Blending Perspectives and Building Common Ground. Where Do We Go From Here?


There are significant roles for service providers, program administrators and policy makers at all levels in order to improve services and achieve better outcomes for families with substance abuse and child maltreatment problems.  Chapter 8 discusses actions the U.S. Department of Health and Human Services (HHS) will take in several areas to improve service provision to families affected by both substance abuse and child maltreatment, and also challenges service providers in the field to take steps to better address families' needs. 

Building Collaborative Working Relationships.  HHS intends to lead the field toward improving communications and developing common ground between the child welfare and substance abuse treatment fields.  Our activities will include:  (1) conducting leadership meetings that will convene national and regional discussions among agency leaders, service providers, and consumers of our services to begin the process of working through our different perspectives to build common ground; (2) preparing informational materials regarding substance abuse screening and assessment tools that can be used in child protective services contexts, and child safety assessments that may be useful for substance abuse treatment providers; and (3) funding a series of small grants to States and communities that will support the planning and implementation of joint strategies for service delivery, staff development and training, treatment retention, relapse management and post-treatment support. 

We challenge State and community leaders in the child welfare and substance abuse fields, in consultation with the juvenile and family courts, to initiate discussions on these issues within their own jurisdictions.  Such discussions should focus on an analysis of the way in which these service systems and the court currently operate and interact with one another, and the impact of these operations on child safety and family functioning.  These deliberations should also identify shared goals, gaps in service, and innovations applicable to their community that can improve the outcomes for children and families. 

Assuring Timely Access to Comprehensive Substance Abuse Treatment Services.  There are currently several important opportunities for States and local communities to expand substance abuse treatment for child welfare clients.  Specific opportunities within the Substance Abuse Prevention and Treatment Block Grant, the Targeted Capacity Expansion Program, Medicaid, and the Temporary Assistance for Needy Families and Welfare to Work Programs are discussed in Chapter 8.  The availability of new resources can promote the building of capacity at the State and local levels to provide services in ways that promote safety and permanency for children and sobriety for families.  State and local leaders are urged to consider the variety of options available to address the substance abuse treatment needs of child welfare clients. 

Improving Our Ability to Engage and Retain Clients in Care and to Support Ongoing Recovery.  In order to assist service providers to implement effective strategies for these clients, the Administration for Children and Families (ACF), the Substance Abuse and Mental Health Administration (SAMHSA) and other partner agencies will:  (1) expand our research in this area to build knowledge and develop effective program strategies; (2) utilize our technical assistance mechanisms to assure materials on effective approaches are available to the field; and (3) make particular efforts to work with the Court Improvement Projects to share information on effective programs, assessing treatment progress, and on the application of drug court methods to juvenile and family courts.  We urge service providers to design programs with a recognition that recovery from addiction is an ongoing process and to structure services in ways that promote retention and provide relapse prevention services. 

Enhancing Children's Services.  As substance abuse treatment programs design services for parents, children's needs also must be addressed.  For children in foster care, increased attention to children's healthy emotional, social, and cognitive development is needed.  In addition, program models are needed to address the particularly high risk of substance abuse and other problematic behaviors among children in foster care.  Among ACF's planned activities in this area are (1) highlighting opportunities to address substance abuse within the Independent Living Program; and (2) developing training materials for foster parents on working with the children they care for to prevent future substance abuse.  In addition, in recent years SAMHSA has significantly expanded its attention to early childhood issues, particularly through the Starting Early Starting Smart Program, which, in conjunction with several partner agencies, funds a child-centered, family-focused, and community-based initiative designed to test the effectiveness of integrating behavioral health services with primary care and early childhood service settings for children age 0-7.  SAMHSA's Center for Substance Abuse Prevention is also planning a new SAMHSA-wide effort focusing on outreach to the children of substance abuse treatment clients.  We challenge State and local service providers to identify opportunities for prevention and treatment services for children who are in foster care and for those under protective supervision in their homes. 

Filling Information Gaps.  Gaps in our knowledge base must be addressed in the coming years to ensure programs and approaches are well grounded in research findings.  A discussion of specific information gaps appear in Chapter 8.  In order to address knowledge gaps, ACF has proposed that these substance abuse issues be the subject of the next annual Federal Forum on Child Abuse and Neglect Research, to take place in the Spring of 1999.  In addition, 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.  SAMHSA's Center for Substance abuse prevention is in the process of implementing two new Knowledge and Application programs, one aimed at children of substance abusing parents and the other aimed at parenting adolescents, which are designed to develop new knowledge about ways to improve substance abuse prevention with these populations.