(Page 3 of 10)

Areas of Assessment

Appropriate planning and intervention with substance-abusing families begins with a careful assessment of a number of infant/child, parental, and environmental factors. It is the combination and interaction among these factors that help the professional evaluate the child's safety in the home and determine the types of services needed by the family. The following sections are intended to provide guidelines for the professional regarding factors that should be explored as part of a comprehensive family assessment.

Assessment of the Infant and Child

Children prenatally exposed to alcohol and other drugs, and children living with substance-abusing parents are vulnerable populations. Often, such children are both biologically and environmentally at risk of developmental lags; many have special needs.

Infant Assessment

Because the minimum standards for adequate parenting may be higher for an infant prenatally exposed to drugs, it is especially important for the professional to assess carefully the infant's health and care requirements. This information generally is gathered through standardized examinations and observations of the infant as well as through interviews with the primary caregiver(s) and involved health care personnel.

In assessing the infant's needs, professionals should consider the following:

Does the newborn exhibit symptoms of drug exposure? (These may occur within several hours of birth, although some newborns may not show symptoms until much later.) Of particular concern are infants who have diarrhea, sleep poorly, are lethargic or irritable, or are on medication for drug-related symptomatology.

Were toxicology screens conducted? If so, what were the results?

Was the infant born prematurely (before 37 weeks of gestational age)? Symptoms related to pre-natal substance exposure may be masked by the infant's degree of illness or the immaturity of the CNS.

Will the infant require special medication and/or equipment such as an apnea monitor or oxygen? If so, caregivers may require special instruction or training.

Does the infant have medical or physical problems that could significantly impact critical life functions or long-term physical and intellectual development? For example, does the infant have a cardiac defect, seizures, or other congenital anomalies? Will the infant require close medical monitoring and frequent pediatric visits? If so, does it appear that the parents' substance abuse may interfere with their ability to provide the needed level of care and to obtain the medical followup required?

Child Assessment

Children can be harmed not only through prenatal drug and alcohol exposure, but also by being raised in environments in which these substances are abused. Often, the basic care of children is inadequate in households with chemically involved caregivers. In comparison with the general population, child maltreatment occurs with greater frequency in substance-abusing families. Alcohol and other drugs can be passed to an infant through breast feeding; fumes from drugs that are smoked may be inhaled by children within the home; substances may be accidentally ingested by children; and youngsters can be deliberately given drugs or alcohol by substance-abusing adults. Professionals should consider the following:

How many children are there in the home? What are their ages?

With whom do the children spend most of their time? What are their activities as well as their relationships with their parents, peers, and other adults? Chemically involved parents/caregivers frequently provide inadequate supervision. Without appropriate parental oversight, young children are at increased risk for victimization and injury.

Are there adequate and appropriate supplies and provisions for the children? Chemically involved parents may use money that should be spent on basic life necessities for the purchase of drugs and/or alcohol.

Are the children receiving ongoing health care? Do any children have chronic illnesses? Are immunizations current? Are there any untreated medical conditions? Do any children have histories of prior injuries, and if so, were these accidental or inflicted? Are the children's growth patterns within expected ranges or is there evidence of failure to thrive?

Are the children enrolled in school? Do the parents meet with school personnel when indicated? Do the children generally appear clean and appropriately dressed when they go to school? How are the children functioning academically? When a chemically involved family has had repeated disruptions in daily routine or frequent changes of address, the children may have missed much school or had to change schools often. Because learning deficits and short attention spans may occur as a result of prenatal substance exposure or environmental instability, it is important to assess all children living in the home with respect to these problems. Children may appear to be physically healthy but may nonetheless have developmental and educational deficiencies.

Because role reversal is common in chemically involved families, has a child assumed the role of a parent by performing adult caregiver tasks? If so, what resources are needed to support the family so that the child can be freed from inappropriate and/or dangerous responsibilities?

Careful observation of all children in a chemically involved family is essential in assessing and planning for the family as a whole, and for making appropriate health care and educational referrals for the children.

Tags: Child Abuse, Addictions

About the Author

www.childwelfare.gov
Formerly the National Clearinghouse on Child Abuse and Neglect Information and the National Adoption Information Clearinghouse, Child Welfare Information Gateway provides access to information and resources to help protect children and strengthen families. A service of the Children's Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.