Parental Substance Abuse : Intervention, Part 2

by Child Welfare Information Gateway

(Page 7 of 10)

Specialized Child Protective Services (CPS) Units

Children often blame themselves for their families' problems and perceive out-of-home placement as "punishment" for something they have done wrong. The child's removal is often equally difficult for the parents, and may only exacerbate parental stresses and feelings of inadequacy.

CPS units that work only with chemically involved families provide knowledgeable and intensive case management services designed to avoid out-of-home care by immediately linking the family with needed and appropriate community resources. To adequately address the complex and special needs of this high-risk population, these CPS caseworkers commonly have low caseloads that allow for frequent home visits, heightened involvement with families, and close collaboration with treatment agencies. Other characteristics of specialized CPS units include extensive training on topics related to alcohol and other drug abuse and vertical case management. Vertical case management promotes continuity of services with a single caseworker handling emergency response, family maintenance, family reunification, and permanency planning services for a given family.

An intensive, generic approach by CPS has several advantages. Parents are usually better supported and assisted in addressing their substance abuse. Additionally, specialized units may enhance CPS caseworkers' ability to document that reasonable efforts were made to keep families together or achieve family reunification. Finally, this intensive approach also may promote earlier implementation of alternative permanent plans for children in cases where family preservation or reunification cannot be achieved.

Family Preservation Programs

More intensive and longer lasting services to children at home are needed to maintain families in times of stress.

Innovative family preservation programs that target substance-abusing families provide intensive in-home interventions with the goal of reducing the need for foster care placement. Typically, although family preservation services are generally provided only on a short-term basis (2 to 5 months), these services are intensive because treatment staff caseloads are extremely small, with experts available for consultation on a 24-hour basis. Staff in such units may at times work in teams to provide mutual consultation and support.

In contrast to traditional service delivery models, family preservation programs use the family home as the primary site for intervention. The services provided by treatment staff can range from concrete "hands-on" assistance with household tasks and child care to more conventional interventions that include individual and family counseling, parent education, and advocacy and referrals for assistance with needed health care, substance abuse treatment, and community services. Family preservation programs typically provide intervention for the family as a unit rather than focusing only on the parent or child. As we gather more data from family preservation programs serving substance-abusing families, we may find that this model will need to be modified to better serve some families.

Innovations in Out-of-Home Care

Transitional Group Care for Foster Children

"You still here, Baby?" Marissa's nurse says, shaking her head. "I thought you'd be long gone." Marissa should be gone. She has been medically cleared for discharge for 3 days.... If only she had a home to go to....

Transitional group care centers have been developed as an alternative to children waiting in hospitals until more permanent foster placements can be found (the so-called "boarder babies") and as a resource for children whose medical, developmental, and familial needs make locating a suitable foster home difficult.

Model group care centers typically provide a range of diagnostic and therapeutic services for children as well as intensive clinical and social services for parents. To diminish the impact of the institutional setting, such programs commonly are designed so that children are cared for by a limited number of consistent caregivers in small family like groupings. Because the children cared for in such settings are likely to have special medical concerns, pediatric and ancillary health care services generally are an integral part of the range of services provided for the children.

In addition, model transitional group care programs also offer enhanced reunification services for parents. Typically this includes individual, family, and group therapy as well as parent education. In order to strengthen the relationship between parents and children, model programs also encourage parents to visit frequently, and centers commonly are open for parental visits on a daily basis. Many centers also conduct extensive outreach activities by phone and through home visits to promote parental visitation and parent participation in reunification efforts.

Specialized Foster Homes

The biggest obstacle standing in the way of foster parents making the commitment to care for drug-exposed infants is the lack of support in regard to the unique problems these special-needs infants bring into the home.... One of the infants we are now caring for has multiple anomalies so severe that she requires a tracheostomy and gastrostomy to maintain life. Just to go to the market requires planning. Jaime cannot go anywhere without a portable suction machine, an apnea monitor, and her medical supplies.

Specialized foster homes have been developed in many communities as a new approach to caring for those drug-affected infants who have complex needs and who otherwise might require institutional settings. Such children include those with HIV infection (AIDS), children with chronic medical problems requiring complex medical regimens, and children who are equipment-dependent. With intensive training and supportive services, caregivers in specialized foster homes have proven able to provide excellent physical care while still maintaining children within a family environment.

In many programs, foster parents who care for these medically fragile children have had experience as foster caregivers. However, several programs have successfully recruited nontraditional foster families, including single parents and homosexual couples. Other programs have been successful in attracting nurses or other individuals with health care backgrounds. Once recruited, foster parents are supported and placements sustained through provision of specialized training, intensive in-home services, and financial incentives.

In model programs, preplacement and ongoing training are routinely provided not only for the foster parents, but also for all adult family members who may be involved in the children's care. Furthermore, home visits by health care professionals such as visiting nurses and physical therapists are provided to reduce the need for clinic and hospital visits. In addition, frequent visits and telephone contacts from agency social workers are encouraged to help families cope with the stress of caring for a chronically ill child and to provide practical assistance with obtaining needed equipment, supplies, and community services. Finally, sponsoring agencies also often provide increased reimbursement rates to appropriately compensate caregivers, funds for respite care, or "respite foster homes" to relieve caregivers.

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.