Blending Perspectives and Building Common Ground. Chapter 5. The Complexity of Child and Family Needs


Families involved with the child welfare system are among the most troubled in our society.  The child welfare system serves as the final safety net, when no other public or private institution has been able to address a family's problems successfully.  It is expected to meet the family's needs and assure a permanent, safe environment for the child, either at home with the biological family or elsewhere.  But even if the child welfare agency, in a particularly egregious case, responds by moving a child out of the family quickly and on to an adoptive home, unless the parents' problems are addressed, the family is likely to remain unhealthy and may reappear at a future date, with another child identified as at-risk.

In maltreating families, maltreatment is rarely the only issue.  Even addiction, while among the most common co-occurring problems, is rarely the only significant one.  Serious mental illness may be present, particularly among substance abusing women.  Domestic violence and HIV/AIDS are also critical factors in the lives of some families.  Poverty is pervasive, and inadequate or unsafe housing are very significant problems, particularly in urban areas.  These serious difficulties combine in the lives of these families to produce extremely complex and dysfunctional situations and relationships that are difficult to resolve.  The presence of so many serious issues also implies that addressing the substance abuse alone is not likely to produce the changes in a family that are necessary to ensure a healthy environment for a child.  Unless the whole of a family's situation is addressed, substance abuse treatment is unlikely to be successful -- and even if a parent achieves abstinence, the other issues present may continue to pose safety problems for the child(ren).

The National Research Council of the Institute of Medicine, in its comprehensive volume Understanding Child Abuse and Neglect (1993), cautions against viewing substance abuse as a monolithic cause of child maltreatment.  The panel notes that substance abuse and child maltreatment are "often complicated by the presence of other social and economic variables ... that confound the analysis of the contributing role of drugs themselves.  At this time the literature on substance abuse and child maltreatment is not well ... developed" (National Research Council, 1993, p. 19).  Mental illness, health problems, past childhood abuse and domestic violence are examples of these other variables.