

Effectiveness of psychosocial interventions for reducing parental substance misuse

Article

Mar 2021

Background: Parental substance use is a substantial public health and safeguarding concern. There have been a number of trials of interventions relating to substance-using parents that have sought to address this risk factor, with potential outcomes for parent and child. Objectives: To assess the effectiveness of psychosocial interventions in reducing parental substance use (alcohol and/or illicit drugs, excluding tobacco). Search methods: We searched the following databases from their inception to July 2020: the Cochrane Drugs and Alcohol Group Specialised Register; CENTRAL; MEDLINE; Embase; PsycINFO; CINAHL; Applied Social Science (ASSIA); Sociological Abstracts; Social Science Citation Index (SSCI), Scopus, ClinicalTrials.gov, WHO ICTRP, and TRoPHI. We also searched key journals and the reference lists of included papers and contacted authors publishing in the field. Selection criteria: We included data from trials of complex psychosocial interventions targeting substance use in parents of children under the age of 21 years. Studies were only included if they had a minimum follow-up period of six months from the start of the intervention and compared psychosocial interventions to comparison conditions. The primary outcome of this review was a reduction in the frequency of parental substance use. Data collection and analysis: We used standard methodological procedures expected by Cochrane. Main results: We included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%). Half of the studies (n = 11; 50%) compared the experimental intervention to usual treatment. Other comparison groups were minimal intervention, attention controls, and alternative intervention. Eight of the included studies reported data relating to our primary outcome at 6- and/or 12-month follow-up and were included in a meta-analysis. We investigated intervention effectiveness separately for alcohol and drugs. Studies were found to be mostly at low or unclear risk for all 'Risk of bias' domains except blinding of participants and personnel and outcome assessment. We found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) -0.32, 95% confidence interval (CI) -0.51 to -0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) -0.25, 95% CI -0.47 to -0.03; 4 studies, 366 participants). We found a significant reduction in frequency of use at 12 months only (SMD -0.21, 95% CI -0.41 to -0.01; 6 studies, 514 participants, moderate-quality evidence). We examined the effect of the intervention type. We found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD -0.35, 95% CI -0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD -0.09, 95% CI -0.86 to 0.61; 1 study, 34 participants) or drug use (6 months: SMD 0.01, 95% CI -0.42 to 0.44; 2 studies; 87 participants and 12 months: SMD -0.08, 95% CI -0.81 to 0.65; 1 study, 32 participants). A parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD -0.21, 95% CI -0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD -0.11, 95% CI -0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence) or frequency of drug use (6 months: SMD 0.10, 95% CI -0.11 to 0.30; 4 studies; 407 participants, moderate-quality evidence and 12 months: SMD -0.13, 95% CI -0.52 to 0.26; 3 studies; 351 participants, very low-quality evidence). Parents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD -0.56, 95% CI -0.96 to -0.16 and 12 months: SMD -0.42, 95% CI -0.82 to -0.03; 2 studies, 113 participants) and drug use (6 months: SMD -0.39, 95% CI -0.75 to -0.03 and 12 months: SMD -0.43, 95% CI -0.80 to -0.07; 2 studies, 131 participants). However, this evidence was of low quality. Psychosocial interventions in which the child was present in the sessions were not effective in reducing the frequency of parental alcohol or drug use, whilst interventions that did not involve children in any of the sessions were found to reduce frequency of alcohol misuse (6 months: SMD -0.47, 95% CI -0.76 to -0.18; 3 studies, 202 participants and 12 months: SMD -0.34, 95% CI -0.69 to 0.00; 2 studies, 147 participants) and drug use at 12-month follow-up (SMD -0.34, 95% CI -0.69 to 0.01; 2 studies, 141 participants). The quality of this evidence was low. Interventions appeared to be more often beneficial for fathers than for mothers. We found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD -0.27, 95% CI -0.50 to -0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD -0.43, 95% CI -0.78 to -0.09; 2 studies, 147 participants and 12 months: SMD -0.34, 95% CI -0.69 to 0.00; 2 studies, 147 participants) and drug use (6 months: SMD -0.31, 95% CI -0.66 to 0.04; 2 studies, 141 participants and 12 months: SMD -0.34, 95% CI -0.69 to 0.01; 2 studies, 141 participants). Authors' conclusions: We found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol and drugs. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. Whilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. We found low-quality evidence from few studies that interventions involving children are not beneficial.

De inzet van Minecraft bij traumatherapie voor een kind met een autismespectrumstoornis

Article

Jan 2021

Kinderen met een autismespectrumstoornis (ASS) hebben meer kans om slachtoffer te worden van kindermishandeling of -verwaarlozing dan neurotypische kinderen. In dit artikel onderzoeken we de impact van trauma op deze kinderen en hun gezin, en staan we stil bij de overeenkomsten tussen ASS-symptomen en de symptomen van hechtingsstoornissen. De behandeling van getraumatiseerde kinderen met ASS is vaak een extra grote uitdaging, omdat deze kinderen doorgaans behept zijn met gebrekkige vaardigheden in sociaal gedrag, communicatie en emotieregulatie, en omdat er een overlap bestaat met de symptomen van verstoorde hechting. Bij traumatherapie voor deze kinderen is de steun en betrokkenheid van gezinsleden van cruciaal belang voor hun herstel. In het artikel wordt een casus beschreven waarin het computerspel Minecraft wordt gebruikt om – bij wijze van aangepaste narratieve component van de Trauma-Focused Cognitive Behavioural Therapy – een verhaalstructuur te bieden aan een elfjarige jongen met ASS. Deze jongen is jarenlang slachtoffer geweest van mishandeling en verwaarlozing en via Minecraft is hij in staat om zijn traumatische ervaringen om te zetten in een ‘trauma-narratief’, met ondersteuning van zijn vader. Door de behandeling verminderen de depressiesymptomen van de cliënt en neemt de invloed van het trauma af. Ook de vader van de cliënt heeft baat bij de behandeling, onder meer doordat hij hierdoor zijn zienswijze over de relatie met andere familieleden kan bijstellen.

Examination of the Influence of Cognitive Behavior Therapy Components, Consumer Satisfaction and Engagement in Mothers Referred for Drug Abuse and Child Neglect on Treatment Outcomes

Article

Full-text available

Jun 2020
BEHAV MODIF

Psychological interventions for child maltreatment have predominately been limited to family-supported, multi-component behavioral therapies. Although these comprehensive programs have resulted in positive outcomes, they are relatively costly and there is limited information available as to how the components of these programs influence treatment outcomes. In this study, the CBT components of an evidence-based treatment for child neglect and drug abuse (Family Behavior Therapy) were examined in regards to consumer preferences, consumer engagement and treatment outcomes. Thirty-five mothers identified for child neglect and drug abuse were administered various CBT components successively and cumulatively based on their preferences. Repeated measure ANOVAs indicated that participants chose to receive components that were specific to managing antecedents to drug abuse and child neglect most frequently, followed by parenting skills training, communication skills training, and job/financial skills training. No differences were found in treatment providers’ ratings of the participants’ engagement across intervention components throughout treatment. Participants rated the intervention components as similarly helpful. Partial correlations revealed that participants’ ratings of helpfulness and provider ratings of participants’ engagement were not associated with improved drug use outcomes at 6- and 10-months post baseline. Participants’ ratings of helpfulness were associated with child maltreatment outcomes at 10-month post baseline, and provider ratings of participants’ engagement were associated with child maltreatment outcomes at both 6- and 10-month post baseline. Participants identified for neglect not related to drug exposure in utero improved at a higher percentage than did participants identified for in utero drug exposure, and receiving behavioral intervention components more frequently led to greater percentages of participants improving in both drug use and child maltreatment outcomes.

The use of Minecraft in the treatment of trauma for a child with Autism Spectrum Disorder: Trauma, ASD, Attachment and Minecraft

Article

May 2020

Children with Autism Spectrum Disorder (ASD) are more likely to be the victims of child abuse and neglect than neurotypical children. This paper explores the impact of trauma on children and families, specifically children with ASD, and takes into consideration the overlapping symptoms of attachment disorders. Due to the social, behavioural, communication, and emotion regulation deficits commonly experienced by children with ASD and the overlap with disrupted attachment, treating trauma in ASD children poses its own unique challenges. At the same time, family support and involvement in the treatment of trauma for a child with ASD is crucial to the child’s recovery. This case study explores how the narrative component of TF‐CBT was adapted using a video game called Minecraft to provide a structure for an 11‐year‐old boy with ASD and a history of abuse and neglect to process his traumatic experiences in a narrative format, with his father as his support person. As a result, the client demonstrated improvements in depression symptoms and reduced perseveration about the trauma itself. The client’s father benefitted from this process as well, in that he reworked his own thinking about his and the client’s relationships with extended family members. Practitioner points • It is challenging to treat trauma in youth with Autism Spectrum Disorder due to deficits in cognition, behaviour, communication, and emotion regulation • Symptoms of attachment disorders overlap with symptoms of ASD, which also presents a challenge to treatment • It is important to consider family history and its impact on attachment when treating trauma symptoms in a child with ASD • This method allowed for a helpful and effective processing and narration of the child’s traumatic experiences, and changes in the father’s perspective of his son’s experiences

Midwest Evaluation of the Adult Functioning of Former Foster Youth: Conditions of Youth Preparing to Leave State Care

Article

Full-text available

Jan 2004

Caseworker-Perceived Caregiver Substance Abuse and Child Protective Services Outcomes

Article

Full-text available

May 2010

The authors used data from the National Survey of Child and Adolescent Well-Being to examine associations of child protective services (CPS) caseworkers' perceptions of caregiver substance abuse with their perceptions of the severity of risk and harm a child experienced as a result of alleged maltreatment, as well as with whether a family experienced a range of CPS outcomes.The outcomes included whether the family received services from CPS, was substantiated for maltreatment, experienced child removal, and was subject to a termination of parental rights (TPR) petition. The authors also compared the magnitude of the association between caseworker-perceived caregiver substance abuse and each outcome to that of the association between other maltreatment-related risk factors and each outcome. Findings suggest that, all else equal, caseworker-perceived caregiver substance abuse is associated with increased caseworker perceptions that children have experienced severe risk and harm and also with an increased probability of each of the CPS outcomes except TPR. Moreover, these associations are equal in magnitude or larger than those between the other risk factors and the outcomes. These findings imply that CPS decisions are heavily influenced by caseworker perceptions of caregiver substance abuse, regardless of the presence of other risk factors for child maltreatment.

The prevalence and characteristics of substance abusers in a child protective service sample

Article

Jan 2008
J Soc Work Pract Addict

L. Jones

An operational classification of disease prevention, in Alcohol, Drug Abuse, and Mental Health Administration

Article

R. Gordon

Analyzing the Educational Backgrounds and Work Experiences of Child Welfare Personnel: A National Study

Article

Jan 1988

Assessed the relationship of the social work profession to the field of public child welfare by analyzing the educational backgrounds of more than 5,000 child welfare personnel and comparing these data to those of a decade ago. Results failed to reveal a significant loss of social work personnel. (Author/ABL)

Effective Intervention with Neglectful Families

Article

Mar 1993
CRIM JUSTICE BEHAV

James M. Gaudin

The limited research on approaches to intervention with neglectful families is reviewed and guidelines for intervening with neglect are suggested. Most outcome studies have not employed experimental designs with control groups. Definitions of neglect vary among studies and distinctions have not been made between subtypes of neglect treated. Intervention programs have been successful in remedying neglect with less than 50% of the families served. Group interventions with child and adolescent victims have been more successful. Behavioral techniques have be used to successfully teach home management, parent-child interaction, and meal preparation skills to neglectful parents. Multiservice interventions are necessary to remedy the multiple problems presented by neglectful families. Group approaches, family treatment, use of paraprofessionals, and social network interventions have been used successfully with neglectful families. Short-term interventions have not been successful.

Parental Substance Abuse and Child Well-Being

Article

Mar 2009

Parental substance abuse is associated with adverse health and developmental outcomes for children. Existing research, however, has not fully explored the relative magnitude of the associations between maternal, paternal, and both parents' substance abuse and child outcomes, nor has it examined these associations in regard to substance abuse among nonresident fathers. We use data from the Fragile Families and Child Wellbeing Study (N = 3,027) to explore these issues among a cohort of 3-year-old children. We find that children living with a substance-abusing parent are at considerable risk for poor health and behavior outcomes, that such risk is not moderated by parent gender, and that it is substantially larger when both parents have substance abuse problems. Moreover, children with substance-abusing fathers are at a potentially higher risk of health and behavior problems when their fathers live with them, although this risk is still substantial when they do not.

Multi-Sector Complexity of Systems of Care for Youth With Mental Health Needs

Article

Jul 2001

Notes that children's mental health services have been revolutionized to reflect the realization that youth with mental health needs are served by multiple service sectors, including child welfare, juvenile justice, special education, primary health care, mental health, and alcohol and drug services. "Systems of care" models have attempted to improve integration of services across these multiple sectors and have been influential in driving policy and funding changes, but these models have focused primarily on cross-sectional service use. The goal of this conceptual article is to expand on these models by identifying factors that affect dynamic, longitudinal multi-sector service use. Greater understanding of these longitudinal patterns may suggest effective targets for intervention. In addition, this conceptual framework may provide a contextual template for current studies of multi-sector service need, use, and effectiveness. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Measuring child, adolescent, and family service use

Article

Nov 2004
New Dir Program Eval

Currently, no method of classifying mental health services is accepted by all service sectors. Because classification is central to understanding the service delivery system for children and families, standardization of methods must be achieved.

Parental substance abuse and child maltreatment: Review and implications for intervention

Article

Feb 1996
CHILD YOUTH SERV REV

This paper reviews the link between the incidence of child abuse and neglect and parental substance abuse. Parenting and women-specific components are needed in existing drug abuse treatment programs. In addition, parenting and pregnant women who are substance abusers can benefit from comprehensive, family-centered treatment services where recovery is addressed in the context of total family needs. The paper reviews selected family preservation programs and family-oriented drug abuse treatment programs and presents preliminary findings from the authors' ongoing outcome evaluation of New York City's Family Rehabilitation Program.

The Missing Link to Child Safety, Permanency, and Well-Being: Addressing Substance Misuse in Child Welfare

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