A key factor in assuring that both substance abuse and child protection issues are addressed is making sure that workers are trained to look for and identify both problems in families served. Yet neither child welfare nor substance abuse pre-service training typically includes information on the other field (Dore et al, 1995). A variety of studies have shown that training for child welfare staff includes inadequate information on substance abuse and case planning skills to use with these families (Gregoire 1994; Tracy 1994). Indeed, one study found that social workers failed to correctly identify and respond to clients' alcohol problems in 83 percent of cases (Kagel, 1987). The 1993 Study of Child Maltreatment in Alcohol Abusing families found that only 21 percent of caretakers of maltreated children received a substance abuse assessment by an alcohol or drug abuse professional (HHS/NCCAN, 1993). If we do not accurately identify these problems, we are unlikely to adequately assess or treat them. Routine screening and identification systems have the potential to improve services provision. For instance, recent HCFA demonstrations to improve medicaid-provided services to pregnant substance abusing women found that systematic screening and identification raised service enrollment rates (Howell et al, 1998). Too often, however, CPS staff do not ask about or follow up on potential substance abuse, and substance abuse treatment providers have a similar stance toward child maltreatment.
Several studies have been identified that address substance abuse training and identification issues for child welfare staff. It appears that less attention has been devoted to assisting substance abuse treatment staff to recognize child safety issues. Many treatment programs have policies about reporting suspected abuse and neglect, but aside from treatment programs specializing in treating women with children, usually little attention is paid to training staff on how to recognize abuse and neglect, the effects it has on children, or how to intervene beyond making a child protective services report. Many of the substance abuse treatment programs that provide residential treatment for women with their children or outpatient programs that have on-site services for children have paid more attention to these issues, but they are few and far between.
Training can improve the ability of workers to identify and intervene with families. For instance, Gregoire (1994) found that following a seven-hour training on substance abuse issues, child welfare workers showed an increased awareness of the connection between alcohol and other drug abuse and child maltreatment. In addition, workers' aversion to engaging clients with alcohol and drug problems decreased. As a recent Child Welfare League of America publication points out, "the prerequisite to a serious commitment on training is a recognition that the great majority of workers in the child welfare system and in the treatment agencies do not know enough about the 'other side' to work effectively across systems" (Young et al, 1998, p. 18).
Both the Administration for Children and Families (ACF) and the Substance Abuse and Mental Health Services Administration (SAMHSA) have recognized the need to improve training on these crossover issues. In 1994, the National Center on Child Abuse and Neglect (NCCAN) issued a widely-used manual on protecting children in substance abusing families (HHS/NCCAN, 1994), and will soon complete a substance abuse training curriculum developed as a result of several communities' activities under Federal demonstration grants during the early 1990s. SAMHSA's Center for Substance Abuse Treatment is also in the process of developing a manual for treatment programs on the implications of child abuse for substance abuse treatment programs. In our discussions with grantees working on both sides of this issue, we were told repeatedly that joint training is an important key to effective collaboration. Until local staff in both fields have opportunities to learn about the other's discipline and to interact constructively with respect to families' needs, they will find it difficult to meet expectations for positive outcomes. Appendix C describes existing Federal child welfare and substance abuse treatment services and research programs, and Chapter 8 will discuss additional steps toward addressing these issues.
One community that has taken seriously the importance of training on these and related issues is Sacramento County, California. Since 1993, the county's Department of Health and Human Services has developed an extensive, three-level training effort for its employees in order to provide child welfare workers and their partners in related agencies the knowledge and skills necessary to identify and intervene with substance abusing families. Topics in the basic level of training include, among others, the awareness that alcoholism and drug dependence are diseases; the effectiveness of different modalities of treatment for different clients; the relevance of client measures of functioning in addition to abstinence; and an awareness of the phases of recovery as measures of parents' readiness for child custody. Staff undergoing additional levels of training may be certified in administering the substance abuse screening instrument used in the county, and become skilled at making assessment-based referrals to the nine treatment options available in the county. Sacramento County has struggled to implement consistent processes to identify substance abuse problems in maltreating parents so that appropriate interventions may be provided. The county's efforts are described in more detail in the recent volume Responding to Alcohol and other Drug Problems in Child Welfare (Young, Gardner & Dennis, 1998).
In 1991, NCCAN funded 25 grants to develop and implement multi-disciplinary training programs on substance abuse and child maltreatment (HHS/NCCAN, 1995b). Evaluations of these efforts indicate that trainees:
- developed an increased awareness and understanding of substance abuse related child abuse and neglect;
- became more accurate in their identification of substance abuse and child abuse in families;
- improved their assessment skills;
- developed a better understanding of the services and resources that were available in their communities and appropriate for these families; and
- reduced frustration levels with other services providers as they gained a better understanding of their mandates and roles.
Process evaluations of these efforts also revealed a number of lessons. These grantees found that success required: that professionals from various disciplines be involved early in the development of training; that needs assessments were essential in assuring curricula addressed the needs of their target populations. In addition, evaluations indicated that outreach and recruitment of potential trainees is extremely difficult because professionals in these fields have to meet numerous time commitments and are likely to be skeptical about the quality and value of additional training. Successful projects involved both management and line staff in training and used a variety of training strategies emphasizing interactive methods.