This document identifies the major literature in the field of cross-system issues involving child welfare, substance use disorders, and dependency courts. It is organized in 15 topic areas, and the time frame is from January, 2000 through March, 2007.
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Categories
Child Welfare Practice
Family Treatment
Family Drug Treatment Court
Incarcerated Persons with Substance Use Disorders
Methamphetamine and Children
Parenting
Parents with Histories of Child Abuse and Neglect
Parents in Substance Abuse Treatment with Histories of Child
Abuse and Neglect
Persons with Substance Use Disorders and Implications for their
Children
Persons with Substance Use Disorders with Histories of Child
Abuse and Neglect
Pregnant Women, Parenting Women, their Children, and Treatment
Implications
Prevalence
Substance Exposed Infants
Systems and Policy Issues
Additional Literature/AOD Treatment
1.
Child Welfare Practice
Choi, S., & Ryan, J.P. (2006). Completing substance abuse treatment in child welfare: The role of
co-occurring problems and primary drug of choice. Child Maltreatment, 11(4), 313-325.
A significant number of substance-abusing parents in the child welfare system do not complete substance
abuse treatments. Consequently, their children experience longer stays in substitute care settings, and the risk of the
termination of parental rights is increased. This study identifies and determines the specific factors that explain the
completion of substance abuse treatment for substance-abusing caregivers in child welfare. The sample includes 871
caregivers enrolled in the Illinois Alcohol and Other Drug Abuse waiver demonstration. The study found that approximately 22% of the
caregivers successfully completed all required levels of substance abuse treatment. Age, employment status, and legal
involvement were significantly associated with the likelihood of completing substance abuse treatment. Heroin users
were significantly less likely to complete treatment as compared with alcohol, cocaine, and marijuana users. The findings are
discussed in terms of policy and practice implications for public child welfare systems. The authors state that the findings
indicate a variety of factors that might be incorporated into pretreatment assessments so that child welfare caseworkers
can initiate preventive measures to decrease attrition and improve treatment completion.
Fuller, T.L., & Wells, S.J. (2003). Predicting maltreatment
recurrence among CPS cases with alcohol and other drug involvement. Children
and Youth Services Review, 25(7), 553-569.
Evidence suggests that the number of Child Protective Services
(CPS) cases involving families with alcohol and other drug (AOD) problems
is increasing, which presents unique challenges to CPS workers who must be
able to determine how a parent's substance use affects their child's safety.
Recent research has identified several factors that consistently predict maltreatment
recurrence; however, these studies have assumed that the risks for recurrence
are the same for all families who come to the attention of CPS. The current
study examined factors predictive of short-term (e.g. within 60 days) maltreatment
recurrence among CPS cases with AOD involvement. The authors found that four
factors were related to an increased risk of short-term maltreatment recurrence:
1) the safety assessment factor involving caretaker AOD use checked "yes;"
2) a high risk assessment rating for caretaker criminal behavior; 3) no police
involvement during the investigation; and 4) families headed by single, African-American
women. The findings of the current study have several implications for CPS
practice. They underscore the importance of including information on caretaker
substance use in ongoing safety and risk assessment activities. Once substance
use has been identified as a risk factor, investigators should have tools
that help them determine the history and extent of addiction, as well as associated
problems such as criminal behaviors, health problems, and mental illness.
It is vital for investigators to then translate this information into an effective
safety plan that addresses the risks present.
Gregoire, K.A., & Schultz, D.J. (2001). Substance-abusing
child welfare parents: Treatment and child placement outcomes. Child Welfare,
80(4), 433-452.
This article provides information on substance abuse interventions
with child welfare parents and describe outcomes for 167 child welfare clients
referred for substance abuse assessments, and when recommended, treatment.
The authors found that nearly one-third of the clients did not complete the
substance abuse assessment required by the agency family plan, indicating
the difficulty intervening in addiction. However, those clients who completed
the assessment and treatment had higher rates of post-referral sobriety, affirming
the value of intervention. The authors also found that prior treatment was
associated with continued substance abuse rather than sobriety indicating
a higher level of severity of addiction. To meet the goals of child safety,
family preservation, and permanency planning, child welfare agencies and substance
abuse service providers must work collaboratively to provide timely, accessible,
and effective substance abuse treatment and support services for child welfare
families with substance abuse problems.
Hohman, M.M., & Butt, R.L. (2001). How soon is too
soon? Addiction recovery and family reunification. Child Welfare, 80(1),
53-67.
This article describes the addiction recovery process and
stages of recovery, the behaviors and attitudes that indicate recovery, and
how recovery impacts parenting. This information is crucial for child welfare
workers involved in decision making regarding family reunification. Two models
of recovery, one from alcoholism and one from cocaine addiction, are reviewed.
In addition, issues encountered in recovery, particularly for women for discussed.
Case examples and discussion demonstrate how child welfare workers can apply
these models in determining the appropriateness of reunification.
Kerwin, M.E. (2005). Collaboration between child welfare
and substance-abuse fields: Combined treatment programs for mothers. Journal
of Pediatric Psychology, 30(7), 581-597.
This article provides a review of collaboration between child welfare
and drug-abuse fields in providing treatment to mothers who abuse drugs and
maltreat their children. A literature review of studies examining effects
of maternal drug abuse on parenting skills and outcomes of interventions for
both maternal drug abuse and parenting skills is provided. Results indicate
that parenting skills differ between mothers who do and do not abuse drugs,
but these studies are primarily limited to mothers of infants and preschoolers.
The author finds that the evidence base for interventions to address both
substance use and parenting in these mothers is growing, but more well-controlled
studies are needed. Opportunities for improved collaboration between fields
are presented. The author concludes that progress has been made toward collaboration
to address drug abuse and parenting skills of mothers who abuse drugs, but
more integrated strategies are needed, especially for mothers who use drugs
and maltreat their children.
Libby, A.M., Orton, H.D., Barth, R.P., Webb, M.B., Burns, B.J., Wood, P.A., & Spicer, P. (2007).
Mental health and substance abuse services to parents of children involved with child welfare: A study of racial
and ethnic differences for American Indian parents. Administration and Policy in Mental Health and Mental Health
Services Research, 34(2), 150-159.
American Indian parents of children involved with child welfare were compared to White, Black and Hispanic
parents on mental health and substance abuse problems and access to treatment. Data came from the National Study of Child
and Adolescent Well-Being, a longitudinal study of a nationally representative sample of children aged 0-14 years involved
with child welfare. The study found that there were significant disparities in the likelihood of receiving mental health,
but not substance abuse, services. Unmet need for mental health and substance abuse treatment characterized all parents in
this study. American Indian parents fared the worst in obtaining mental health treatment. Parents of children at home and
of older children were less likely to access mental health or substance abuse treatment.
Marsh, J.C., Ryan, J.P., Choi, S., & Testa, M.F. (2006).
Integrated services for families with multiple problems: Obstacles to family
reunification. Children and Youth Services Review, 28(9), 1074-1087.
Child welfare clients with co-occurring problems are recognized
as clients who have difficulty achieving positive child welfare outcomes. The current
study focuses on families in the child welfare system with co-occurring problems and
the impact of such problems on the likelihood of reunification. The current study
contributes to the literature on service integration by examining whether it is necessary
to go beyond assessment and service access to insure families make progress in each co-occurring
problem area to achieve reunification. The sample is comprised of 724 substance-abusing families
enrolled in the Illinois Title IV-E Alcohol and Other Drug Abuse (AODA) Waiver Demonstration.
Data on client progress consisted of provider ratings completed quarterly to track progress
related to problems of substance abuse, domestic violence, housing and mental health. The
findings indicate that progress in resolving co-occurring problem areas increases the likelihood
of achieving family reunification. Thus, the provision of the child welfare service model alone
is insufficient. In order for child welfare systems to increase reunification rates, services
must target the specific needs of individual families and assist them in achieving progress
within co-occurring problem areas. Successful integrated service programs must identify the
range of specific problems that clients are dealing with and insure that they address and
resolve these problems in order to increase the likelihood of family reunification.
Miller, K.A., Fisher, P.A., Fetrow, B., & Jordan,
K. (2006). Trouble on the journey home: Reunification failures in foster care.
Children and Youth Services Review, 28(3), 260-274.
This article examined parent, child, family, environmental,
and service utilization factors hypothesized to be associated with reunification
failure. The sample for the study included foster children who, at reunification
with their birth parents, ranged in age from 4-7 years. All participants were
reunified with at least one parent. Among the variables found to significantly
differentiate between failed and successful reunifications were parental utilization
of substance abuse treatment, child utilization of special educational services,
child utilization of individual, family, or group therapy, overall parenting
skill level, appropriate use of discipline, and quality of neighborhood. The
authors discuss the implications of these results for policies aimed at increasing
the success rate of reunifications following foster care.
Mullins, S.M., Suarez, M., Ondersma, S.J., & Page,
M.C. (2004). The impact of motivational interviewing on substance abuse treatment
retention: A randomized control trial of women involved with child welfare.
Journal of Substance Abuse Treatment, 27(1), 51-58.
Previous studies have supported the efficacy of Motivational
Interviewing (MI) in increasing treatment engagement and retention among people
with substance abuse disorders. However, few studies have assessed the impact
of MI with coerced populations, particularly women referred to drug abuse
treatment by child welfare due to prenatal drug use. This study sought to
examine the impact of individual MI sessions on treatment retention and engagement
in a treatment program serving clients under heavy child protective services
pressure to participate. Seventy-one such women who used drugs during pregnancy
were randomly assigned to either receive three MI sessions or to watch two
educational videos and participate in a home visit. Treatment retention group
attendance and random urine analysis results were evaluated in these women
during the first 8 weeks of treatment. No differences were found between the
two conditions on these variables. Possible reasons for these negative findings
are discussed, including the possibility that MI may not provide any additional
benefit when the population is coerced or when they are concerned that specific
information about their progress will be shared with the court and with their
child welfare worker.
Nishimoto, R., & Roberts, A. (2001). Coercion and drug
treatment for postpartum women. American Journal of Drug and Alcohol Abuse,
27(1), 161-181.
Some have contended that there is a role for coercion in drug
treatment and that external pressures from family and the courts are necessary
factors in successful treatment, particularly regarding women who are parenting
and who are in the child welfare system. This research examined the extent
to which various indicators of coercion were related to treatment retention
in a gender-specific treatment program and a traditional outpatient program
for pregnant and postpartum women who were mandated to enter treatment. Women
who were given custody of their infant stayed in treatment longer than women
who did not have custody. Women who had custody and were in the intensive
day treatment program also completed treatment at a much higher rate than
those in the traditional program. These findings have important implications
for social work practice as the decision to place a newborn infant with a
mother who has a history of or is currently abusing or dependent on substances
is a serious concern for child welfare workers.
Rittner, B., & Dozier, C.D. (2000). Effects of court-ordered
substance abuse treatment in child protection cases. Social Work, 45(2),
131-140.
Courts often play active roles in the lives of families supervised
by child protective services (CPS). Judges adjudicate dependency, mandate
services, determine placements of children, and order continued supervision
or termination of parental rights or services. This study examined the effects
of court orders in preventing recurrence of substance abuse in the cases of
447 children in kinship care while under CPS supervision. In addition, the
effects of court orders on duration of service and on numbers of placements
were studied. Results suggested that court interventions had mixed outcomes.
Levels of compliance with mandated substance abuse and mental health treatment
did not appear to influence rates of re-abuse or duration of service. Court
orders appeared to affect both the number of caretakers and placements the
children experienced. Children adjudicated dependent were more likely to have
multiple caretakers than those under voluntary supervision. This study suggests
that further research is needed to determine how compliance with court-ordered
treatment should be used by workers in making decisions about continued supervision.
In addition, the authors highlight the importance of adequate substance use
and abuse screening in good case planning.
Smith, A., Krisman, K., Strozier, A.L., & Marley, M.A.
(2004). Breaking through the bars: Exploring the experiences of addicted incarcerated
parents whose children are cared for by relatives. Families in Society,
85(2), 187-195.
Although research on addictions, incarceration, and kinship
care has attracted the interests of social workers, little research is available
that provides insight into the unique experience of incarcerated parents who
are receiving substance abuse treatment and whose children are being raised
by relatives. The present study sought to clarify the issues encountered by
incarcerated parents, their children, and relative caregivers in an attempt
to develop recommendations for a multidisciplinary, wraparound approach to
designing services for these families during and after incarceration. To do
so, researchers conducted a series of open-ended semistructured interviews
with 25 incarcerated men and women who received substance abuse treatment
while their children were being cared for by relatives. Respondents in this
study were asked questions designed to explore issues such as parent-child
bonding, relationships with caregivers, and the impact of drug abuse and incarceration
on the family. The results revealed that many children had continuously resided
with relative caregivers for a long period of time beginning before the parent’s
incarceration and that many of the incarcerated parents had not seen their
children since being incarcerated. Results of this study indicate that there
is a need for a multidisciplinary, wraparound approach to designing services
for affected parents, children, and caregivers. Professionals working in substance
abuse treatment, child welfare, and corrections can benefit from gaining a
better understanding of incarcerated parents’ feelings and concerns
about being separated from their children and the resulting impact on the
children and relative caregivers. This awareness can contribute to treatment
relationships that encourage an improved sense of self, more support for substance
abuse recovery, and stronger familial relationships for incarcerated parents.
It is recommended that social workers include the biological parent in family
decision making and facilitate visitation with all members of the kinship
family system in order to help strengthen the parent’s self-perception
as well of their understanding of the children and relative caregiver.
Smith, B.D. (2003). How parental drug use and drug treatment
compliance relate to family reunification. Child Welfare, 82(3), 335-365.
This study assesses the relationships among parental drug
use, drug treatment compliance, and reunification from substitute care. Parental
drug use and treatment compliance have been presented as justification for
a new emphasis in child welfare policy and practice, especially due to the
shorter permanency timelines. Using in-person survey data and state administrative
data, the study finds that drug treatment compliance is associated with faster
reunification, even when accounting for ongoing drug use and three parenting
measures. The findings are consistent with a conceptual framework suggesting
that certain client actions, such as drug treatment compliance, may serve
as markers that substantially affect client outcomes. This study contributes
to the growing body of empirical literature on the correlates of reunification,
including parents’ treatment compliance.
Stahmer, A.C., Leslie, L.K., Hurlburt, M., Barth, R.P.,
Webb, M.B, Landsverk, J., & Zhang, J. (2005). Developmental and behavioral
needs and service use for young children in child welfare. Pediatrics,
116(4), 891-900.
The purpose of this study was to determine the level of developmental
and behavioral need in young children entering child welfare (CW), estimate
early intervention services use, and examine variation in need and service
use based on age and level of involvement with CW by using a national probability
sample in the United States. As part of the National Survey of Child and Adolescent
Well-Being, data were collected on 2813 children under 6 years of age for
whom possible abuse or neglect was investigated by CW agencies. Results indicate
that both toddlers (41.8%) and preschoolers (68.1%) in CW have high developmental
and behavioral needs; however, few children are receiving services for these
issues (22.7% overall). Children that remain with their biological parents
have similar needs to those in out-of-home care but are less likely to use
services. Children under 3 years of age are least likely to use services.
Children referred to CW have high developmental and behavioral need regardless
of the level of CW involvement. The authors conclude that mechanisms need
to be developed to address disparities in access to intervention.
Suchman, N., Mayes, L., Conti, J., Slade, A., & Rounsaville,
B. (2004). Rethinking parenting interventions for drug-dependent mothers:
From behavior management to fostering emotional bonds. Journal of Substance
Abuse Treatment, 27(3), 179-185.
Mothers who are physically and/or psychologically dependent
upon alcohol and illicit drugs are at risk for a wide range of parenting deficits
beginning when their children are infants and continuing as their children
move through school-age and adolescent years. Behavioral parent training programs
for drug-dependent mothers have had limited success in improving parent-child
relationships or children’s psychological adjustment. One reason behavioral
parenting programs may have had limited success is the lack of attention to
the emotional quality of the parent-child relationship. Research on attachment
suggests that the emotional quality of mother-child relationships is an important
predictor of children’s psychological development through school-age
and adolescent years. In this paper, the authors present a rationale and approach
for developing attachment-based parenting interventions for drug-dependent
mothers and report preliminary data on the feasibility of offering an attachment-based
parenting intervention in an outpatient drug treatment program for women.
Zimmer, M.H., & Panko, L.M. (2006). Developmental status
and service use among children in the child welfare system: A national survey.
Archives of Pediatrics & Adolescent Medicine, 160(2), 183-188.
This study estimated the prevalence of developmental delay
and service use among children in the child welfare system and identified
factors that influence developmental delay and use of these services. Subjects
were children aged 0 to 10 years (n = 4324) and their caregivers, who were
interviewed within 60 days of a report being made to the child welfare system.
The sample was part of the National Survey of Child and Adolescent Well-Being.
Children's development was measured directly using standardized assessment
tools. Three questions from the caregiver interviews estimated receipt of
developmental services. Prevalence of developmental delay and service use
by age group, type of maltreatment, type of placement, race, sex, and income
were reported. The authors found that younger children aged 0 to 2 and 3 to
5 years had higher rates, 33% and 36%, respectively, of developmental delay
than school-aged children (13%). Despite their high prevalence of developmental
delay, children aged 0 to 2 years were less likely to receive developmental
services than preschool-aged children or school-aged children. The authors
conclude that rates of developmental delay are high and developmental services
are underused, particularly by young children in the child welfare system.
In addition, the authors suggest that strategies for overcoming barriers to
using early intervention services should be implemented.
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2. Family Treatment
Center for Substance Abuse Treatment. (2004). Substance
abuse treatment and family therapy. Treatment Improvement Protocol (TIP)
Series, No. 39. DHHS Publication No. (SMA) 04-3957. Rockville, MD: Substance
Abuse and Mental Health Services Administration.
Family therapy has a long and solid history within the broad
mental health field. Substance abuse treatment, on the other hand, developed
in considerable isolation. This TIP represents advice on how both fields can
profit from an understanding and incorporating the methods and theories of
the other field. The primary audience for this TIP is substance abuse treatment
counselors; family therapists are a secondary audience. This TIP addresses
how substance abuse affects the entire family and how substance abuse treatment
providers can use principles from family therapy to change the interactions
between family members. Basic information about family therapy for substance
abuse treatment professionals and basic information about substance abuse
for family therapists is provided. The TIP presents the models, techniques,
and principles of family therapy, with special attention to the stages of
motivation as well as to treatment and recovery. Discussion also focuses on
clinical decision-making and training, supervision, cultural considerations,
special populations, funding, and research. The TIP concludes with policy
and program issues for administrators and trainers to consider for effectively
joining family therapy and substance abuse treatment.
Diamond, G., & Josephson, A. (2005). Family-based treatment
research: A 10-year update. Journal of the American Academy of Child and
Adolescent Psychiatry, 44(9), 872-887.
This article provides an update on the state of the art of
family-based treatment research. The authors reviewed randomized clinical
trials conducted in the past 10 years that included parents as a primary participant
in treatment of child and adolescent psychiatric problems. Studies were identified
from major literature search engines and current significant pilot work was
identified in the National Institute of Mental Health Computer Retrieval of
Information on Scientific Projects Web page or from the authors themselves.
The results indicate that family treatments have proven effective with externalizing
disorders, particularly conduct and substance abuse disorders, and in reducing
the comorbid family and school behavior problems associated with attention-deficit/hyperactivity
disorder. In addition, several new studies suggest that family treatments
or treatment augmented by family treatments are effective for depression and
anxiety. The authors conclude that for many disorders, family treatments can
be an effective stand-alone intervention or an augmentation to other treatments.
They state that engaging parents in the treatment process and reducing the
toxicity of a negative family environment can contribute to better treatment
engagement, retention, compliance, effectiveness, and maintenance of gains.
Lastly, recommendations for the next decade of research and some implications
of family-based treatment for child and adolescent psychiatry are explored.
Jackson., V. (2004). Residential treatment for parents
and their children: The Village experience. NIDA Science & Practice
Perspectives, 2(2), 44-53. Available at: http://www.drugabuse.gov/PDF/Perspectives/vol2no2/05Perspectives-Residential.pdf
The Village South, Inc., in Miami, Florida, offers comprehensive
substance abuse treatment and prevention services to adults, adolescents,
and children. The Village’s Families in Transition (FIT) program, launched
in the early 1990s as one of the Nation’s first 11 federally funded
programs for women with children, has provided services to nearly 800 parents
and approximately 2,000 children. This article discusses the philosophy behind
FIT’s family focused residential treatment program, characterizes its
participants, describes its challenges and successes, and points out research
needs that have come to light through experience with mothers and children
in treatment.
Knight, D.K., Logan, S.M., & Simpson, D.D. (2001).
Predictors of program completion for women in residential substance abuse
treatment. American Journal of Drug and Alcohol Abuse, 27(1), 1-18.
Although there is increasing emphasis on providing drug treatment
programs for women that address their specific needs (including parenting
and childcare), some women still fail to complete treatment. Because of the
limited information about the barriers involved, this study examines pretreatment
characteristics as predictors of program completion for 87 women who were
pregnant or who entered residential treatment with their children. Women who
completed program requirements were more likely to have a high school degree
or equivalent, no arrests in the 6 months before admission, and friends who
were less deviant. These findings support the need for specialized education
and services that address social deviancy of pregnant and/or parenting women.
McComish, J.F., Greenberg, R., Ager, J., Essenmacher, L.,
Orgain, L.S., & Bacik, W.J. (2003). Family-focused substance abuse treatment:
A program evaluation. Journal of Psychoactive Drugs, 35(3), 321-331.
Until recently, few programs were available for children whose
mothers are in recovery. A refinement of the gender-specific model of substance
abuse treatment, the "family-focused" approach, has placed increased
emphasis on the needs of children and other family members. However, because
these programs are relatively new, little is known about the effectiveness
of this type of treatment for either the mother or her children. This article
presents findings from a three-year evaluation of a family-focused residential
treatment program for women and their children. Longitudinal assessment of
the mothers indicated that their psychosocial status and parenting attitudes
improved over time. Additionally, the mothers remained in treatment longer.
At intake, as a group, the children who were birth to three years of age did
not exhibit developmental delay. However, developmental concerns were identified
for some children in the areas of motor and/or language development. The results
reported here provide beginning evidence that family-focused treatment improves
retention, psychosocial functioning, and parenting attitudes of pregnant and
parenting women. They also support the evidence that having children on site
improved retention in treatment for pregnant and parenting women, as well
as self-esteem, depression, and parenting. This study also provides a mechanism
for early identification and intervention for children.
Metsch, L.R., Wolfe, H.P., Fewell, R., McCoy, C.B., Elwood,
W.N., Wohler-Torres, B., et al. (2001). Treating substance-using women and
their children in public housing: Preliminary evaluation findings. Child
Welfare, 80(2), 199-220.
Demonstration research and service programs have been initiated
to verify that comprehensive, long-term residential treatment services for
women will decrease alcohol and drug use, reduce reliance on social and health
welfare programs, and improve functioning in specific life-skill and vocation
areas. The article reports on one such program, SafePort, a residential substance
abuse treatment program within public housing to provide drug treatment to
parenting women. All family members-women, children, and significant others-receive
comprehensive assessments to determine appropriate therapeutic interventions
to resolve their problems. Preliminary evaluation findings suggest that women
who participate with their children are more likely to remain drug free than
are those who participated without their children. This model suggests that
providing women and their children with a home as well as treatment for substance
abuse and related issues facilitates women’s abstinence from drug use
after treatment.
Smith, B.D., & Marsh, J.C. (2002). Client-service matching
in substance abuse treatment for women with children. Journal of Substance
Abuse Treatment, 22(3), 161-168.
This article addresses the relation between services matched
to client-identified needs and substance abuse treatment outcomes for women
with children. The study uses data collected for a program evaluation of an
enhanced substance abuse services program for mothers involved with the child
welfare system. In-person surveys were conducted with 183 women who were currently
attending, or had recently completed substance abuse treatment. Matched counseling
services (domestic violence services, family counseling) were associated with
reports of reduced substance use; matched ancillary services (housing, job
training, legal services) were associated with clients' satisfaction with
treatment. However, the total number of services clients received had a stronger
relationship to treatment outcomes than did services matched to client-identified
needs. This study suggests that the substance abuse treatment clients have
many service needs and that few of these needs were addressed by their treatment
programs. Substance abuse treatment services are effectively enhanced when
health and social services are also provided.
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3. Family Drug Treatment Court
Dice, J.L., Claussen, A.H., Katz, L.F., & Cohen, J.B.
(2004). Parenting in dependency drug court. Juvenile and Family Court Journal,
55(3), 1-10.
This article discusses the underlying approach and philosophy
of the Miami-Dade Dependency Drug Court (DDC), which addresses the needs of
families affected by substance abuse through a comprehensive and therapeutic
approach. The DDC works with community agencies to provide services that effectively
treat the family as a unit. The DDC provides a model approach to addressing
risk factors associated with substance abuse in families and a model approach
to collaboration with community stakeholders. This article discusses the process
of adapting a parenting program to meet the needs of families in the DDC.
Edwards, L.P. , & Ray, J.A. (2005). Judicial perspectives
on family drug treatment courts. Juvenile and Family Court Journal, 56(3),
1-27.
Family Drug Treatment Courts are a specialized calendar or docket that operates
within the juvenile dependency court. These courts provide the setting for
a collaborative effort by the court and all the participants in the child
protection system to come together in a non-adversarial setting to determine
the individual treatment needs of substance-abusing parents whose children
are under the jurisdiction of the dependency court. This article is intended
to give judges and others a judicial perspective on FDTCs, and to offer some
assistance for those who are operating or who are considering creating one.
Green, B.L., Furrer, C., Worcel, S., Burrus, S., & Finigan, M.W. (2007). How effective are
family treatment drug courts? Outcomes from a four-site national study. Child Maltreatment, 12(1), 43-59.
Family treatment drug courts (FTDCs) are a rapidly expanding program model designed to
improve treatment and child welfare outcomes for families involved in child welfare who have substance
abuse problems. The present study examines the effectiveness of the FTDC in improving treatment and child
welfare outcomes for parents. This study compares outcomes for 250 FTDC participants to those of similar
parents who did not receive FTDC services in four sites. Results show that FTDC parents, compared to comparison
parents, entered substance abuse treatment more quickly, stayed in treatment longer, and completed more treatment episodes. Furthermore, children of FTDC parents entered permanent placements more quickly and were more likely to be reunified,
with their parents, compared to children of non-FTDC participants. Finally, the FTDC program appears to have
a "value added" in facilitating positive child welfare outcomes above and beyond the influence of positive
treatment experiences. The authors note that one important aspect of the FTDC context that has been seen as
important to its success is the increased information sharing between treatment, child welfare, the courts,
and the regular contact between judges and participants. The study also suggests that FTDCs are supporting
parents who may struggle with treatment.
Malbin, D.V. (2004). Fetal alcohol spectrum disorder (FASD)
and the role of family court judges in improving outcomes for children and
families. Juvenile and Family Court Journal, 55(2), 53-63.
The purpose of this article is to support increased recognition
and efficacy of services for people with Fetal Alcohol Spectrum Disorder (FASD)
in the legal system. FASD is under-reported, under-diagnosed, and over-represented
in juvenile justice. Prenatal alcohol and other drug exposure causes brain
damage that affects behaviors, e.g., poor judgment, impulsivity, difficulty
learning from experience, and difficulty understanding consequences, leading
to multiple diagnoses such as Attention Deficit Disorder, Conduct Disorder,
Oppositional Defiant Disorder and Emotionally Disturbed. FASD is an invisible
physical disability; most people with FASD have no observable physical characteristics.
The courts are in an important position to increase awareness of this problem
by simply asking whether FASD is a factor that needs to be considered. This
article includes: (1) an overview of FASD diagnostic criteria and current
terminology; (2) exploration of FASD as a physical disability with behavioral
symptoms; (3) a case example illustrating common patterns of behaviors in
children and adults with FASD without identification and improved outcomes
following identification and implementation of appropriate treatment; and
(4) recommendations for family court judges. The courts are in an important
position to increase awareness of this problem by encouraging advocates and
professionals to learn more about FASD and to take it into account when making
recommendations to the court.
Worcel, S., Furrer, C., Green, B.L., & Rhodes, B. (2006).
Family treatment drug court evaluation final phase I study report.
Portland, OR: NPC Research.
This report presents the final analysis of Phase I
of the Family Treatment Drug Court (FTDC) Evaluation. The FTDC Evaluation,
funded by the U.S. Department of Health and Human Services Substance Abuse
and Mental Health Services Administration’s Center for Substance Abuse Treatment,
is a 4-year study conducted by NPC Research aimed at investigating the short- and
long-term child welfare and treatment outcomes for families involved with these
innovative programs. There are four study sites participating in this evaluation:
San Diego County, CA; Santa Clara County, CA; Suffolk County, NY; and Washoe County, NV.
The Phase I design collected archival administrative data on past participants in the
FTDCs and similar comparison group cases, and included information about placement changes,
types of placements, treatment services and outcomes, case lengths and resolutions, and
demographic and background information about the families involved with the cases. Results
indicated that rapid entry into drug court and treatment services appear to be related to a
number of positive outcomes, including more treatment completion, shorter times to permanent
placement, and shorter case closure. In addition, parents who entered treatment faster, stayed
in treatment longer, and completed treatment were more likely to graduate from drug court and
were more likely to have faster time to permanent placement.
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4. Incarcerated Persons with Substance Use
Disorders
Hanlon, T.E., O’Grady, K.E., Bennett-Sears, T., &
Callaman, J.M. (2005). Incarcerated drug-abusing mothers: Their characteristics
and vulnerability. American Journal of Drug and Alcohol Abuse, 31(1),
59-77.
Although the number of mothers with histories of drug addiction
who are incarcerated has grown substantially in recent years, there is little
information on their unique characteristics and vulnerability. This study
provides treatment-relevant information on the early life circumstances and
developmental experiences of incarcerated substance-abusing women; examines
the extent to which risk and protective factors derived from these early circumstances
and experiences were associated with the adjustment and functioning of the
mothers as adults; and contributes to an understanding of the general emotional
adjustment of the mothers and their perceptions of themselves as parents.
The subjects were 167 incarcerated drug-abusing mothers from Baltimore City
who had volunteered for a parenting program offered at a Maryland correctional
facility. Results revealed significant relationships between higher risk levels
(i.e., lack of a structured, nurturing home environment during adolescence,
association with deviant peers), and less favorable current adjustment. There
was a high level of emotional attachment between the mothers and their children,
yet many of the incarcerated mothers lacked confidence in their parenting
skills. The authors also found that despite the potential disruption stemming
from their mothers’ drug use and incarceration, many of the children
in the sample were protected to some extent from the negative consequences
of these circumstances by a strong kinship environment. The above considerations
must be taken into account in planning interventions targeting incarcerated
addicted mothers. The first priority in assisting these mothers should involve
the provision of a drug abuse treatment intervention, both prior to and following
their release from custody, that highlights the incompatability of drug abuse
and successful parenting practices. In addition, in this and/or supplemental
clinical services, the mothers should be given specific assistance in developing
their parenting skills, in reestablishing relationships with their children,
and in addressing present family circumstances having a direct bearing on
her reintegration within the family that includes input from both the current
caretakers and the children
Marsh, J.C., & Cao, D. (2005). Parents in substance
abuse treatment: Implications for child welfare practice. Children and
Youth Services Review, 27(12), 1259-1278.
Substance abuse treatment in parents of young children is
an important element of child welfare services. Increasingly, child welfare
agencies, confronted with increasing numbers of substance abusing client,
seek to integrate substance abuse treatment into child welfare services. These
efforts are limited by a lack of targeted information about effective substance
abuse treatment for parents. This study compares the predictive factors of
post-treatment drug use in organizational, service and individual characteristics
between 1237 parents and 1905 non-parents, mothers and fathers. The results
show that treatment duration and the frequency of counseling available in
treatment facilities are the most predictive factors for parents when other
factors are controlled. Further, treatment duration, onsite service availability,
and frequency of counseling available are significant factors in predicting
post-treatment drug use for fathers, but not for mothers. The authors concluded
that outcomes are better for parents who receive services in treatment organizations
that provide counseling on a frequent schedule (once a week or more). Further,
treatment duration and receipt of comprehensive services were specifically
predictive for fathers but not for mothers. These findings have implications
for improving substance abuse treatment services for parents in child welfare
settings. For example, programs seeking to integrate substance abuse and child
welfare services will be most effective when they can connect with substance
abuse treatment programs that are able to (a) retain parents in treatment,
and (b) tailor services to address health and social problems that typically
co-occurring with substance abuse.
Somervell, A.M., Saylor, C., & Mao, C.L. (2005). Public
health nurse interventions for women in a dependency drug court. Public
Health Nursing, 22(1), 59-64.
There is an increasing number of children placed in foster
care due to abuse and neglect. Parents of these children often have difficult
drug abuse problems leading to the removal of their children. The cost of
caring for these children is staggering, reaching an estimated $24 billion.
One program in Northern California that has been created to assist parents
is dependency drug court. This research utilized qualitative and quantitative
data to identify the perceived needs of women who have graduated from this
dependency drug court (n = 50) and what they think the public health nurse
(PHN) could do to intervene in the difficult process of going through dependency
drug court and reunifying with their children. In addition, select interviews
were conducted with former drug court recipients who were functioning as "mentor
moms" (n = 4). Themes relating to successful strategies emerged from
the interviews. They included respect, validation, empowerment, understanding,
and support. Common barriers such as overwhelming feelings of anger, denial,
and hopelessness contributed to stress during recovery. Among strategies recommended
by the mentor moms was a suggestion for PHNs to bridge the information gap
through regular reports on the development and health of their children during
the time they reside in foster care.
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5. Methamphetamine and Children
Brecht, M.L., Anglin, M.D., & Dylan, M. (2005). Coerced
treatment for methamphetamine abuse: Differential patient characteristics
and outcomes. American Journal of Drug and Alcohol Abuse, 31(2), 337-356.
Policymakers have responded to the increase in the prevalence
of methamphetamine (MA) use and the associated social costs (such as crime
and child abuse and neglect) by mandating a growing number of MA users to
substance abuse treatment via the criminal justice system (CJS) and/or child
protective service (CPS) agencies. However, empirical evidence remains sparse
about treatment outcomes specifically for MA users who report that their treatment
admission occurred under such pressures. This article assesses the relationship
of perceived legal pressure for treatment entry to treatment outcomes for
a sample of 350 MA-using clients from a large county publicly-funded substance
abuse treatment system. Approximately half the clients reported legal pressure
to enter the index treatment episode. Those reporting pressure were younger,
less likely to have received residential treatment, and had longer treatment
episodes than those not reporting pressure. Outcomes did not differ significantly
in simple comparisons between the pressured and nonpressured groups; however,
when client and treatment characteristics were controlled, the short term
outcome of relapse within 6 months was worse for those reporting legal pressure.
Outcomes did not differ by source of pressure. Such results offer optimism
for individuals and socially-beneficial outcomes of the growing policy emphasis
for substance abuse treatment of MA and other drug users through drug court
and other CJS jurisdictions.
Brecht, M.L., Greenwell, L., von Mayrhauser, C., & Anglin, M.D. (2006).
Two-year outcomes of treatment for methamphetamine use. Journal of Psychoactive Drugs, Suppl 3, 415-426.
While evaluation research supports the general effectiveness of substance abuse treatment, there
is not a comprehensive literature on treatment effectiveness for methamphetamine (MA) use. The authors consider three
outcome measures - MA use, criminal activity, and employment-compared across three periods: 24-months pretreatment,
during treatment, and 24-months post-treatment. Data are from an intensive natural history interview conducted two to
three years after treatment for 349 randomly selected admissions to treatment for MA abuse in a large publicly-funded
county treatment system. Results showed reduction in MA use and crime during and following treatment and increased
employment following treatment over pretreatment levels. Analyses showed higher levels of education and more time in
treatment related to more positive post-treatment outcomes for all three measures. Lower percentage of post-treatment
months with MA use also was related to more pretreatment MA-related problems, lower pretreatment MA use, and residential
(compared to outpatient) treatment modality. Lower post-treatment criminal activity was also related to gender
(being female), lower pretreatment criminal activity, and residential modality. Higher percentage of post-treatment
months with employment also was related to gender (being male), ethnicity (not African-American), and higher
pretreatment employment. The authors conclude that the study results for all three outcome measures showed benefits
of treatment for MA users, a pattern of findings that is consistent with results of general large-scale treatment
outcomes studies of community-based treatment of other substances.
Carnevale Associates. (2004, October). Children endangered
by methamphetamine: Drug endangered children. Darnestown, MD: Author.
Available online at: http://www.carnevaleassociates.com/CAPolBrief-DEC.pdf#search='Carnevale%20Associates%20and%202004%20and%20Children%20endangered'
The growth in methamphetamine production and use has grown
significantly over the past decade. As a result significant numbers of children
have been endangered due to direct or indirect exposure to methamphetamine
or living in a dwelling where methamphetamine is used or manufactured. This
policy brief examines the scope of the drug endangered children, damaging
effects of methamphetamine lab exposure, the effects on prenatal development,
federal help available, State legislative actions, and the National Alliance
for Model State Drug Laws. This brief also identifies the need for policies
to improve medical protocols, medical research, and awareness and intervention.
Haight, W., Jacobsen, T., Black, J., Kingery, L., Sheridan,
K., & Mulder, C. (2005). “In these bleak days": Parent methamphetamine
abuse and child welfare in the rural Midwest. Children and Youth Services
Review, 27(8), 949-971.
This report describes the impact of parent methamphetamine abuse on the
development and wellbeing of school-aged children, and considers implications
for culturally appropriate child welfare services. Thirty-five adult informants
from several, adjacent rural Midwestern counties in the United States were
interviewed as part of a larger ethnographic study. Child welfare workers,
other community professionals (educators, counselors, law enforcement personnel,
and substance abuse treatment providers), and foster caregivers described
their experiences with families involved with methamphetamine. Overall, informants
described that children are brought by their methamphetamine-abusing parents
into a rural drug culture characterized by distinct, antisocial beliefs and
practices. Children's experience of this culture includes environmental danger,
chaos, neglect, abuse, loss, and isolation. Informants believed that children
develop antisocial beliefs and practices such as lying, stealing, drug use,
and violence through direct teaching by their parents and, indirectly, through
observing parents' own antisocial behavior. Informants described children
as displaying psychological, social, and educational disturbances. They also
described individual variation in functioning across children that they attributed,
in part, to individual (e.g., temperament, intelligence), familial (e.g.,
extended family), and community (e.g., school) characteristics. Informants
noted a need for effective child mental health services in the area, and for
ensuring a positive environment for children's future development through
education of the children, foster parents and other community members. The
authors discuss four strategies for enhancing the development of school-aged
children whose parents abuse methamphetamine: (1) enhancing education in schools
and communities; (2) enhancing timely, child welfare involvement with children
of methamphetamine abusers; (3) providing timely access to quality mental
health services focused on adequate assessment, trauma, and socialization;
and (4) employing culturally and developmentally sensitive intervention practices.
Hohman, M., Oliver, R., & Wright, W. (2004). Methamphetamine
abuse and manufacture: The child welfare response. Social Work, 49(3),
373-381.
Methamphetamine abuse is on the rise, particularly by women
of childbearing age. This article describes the history of methamphetamine,
the effects of methamphetamine use, treatment for methamphetamine abuse, and
the effects of exposure to methamphetamine during pregnancy. The authors examine
the ways exposure to the manufacture of this drug affects clients and social
workers in the course of their work. Because children are frequently found
at the scene of a manufacturing laboratory, the child welfare system often
becomes involved, and child protective services and other social work agencies
need protocols on how to recognize home laboratories and on how to address
the needs of these children and their parents. In 1997, California created
and implemented Drug-Endangered Children's units in seven counties to address
the needs of children from families that manufacture methamphetamine; these
units involve collaborative efforts among child protective workers, district
attorneys, physicians, and police officers. A case example provides information
about the role of social workers and their collaboration with these multiple
systems.
Smith, L.M., LaGasse, L.L., Derauf, C., Grant, P., Shah, R., Arria, A., et al. (2006). The Infant Development, Environment, and Lifestyle Study: Effects of prenatal methamphetamine exposure, polydrug exposure, and poverty on intrauterine growth. Pediatrics, 118(3), 1149-1156.
Methamphetamine use among pregnant women is an increasing problem in the United States. Effects of methamphetamine use during pregnancy on fetal growth have not been reported in large, prospective studies. This study examined the neonatal growth effects of prenatal methamphetamine exposure in the multicenter, longitudinal Infant Development, Environment and Lifestyle (IDEAL) study. The IDEAL study screened 13 808 subjects at 4 clinical centers: 1618 were eligible and consented, among which 84 were methamphetamine exposed, and 1534 were unexposed. The authors found that the methamphetamine exposed group was 3.5 times more likely to be small for gestational age than the unexposed group. Mothers who used tobacco during pregnancy were nearly 2 times more likely to have small-for-gestational-age infants. In addition, less maternal weight gain during pregnancy was more likely to result in a small-for-gestational-age infant. Birthweight in the methamphetamine exposed group was lower than the unexposed group. These findings suggest that prenatal methamphetamine use is associated with fetal growth restriction after adjusting for covariates. Continued follow-up will determine if these infants are at increased risk for growth abnormalities in the future.
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6. Parenting
Carlson, B.E., Matto, H., Smith, C., & Eversman, M. (2006). A pilot study of reunification
following drug abuse treatment: Recovering the mother role. Journal of Drug Issues, 36(4), 877-902.
This qualitative study explored the experiences of women in recovery from drug abuse who had resumed
parenting their children after child placement. Six mothers and 11 service providers from substance abuse treatment and
child welfare agencies were interviewed about their perceptions of the experience of being reunified with one's children
following substance abuse treatment Findings revealed that mothers have intense emotional reactions to having children placed,
which can motivate recovery but also be a source of stress. A variety of supports were identified as necessary to prepare
mothers for resuming care of children beyond substance abuse treatment including counseling, child care, financial support,
and parenting education. Reunification, however desirable, was described as overwhelming and fraught with parenting challenges,
such as effective limit setting with children. Numerous challenges and barriers to successful reunification were identified,
such as stigmatization in the child welfare system. The authors state that the results suggest the need for continuity and coordination in service delivery that targets several key areas of skill development for substance-abusing mothers following
initial treatment and post-reunification with children. This would require coordinated, effective collaborations between
treatment providers, the child protective system, and community-based child welfare providers.
Kettinger, L.A., Nair, P., & Schuler, M.E. (2000).
Exposure to environmental risk factors and parenting attitudes among substance-abusing
women. American Journal of Drug and Alcohol Abuse, 26(1), 1-11.
This study examined the amount of exposure to negative environmental
risks and their association with parenting attitudes among a group of 198
inner city substance-abusing women. Mothers were recruited at delivery and
were part of a randomized longitudinal intervention study for substance-abusing
women and their infants. When the infants were 18 months old, a cumulative
environmental risk score was calculated for each mother based on nine factors:
violence (both domestic and environmental), depression, homelessness, incarceration,
number of children, life stress, psychiatric problems, and absence of significant
other. Based on their cumulative scores, mothers were placed in a low or high
environmental risk group. Mothers in the high-risk group had fewer years of
education, were younger when their first child was born, and had significantly
worse scores on parenting attitude scales. Given the current state of welfare
reform, it is important to determine which factors besides maternal substance
abuse place these mothers at risk for poor parenting.
McMahon, T.J., Winkel, J.D., Luthar, S.S., & Rounsaville,
B.J. (2005). Looking for poppa: Parenting status of men versus women seeking
drug abuse treatment. American Journal of Drug and Alcohol Abuse, 31(1),
79-91.
Research on drug abuse and fathering has been hampered by
inadequate documentation of parenting responsibilities within samples of drug-abusing
men and the status of men as fathers if rarely noted in published studies
of the general population or in individuals seeking treatment. Thus, this
study was designed to document the parenting status of drug-dependent men
seeking methadone maintenance treatment and to clarify ways their status as
parents differs from that of drug-dependent women. Data concerning demographic
characteristics, drug abuse history, and parenting status were systematically
coded from the medical records of 362 men and 162 women seeking methadone
maintenance treatment during a 12-month period. Results indicated that, although
a greater proportion of women were the parent of at least one biological child,
there were actually more fathers than mothers seeking treatment. Among the
parents, fathers were more likely to have been abusing opioids when they first
became a parent, and they were more likely to be living away from their children.
There were no significant gender differences in the number of children or
the average age of children. The results suggested that fathering may be an
important, but largely neglected, treatment issue for drug-abusing men, one
which requires clinical interventions to support them in their role as fathers.
These results indicate a need to better document the ways the parenting behavior
of drug-abusing men differs from both that of drug-abusing women and men with
no history of drug and alcohol abuse. Lastly, there is a need to better document
ways the parenting behavior of drug-abusing fathers affects the cognitive,
emotional, and social development of their children.
Moore, J., & Finkelstein, N. (2001). Parenting services
for families affected by substance abuse. Child Welfare, 80(2), 221-238.
This article describes the development, implementation, and
replication of a group-based parenting program for families affected by substance
abuse, the Nurturing Program for Families in Substance Abuse Treatment and
Recovery. Developed as a result of a federally funded demonstration project
for pregnant and parenting women in substance abuse treatment, this program
represents significant changes in substance abuse treatment services and increases
the ability of child welfare and substance abuse service systems to coordinate
service planning. Preliminary results indicate that this program improves
parenting, as measured on objective scales; enhances parents' satisfaction
and competence, as measured by participant reports; and is based on principles
demonstrated to be effective in reducing risk of both child abuse and neglect
and substance abuse for both parents and children. The Nurturing Program for
Families in Substance Abuse Treatment and Recovery was designed to be easily
adapted to the needs of different agencies and client populations. The development
of a parenting program specifically for families affected by substance abuse
enhances opportunities for substance abuse and child welfare systems to work
together for the families they both serve. This leads to not only greater
understanding of each other’s missions and how they are often seen as
conflicting with one another, but to the building of more trusting, collaborative
relationships across systems.
Suchman, N., Pajulo, M., DeCoste, C., & Mayes, L. (2006).
Parenting interventions for drug-dependent mothers and their young children: The
case for an attachment-based approach. Family Relations, 55(2), 211-226.
Maternal substance abuse is the most common factor involved
when children come to the attention of the child welfare system. Although there
is a clear need for clinical trials to evaluate parenting interventions for
drug-dependent women, few studies to date have systematically examined the
efficacy of interventions for this population. The authors review six published
reports of outpatient interventions that aimed to enhance the caregiving skills of
substance-abusing mothers caring for children between birth and 5 years of age.
Following a discussion of the implications of these studies, the authors describe
an attachment-based intervention that addresses these implications and has demonstrated
preliminary feasibility in a pilot trial.
Velez, M.L., Jansson, L.M., Montoya, I.D., Schweitzer,
W., Golden, A., & Svikis, D. (2004). Parenting knowledge among substance
abusing women in treatment. Journal of Substance Abuse Treatment, 27(3),
215-222.
The purpose of this study was to assess parenting knowledge
and beliefs among drug abusing pregnant and recently postpartum women engaged
in a comprehensive substance abuse treatment program. In addition, this study
examined the effects of a parenting skills training program incorporated into
a maternal substance abuse treatment program. Seventy-three pregnant and drug-dependent
women received a manualized 8-week training program on parenting instruction.
Preliminary results obtained from this clinic-based sample suggest that these
substance abusing mothers lacked important parenting knowledge and held misconceptions
about basic parenting practices. This knowledge improved after comprehensive
substance abuse treatment that included parenting training. This study demonstrated
that parenting skills training, as a component of drug treatment, was associated
with at least short-term improvements in parenting knowledge. Parenting knowledge
and practices are particularly important for this group of women, as their
children are at high risk for developmental and other difficulties. Therefore,
systematic evaluation of parenting knowledge among women of childbearing age
entering substance abuse treatment is recommended. Substance abuse treatment
for drug-dependent pregnant and postpartum women should include a parenting
skills training component with the ultimate goal of improving the overall
development of the drug-exposed child.
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7. Parents with Histories of Child
Abuse and Neglect
Felitti, V.J. (2002). The relation between adverse childhood
experiences and adult health: Turning gold into lead. The Permanente Journal,
6(1), 44-47. Available online at: http://xnet.kp.org/permanentejournal/winter02/goldtolead.pdf
This article reports on the Adverse Childhood Experiences
Study, a long term, in-depth analysis of over 17,000 adult Americans, matching
their current health status against adverse childhood experiences that occurred
on average a half-century earlier. The study found that adverse childhood
experiences are quite common although typically concealed and unrecognized;
that they still have a profound effect a half century later, and that they
are the main determinant of the health and social well-being of the nation.
The findings are of direct importance to the everyday practice of medicine
and psychiatry because they indicate that much of what is recognized as common
in adult medicine is the result of what is not recognized in childhood. The
ACE Study challenges as superficial the current conceptions of depression
and addiction, showing them to have a very strong dose-response relationship
to antecedent life experiences.
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8. Persons in Substance Abuse Treatment
with Histories of Child Abuse and Neglect
Boles, S.M., Joshi, V., Grella, C., & Wellisch, J.
(2005). Childhood sexual abuse patterns, psychosocial correlates, and treatment
outcomes among adults in drug abuse treatment. Journal of Child Sexual
Abuse, 14(1), 39-55.
This study reports on the effects of having a history of childhood
sexual abuse (CSA) on treatment outcomes among substance abusing men and women
(N = 2,434) in a national, multi-site study of drug treatment outcomes. A
history of CSA was reported by 27.2% of the women and 9.2% of the men. Patients
reporting CSA were younger at entry into the current drug treatment, were
more likely to be White, were more likely to have a comorbid mental disorder,
be alcohol or cocaine dependent, had higher levels of criminal activities,
had a higher level of problem recognition, and had a more negative peer influence
than patients without CSA. A history of abuse was also related to a lower
likelihood of post-treatment abstinence. High concentrations of adults with
abuse histories indicate that drug treatment represents an opportunity for
targeted intervention strategies to address the often traumatic experiences
associated with abuse, and the link between these abusive strategies and drug
use.
Brems, C., Johnson, M.E., Neal, D., & Freemon, M..
(2004). Childhood abuse history and substance use among men and women receiving
detoxification services. American Journal of Drug and Alcohol Abuse, 30(4),
799-821.
The current study was designed to shed additional light on
the link of childhood victimization and subsequent substance use and psychological
adjustment among men and women receiving detoxification services at a large,
comprehensive substance abuse treatment center in the Northwestern United
States. Specifically, this study assesses the link between childhood sexual
and physical abuse and subsequent life adjustment via the following variables:
type and severity of substance use, psychological symptoms, and criminal behavior.
Results revealed 20% of men and more than 40% of women reported childhood
physical or sexual abuse. Sexual or physical abuse had negative sequelae,
regardless of gender. Individuals with abuse history reported earlier age
of onset of drinking, more problems associated with use of alcohol/drugs,
more severe psychopathology, and more lifetime arrests, arrests related to
substance use, and arrests related to mental health. Given their high reported
rates of both types of abuse, especially among women, it appears crucial to
screen for abuse histories among individuals seeking detoxification services.
Early intervention may be made possible by identifying consumers with such
histories early on in their contacts with the substance abuse treatment system
and more appropriate treatment planning will ensue. In addition, they will
most likely benefit from additional mental health counseling because they
have greater psychological distress than individuals without abuse histories.
Criminal activity also increases among individuals with abuse histories, making
prevention plans in this regard necessary to serve this population appropriately.
This is particularly true with regard to criminal activity that occurs under
the influence of drugs or alcohol or in the presence of symptoms of mental
illness.
Center for Substance Abuse Treatment. (2000). Substance
abuse treatment for persons with child abuse and neglect issues. Treatment
Improvement Protocol (TIP) Series, No. 36. DHHS Publication No. (SMA) 00-3357.
Rockville, MD: Substance Abuse and Mental Health Services Administration.
Research and clinical evidence indicates that physical, sexual,
and emotional abuse and neglect during childhood can increase a person’s
risk of developing substance abuse disorders. This TIP examines treatment
issues for both adult survivors of child abuse and neglect and adults in treatment
who may be abusing or neglecting their own children. This TIP does not, however,
address the treatment needs of children who are currently being abused or
who are abusing substances. Definitions and rates of child abuse and neglect
are provided for the general population and among those in substance abuse
treatment. There is also a review of the literature on links between childhood
abuse and subsequent substance abuse. Screening and assessment tools that
can be used to determine whether a client has a history of childhood abuse
or neglect are included and guidelines on treating clients with histories
of child abuse or neglect are provided. The TIP also discusses the personal
issues that counselors may encounter when working with clients with histories
of abuse or neglect and offers suggestions for addressing them. Treatment
guidelines and an overview of the legal issues that counselors should be aware
of as mandated reporters are provided. Also included is an overview of continuing
and emerging trends such as fast-track adoption and welfare reform.
Pirard, S., Sharon, E., Kang, S.K., Angarita, G.A., &
Gastfriend, D.R. (2005). Prevalence of physical and sexual abuse among substance
abuse patients and impact on treatment outcomes. Drug and Alcohol Dependence,
78(1), 57-64.
More than half of substance abusers entering addiction treatment report a
history of physical or sexual abuse. It is unclear if such a history impacts
treatment outcomes. This one-year follow-up study of 700 substance abusers
sought to clarify the relationship between lifetime physical and/or sexual
abuse and addiction treatment outcome to help address the specific needs of
this population. This study found that abused subjects, predominantly women,
were significantly more impaired at baseline on clinical dimensions including
family/social severity and psychiatric severity as measured by the Addiction
Severity Index, and general level of functioning than non-abused subjects.
In addition, the abused group less frequently endorsed heroin and cocaine
in favor of alcohol and polydrug use. Abused subjects reported more prior
medical and psychiatric treatments. Abuse history was not a predictor of no-show
for treatment. Over the 1-year follow-up, lifetime physical and/or sexual
abuse was significantly associated with worse psychiatric status and more
psychiatric hospitalizations and outpatient treatment despite receiving similar
intensive addiction treatment. These findings indicate that substance abuse
patients with lifetime physical or sexual abuse have worse treatment outcomes
than their counterparts. The development of programs that would specifically
address the needs of substance abusers with histories of abuse might improve
the efficacy and lower the costs of treatment for this population.
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9. Persons with Substance Use Disorders
and Implications for their Children
Barth, R.P., Gibbons, C., & Guo, S. (2006). Substance
abuse treatment and the recurrence of maltreatment among caregivers with children
living at home: A propensity score analysis. Journal of Substance Abuse
Treatment, 30(2), 93-104.
Policy and programmatic initiatives of the last decade have
focused on increased coordination of services and expansion of prompt substance
abuse treatment for mothers initially involved with child welfare services
(CWS). Yet, little evidence has been amassed concerning the implications of
this approach on the recurrent need for CWS. This study examines data from
a large national probability sample of children and their caregivers involved
with CWS following an allegation of maltreatment. Data include the recurrence
of maltreatment reports for this group of children who remain at home. Selected
from 1,101 caregivers with an indicated substance abuse problem, a group of
224 clients who did not receive services were compared with 224 treated clients.
Results showed that clients who received substance abuse treatment were nearly
twice as likely to have another child abuse report within 18 months. Reasons
why participation in substance abuse treatment may result in greater involvement
with CWS are posited.
Conners, N.A., Bradley, R.H., Mansell, L.W., Liu, J.Y.,
Roberts, T.J., Burgdorf, K., et al. (2004). Children of mothers with serious
substance abuse problems: An accumulation of risks. American Journal of
Drug and Alcohol Abuse, 30(1), 85-100.
The purpose of this study was to offer some insight into the
life circumstances and experiences of a large group of children affected by
maternal addiction. The study addresses the characteristics of their caregivers,
the multiple risk factors faced by these children, their health and development,
and their school performance. Data were collected from mothers at intake into
50 publicly funded residential substance abuse treatment programs for pregnant
and parenting women. Findings from this study suggest that children whose
mothers abuse alcohol or other drugs confront a high level of risk and are
at increased vulnerability for physical, academic, and social-emotional problems.
Children affected by maternal addiction are in need of long-term supportive
services. Programs are needed to fully address the fully array of immediate,
transitional, and long-term needs of these children as individuals or members
of a family. Treating the complex needs of children requires a team of professionals
that extends well beyond the kind of team found in a traditional treatment
setting.
Grella, C.E., Hser, Y.-I., & Huang, Y.-C. (2006). Mothers
in substance abuse treatment: Differences in characteristics based on involvement
with child welfare services. Child Abuse & Neglect, 30(1), 55-73.
Greater awareness of the role of parental substance abuse
in child maltreatment makes it imperative that the substance abuse treatment
and child welfare systems coordinate services for these parents. Yet little
is known about the characteristics of child-welfare involved parents (primarily
mothers) who enter into substance abuse treatment. This paper compares the
characteristics of mothers in substance abuse treatment who were and were
not involved with child welfare services, and discusses the treatment implications
of these differences. Data were obtained from a statewide treatment outcome
monitoring project in California. Clients were assessed at treatment admission
using the Addiction Severity Index. The authors found that mothers who were
involved with child welfare were younger, had more children, and had more
economic problems. They were more likely to be referred by the criminal justice
system or other service providers, to have a history of physical abuse, and
to be treated in outpatient programs. They had lower levels of alcohol severity,
but did not differ with regard to psychiatric severity or criminal involvement.
Primary users of methamphetamine were disproportionately represented among
this group and had a distinct profile from primary alcohol- and opiate-users.
The authors conclude that mothers involved with child welfare enter substance
abuse treatment through different avenues and present a clinical profile of
treatment needs related to exposure to physical abuse, economic instability,
and criminal justice involvement.
Jones, L. (2005). The prevalence and characteristics of
substance abusers in a child protective service sample. Journal of Social
Work Practice in Addictions, 4(2), 33-50.
The purpose of this research was to identify characteristics
of substance abusers in a child protective services caseload. The random sample
of 443 children was drawn from an urban county from all children with a substantiated
abuse case. Files of children were reviewed to derive data. Sixty-eight percent
of the children had mothers who abused alcohol or drugs, and 37 percent of
them had mothers who abused both. Substance abuse, service contacts, public
assistance, homelessness, and household conditions in the service plan were
all associated with child removal from the home. These findings suggest that
the risks associated with substance abuse are not necessarily ameliorated
with social work intervention.
Kovalesky, A. (2001). Factors affecting mother-child visiting
identified by women with histories of substance abuse and child custody loss.
Child Welfare, 80(6), 749-768.
The influence of maternal substance abuse upon the placement
of children in out-of-home care increased significantly in the 1980s and 1990s,
affecting mother-child visiting in numerous ways. The present study sought
to identify factors that affect mother-child visiting when maternal substance
abuse is a contributing reason to the placement of a child in out-of-home
care. Content analysis of interview data from 15 mothers with histories of
illegal drug use and child custody loss provides insight into five major factors
that can promote or inhibit visiting: (1) mother's drug use and health status,
(2) effects of visits on the child, (3) transportation, (4) scheduling/visit
settings, and (5) support of others. The authors conclude that if treatment
for the mother’s substance abuse problem is not imminently available
following child custody loss, the mother may find it difficult to maintain
her abstinence for visits with her child. In addition, the visits themselves
can elicit such strong emotional responses regarding custody loss that a relapse
can occur following a visit. The authors state that ready access to a counselor,
12-step sponsor, substance abuse treatment program, or other source of support
is essential to promoting mother-child visiting.
Lam, W.K.K., Wechsberg,W., & Zule, W. (2004). African-American
women who use crack cocaine: A comparison of mothers who live with and have
been separated from their children. Child Abuse & Neglect, 28(11),
1229-1247.
This study examined factors that influenced caregiver status
for African-American mothers who use crack cocaine but are not receiving drug
treatment and participated in an HIV prevention study in North Carolina. Given
that many mothers who use illicit drugs may retain care of their children,
understanding the contexts in which these mothers and their children live
is important for advancing research and practice in the fields of substance
abuse and child welfare. This study fills an important gap of the literature
by examining factors that affect whether mothers retain care of their children
among a rarely studied sample of African American women who actively abuse
drugs but are not connected to formal service or welfare systems. Caregiver
mothers who were living with at least one of their children were compared
with non-Caregivers who were separated from all of their children. Non-Caregivers
were more likely to be older, to have been physically abused as children,
to trade sex more frequently, to be homeless, to have no health insurance,
report higher frequencies of drug use, risky sex practices, psychological
distress, and victimization experiences. Findings that socio-environmental
factors were more strongly associated with caregiver status than crack use
underscore the importance of contextual issues such as housing, victimization
history, and resources in serving maternal crack users. This article suggests
that community outreach and interventions that engage mothers who use drugs
and live with their children may be more effective strategies than formal
office-based services to link mothers who use crack and their children to
needed drug treatment and family and child services.
McNichol, T., & Tash, C. (2001). Parental substance
abuse and the development of children in family foster care. Child Welfare,
80(2), 239-256.
The purpose of this study was to examine the impact of parental
substance abuse on the development of 268 children in family foster care and
to document their verbal and nonverbal skills and behavioral characteristics.
In addition, this study, analyzed changes in these skills and characteristics
after a period of time in family foster care and examined where the children
were subsequently placed. As a group, the children in family foster care presented
with low average cognitive skills and made significant improvement in cognitive
functioning during placement. The children with prenatal exposure to drugs
scored significantly lower in cognitive skills at the beginning of placement
but made significantly more progress than the other children during placement.
Behavior ratings by the foster parents and teachers revealed that 29% of the
children had scores in the significant range, and the children exposed prenatally
to drugs had a higher incidence of behavior problems at school compared to
family foster care peers. Policy implications focus on selection, training,
and support of foster families, increased mental health services, early identification
of needs, individualization of intervention programs to nurture hidden cognitive
potential and address specific acting-out behavior problems, comprehensive
planning that includes the child’s functioning and behaviors at school,
and additional funding of research on the causes and treatment of substance
abuse and methods of improving outcomes for children in family foster care.
Schilling, R., Mares, A., & El-Bassel, N. (2004). Women
in detoxification: Loss of guardianship of their children. Children and
Youth Services Review, 26(5), 463-480.
Conducted in hospital-based clinics in New York City, this
study depicts the living circumstances of children of women in detoxification
for heroin or crack cocaine. Structured interviews were conducted with 160
African American and 96 Latina female patients who had at least one child
under age 18. High-risk drug use was common, including injection, frequenting
crack houses, overdosing and trading sex for drugs. Fewer than half of the
mothers had a high school education, and few received income from wages or
child support. Mothers, with a mean age of 36, reported an average of 2.84
minor children. Only 34% of children were in the guardianship care of their
mothers alone or mothers and their partners. Only 21% of mothers indicated
that they were the guardians of all of their minor children. Rates of guardianship
and custody were somewhat higher for Latina mothers compared to African American
mothers. The most important sources of care for the children were grandparents,
other relatives and foster parents. Of the children of detoxifying mothers,
21% were living with a non-relative, whereas in a national comparison sample
of African American and Latino households, only 2% of children were living
with non-relatives. The study also found that women who did not live in their
own home, had less education and used multiple drugs were more likely to have
lost guardianship of one or more children. Study findings expand understanding
of the detrimental effects of parental drug abuse on children's life opportunities.
Suchman, N.E., McMahon, T.J., Zhang, H., Mayes, L.C., &
Luthar, S. (2006). Substance-abusing mothers and disruptions in child custody:
An attachment perspective. Journal of Substance Abuse Treatment, 30(3), 197-204.
Using an attachment framework, the authors examined (1)
whether substance-abusing mothers perceptions of how they were parented were
related to the severity of their substance abuse and psychological maladjustment
and (2) whether these two factors mediated the association between mothers
perceptions of how they were parented and their children's placement out of home.
The sample included 108 mothers of 248 children who completed interviews upon admission
to a methadone maintenance program for women. Measures included lifetime risk composite
scores derived from the Addiction Severity Index, the Parental Bonding Instrument, and
a demographics questionnaire. The authors found that out-of-home placement of substance-abusing
children appeared to be linked with risks at multiple levels of influence
(e.g., sociodemographic, family/social, individual maternal adjustment, and child
characteristics). In addition, mothers who perceived their own mothers as uncaring
and intrusive were more likely to have developed severe substance abuse problems and
psychological maladjustment and to have lost custody of a minor child. The authors suggest
that the findings are consistent with an attachment perspective on parenting suggesting that
the internal psychological processes of a parent play a critical role in the continuity of parenting.
VanDeMark, N.R., Russell, L.A., O’Keefe, M., Finkelstein,
N., Noether, C.D., & Gampel, J.C. (2005). Children of mothers with histories
of substance abuse, mental illness, and trauma. Journal of Community Psychology,
33(4), 445-459.
Children exposed to parental substance abuse, mental illness,
and violence face profound challenges, including increased risk for emotional
and behavioral problems, substance abuse, and victimization. In this article,
the authors describe the characteristics of a sample of children of women
entering treatment. The children had been exposed to domestic violence, frequent
child welfare involvement, and residential instability. Parental entry into
treatment affords treatment providers an opportunity to intervene early with
these children, enabling them to offer supportive and preventive services
and to help children build skills to avoid problems later. Treatment providers
are encouraged to offer assessment and services to children of parents entering
treatment, capitalizing oil the opportunity to intervene early with a group
of children who are at risk for problems with significant individual and social
consequences.
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10. Persons with Substance Use
Disorders with Histories of Child Abuse and Neglect
Hyman, S.M., Garcia, M., & Sinha, R. (2006). Gender specific associations between types of childhood maltreatment and the onset, escalation and severity of substance use in cocaine dependent adults. American Journal of Drug and Alcohol Abuse, 32(4), 655-664.
The authors examined associations between types of childhood maltreatment and the onset, escalation, and severity of substance use in cocaine dependent adults. Results indicated that, in men (n = 55), emotional abuse was associated with a younger age of first alcohol use and a greater severity of substance abuse. In women (n = 32), sexual abuse, emotional abuse, and overall maltreatment was associated with a younger age of first alcohol use, and emotional abuse, emotional neglect, and overall maltreatment was associated with a greater severity of substance abuse. There was no association between childhood maltreatment and age of nicotine or cocaine use. However, age of first alcohol use predicted age of first cocaine use in both genders. All associations were stronger in women. Findings suggest that early intervention for childhood victims, especially females, may delay or prevent the early onset of alcohol use and reduce the risk for a more severe course of addiction.
Libby, A.M., Orton, H.D., Novins, D.K., Spicer, P., Buchwald,
D., Beals, J., & Manson, S.M. (2004). Childhood physical and sexual abuse
and subsequent alcohol and drug use disorders in two American-Indian tribes. Journal of Studies on Alcohol, 65(1), 74-83.
The purpose of this study was to examine the relationship
of childhood physical and sexual abuse to subsequent lifetime alcohol or drug
use disorders among two American Indian tribes. A sample of 3,084 American
Indians participated in a large-scale, community-based study. Participants
were asked about traumatic events and family history and were administered
standard diagnostic measures of substance use disorders. Prevalence of childhood
physical abuse was approximately 7% for both tribes, and childhood sexual
abuse was 4%-5%, much higher for females. Childhood physical abuse had a stronger
effect than childhood sexual abuse on lifetime substance dependence. Childhood
sexual abuse, on the other hand, was more associated with lifetime substance
abuse. Females more commonly experienced childhood abuse but were less likely
than males to develop substance use disorders. The results provide clinical
guidance to constellations of risk factors and expand the population at risk
to include males. This study is unique in that it is one of the few that examines
tribal and cultural variations among American Indians. The authors provide
several observations that would be helpful when developing interventions for
this population.
Liebschutz, J., Savetsky, J.B., Saitz, R., Horton, N.J.,
Lloyd-Travaglini, C., & Samet, J.H. (2002). The relationship between sexual
and physical abuse and substance abuse consequences. Journal of Substance
Abuse Treatment, 22(3), 121-128.
This study examines the relationship between past physical
and sexual abuse and drug and alcohol related consequences. Three hundred
fifty-nine male and 111 female subjects were recruited from an urban inpatient
detoxification unit. Eighty-one percent of women and 69% of men report past
physical and sexual abuse, starting at a median age of 13 and 11, respectively.
Physical and sexual abuse was significantly associated with more substance
abuse consequences for both men and women. This study reinforces the high
rate of physical and sexual abuse among both men and women admitted for detoxification.
Thus, future research should develop interventions to lessen the substance
abuse consequences of physical and sexual abuse. There is a need for trauma
and PTSD assessments among substance abuse clients, and battered women’s
shelters should be aware of substance abuse issues among its clients.
Widom, C.S., & Hiller-Sturmhofel, S. (2001). Alcohol
abuse as risk factor for and consequence of child abuse. Alcohol Research
and Health, 25(1), 52-57.
The relationship between child abuse and the use or abuse
of alcohol has two aspects. First, some findings have indicated that parental
alcohol abuse may be associated with the physical or sexual abuse of children.
Research findings in this area remain inconsistent, however. Second, the experience
of being abused as a child may increase a person's risk for alcohol-related
problems as an adult. This relationship has best been demonstrated in women
who had been victims of childhood abuse. Several factors most likely contribute
to or influence this relationship, including coping skills; antisocial behavior;
and psychological problems, such as posttraumatic stress disorder. This article
review studies assessing alcohol-related and non-alcohol-related factors that
might contribute to parental child abuse and presents research findings concerning
the relationship between childhood victimization and subsequent adult alcohol
abuse. Within this discussion, the article explores how future research may
identify further characteristics that could increase a person’s risk
for developing alcohol abuse as a consequence of childhood victimization.
Widom, C.S., Schuck, A.M., & White, H. R. (2006). An examination of pathways from childhood victimization to violence: The role of early aggression and problematic alcohol use. Violence and Victims, 21(6), 675-691.
Using prospective data from a cohort design study involving documented cases of child abuse and neglect and a matched control group, the authors examine two potential pathways between childhood victimization and violent criminal behavior: early aggressive behavior and problematic drinking. Results revealed different pathways for men and women. For men, child maltreatment has direct and indirect (through aggressive behavior and problematic alcohol use) paths to violence. For women, problematic alcohol use mediates the relationship between childhood victimization and violence, and, independent of child maltreatment, early aggression leads to alcohol problems, which lead to violence. The authors suggest that interventions for victims of childhood maltreatment need to recognize the role of early aggressive behavior and alcohol problems as risk factors for subsequent violence.
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11. Pregnant Women, Parenting Women,
their Children, and Treatment Implications
Berger, L.M. (2002). Estimating the benefits and costs
of a universal substance abuse screening and treatment referral policy for
pregnant women. Journal of Social Service Research, 29(1), 57-84.
Prenatal substance exposure poses a significant public health
problem in terms of both its economic costs to society and the health and
development of those children affected. While substance abusing pregnant women
and their children could benefit from early identification and appropriate
interventions, drug testing of infants is controversial, and there is currently
no national policy regarding the drug testing of infants, nor substance abuse
screening for pregnant women. This paper provides a cost-benefit analysis
of a universal substance abuse screening and treatment referral policy for
pregnant women. The results indicate that mothers and children are likely
to benefit economically from a universal substance abuse screening and intervention
policy. The extent to which society and non-participants would incur economic
costs or reap economic benefits from such a policy, however, is dependent
on CPS reporting practices and investigation rates, as well as foster care
entry rates. Results suggest that the monetary benefits of such a policy will
only outweigh its costs if it does little to increase post-birth child protective
services reporting and/or foster care placement rates. Thus, additional policies
regarding the ways in which screening results are utilized may be important
factors in determining the effects of a universal substance abuse screening
policy for pregnant women.
Clark, H.W. (2001). Residential substance abuse treatment
for pregnant and postpartum women and their children: Treatment and policy
implications. Child Welfare, 80(2), 179-198.
In FY 1993 and FY 1995, the federal government awarded 27
five-year grants that supported 35 residential treatment projects for substance-abusing
pregnant and postpartum women (PPW) and their children. The impetus for the
PPW program came not only from legislation, but from an increasing focus on
research corroborating the significant consequences of substance abuse for
women and their children. These projects provided comprehensive, culturally
competent, and gender-sensitive treatment. Preliminary findings indicate that
comprehensive residential treatment in which infants and young children live
with their mothers is a promising approach for alleviating the women’s
substance abuse and other problems, improving birth outcomes, and helping
these mothers become more competent parents. These programs were also found
to help the women reduce substance use, avoid criminal activity, and become
responsible wage earners. The findings from the PPW program demonstrate the
importance of treatment services for these families and it appears that intensive,
comprehensive, and prolonged residential services are effective for women
with multiple, serious needs, with benefits for both mothers and children.
Future cost data are expected to demonstrate the efficiencies and benefits
of these projects compared to no treatment.
Conners, N.A., Grant, A., Crone, C.C., & Whiteside-Mansell, L. (2006). Substance abuse treatment for mothers: Treatment outcomes and the impact of length of stay. Journal of Substance Abuse Treatment, 31(4), 447-456.
This article examines the treatment outcomes of 305 women enrolled in a comprehensive, residential substance abuse treatment program for pregnant and parenting women and their children. The women were assessed at intake and three times in the year after discharge. Analyses focused on change in client functioning over time, and investigating the impact of length of stay in treatment on client outcomes. Comparisons of clients' functioning before and after treatment suggest significant improvements in a number of domains, including substance use, employment, legal involvement, mental health, parenting attitudes, and risky behaviors. Longer treatment stays were associated with abstinence from AOD, reductions in cigarette use, employment and higher income, a reduced likelihood of being arrested, a reduction in symptoms of depression, and more positive parenting attitudes.
Day, N.L., Goldschmidt, L., & Thomas, C.A. (2006).
Prenatal marijuana exposure contributes to the prediction of marijuana use at
age 14. Addiction, 101(9), 1313-1322.
The purpose of this study was to evaluate the effects of prenatal
marijuana exposure (PME) on the age of onset and frequency of marijuana use among
14-year-olds. In this longitudinal cohort study, women were recruited in their fourth
prenatal month from a hospital-based prenatal clinic. Women and children were followed
throughout pregnancy and at multiple time-points into adolescence. The women ranged in
age from 18 to 42, half were African American and half Caucasian, and most were of lower
socio-economic status. The women were generally light to moderate substance users during
pregnancy and subsequently. At 14 years, 580 of the 763 offspring-mother pairs (76%) were
assessed regarding socio-demographic, environmental, psychological, behavioral, biological and
developmental factors. A total of 563 pairs (74%) were included in this analysis. Outcomes were
age of onset and frequency of marijuana use at age 14. PME predicted age of onset and frequency of
marijuana use among the 14-year-old offspring. This finding was significant after controlling for
other variables including the child's current alcohol and tobacco use, pubertal stage, sexual
activity, delinquency, peer drug use, family history of drug abuse and characteristics of the home
environment including parental depression, current drug use and strictness/supervision. The authors
conclude that prenatal exposure to marijuana, in addition to other factors, is a significant predictor
of marijuana use at age 14.
Hohman, M.M., Shillington, A.M., & Baxter, H.G. (2003).
A comparison of pregnant women presenting for alcohol and other drug treatment
by CPS status. Child Abuse and Neglect, 27(3), 303-317.
The purpose of this study is to describe the demographic,
substance use, and treatment variables of 678 treatment seeking pregnant women
and to compare these variables based on Child Protective Service (CPS) status.
The authors found that pregnant women reporting CPS involvement were similar
to non-CPS women on demographic variables but differed on drug use and treatment
variables. CPS women were more likely to report marijuana use as their primary
problem drug, be mandated to treatment, attend day treatment and be released
from treatment unsatisfactorily compared to the non-CPS pregnant women. Those
without CPS involvement were more likely to report cocaine or crack as their
primary drug, attend outpatient treatment and be found to have a satisfactory
release from treatment compared to those with CPS involvement. Significant
predictors of CPS involvement were mandated status and unsatisfactory treatment
release. The authors postulate that the specific demands of CPS requirements
may be burdensome on pregnant women. CPS demands may include parenting classes,
monitored visits, working with a social worker on concurrent planning, and
adhering to specific timelines to prepare
for reunification or removal. The authors state that both AOD treatment services
and CPS need to examine their policies and practices with pregnant substance-abusing
women, to determine if treatment needs are not being met and if burdensome
expectation are being placed upon them.
Hser, Y.I., & Niv, N. (2006). Pregnant women in women-only and mixed-gender substance abuse treatment
programs: A comparison of client characteristics and program services. Journal of Behavioral Health Services & Research,
33(4), 431-442.
This study compared characteristics of pregnant women treated in women-only (WO) and mixed-gender (MG)
substance abuse treatment programs and compared services provided by these two types of programs. Participants were 407
pregnant women who were admitted to 7 WO programs and 29 MG programs in 13 counties across California during 2000-2002.
Pregnant women treated in WO programs demonstrated greater severity in drug use, legal problems, and psychiatric problems
than those treated in the MG programs. They were also less likely to be employed and more likely to be homeless. Women-only
programs were more likely to offer child care, children's psychological services, and HIV testing. The greater problem severity
of pregnant women treated in WO programs suggests that these specialized services are filling an important gap in addiction
services, although further expansion is warranted in psychiatric, legal, and employment services.
O'Connor, M.J., & Whaley, S.E. (2006). Health care
provider advice and risk factors associated with alcohol consumption following
pregnancy recognition. Journal of Studies on Alcohol, 67(1), 22-31.
This study examined the extent to which pregnant women participating
in the Special Supplemental Nutrition Program for Women, Infants, and Children
(WIC) were counseled by their health care providers to stop drinking alcohol
during pregnancy A second purpose was to identify characteristics associated
with alcohol consumption postrecognition of pregnancy. The sample consisted
of 279 women who continued to drink after learning they were pregnant. Measures
of provider advice on alcohol consumption, demographic characteristics caffeine
intake, smoking, other drug use, alcohol risk (using the TWEAK scale), and
depressive symptoms on the Center for Epidemiological Studies Depression Scale
(CES-D) were collected. The authors found that 62% of women had significantly
high TWEAK scores, and 60% scored within the clinical range for depression.
Sixty percent of sample women had been advised by their care providers not
to drink alcohol during pregnancy. Women who were most likely to receive advice
were black non-Hispanic and Hispanic, were Spanish speaking, were less educated,
were on public assistance, and had a higher number of alcohol-related risk
behaviors. Advanced age, public assistance, caffeine use, smoking, and elevated
TWEAK and CES-D scores predicted elevations in alcohol consumption rates.
The authors concluded that although advice to stop drinking during pregnancy
was provided to 60% of this sample, women continued to drink following pregnancy
recognition, with alcohol consumption rates highly associated with sociodemographic
and psychological factors, namely maternal depression. Because elevations
in alcohol consumption during pregnancy are associated with poorer developmental
outcomes for children, further efforts are needed to better address social
and mental health factors that influence consumption.
Roberts, A.C., & Nishimoto, R. (2006). Barriers to
engaging and retaining African-American post-partum women in drug treatment.
Journal of Drug Issues, 36(1), 53-76.
Little is known about barriers to engaging and retaining African-American
women in drug treatment. This study examines (a) what barriers made it difficult for a sample
of 221 African-American women to participate in treatment, (b) the extent to which those
barriers differed by program modality, and (3) the extent to which those barriers were
related to length of time in treatment and treatment completion. Findings revealed that
barriers considered to be internal in nature (i.e., drug severity, did not feel like going,
and felt I could manage on my own) were most frequently reported. Only a few program-related
barriers were found to be related to length of time in treatment and both internal and
programmatic barriers had an effect on treatment completion. Implications for policy decisions,
future research, and clinical competence in addressing barriers to treatment for African-American
women are discussed.
Shankaran, S., Lester, B.M., Das, A., Bauer, C.R., Bada, H.S., Lagasse, L., & Higgins, R. (2007).
Impact of maternal substance use during pregnancy on childhood outcome. Seminars in Fetal Neonatal Medicine,
12(2), 143-150.
The impact of maternal substance abuse is reflected in the 2002-2003 National Survey on Drug Use and Health.
Among pregnant women in the 15-44 age group, 4.3%, 18% and 9.8% used illicit drugs, tobacco and alcohol, respectively.
Maternal pregnancy complications following substance use include increases in sexually transmitted disorders, placental abruption
and HIV-positive status. Effects on the neonate include a decrease in growth parameters and increases in central nervous system
and autonomic nervous system signs and in referrals to child protective agencies. In childhood, behavioral and cognitive effects
are seen after prenatal cocaine exposure; tobacco and alcohol have separate and specific effects. The ongoing use of alcohol
and tobacco by the caretaker affects childhood behavior. Therefore, efforts should be made to prevent and treat behavioral
problems as well as to limit the onset of drug use by adolescent children born to women who use drugs during pregnancy.
Sun, A-P. (2004). Principles for practice with substance-abusing
pregnant women: A framework based on the five social work intervention roles.
Social Work, 49(3), 383-394.
The author discusses components essential to pregnancy-specific
substance abuse treatment, based on a review of the literature. Elements and
issues related to substance abuse during pregnancy are identified under the
five social work intervention roles: teacher, broker, clinician, mediator,
and advocate. These five roles are used as a framework and integrate relevant
literature. The concepts and approaches presented in this article can be applied
by social workers in residential or outpatient substance abuse treatment programs;
hospital prenatal, labor, and delivery units; the child welfare system; public
health districts; or community family service centers.
Worley, L.L.M., Conners, N.A., Crone, C.C., Williams, V.L.,
& Bokony, P.A. (2005). Building a residential treatment program for dually
diagnosed women with their children. Archives of Women's Mental Health,
8(2), 105-111.
The epidemic of drug and alcohol abuse in our nation impacts millions of women,
mothers, and children. Addicted mothers with complex problems and numerous
co-morbidities present unique treatment challenges. This intergenerational
cycle of abuse and addiction is difficult to stop. Arkansas CARES (Center
for Addictions Research Education and Services, referred to in this article
as CARES) initially was created to treat addicted pregnant and postpartum
women and their infants. CARES evolved into a residential treatment program
for dually diagnosed mothers with their children. The purpose of this study
is to share a glimpse inside the treatment program and lessons learned along
the way in an effort to assist others who are interested in building treatment
programs for addicted women with their children.
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12. Prevalence
Duran, B., Malcoe, L.H., Sanders, M., Waitzkin, H., Skipper,
B., & Yager, J. (2004). Child maltreatment prevalence and mental disorders
outcomes among American Indian women in primary care. Child Abuse Neglect,
28(2), 131-145.
The prevalence of child maltreatment among American Indian
families and communities is not well documented, nor is the effect of maltreatment
on the mental health of individuals as they grow into adulthood. Understanding
the extent and nature of exposure to child maltreatment among American Indian
women presenting for primary care is important, and contributes directly to
treatment availability and options for patients reporting mental health problems.
The purpose of this study was to examine the prevalence, types, and severity
of child abuse and neglect, and study the relationship between child abuse
and neglect and lifetime psychiatric disorders among 234 American Indian women
using primary care services. Approximately three-quarters of respondents reported
some type of childhood abuse or neglect; over 40% reported exposure to severe
maltreatment. Severity of child maltreatment was associated in a dose response
manner with lifetime diagnosis of mental disorders. Severe child maltreatment
was strongly associated with lifetime PTSD, and was moderately associated
with lifetime substance use disorders, mood disorders, and with two or more
disorders. Child abuse and neglect was common in our sample of American Indian
women in primary care and was positively associated with lifetime psychiatric
disorders outcomes. Screening for abuse and neglect and psychiatric disorders
would enhance the treatment of patients seeking primary care services. Primary
prevention of child maltreatment might reduce the high prevalence of mental
disorders among American Indian women. These findings also confirm the importance
of increasing funds and other resources for observation, primary prevention
and treatment programs, and research of child abuse and neglect in American
Indian populations.
Office of Applied Studies (2003, June). The NHSDA report:
Children living with substance-abusing or substance-dependent parents.
Rockville,
