Blending Perspectives and Building Common Ground. Chapter 7. Service Delivery Models: Approaches to Addressing Joint Substance Abuse and Child Maltreatment Problems


Addressing the problems of substance abuse and child maltreatment requires intervention at a variety of levels.  Among the clear lessons that have emerged in the decades of effort by dedicated service providers in both fields is that there are no easy answers and that what works for one family will not necessarily work for another.  Flexibility and comprehensiveness are key, and, particularly when dealing with these multi-problem clients, collaborative working relationships across agencies are essential.

A variety of documents have been written about building interagency collaborative relationships, generally (e.g., Melaville et al, 1993; Mattessich & Monsey, 1992; Gardner, in press) and specifically to address substance abuse and child maltreatment in families (Young, Gardner and Dennis, 1998; Jones and Hutchins, 1993).  Collaborative working relationships are important for several reasons:  (1) they enable service providers to meet a broader range of family needs; (2) they allow agencies to better coordinate their efforts and ensure that they neither overwhelm families with requirements nor impose conflicting demands; and (3) they enable a more efficient use of limited resources and prevent inefficient parallel program development.  Effective teamwork is difficult to achieve, however, and harder to sustain.  But it is only by working together that our agencies are likely to make progress in serving these children and families well.  No single agency can provide all the supports these families need, nor does any agency alone have the knowledge or authority upon which to make informed decisions about the strengths and needs of the family as a unit, parents and children.

The sections below describe interventions for families with substance abuse and child maltreatment issues across a spectrum of care, and, to the extent information is available, describe what is known about the effectiveness of interventions.  Generally, however, information on the effectiveness of interventions to address child maltreatment is sparse.  Few studies of child maltreatment interventions directly address the particular issue of substance abuse.  Similarly, few evaluations of substance abuse interventions directly address child maltreatment. Nonetheless, below we describe what we know about:

  • Valuing Prevention
  • Strengthening Training and Identification Skills
  • Enhancing Risk Assessment, Needs Assessment, and Referral Capacity
  • Increasing the Availability, Access and Appropriateness of Substance Abuse Treatment
  • Promoting Client Retention and the Effectiveness of Services
  • Improving Time Lines and Decision Making for Children
  • Supporting Ongoing Recovery