Blending Perspectives and Building Common Ground. Chapter 1. Introduction


In a field where difficult decisions are made every day, child welfare workers face particular dilemmas when working with the extremely troubled families whose complex and multiple problems include both substance abuse and child maltreatment.

Central to their challenge is that addiction to alcohol and other drugs can be a chronic, relapsing disorder and recovery can be a long term process.  At the same time, children have an immediate need for safe and stable homes in which to grow up.  Balancing these factors, as parents make sincere efforts to provide safe and loving homes for their children, represents a key challenge for the child welfare field and for judges making critical custody decisions.

Substance abuse (including both licit and illicit drugs) can impair a parent's judgment and priorities, rendering the parent unable to provide the consistent care, supervision, and guidance children need.  For child welfare workers it is often difficult to determine what level of functional improvement will enable a parent with substance abuse problems to resume or retain his or her parental role without jeopardizing child safety, particularly as relapse remains a significant possibility.  As child welfare workers address safety concerns, substance abuse treatment counselors work to ensure that the treatment process promotes recovery while addressing parents' concerns about their children's safety and their fear of losing their children to the child welfare system.

An important challenge facing both the child welfare and substance abuse fields is to take a comprehensive view of families' situations and to understand the contributions of various problematic behaviors to child maltreatment.  The relationship between substance abuse and child welfare is complicated by the presence of other personal, health, environmental, social and economic factors.  These factors, in many cases, contribute to the development of addiction and confound both the process of securing safe, stable homes for children and the treatment process.  For this reason, although this report concentrates on the relationship between substance abuse and child maltreatment, it is important to note that all major family problems must be addressed to achieve substance abuse treatment success and child safety.

Many in the child welfare field have recognized for a number of years that substance abuse is central to child welfare issues (Child Welfare League of America North American Commission on Chemical Dependency, 1992).  But with the implementation of the Adoption and Safe Families Act (ASFA, P.L. 105-89) and renewed emphasis on achieving permanency for children in the child welfare system, finding effective ways to address concurrent substance abuse and child maltreatment problems in families takes on renewed importance.  As the Adoption and Safe Families Act was developed, the Congress debated potential Federal policies that would allow child welfare agencies and partners in the substance abuse treatment field to better address the needs of parents whose substance abuse problems rendered them unable to care for their children.  After considerable debate on a variety of measures, Congress asked for more information.  Section 405 of ASFA required that the Secretary of Health and Human Services (HHS) prepare a Report to Congress on Substance Abuse and Child Protection Services.  In particular, the law required the Department to submit a report that:

"describes the extent and scope of the problem of substance abuse in the child welfare population, the types of services provided to such population, and the outcomes resulting from the provision of such services to such population.  The report shall include recommendations for any legislation that may be needed to improve coordination in providing such services to such population."

This document fulfills this legislative mandate.  Although intended for Congress, the report will also be of interest to other national, State, and local policy makers concerned with substance abuse and child maltreatment.  Over the past year, staff from several agencies within HHS have worked together to gather information from the fields of child welfare and substance abuse prevention and treatment regarding the needs of families in which both substance abuse and child maltreatment are present.  Along the way we have consulted with practitioners and researchers in both fields regarding their views of how efforts could be improved to better meet the needs of the children and families we serve.  In conversations and focus groups we solicited input on several topics, including:

  • What are the most important themes and messages that the report should address?
  • What are the most significant problems in current relationships between child welfare agencies and substance abuse treatment agencies?
  • What are the most important issues that agencies need to consider in establishing partnerships between substance abuse and child protection agencies?
  • What are the most promising approaches to addressing concurrent substance abuse and child protection issues in families?
  • What are the most important ways in which the Federal Government could assist in the improvement of practice in this area?

In conducting research for this report, it became clear that the child welfare and substance abuse fields have different definitions of "the client," different training and education which lead to different perspectives in defining families' problems, and often see each other as at fault when conflicts arise.  Our professions have a long way to go in learning about one another, blending perspectives, and developing ways to work together more effectively.  The lack of understanding, different and often conflicting frameworks and priorities, as well as a lack of communication and collaboration among the providers of care in the child welfare and substance abuse fields must be addressed if we are to better serve the children and families who most need our help.