KAP Keys Based on TIP 36 

Substance Abuse Treatment for Persons With 

Child Abuse and Neglect Issues 

CSAT’s 

Knowledge Application Program 

KAP Keys 

For Clinicians 

Based on TIP 36 

Substance Abuse Treatment 

for Persons With Child 

Abuse and 

Neglect Issues 
KAP Keys Based on TIP 36

Substance Abuse Treatment for Persons With 

Child Abuse and Neglect Issues

Introduction 

These KAP Keys were developed to accompany the Treatment 

Improvement Protocol (TIP) Series published by the Center for 

Substance Abuse Treatment (CSAT), Substance Abuse and 

Mental Health Services Administration. These KAP Keys are 

based entirely on TIP 36 and are designed to meet the needs 

of the busy clinician for concise, easily accessed “how-to” 

information. 

For more information on the topics in these KAP Keys, see TIP 36. 

Other Treatment Improvement Protocols that 

are relevant to these KAP Keys: 

TIP 25, Substance Abuse Treatment and Domestic Violence 

(1997) (SMA) 12-4076 

TIP 27, Comprehensive Case Management for Substance 

Abuse Treatment (1998) (SMA) 12-4215 

TIP 42, Substance Abuse Treatment for Persons With 

Co-Occurring Disorders (2005) (SMA) 08-3992 
KAP Keys Based on TIP 36

Substance Abuse Treatment for Persons With 

Child Abuse and Neglect Issues

Symptoms/Syndromes Associated 

With Childhood Abuse and Neglect 

Common 

 Excessive feelings of 

– Helplessness 

– Low self-esteem 

– Guilt 

– Shame 

– Anxiety 

– Depression 

– Anger 

 Suicidal behavior 

 Posttraumatic stress disorders 

 Substance abuse disorders 

 Difficulty in close or intimate relationships 

Less Common 

 Symptoms of dissociation 

 Dissociative (traumatic) amnesia 

 Dissociative identity disorder 

 Borderline personality disorder 

 Antisocial personality disorder 

 Somatization 

 Compulsive/indiscriminate sexual activity 

 Bingeing, chronic overeating, eating disorders 

 Self-mutilation or other self-harm 
KAP Keys Based on TIP 36

Substance Abuse Treatment for Persons With 

Child Abuse and Neglect Issues

2

Screening Questions: Detecting a 

History of Childhood Abuse or Neglect 

The following questions can be used to help screen for a history 

of childhood abuse or neglect. They can be asked as written, 

or they can be asked in relation to developmental stages. To 

do so, ask the same question with an introductory phrase that 

reflects different time periods or developmental stages. For 

example, the question “Were you treated harshly as a child?” 

can be rephrased as, “When you were 5 to 10 years old...” or 

“When you were 11 to 15 years old....” 

Screening Questions 

1. Were there any significant traumatic events in your 

family while you were growing up? For example, did 

any of the following events occur in your family: 

– Death? 

– Prolonged hospitalization of a parent/sibling? 

– Incarceration of a parent or sibling? 

– Divorce? 

– A chronic disease? 

2. Were you treated harshly as a child? 

3. Did you ever experience physical abuse as a child? 

4. Did you ever experience sexual abuse as a child? 

5. Did you ever experience emotional abuse as a child? 

6. Did you experience inappropriate physical or 

sexual contact with an adult or person at least 

5 years older than you while you were growing up? 

7. When you were a child, was there violence in your 

household, such as battering involving siblings or 

a parent and his or her partner? 

8. Do you feel that your parents neglected you while 

you were growing up? 

Continued on next page 
KAP Keys Based on TIP 36

Substance Abuse Treatment for Persons With 

Child Abuse and Neglect Issues

3

 9. Were there ever periods during which you did not have 

adequate food, clothing, shelter, or protection? 

10. Did your parents use alcohol or drugs frequently when 

you were growing up? 

11. Did you ever use alcohol or drugs with them? 

12. Have you or has anyone in your family ever been 

involved with the children’s protective system? 

13. Did you ever live away from your parents? 

14. Were you or your siblings ever in foster care? 

15. When you were a child, were there any periods when 

you felt unsafe or in danger? 

16. When you were growing up, did anyone in your family 

use alcohol or drugs? How did his or her alcohol or 

drug use affect you as a child? 

17. Have you ever felt that abuse or neglect was justified 

based on your misbehavior or shortcomings? 

18. Did you feel that the abuse was your fault and that 

you deserved it? 

Adapted from TIP 36, Substance Abuse Treatment for Persons 

With Child Abuse and Neglect Issues, page 24. 

Screening Questions: Detecting a 

History of Childhood Abuse or Neglect 
KAP Keys Based on TIP 36

Substance Abuse Treatment for Persons With 

Child Abuse and Neglect Issues

4

Behavioral Clues 

The following behavior may indicate that a parent or caregiver 

is abusing or neglecting children: 

 Name calling or negative or belittling labeling of children. 

 Telling stories that suggest children are living in unsafe 

conditions (e.g., being left alone, traveling in unsafe 

neighborhoods). 

 Blaming children or directing misplaced anger at them that 

may mask guilt about poor parenting. 

 Inappropriately describing children in terms of their 

development (e.g., having expectations for a 4-year-old 

that should be reserved for a 12-year-old). 

 Giving children too many responsibilities and too much 

autonomy for their age. 

 Sexualizing the child. 

 Imposing inappropriate disciplinary measures: an 

inability to distinguish between discipline (guiding) 

and punishment (hurting). 

Adapted from TIP 36, Substance Abuse Treatment for Persons With 

Child Abuse and Neglect Issues, page 80. 
KAP Keys Based on TIP 36

Substance Abuse Treatment for Persons With 

Child Abuse and Neglect Issues

5

What Children’s Protective 

Services Agencies Should Do 

 Respond to reports of child abuse and neglect, and 

identify children who are being maltreated or at risk for 

maltreatment. 

 Assess the situation—the safety of the child or children, the 

risk of further maltreatment, the resources and needs of the 

parents and extended families, and their willingness and 

motivation to receive help. 

 Assemble the resources and services needed to support the 

family and protect the children. 

 Provide settings for alternative or substitute care for children 

who cannot safely remain at home. 

 Evaluate progress and assess the need for further attention 

by children’s protective services. 

Adapted from TIP 36, Substance Abuse Treatment for Persons With 

Child Abuse and Neglect Issues, page 88. 
KAP Keys Based on TIP 36 

Substance Abuse Treatment for Persons With 

Child Abuse and Neglect Issues 

Ordering Information 

TIP 36 

Substance Abuse Treatment for Persons 

With Child Abuse and Neglect Issues 

Three Ways to Obtain FREE Copies 

of All TIPs Products: 

1. Call SAMHSA: 1-877-SAMHSA-7 (1-877-726-4727) 

(English and Español) 

2. Visit SAMHSA’s Publications Ordering Web page at 

http://store.samhsa.gov 

3. Access TIPs online: http://kap.samhsa.gov 

Do not reproduce or distribute this publication for a fee 

without specific, written authorization from the Office of 

Communications, Substance Abuse and Mental Health 

Services Administration, U.S. Department of Health and 

Human Services. 

HHS Publication No. (SMA) 12-3605 

First printed 2001 

Revised 2008, 2011, and 2012