Blending Perspectives and Building Common Ground. Chapter 8. Where Do We Go From Here? Directions and Next Steps for Federal, State, and Local Efforts

04/01/1999

By listening to partners, reviewing what has been learned through decades of research in both the child welfare and alcohol and drug fields, and conducting additional focused analyses of the data collected by HHS, the agencies involved in producing this report have begun to understand the complex interactions among substance abuse, child maltreatment, and other problems within families, and among the service providers and policy makers in these and related fields who struggle to make a difference in the lives of children and families.  Available information indicates that while the nation is a long way from having in place an effective, smoothly functioning service network to address these issues, there are clear indications of how services must be refocused in order to generate better outcomes:  safety, stability and improved developmental outcomes for children; healthier, sober, and more productive parents; and better-functioning families.

Nationally and in many States and communities, mutual lack of knowledge, understanding, and trust creates barriers that hinder effective collaboration between child welfare and substance abuse treatment agencies and professionals, as well as with other services systems and judges and court personnel.  These barriers ultimately prevent effective service delivery to families with substance abuse and related problems, further placing their children at risk, or preventing their healing.  The most critical problem is the scarcity in many communities of available, appropriate services designed to address the multiple problems these clients face.  The preceding chapters have detailed the parameters of the problem and have explored isolated promising efforts in communities across the nation.  This chapter suggests steps that might be taken to improve the situation more broadly.  It is important to note that there is not currently a consensus in the field as to how to solve these problems effectively.  Yet finding common ground is imperative if these fields are to "do right" by the families who are clients of both systems.  To the extent that the differences between the child welfare and substance abuse treatment fields prevent collaboration and quality service delivery, service systems will continue to fail these families.

While the Congress has asked Federal agencies within the U.S. Department of Health and Human Services to prepare this Report to Congress, much of the difficult work of building effective collaboration between these fields must happen at the local and State levels.  In discussions with practitioners, their national associations and advocates, several themes emerged regarding steps the Federal Government could take that would assist agencies to improve their working relationships and ultimately the services delivered to families.  A number of these are discussed below.  It must be acknowledged, however, that neither the child welfare system nor the substance abuse treatment system is nationally operated, and while the Federal government provides significant funding and related structure to both fields, the day-to-day relationships which ultimately determine effective service provision are primarily local.  Therefore it is not sufficient to discuss what the Federal government should do to address these issues.  There are significant roles for service providers, program administrators and policy makers at all levels, from front line social workers and treatment counselors to agency administrators, political leaders and judges at the community and State levels as well as in Federal agencies.

With the implementation of the Adoption and Safe Families Act, child welfare agencies are required under most circumstances to make decisions about permanent living arrangements for children within 12 to 15 months of the time they enter foster care.  Equally, agencies are required to make reasonable efforts to prevent foster care placement and reunify families, so long as children can be kept safe.  It is hard to argue that these reasonable efforts for a substance abusing parent do not include substance abuse treatment.  Yet it is clear that case plans for many parents of children in foster care do not include substance abuse assessment and, as needed, treatment, even when substance abuse is identified or suspected.  Even if a case plan requires a parent to attend substance abuse treatment, in many instances there is not an available treatment slot in a program with services designed for women and parents, or outreach and engagement efforts are insufficient to secure clients' participation.  Finally, it is clear that substance abuse is rarely the only serious problem in families whose children are neglected or abused and it cannot be expected that abstinence alone will produce healthy, functioning families.

While discussions of improving the situation usually focus on funding, addressing the problem is not just an issue of funding.  Rather, service providers on both sides of the divide, child welfare and substance abuse treatment, must change how they do business, and especially how they deal with each other.  As McMahon and Luthar (1998, p. 147) recently observed, "regardless of how difficult the clients might be and how easy it may be to blame them when things do not go well, provider-provider interaction is often the critical and rarely acknowledged factor in many of our service delivery failures."

Below, five topics are described on which important actions must occur in order to improve outcomes for these vulnerable children and families.  Strengthening both fields' activities on these issues will improve the ability of front line staff to achieve, whenever possible within a reasonable time frame, safe and well-functioning families, and, when family preservation or reunification is not possible, other permanent living arrangements for children.  Whether or not the children can return home, there must be a continuing commitment to parents' recovery as well as to the well being of their children.  No agency can be complacent or claim that the burden of action is solely on another system or another level of government.  Progress is possible only if approaches are adapted at all points in the process to focus, in a collaborative manner, on achieving client outcomes.