Parental Substance Abuse : Assessment of the Adolescent and the Parent

by Child Welfare Information Gateway

(Page 4 of 10)

Assessment of the Adolescent

Adolescents with alcohol or other drug use problems are often experiencing other problems as well. These problems may include mental health problems, violence between family members, child abuse, and involvement with the criminal justice system. Adolescents living in such troubled environments are likely to be experiencing difficulties in a number of areas, including family relationships, physical abuse/sexual victimization, educational performance, and emotional/psychological functioning. Many of these difficulties can be traced to an early age and, if not addressed, place these youths at high risk of future drug use and delinquency/crime.

In view of the often interrelated nature of these problems, it is important that the assessment of adolescents in substance-abusing households be holistic and comprehensive-rather than in one-problem-at-a-time terms. Information needs to be collected on their experience of specific problems so that service needs can be identified and appropriate interventions developed.

Before comprehensive assessment begins, it is important for the assessor to determine what constitutes the "family" for the adolescent who is to be evaluated and to be respectful of cultural and ethnic variations in family structure. For many members of society, the traditional definition of family is no longer applicable. A given adolescent may derive his/her physical (e.g., food and shelter), emotional, spiritual, and cultural needs from different individuals. Persons who serve as family in the adolescent's life by virtue of providing for physical, emotional, and/or spiritual needs should be included in the assessment process.

Within available time and resources, efforts should be made to assess the adolescent in a range of domains, including health history, psychosocial background, educational experiences, and community agency involvement, as detailed below:

• medical history (including illnesses, infectious diseases, and HIV status);
• mental health problems and history (including previous evaluations and treatment);
• family environment and how the adolescent perceives this situation--including perceptions and evaluations of any parental alcohol and other drug use, mental or physical health problems (e.g., chronic illnesses), family interrelationship problems, incarceration, or illegal activity;
• physical or sexual abuse experiences, as well as other developmental issues;
• strengths or resiliency factors, including self-esteem, family, other community supports, and coping skills;
• alcohol and other drug use, including the use of over-the-counter and psychotherapeutic drugs, tobacco, and caffeine;
• peer relationships, including gang involvement;
• leisure and spare-time activities;
• educational history, including academic performance, learning difficulties, and school behavior or attendance issues;
• history of involvement with social service agencies, including child welfare and foster home placements; and
• nature and degree of involvement with the juvenile justice system.

It is important to appreciate that assessment of the adolescent does not constitute an end in itself. Rather, the assessment process carries the implicit promise that identification of problems in the various domains that are assessed will lead to a written report that will be used as a basis for linking troubled adolescents with needed services. The report should specify treatment recommendations as well as need posttreatment services. It should represent an action plan that the family and the adolescent can accept and support. Rather than serving as a passive agent in the assessment process, the assessor should be a broker who sees to it that needed services are arranged for and provided.

Assessment of the Parent

Professionals working with chemically involved families may experience difficulty assessing the parents. First, their training may not have provided these professionals with a knowledge base for understanding substance abuse and its impact on individual and family functioning, parenting, and child health and development. Second, some professionals may feel uncomfortable and intrusive when inquiring about alcohol or other drug use and related lifestyle activities because of the legal and moral implications of illicit use. Third, often child abuse, substance abuse, developmental disabilities, and mental and physical health care problems are connected in chemically involved families, whereas individuals working in each of these specialized areas commonly have little contact with each other or knowledge about each other's related fields. Fourth, stereotypes of drug-addicted or alcoholic individuals may lead professionals to mistake or overlook chemical dependency.

To overcome these obstacles, it is imperative that professionals learn to recognize, identify, and assess for substance abuse and to determine how substance abuse is perceived within the family and within the context of the family's culture. Only then can they develop a service/treatment plan that is appropriate to the needs of the family. In addition, by having supervision and consultation services readily available, professionals can be assisted in developing and maintaining an empathic, nonjudgmental, and informed approach. As part of the comprehensive assessment, the following parental factors should always be evaluated, including substance abuse history, drug and alcohol treatment history, health and health care, mental health and history of psychiatric treatment, criminal history, level of cooperation, awareness of the impact of alcohol and other drug use on the child, parenting skills and responsiveness to the child, history of abuse and/or neglect, and work history and education, as detailed below.

About the Author

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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.