For many substance abuse treatment programs, the adult is the primary client and the one around whom services revolve. The adult's relationship with the drug is the focus of the clinical intervention, and everything else in the client's life is of secondary importance. While family relationships and other life issues are assessed, they are not the principal focus and may be de-emphasized until at least several months into the treatment process, if the client remains with the program that long. While parents may discuss their children in group therapy sessions, most treatment programs do not consider children and other family members to be clients, do not include them in therapeutic activities, and may not know whether the client even has children or whether child protective services is involved with the family, unless the client raises the issue or the child welfare agency was the client's referral source.
For many parenting women who enter substance abuse treatment, however, concerns about their parenting and the effects of their substance abuse on their children are key reasons why they enter treatment in the first place (HHS/SAMHSA, 1996b; Gerstein et al, 1997). Unless these issues are addressed, the women may not be getting what they seek from treatment. This may contribute to high drop out rates for women in treatment programs that are not specifically designed to assess and treat these and related critical issues. Lack of attention to family issues also frustrates child welfare workers who may have referred the parent for substance abuse treatment in the first place, but do not see improved parenting and child safety as a consequence of the substance abuse agency's treatment plan.
For child welfare agencies, the child is the focus of activity, and the entire family is usually defined as the client. A variety of services may be offered to the family, with the intent of assuring the child's safety, within the family if possible. But when a choice must be made in balancing children's needs and parents' needs, the mandates of child welfare agencies demand that the children must come first.
With both agencies viewing themselves as the primary service provider, differences may arise around who the client is, what service goals are selected, who is responsible for assuring that outcomes are achieved, what information gets shared and with whom, and myriad other day-to-day issues around working with clients.