Unless workers can appropriately identify risk to children, accurately assess client needs, refer clients to appropriate services in their communities, and evaluate clients' progress, treatment plans are likely to be based on inadequate, erroneous, or useless information. Yet many child protection risk assessments barely mention substance abuse (Dore et al, 1995). The Child Welfare League of America recently found that 18 of 47 child protection risk assessment protocols reviewed did not address parental drug abuse, 19 did not address parental alcohol abuse and 35 did not include items about a child's potential substance abuse (CWLA, 1998).
There is further evidence that even when the issue does appear on forms, workers may be uncomfortable asking about it. An NCCAN-funded study entitled Casework Decision-Making in CPS, based on the risk assessment model utilized in Washington State and interviews with workers there, found that substance abuse is one of the three risk factors most likely to be rated as "insufficient information to assess." One explanation offered by the study's principal investigator is that workers are often questioned in court as to their qualifications to make substance abuse assessments and because most are not certified assessors, they tend to rate that factor as "insufficient information to assess" unless they have clear evidence of such a problem. Washington State now requires workers to order a substance abuse evaluation in the absence of clear, sufficient information (English, 1998).
An important set of innovations regarding assessment and referral of maltreating parents to substance abuse services is occurring in the State of Delaware under a Federal demonstration project. Under normal circumstances, Federal foster care funding under title IV-E of the Social Security Act may be used only for foster care maintenance payments on behalf of eligible children in foster care as well as for expenses related to the administration of foster care. Delaware requested and has received a demonstration waiver allowing the State to use some of these funds for a system of substance abuse assessment and referral. This system provides for staff from the substance abuse agency to be located in child welfare offices to do substance abuse assessments and to identify appropriate substance abuse treatment resources for those parents who need them. While the project has not yet been operating long enough for thorough evaluation, initial results show that the demonstration is improving the engagement of clients in substance abuse treatment services. Indications so far are that foster care costs for families participating in the demonstration will be significantly reduced in comparison to the control group (Lockwood, 1998). The State of New Hampshire will begin a similar demonstration soon, to further test the efficacy of using substance abuse assessment and referral staff in a child welfare agency.
Outstationing substance abuse staff to child welfare agencies is also occurring in other communities using more standard financing mechanisms, most often using State or Federal substance abuse treatment funds. Such co-location allows more timely and accurate substance abuse assessments than might otherwise be available to a child welfare agency. Another alternative is for a child welfare agency to arrange with local substance abuse services providers to set aside several assessment appointments per week (based on the child welfare agency's typical need) that are designated as the slots for parents whose children have just been placed in foster care or on whom child abuse or neglect complaints have just been substantiated. In this way, long waiting lists for assessments can be avoided for these parents in crisis, and the child welfare agency can quickly determine what substance abuse services should be included in a family's service plan.
Key to making appropriate service referrals is knowing the treatment providers in the local community and the services they offer. Social service agencies are now a relatively minor source of referrals to alcohol and other drug treatment facilities. One recent study revealed that in 1996, 7.2 percent of referrals to alcohol and drug programs were from welfare and social service agencies, including child welfare (Horgan & Levine, in press). As ongoing working relationships are established, it is essential that substance abuse treatment providers understand what the child welfare agency is expecting treatment to accomplish, and that, in turn, the child welfare agency understands what substance abuse treatment can provide. To the extent that these expectations are not entirely compatible initially, ongoing discussions may be needed.
As child welfare agencies become more active sources of substance abuse treatment referrals, a number of administrative procedures may be necessary to facilitate the ongoing exchange of information about joint clients. For instance, establishing processes to get consent from the client at the time of referral for the sharing of treatment information between the child welfare and substance abuse agency can avoid considerable frustration and delays later on when the child welfare agency wants information regarding the results of an evaluation or the client's progress in treatment. In most cases child welfare clients are willing to sign release of information forms because they are eager to cooperate in order to retain or regain custody of children. Establishing Qualified Service Organization Agreements (QSOAs) between service providers is another way of assuring that information can be shared on behalf of clients within the scope of Federal drug treatment confidentiality guidelines. As discussed in chapter 6, under a QSOA, in certain circumstances client-specific information may be shared between the substance abuse treatment agency and another agency providing services to the program and its clients without the consent of individual clients.
In many communities, substance abuse treatment providers routinely provide biweekly or monthly progress reports on clients to their referral sources. Child welfare agencies may wish to work out such arrangements with their treatment agency partners to assure that they have timely and up-to-date information upon which to base case decisions. Agreeing ahead of time on formats and content for such updates may also help assure the usefulness of information exchanged.