Addressing the problems of substance abuse and child maltreatment requires interventions at a variety of levels. Among the clear lessons that have emerged from the decades of effort by dedicated service providers in both fields are that there are no easy answers and that what works for one family will not necessarily work for another. It is only by working together that agencies are likely to make progress in serving these families well. Efforts to address the dual problems of substance abuse and child maltreatment must include the following:
Valuing Prevention. The maltreated children we serve now are at high risk of becoming the next generation of adults with addiction problems and/or the next generation of abusive or neglectful parents. An effective approach to addressing substance abuse among parents and its harmful effects on children must include a strong prevention component.
Strengthening Training and Identification Skills. A key factor in assuring that both substance abuse and child protection issues are addressed is making sure that workers are trained to identify both problems in families served. Training can improve the ability of workers to identify and intervene effectively with families.
Enhancing Risk Assessment, Needs Assessment, and Referral Capacity. 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.
Increasing the Availability, Access and Appropriateness of Substance Abuse Treatment. Child welfare agencies consistently report difficulty obtaining substance abuse treatment for clients who need it, particularly programs that are designed to meet the specific needs of women with children. Until clients have access to quality substance abuse treatment services, it is unrealistic to expect significant improvement in problems surrounding their substance abuse.
Promoting Client Retention and the Effectiveness of Services. The experience of substance abuse treatment programs, particularly those geared toward parents and their children, demonstrates that many clients can and do improve their lives and many are able to resume their parenting roles. Service providers have discovered repeatedly, however, that it is extremely challenging to engage and retain these clients in treatment programs.
Improving Time Lines and Decision Making for Children. Among the key issues in improving child welfare services is ensuring that permanency decisions are made in keeping with a child's developmental time line. Common to the variety of innovations being developed in communities to improve outcomes for children in foster care are that efforts to resolve the issues which led to maltreatment must begin immediately; appropriate intervention plans are developed with the family's involvement and are monitored closely; and lack of progress or non-compliance with the treatment plan is dealt with swiftly.
Supporting Ongoing Recovery. One of the frustrations frequently expressed by professionals working with families with substance abuse and child maltreatment problems is that significant setbacks often occur after long strides have been made. While recovery is a lifelong process, most interventions are designed to be short term. For this population, however, short term interventions may not be sufficient and continuing care is critical.
While the substance abuse and child protection fields have a long way to go toward improving how they work together to serve their mutual clients, a great deal has been learned about what it takes to produce positive outcomes for these parents and children. Improved efforts across a wide spectrum of activities are needed throughout our nation. While no community has yet put in place an entirely satisfactory response network, the examples and research results described in this report demonstrate that there are solid indications of how outcomes can be improved at each stage of intervention.