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, particularly in the weeks immediately following discharge. During our consultation process, we heard from a number of sources comments such as, "we can get these clients clean and sober. It's the longer term, after we step back, that's the problem." Families often lack the ongoing support structures, formal and informal, that make sustained recovery possible. Especially important in ongoing recovery efforts are that the client learns the skills to create drug-free leisure time effectively after treatment and socialize without intoxicants.
Recovery is a lifelong process, but the substance abuse treatment field has come to view chronic relapse as a preventable part of the recovery process (HHS/SAMHSA, 1996a). There are predictable causes of relapse during each stage of recovery. For instance, during early recovery (described in Chapter 2 and which encompasses the first year to two years of sobriety), it is the lack of effective social and recovery skills needed to build a sobriety-based lifestyle that is the major cause of relapse. By understanding these issues and teaching clients the skills they need to successfully overcome them, substance abuse treatment programs can reduce relapse rates. Child welfare agencies can also assist in this process by recognizing how their actions regarding custody, visitation and other family issues affect the recovery process. Without needed support, even positive actions like the return of custody can undermine recovery.
Most of our interventions with families are designed to be short term. Indeed, the main Federal child welfare program directed at these problems was for years called the Emergency Services Program, calling forth images of short term interventions which grantees subsequently found completely inadequate to address the complex family situations confronting them. One of the most common themes in grantees' progress reports and process evaluation results was that intervention periods needed to be much longer than grantees anticipated (HHS/NCCAN, 1995b). Grantees of ACF's Abandoned Infants Assistance program, intended to prevent the abandonment of drug-exposed and/or HIV+ infants, as well as SAMHSA grantees serving these clients, had similar experiences, often extending their intervention periods beyond their initial expectations.
Continuing care for this population is critical. Without it, relapse rates are high, even after long periods of sobriety while in treatment. It is at this point in treatment that the need for safe, affordable and sober housing is especially critical. Also, because issues related to substance abuse, such as a client's possible history of sexual abuse or incest, may go beyond the scope of substance abuse treatment, ongoing efforts to address such issues may need to continue long after leaving formal substance abuse treatment. For recovery to be successful, treatment counselors must help the client identify stressful areas in her life and learn to locate and use resources to deal with the stress.
Some have suggested that we may need to rethink the short term way in which we conceptualize child welfare interventions and instead provide longer term interventions for at least some families. The current movement toward two-track child protective services systems with many families receiving non-coercive, community-based support may be an opportunity to provide such longer-term services. Post placement support services, provided after a child returns home in order to assure the success of reunification, can also play this role. Such services may also be developed and implemented using the Promoting Safe and Stable Families Program (formerly the Family Preservation and Family Support Program) administered by the Children's Bureau. However they are provided, services of this sort can help assure child safety and family stability on a more ongoing basis and prevent the need either for initial foster care placements or for the re-entry of children into foster care following reunification.