Our fields' understanding of the interrelated issues of substance abuse and child maltreatment has progressed significantly over the past decade. Research and demonstration programs sponsored by SAMHSA, ACF, NIDA and NIAAA have been instrumental in exploring these issues and testing intervention approaches. For instance, CSAT's demonstration programs for women with children have helped build model substance abuse treatment programs that also serve children and which provide parenting training to treatment clients. While our understanding of these issues has improved, it has also become clear that significant gaps in the knowledge base remain. These gaps must be addressed in the coming years to ensure programs and approaches are well grounded in research findings.
As noted above, there are significant gaps in knowledge about the interrelationships among substance abuse, child maltreatment, and related problems. The discussion below describes a number of the gaps that became clear as we developed this report.
Regarding the extent and scope of the problem, much better information is available nationally on the prevalence and severity of substance abuse among child welfare clients than there is about the prevalence and severity of child welfare and parenting issues in families with substance abuse problems. In the child welfare system, the new Adoption and Foster Care Analysis and Reporting System (AFCARS) will soon provide more accurate information nationally about the extent to which substance abuse has contributed to children's placement in foster care. There is currently no data being collected through Federal substance abuse data systems, however, about clients' children. The National Household Survey on Drug Abuse does collect information about whether respondents have children in their households, although in depth analysis of this information is not often conducted.
That these clients have complex needs has become a familiar refrain among service providers in both the substance abuse and the child protection systems, and it is the truth. However, while many sources list a multitude of problems often affecting these clients, there exists little information on the relationships between various needs, and virtually no information on causal relationships among co-existing problems. In addition, there is considerably more information on the small population of infants prenatally exposed to illicit drugs and alcohol than on the much larger population of children living in households with ongoing alcohol and illicit drug abuse.
Barriers to service are a common subject of research, often as evaluators try to determine why programs have been unsuccessful in meeting their goals. Programs in the substance abuse and child welfare fields often list many of the same barriers to service, generally relating to the complexity of child and family needs. Less has been written, however, about cross-system efforts to address barriers, their results, and why such efforts have been difficult to establish and maintain.
For some years now, communities have sought approaches to addressing the joint problems of substance abuse and child maltreatment. But while there is considerable information about single system approaches, there are only a few studies documenting cross-system approaches to these problems. Most of those that do exist were conducted under the auspices of demonstration grants initiated by the Administration for Children and Families or the Substance Abuse and Mental Health Services Administration. State- and community-generated activities have not generally been evaluated. In addition, while these grantees have learned a great deal about developing and implementing comprehensive services for these families, what has been produced thus far are a series of consensus-based "lessons learned" and "promising strategies." To date there is little effectiveness data to guide practice in this area.
In order to address knowledge gaps,
- ACF has proposed that these issues be the subject of the next annual Federal Forum on Child Abuse and Neglect Research, to take place in the Spring of 1999. ACF will urge the variety of research agencies within HHS and elsewhere in the Federal Government to consider these issues as they formulate their future research agendas.
- The National Institutes of Health, in partnership with ACF, other HHS agencies and the Department of Justice, will soon issue a grant announcement soliciting research proposals addressing child neglect. It is expected that a number of the proposals will address alcohol and drug abuse as factors in child neglect. Studies and research are needed on the links between physical and sexual abuse and substance abuse. In addition, studies of co-occurring and/or predisposing factors to substance abuse and child maltreatment, such as mental disorders, are urgently needed. While our knowledge base is quite thin, it nonetheless is clear that successful intervention with substance abuse and child maltreatment will necessitate treatment of such comorbid conditions as mental disorders.
- SAMHSA's Center for Substance Abuse Prevention (CSAP) has two new Knowledge Development and Application (KDA) programs, Children of Substance-Abusing Parents (COSAPs) and Initiatives on Welfare Reform and Substance Abuse Prevention for Parenting Adolescents (Parenting Adolescents), which are designed to develop new knowledge about ways to improve the prevention of substance abuse aimed at children of substance abusing parents or parenting teens. The knowledge generated from the SAMHSA KDA grants will be used to work with State and local governments as well as providers, families, and consumers to improve or develop comprehensive systems of care which address the issues of substance abuse and child welfare.
- SAMHSA's/CSAP has implemented a new Family Strengthening cross-site grantee program in over 100 communities across the country in order to increase our knowledge about how to better disseminate research-based models currently available and how to convince practitioners in the field to adopt models that have proven effective and to adapt them to diverse populations.
- The National Association of Children of Alcoholics has conducted a call for program submissions from the field to determine what types of prevention services are being provided to children of substance abusing parents in schools, treatment and youth program settings. SAMHSA/CSAP will support the analysis of these prevention programs to determine those that are the most cost-beneficial and promote their adoption with block grant and local prevention funding.
Researchers in the substance abuse field are urged to consider parenting issues as they develop research on the consequences of substance abuse and the effects of substance abuse treatment. Similarly, child maltreatment researchers are urged to consider the role of substance abuse in the dynamics of maltreating families.