Parental Substance Abuse : Intervention

by Child Welfare Information Gateway

(Page 6 of 10)

CASE VIGNETTE: Repeated, court-mandated participation in a series of substance abuse treatment programs continued to be ineffective. Five years after Timmy's birth, while under the influence of heroin, Lisa was involved in a hit-and-run accident. Terrified that she might have killed an elderly man, Lisa burst into her mother's home and told her that she needed help. After a 3-month prison sentence followed by 9 months in an intensive residential treatment and job training program, Lisa finally attained sobriety. Two years later, she continues to work full-time, has developed a supportive relationship with her mother, and has regained custody of her two children.

Since the 1960's, the scope of the problem of substance abuse and its devastating consequences for families have become increasingly apparent. However, our understanding of the phenomenon of chemical dependency and what constitutes effective treatment for substance abusers and their children remains limited. Better information is needed about what treatment efforts are most successful in helping mothers and fathers to stop abusing alcohol and other drugs, what supportive services are most effective in helping chemically involved families stay together, and what approaches are most effective in promoting family reunification. We also need to learn more about how to best intervene to help children whose health and development have been compromised by their parents' substance abuse, how to better support and encourage extended family care, and how to recruit and retain appropriate foster homes for children unable to remain with their parents.

Many of the model programs and interventions described in this chapter were developed in the attempt to find solutions for these as yet unanswered questions. These programs represent innovative and hopeful approaches for dealing with the complexities of parental substance abuse and demonstrate that chemically involved families can indeed be helped to become more functional with appropriate interventions and adequate resources.

It is important to remember that chemically dependent families may benefit from many of the services that are described in companion manuals in this series, such as A Coordinated Response to Child Abuse and Neglect: A Basic Manual. However, because of their unique needs, substance-abusing parents and their children often also require additional services or adaptations of conventional service delivery approaches. The purpose of this chapter is to provide examples of model programs and innovative strategies that have been developed to more effectively meet the special needs of this population in the areas of substance abuse treatment, child welfare services, foster care, health care, and education. For communities without such specialized programs, the chapter also provides suggestions for developing collaborative and coordinated services at the local level.

Comprehensive Treatment Approaches

Programs for Pregnant and Parenting Women with Children

The multiple needs of infants and mothers produce a strong impetus to treat mother and baby separately. However, the true clinical challenge is to provide interventions to support the mother and protect the infant, while additionally promoting positive mother-infant interaction and the formulation of a positive relationship.

Innovative day treatment programs have been developed to address the specific and unique needs of pregnant and parenting women caring for young children. These programs commonly provide health care, social services, and substance abuse treatment as well as a continuum of rehabilitative and case management services that focus on both the mother and the child.

In general, programs for pregnant and parenting women differ from traditional treatment modalities in several respects. First, key services are integrated and colocated to reduce the fragmentation that commonly occurs when families are involved with multiple agencies. Second, in contrast to conventional approaches that tend to emphasize the treatment needs of single males and use confrontational methods, programs for pregnant and parenting women commonly use a supportive approach that is family focused. For chemically involved women, the supportive approach is more effective in addressing their backgrounds, which often include physical and sexual abuse, as well as their shared feelings of low self-esteem and powerlessness.

Programs for pregnant and parenting women also provide a wide range of ancillary services, including transportation and child care, to further reduce the logistical barriers that are known to prevent women from seeking treatment. Unlike conventional programs, model projects provide aggressive community outreach that commonly includes home visits and enhanced after-care to reduce recidivism. The range of services typically provided by model programs includes:

• prenatal care (obstetrical services, health education, and nutritional counseling);
• chemical dependency treatment (individual and family therapy, group counseling and support, urine testing, 12-step participation, and pharmacologic intervention);
• parent education and training;
• pediatric care (medical services, developmental testing, and psychological assessments);
• social services (assistance with housing, legal, welfare, and basic survival needs); and
• supportive services (onsite child care, transportation or bus passes, vocational counseling).

Residential Treatment

Most pregnant addicts seeking treatment already have children and, if the treatment program is residential, a woman may be faced with the choice of foregoing treatment or placing her children in foster care.

Residential treatment facilities designed specifically for pregnant women and women with children allow mothers and children to remain together during the course of the family's treatment. As an intensive intervention modality, residential programs serve those chemically involved families with the most severe substance abuse problems and the fewest social supports as well as those for whom outpatient treatment has proven unsuccessful. For families involved with the child welfare system, residential treatment may offer an alternative to the children's out-of-home placement.

Model programs vary in length from 9 to 24 months and commonly provide a range of psychological, social, medical, educational, and vocational services for parents as well as counseling and developmentally appropriate play and educational activities for children. Through highly structured programming, residential treatment facilities attempt to promote lifestyle changes that support sobriety and healthier patterns of family interaction. Although this intensive treatment approach is costly, in comparison with outpatient programs, residential care offers several important advantages for families. These include a consistent, safe, and supportive environment for children, drug-free housing, and removal of the family from the destructive environments that may have contributed to or supported parental addiction.

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.