Children’s Bureau/ACYF/ACF/HHS

800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov

Parental Substance Use and 

the Child Welfare System

BULLETIN FOR 

PROFESSIONALS

October 2014

WHAT’S INSIDE

The relationship 

between substance 

use disorders and child 

maltreatment

The impact of parental 

substance use on 

children

Child welfare laws 

related to parental 

substance use

Service delivery 

challenges

Innovative prevention 

and treatment 

approaches

Promising child welfare 

casework practices

Systems change and 

collaboration

Grant programs

Resources for further 

information

Many families receiving child welfare services are 

affected by parental substance use. Identifying 

substance abuse and meeting the complex needs 

of parents with substance use disorders and those 

of their children can be challenging. Over the 

past two decades, innovative approaches coupled 

with new research and program evaluation 

have helped point to new directions for more 

effective, collaborative, and holistic service 

delivery to support both parents and children. 

This bulletin provides child welfare workers 

and related professionals with information on 

the intersection of substance use disorders and 

child maltreatment and describes strategies for 

prevention, intervention, and treatment, including 

examples of effective programs and practices.
Parental Substance Use and the Child Welfare System https://www.childwelfare.gov

2

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The Relationship Between Substance 

Use Disorders and Child Maltreatment

It is difficult to provide precise, current statistics on the 

number of families in child welfare affected by parental 

substance use or dependency since there is no ongoing, 

standardized, national data collection on the topic. 

In a 1999 report to Congress, the U.S. Department of 

Health and Human Services (HHS) reported that studies 

showed that between one-third and two-thirds of child 

maltreatment cases were affected by substance use to 

some degree (HHS, 1999). More recent research reviews 

suggest that the range may be even wider (Barth, 

2009; Traube, 2012). The variation in estimates may be 

attributable, in part, to differences in the populations 

studied and the type of child welfare involvement 

(e.g., reports, substantiation, out-of-home placement); 

differences in how substance use (or substance abuse or 

substance use disorder) is defined and measured; and 

variations in State and local child welfare policies and 

practices for case documentation of substance abuse.

Children of Parents With Substance Use 

Disorders

An estimated 12 percent of children in this country live 

with a parent who is dependent on or abuses alcohol 

or other drugs (HHS, Substance Abuse and Mental 

Health Services Administration [SAMHSA], Office of 

Applied Studies, 2009). Based on data from the period 

2002 to 2007, the National Survey on Drug Use and 

Health (NSDUH) reported that 8.3 million children 

under 18 years of age lived with at least one substancedependent or substance-abusing parent.1

 Of these 

children, approximately 7.3 million lived with a parent 

who was dependent on or abused alcohol, and about 

2.2 million lived with a parent who was dependent on or 

abused illicit drugs. While many of these children will not 

experience abuse or neglect, they are at increased risk for 

maltreatment and entering the child welfare system. 

1 NSDUH is an annual SAMHSA survey of a representative sample of the 

national population. It defines dependence and abuse using criteria specified 

in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which 

includes symptoms such as withdrawal, tolerance, use in dangerous situations, 

trouble with the law, and interference in major obligations at work, school, or 

home over the past year. The most recent data analyzed related to children of 

substance abusing or dependent parents are from the 2002 to 2007 surveys.

For more than 400,000 infants each year (about 10 percent 

of all births), substance exposure begins prenatally (Young 

et al., 2009). State and local surveys have documented 

prenatal substance use as high as 30 percent in some 

populations (Chasnoff, 2010). Based on NSDUH data from 

2011 and 2012, approximately 5.9 percent of pregnant 

women aged 15 to 44 were current illicit drug users. 

Younger pregnant women generally reported the greatest 

substance use, with rates approaching 18.3 percent 

among 15- to 17-year-olds. Among pregnant women aged 

15 to 44 years old, about 8.5 percent reported current 

alcohol use, 2.7 percent reported binge drinking, and .3 

percent reported heavy drinking (HHS SAMHSA, 2013a). 

Parental Substance Abuse as a Risk Factor 

for Maltreatment and Child Welfare 

Involvement

Parental substance abuse is recognized as a risk factor 

for child maltreatment and child welfare involvement 

(Institute of Medicine and National Research Council, 

2013). Research shows that children with parents who 

abuse alcohol or drugs are more likely to experience 

abuse or neglect than children in other households (Dube 

et al., 2001; Hanson et al., 2006). One longitudinal study 

(Dubowitz et al., 2011) identified parental substance abuse 

(specifically, maternal drug use) as one of five key factors 

that predicted a report to child protective services (CPS) 

for abuse or neglect. Once a report is substantiated, 

children of parents with substance use issues are more 

likely to be placed in out-of-home care and more likely to 

stay in care longer than other children (Barth, Gibbons, 

& Guo, 2006; HHS, 1999). The National Survey of Child 

and Adolescent Well-Being (NSCAW) estimates that 61 

percent of infants and 41 percent of older children in outof-home care are from families with active alcohol or drug 

abuse (Wulczyn, Ernst, & Fisher, 2011).

According to data in the Adoption and Foster Care 

Analysis and Reporting System (AFCARS), parental 

substance abuse is frequently reported as a reason for 

removal, particularly in combination with neglect (Correia, 

2013). For almost 31 percent of all children placed in 

foster care in 2012, parental alcohol or drug use was the 

documented reason for removal, and in several States 
Parental Substance Use and the Child Welfare System https://www.childwelfare.gov

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that percentage surpassed 60 percent (National Data 

Archive on Child Abuse and Neglect, 2012). Nevertheless, 

many caregivers whose children remain at home after an 

investigation also have substance abuse issues. NSCAW 

found that the need for substance abuse services among 

in-home caregivers receiving child welfare services was 

substantially higher than that of adults nationwide (29 

percent as compared with 20 percent, respectively, for 

parents ages 18 to 25, and 29 percent versus 7 percent for 

parents over age 26) (Wilson, Dolan, Smith, Casanueva, & 

Ringeisen, 2012). 

Role of Co-occurring Issues

While the link between substance abuse and child 

maltreatment is well documented, it is not clear how 

much is a direct causal connection and how much can 

be attributed to other co-occurring issues. National data 

reveal that slightly more than one-third of adults with 

substance use disorders have a co-occurring mental 

illness (HHS SAMHSA, 2013b). Research on women 

with substance abuse problems shows high rates of 

posttraumatic stress disorder (PTSD), most commonly 

stemming from a history of childhood physical and/

or sexual assault (Najavits, Weiss, & Shaw, 1997). Many 

parents with substance abuse problems also experience 

social isolation, poverty, unstable housing, and domestic 

violence. These co-occurring issues may contribute 

to both the substance use and the child maltreatment 

(Testa & Smith, 2009). Evidence increasingly points to 

a critical role of stress and reactions within the brain to 

stress, which can lead to both drug-seeking activity and 

inappropriate caregiving (Chaplin & Sinha, 2013).

Impact of Parental Substance Use on 

Children

The way parents with substance use disorders behave 

and interact with their children can have a multifaceted 

impact on the children. The effects can be both indirect 

(e.g., through a chaotic living environment) and direct 

(e.g., physical or sexual abuse). Parental substance use 

can affect parenting, prenatal development, and early 

childhood and adolescent development. It is important 

to recognize, however, that not all children of parents with 

substance use issues will suffer abuse, neglect, or other 

negative outcomes.

Parenting

A parent’s substance use disorder may affect his or her 

ability to function effectively in a parental role. Ineffective 

or inconsistent parenting can be due to the following:

 Physical or mental impairments caused by alcohol or 

other drugs

 Reduced capacity to respond to a child’s cues and 

needs

 Difficulties regulating emotions and controlling anger 

and impulsivity 

 Disruptions in healthy parent-child attachment 

 Spending limited funds on alcohol and drugs rather 

than food or other household needs

 Spending time seeking out, manufacturing, or using 

alcohol or other drugs

 Incarceration, which can result in inadequate or 

inappropriate supervision for children

 Estrangement from family and other social supports

Family life for children with one or both parents that abuse 

drugs or alcohol often can be chaotic and unpredictable. 

Children’s basic needs—including nutrition, supervision, 

and nurturing—may go unmet, which can result in 

neglect. These families often experience a number 

of other problems—such as mental illness, domestic 

violence, unemployment, and housing instability—that 

also affect parenting and contribute to high levels of 

stress (National Abandoned Infants Assistance Resource 

Center [AIA], 2012). A parent with a substance abuse 

disorder may be unable to regulate stress and other 

emotions, which can lead to impulsive and reactive 

behavior that may escalate to physical abuse (Chaplin & 

Sinha, 2013).

Different substances may have different effects on 

parenting and safety (Testa & Smith, 2009). For example, 

the threats to a child of a parent who becomes sedated 

and inattentive after drinking excessively differ from 

the threats posed by a parent who exhibits aggressive 

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side effects from methamphetamine use. Dangers may 

be posed not only from use of illegal drugs, but also, 

and increasingly, from abuse of prescription drugs (pain 

relievers, anti-anxiety medicines, and sleeping pills). (For 

more information on effects of various substances, see 

http://www.drugabuse.gov/drugs-abuse/commonlyabused-drugs/health-effects.) Polysubstance use (multiple 

drugs) may make it difficult to determine the specific and 

compounded effects on any individual. Further, risks for 

the child’s safety may differ depending upon the level and 

severity of parental substance use and associated adverse 

effects.2

Prenatal and Infant Development

The effects of parental substance use disorders on a child 

can begin before the child is born. Maternal drug and 

alcohol use during pregnancy have been associated with 

premature birth, low birth weight, slowed growth, and a 

variety of physical, emotional, behavioral, and cognitive 

problems (AIA, 2012; National Institute on Drug Abuse 

[NIDA], 2011). Research suggests powerful effects of legal 

drugs, such as tobacco, as well as illegal drugs on prenatal 

and early childhood development (HHS SAMHSA, 2014). 

Fetal alcohol spectrum disorders (FASD) are a set of 

conditions that affect an estimated 40,000 infants 

born each year to mothers who drank alcohol during 

pregnancy (Prevention First, n.d.). Children with FASD may 

experience mild to severe physical, mental, behavioral, 

and/or learning disabilities, some of which may have 

lifelong implications (e.g., brain damage, physical defects, 

attention deficits) (National Organization on Fetal Alcohol 

Syndrome, 2012). In addition, increasing numbers of 

newborns—approximately 3 per 1,000 hospital births 

each year—are affected by neonatal abstinence syndrome 

(NAS), a group of problems that occur in a newborn who 

was exposed prenatally to addictive illegal or prescription 

drugs (Patrick et al., 2012).

The full impact of prenatal substance exposure depends 

on a number of factors. These include the frequency, 

2 The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition

(DSM-5) states that substance use disorders are measured on a continuum 

from mild to severe determined by the presence of adverse effects associated 

with substance use. For more information on the DSM-5 classification of 

substance-related disorders, see http://www.psychiatry.org/dsm5.

timing, and type of substances used by pregnant women; 

co-occurring environmental deficiencies; and the extent 

of prenatal care (AIA, 2012). Research suggests that some 

of the negative outcomes of prenatal exposure can be 

improved by supportive home environments and positive 

parenting practices (NIDA, 2011). 

Child and Adolescent Development

Children and youth of parents who use or abuse 

substances and have parenting difficulties have an 

increased chance of experiencing a variety of negative 

outcomes (Felitti et al., 1998; HHS, 1999; Staton-Tindall et 

al., 2013):

 Poor cognitive, social, and emotional development

 Depression, anxiety, and other trauma and mental 

health symptoms

 Physical and health issues

 Substance use problems

Parental substance use can affect the well-being of 

children and youth in complex ways. For example, an 

infant who receives inconsistent care and nurturing 

from a parent engaged in addiction-related behaviors 

may suffer from attachment difficulties that can then 

interfere with the growing child’s emotional development. 

Adolescent children of parents with substance use 

disorders, particularly those who have experienced child 

maltreatment and foster care, may turn to substances 

themselves as a coping mechanism. In addition, children 

of parents with substance use issues are more likely 

to experience trauma and its effects, which include 

difficulties with concentration and learning, controlling 

physical and emotional responses to stress, and forming 

trusting relationships (Staton-Tindall et al., 2013).

Child Welfare Laws Related to Parental 

Substance Use

In response to concerns over the potential negative 

impact on children of parental substance abuse and 

illegal drug-related activities, approximately 47 States and 

the District of Columbia have child protection laws that 

address some aspect of parental substance use. Some 

States have expanded their civil definitions of child abuse 

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and neglect to include a caregiver’s use of a controlled 

substance that impairs the ability to adequately care for 

a child and/or exposure of a child to illegal drug activity 

(e.g., sale or distribution of drugs, home-based meth 

labs). Exposure of children to illegal drug activity is also 

addressed in 33 States’ criminal statutes (Child Welfare 

Information Gateway, 2012). (For information on different 

States’ statutes, visit https://www.childwelfare.gov/

systemwide/laws_policies/statutes/drugexposed.cfm.)

Federal and State laws also address prenatal drug 

exposure. The Child Abuse Prevention and Treatment 

Act (CAPTA) requires States receiving CAPTA funds to 

have policies and procedures for health-care personnel 

to notify CPS of substance-exposed newborns and to 

develop procedures for safe care of affected infants. As 

yet, there are no national data on CAPTA-related reports 

for substance-exposed newborns. In some State statutes, 

substance abuse during pregnancy is considered child 

abuse and/or grounds for termination of parental rights. 

State statutes and State and local policies vary widely in 

their requirements for reporting suspected prenatal drug 

abuse, testing for drug exposure, CPS response, forced 

admission to treatment of pregnant women who use 

drugs, and priority access for pregnant women to Statefunded treatment programs (Guttmacher Institute, 2014). 

Service Delivery Challenges

Despite the fact that a large percentage of parents 

who are investigated in child protection cases require 

treatment for alcohol or drug dependence, the 

percentage of parents who actually receive services 

is limited, compared to the need. Also, many parents 

who begin treatment do not complete it (Traube, 2012). 

Historically, insufficient collaboration has hindered the 

ability of child welfare, substance abuse treatment, and 

family/dependency court systems to support these 

families.

Child welfare agencies face a number of difficulties 

in serving children and families affected by parental 

substance use disorders, including:

 Insufficient service availability or scope of services to 

meet existing needs

 Inadequate funds for services and/or dependence on 

client insurance coverage

 Difficulties in engaging and retaining parents in 

treatment

 Knowledge gaps among child welfare workers to 

meet the comprehensive needs of families with 

substance use issues

 Lack of coordination between the child welfare 

system and other services and systems, including 

hospitals that may screen for drug exposure, treatment 

agencies, mental health services, criminal justice 

system, and family/dependency courts

 Differences in perspectives and timeframes,

reflecting different guiding policies, philosophies, and 

goals in child welfare and substance abuse treatment 

systems (for example, a focus on the safety and wellbeing of the child without sufficient focus on parents’ 

recovery)

A critical challenge for child welfare professionals 

is meeting legislative requirements regarding child 

permanency while allowing for sufficient progress in 

substance abuse recovery and development of parenting 

capacity. The Adoption and Safe Families Act (ASFA) 

requires that a child welfare agency file a petition for 

termination of parental rights if a child has been in 

foster care for 15 of the past 22 months, unless it is not 

in the best interest of the child. Many agencies struggle 

with adhering to this timeframe due to problems with 

accessing substance abuse services in a timely manner. In 

addition, treatment may take many months (often longer 

than the ASFA timeline allows), and achieving sufficient 

stability to care for children may take even longer. 

Addressing addiction can require extended recovery 

periods, and relapses can occur. 

Innovative Prevention and Treatment 

Approaches

While parental substance abuse continues to be a major 

challenge in child welfare, the past two decades have 

witnessed some new and more effective approaches 

and innovative programs to address child protection 

for families where substance abuse is an issue. Some 

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examples of promising and innovative prevention and 

treatment approaches include the following:

Promotion of protective factors, such as social 

connections, concrete supports, and parenting 

knowledge, to support families and buffer risks 

Early identification of at-risk families in substance 

abuse treatment programs and through expanded 

prenatal screening initiatives so that prevention services 

can be provided to promote child safety and well-being in 

the home

Priority and timely access to substance abuse treatment 

slots for mothers involved in the child welfare system

Gender-sensitive treatment and support services 

that respond to the specific needs, characteristics, and 

co-occurring issues of women who have substance use 

disorders

Family-centered treatment services, including inpatient 

treatment for mothers in facilities where they can have 

their children with them and programs that provide 

services to each family member 

Recovery coaches or mentoring of parents to support 

treatment, recovery, and parenting 

Shared family care in which a family experiencing 

parental substance use and child maltreatment is placed 

with a host family for support and mentoring

Find more information on specific programs and service 

models:

 National Center on Substance Abuse and Child 

Welfare (NCSACW), Regional Partnership Grant 

(RPG) Program: Overview of Grantees’ Services and 

Interventions 

https://www.ncsacw.samhsa.gov/files/RPG_Program_

Brief_2_Services_508_reduced.pdf

 NRC for In-Home Services, In-Home Programs for Drug 

Affected Families

https://www.nrc-ihs.org/sites/default/files/

drugaffectedmemo.pdf

 SAMHSA’s National Registry of Evidence-Based 

Programs and Practices 

http://www.nrepp.samhsa.gov/

Program Highlight: Illinois 

Recovery Coaches 

As part of Illinois’ title IV-E waiver demonstration, 

recovery coaches provide intensive outreach 

and engagement services for families whose 

children have been placed in foster care due to 

parental substance abuse and maltreatment. 

Recovery coaches work with parents, child 

welfare caseworkers, and treatment agencies to 

remove barriers to treatment, engage parents 

in treatment, and provide ongoing support 

following reunification. An experimental 

evaluation (Ryan and Huang, 2012) found that, 

compared to families who received standard 

services, parents working with recovery coaches 

were more likely to access substance abuse 

treatment and did so more quickly. In addition, 

they achieved safe family reunification and 

reduced the length of time children spent in 

out-of-home care. Enhanced services to address 

co-occurring issues were found to be particularly 

important. (See http://cfrc.illinois.edu/pubs/

rp_20120701_IllinoisAODAIV-EWaiverDemonstrati

onFinalEvaluationReport.pdf.)

Promising Child Welfare Casework 

Practices

In working with families affected by substance abuse, 

child welfare workers can use a variety of strategies to 

help meet parents’ needs while also promoting safety, 

permanency, and well-being of their children. To begin, 

workers need to build their understanding of parental 

substance use issues, its signs, the effects on parenting 

and child safety, and what to expect during a parent’s 

treatment and recovery. Specific casework practice 

strategies reflect:
Parental Substance Use and the Child Welfare System https://www.childwelfare.gov

7

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Family engagement. Engagement strategies that help 

motivate parents to enter and remain in substance abuse 

services are critical to enhancing treatment outcomes 

(Wisdom, Pollock, & Hopping-Winn, 2011). An essential 

part of this process is partnering with parents to develop 

plans that address individual needs, such as a woman’s 

own trauma history, as well as needs for support 

services like child care and transportation. Child welfare 

workers can help create supportive environments, build 

nonjudgmental relationships, and implement evidencebased motivational approaches, such as motivational 

interviewing.3

Routine screening and assessment. Screening family 

members for possible substance use disorders with the 

use of brief, validated, and culturally appropriate tools 

should be a routine part of child welfare investigation and 

case monitoring. Once a substance use issue has been 

identified through screening, alcohol and drug treatment 

providers can conduct more indepth assessments of 

its nature and extent, the impact on the child, and 

recommended treatment. Find more information on 

screening tools and collaborative strategies: 

 Screening and Assessment for Family Engagement, 

Retention and Recovery at http://www.ncsacw.samhsa.

gov/files/SAFERR.pdf

 Protecting Children in Families Affected by Substance 

Use Disorders at https://www.childwelfare.gov/pubs/

usermanuals/substanceuse/chapterfour.cfm

Individualized treatment and case plans. Caseworkers 

can help match parents with evidence-based treatment 

programs and support services that meet their specific 

needs. Working collaboratively with families, alcohol and 

drug treatment professionals, and the courts, caseworkers 

can help develop and coordinate case and treatment 

plans. 

Support of parents in treatment and recovery. Child 

welfare workers can support parents in their efforts to 

build coping and parenting skills, help them pay attention 

3 For general information about motivational interviewing, visit http://

motivationalinterview.org/; see also the Rocky Mountain Quality Improvement 

Center’s Pre-Treatment Program Curriculum Guide: Motivational Interviewing

at http://www.americanhumane.org/assets/pdfs/children/pc-rmqic-ptp-guide.

pdf.

to triggers for substance-using behaviors, and work 

collaboratively on safety plans to protect children during a 

potential relapse (Breshears, Yeh, & Young, 2009). Workers 

also can help coordinate services, make formal and 

informal connections, and encourage parents in looking 

forward to their role as caregivers (DiLorenzo, 2013). 

Providing services for children of parents with 

substance use issues. Given the developmental and 

emotional effects of parental substance abuse on children 

and youth in child welfare, it is important that child 

welfare workers collaborate with behavioral/mental health 

professionals to conduct screenings and assessments and 

link children and youth to appropriate, evidence-based 

services that promote wellness. Individualized services 

should address the child or youth’s strengths and needs, 

trauma symptoms, effects associated with prenatal or 

postnatal exposure to parental substance use, and risk for 

developing substance use disorders themselves.

Permanency planning. ASFA and treatment timeframes 

become significant considerations in permanency plans 

and reunification goals in families affected by substance 

abuse. Concurrent planning, in which an alternative 

permanency plan is pursued at the same time as the 

reunification plan, can play an important part in ensuring 

that children achieve permanency in a timely manner. 

For instance, guardianship by a relative or adoption by 

foster parents might be the concurrent goal if family 

reunification is not viable. (For more information, read 

Information Gateway’s Concurrent Planning: What the 

Evidence Shows at https://www.childwelfare.gov/pubs/

issue_briefs/concurrent_evidence/.)

For child welfare training and other resources related 

to improving the safety, permanency, well-being, and 

recovery outcomes for children and families, visit the 

NCSACW website at https://www.ncsacw.samhsa.gov.

Systems Change and Collaboration

Since the late 1990s, systems-level collaboration and 

service integration strategies have been increasingly 

implemented to coordinate services from child welfare, 

treatment, dependency courts, and other service systems 

for families affected by substance use. Communication 
Parental Substance Use and the Child Welfare System https://www.childwelfare.gov

8

and active collaboration across systems help ensure 

that parents in need of substance abuse treatment 

are identified and receive appropriate treatment in a 

timely manner, while children’s intervention needs are 

also addressed. To meet complex needs, collaborative 

practice provides access to a wider array of resources 

than is traditionally available from an individual system 

(Children and Family Futures, 2011). Collaborative and 

integrated strategies have shown promising results—

women remain in treatment longer, are more likely to 

reduce substance use, and are more likely to remain or 

reunite with their children (HHS, 2014; Marsh & Smith, 

2011). 

Family treatment drug courts (also known as family 

drug courts and dependency drug courts) represent a 

cross-system approach with demonstrated success. These 

courts use judicial system authority and collaborative 

partnerships to support timely substance abuse treatment 

for parents, provision of a wide range of services for 

families, and monitoring of recovery components. 

Evaluations have linked these courts with improvements 

in treatment enrollment, treatment completion, and 

family reunification (Marlowe & Carey, 2012). The following 

websites provide additional information:

 Learn more about existing family treatment drug 

court programs at https://www.ncsacw.samhsa.gov/

resources/resources-drug-courts.aspx.

 Find guidelines to develop or enhance drug court 

programs in Guidance to States: Recommendations for 

Developing Family Drug Court Guidelines, available 

from http://www.cffutures.org/files/publications/FDCGuidelines.pdf.

Examples of other cross-systems changes to overcome 

traditional “siloed” approaches include:

Cross-training of child welfare and substance abuse 

treatment professionals to build an understanding of each 

other’s systems, legal requirements (e.g., ASFA), goals, 

approaches, and shared interests

Collocation of substance abuse specialists in child 

welfare offices to assess and engage parents, provide 

services to families, and offer training and consultation 

services to child welfare workers (see Substance Abuse 

Specialists in Child Welfare Agencies and Dependency 

Courts Considerations for Program Designers and 

Evaluators, http://www.ncsacw.samhsa.gov/resources/

resources-Substance-Abuse-Specialists.aspx)

Cross-system partnerships, based on shared principles 

that ensure coordinated services through formal linkages 

(such as interagency agreements) between child welfare, 

treatment, and other community agencies

Cross-system information sharing related to screening 

and assessment results, case plans, treatment plans, and 

progress toward goals, which can support professionals 

in each system to make informed decisions, while still 

adhering to confidentiality parameters (see https://www.

ncsacw.samhsa.gov/resources/information-sharing.aspx)

Program Highlight: King County 

Family Treatment Court

Begun in 2004, Washington State’s King County 

Family Treatment Court was designed to improve 

the safety and well-being of children in child 

welfare by providing parents with access to drug 

and alcohol treatment, judicial monitoring, and 

individualized services. Program components 

include early intervention, comprehensive services 

for the entire family, and a holistic approach 

to strengthening family functioning. A quasiexperimental evaluation found that, compared to 

parents served by a regular dependency court, 

family treatment court parents entered treatment 

sooner and were more likely to successfully 

complete treatment. In addition, children in the 

family treatment court group spent less time 

in out-of-home care and were more likely to 

permanently reunite with their parents (Bruns, 

Pullman, Weathers, Wirschem, & Murphy, 2012). 

For more information, visit http://www.kingcounty.

gov/courts/JuvenileCourt/famtreat.aspx.

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Joint planning and case management to help safeguard 

against parents becoming overwhelmed by multiple and 

potentially conflicting requirements of different systems

Wraparound and comprehensive community services

that address multiple service needs of parents and 

children, including those related to parenting skills, 

mental health, health, domestic violence, housing, 

employment, income support, education, and child care

Flexible financing strategies that leverage or combine 

various funding streams to address the needs of 

substance abuse treatment for families involved in child 

welfare

Linked data systems that track progress toward shared 

system objectives and achievement of desired outcomes 

while also promoting shared accountability 

For more information on collaborative practices and tools, 

see these NCSACW resources:

 The Collaborative Practice Model for Family Recovery, 

Safety and Stability, at http://www.cffutures.org/files/

PracticeModel.pdf

 Webpages related to In-Depth Technical Assistance 

(IDTA), at https://www.ncsacw.samhsa.gov/technical/

idta.aspx

Grant Programs

The Children’s Bureau has funded several discretionary 

grant programs that support demonstration projects with 

the goal of improving outcomes for children and families 

in which one or more parents have a substance use 

problem. Recent grant programs include:

Regional Partnership Grants (RPGs) to Increase 

the Well-Being of, and to Improve the Permanency 

Outcomes for, Children Affected by Substance 

Abuse. Since 2012, 70 grants4 have been awarded to 

regional partnerships nationwide to foster cross-system 

collaboration and service integration for families with 

children who are in or at risk of entering foster care as a 

4 Authorized by the Child and Family Services Improvement Act of 2006, the 

Children’s Bureau awarded 53 first round RPGs. The Child and Family Services 

Improvement and Innovation Act of 2011 reauthorized the program (dropping 

the earlier focus on methamphetamine abuse) and enabled the funding of 17 

new second round RPGs and 2-year extensions for 8 first round grants.

result of a parent’s substance abuse. The grants address 

common challenges, such as engagement and retention 

of parents in treatment, service shortages, and conflicting 

approaches and timeframes across systems. Evaluation 

findings show evidence of enhanced collaboration and 

changed practice models, improvements in parental 

capacity to care for children, and promising results for 

safety, permanency, and child and family well-being 

(DeCerchio, Rodi, & Stedt, 2014). (For more information, 

visit https://www.ncsacw.samhsa.gov/technical/rpg-i.

aspx.)

Comprehensive Support Services for Families Affected 

by Substance Abuse and/or HIV/AIDS. Authorized by 

the Abandoned Infants Assistance Act, these grants offer 

services to support infants and young children who have 

been exposed to a dangerous drug or HIV/AIDS and 

are at risk of out-of-home placement. Services provided 

to children and their caregivers include prevention and 

early intervention services, family-based substance abuse 

treatment, child and family counseling, referrals to mental 

health services, and parenting skills training. (For more 

information, visit http://aia.berkeley.edu/aia-projects/

general-information/.)

Family Connection Grants: Comprehensive Residential 

Family Treatment Projects. Part of a larger cluster of 

demonstration grants to help reconnect family members 

with children in or at risk of entering foster care, these 

projects provide services for chemically dependent 

women, their children, extended family members, and 

partners. Services include intensive substance abuse 

treatment, mental health and health services, parenting 

skills, employment support, child care, and other services 

that support comprehensive family needs. 

In addition, a few Children’s Bureau title IV-E child 

welfare waiver demonstration projects have provided 

opportunities to develop and test innovative substance 

abuse interventions. For example, Illinois and Oregon 

have implemented mentoring and coaching programs 

for parents in child welfare in need of substance abuse 

treatment. Previous projects in Delaware and New 

Hampshire collocated substance abuse counselors within 

child welfare agencies. (For information on child welfare 

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway. 

Available online at https://www.childwelfare.gov/pubs/factsheets/parentalsubabuse.cfm
Parental Substance Use and the Child Welfare System https://www.childwelfare.gov

10

waivers, see http://www.acf.hhs.gov/sites/default/files/cb/

waiver_profiles_vol1.pdf.) 

SAMHSA also funds grant programs with the goal of 

enhancing services and improving outcomes for families 

affected by parental substance abuse. Recent programs 

include Services Grant Program for Residential 

Treatment for Pregnant and Postpartum Women and 

Grants to Expand Services to Children Affected by 

Methamphetamine in Families Participating in Family 

Treatment Drug Court (see https://www.ncsacw.samhsa.

gov/technical/cam.aspx). 

Conclusion

As new demonstration and innovation projects continue 

to be implemented, expanded, and evaluated, the field 

continues to learn more about promising and effective 

approaches to holistically address the complex needs 

of families with substance use issues. In particular, 

there is a continuing call for and movement toward 

enhanced collaboration among child welfare, substance 

abuse treatment, courts, and other systems to provide 

coordinated and comprehensive services to both children 

and their parents. Further, the use of enhanced and linked 

information systems will improve the collective ability 

to track and share the results of collaborative efforts to 

achieve better outcomes for these families and children.

Resources for Further Information

 Child Welfare Information Gateway 

https://www.childwelfare.gov/systemwide/substance/

 Children and Family Futures 

http://www.cffutures.org/

 National Abandoned Infants Assistance Resource 

Center

http://aia.berkeley.edu

 National Center on Substance Abuse and Child 

Welfare

https://www.ncsacw.samhsa.gov/

 National Institute on Drug Abuse 

http://www.nida.nih.gov

 National Registry of Evidenced-Based Programs and 

Practices

http://www.nrepp.samhsa.gov/

 Substance Abuse and Mental Health Services 

Administration 

http://www.samhsa.gov/

References

Barth, R., 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.

Barth, R. (2009). Preventing child abuse and neglect 

with parent training: Evidence and opportunities. 

Future of Children, 19(2), 95-118. Retrieved from http://

futureofchildren.org/publications/journals/journal_

details/index.xml?journalid=71

Breshears, E. M., Yeh, S., & Young, N. K. (2009). 

Understanding substance abuse and facilitating 

recovery: A guide for child welfare workers. Rockville, 

MD: Substance Abuse and Mental Health Services 

Administration. Retrieved from http://www.ncsacw.

samhsa.gov/files/UnderstandingSAGuide.pdf

Bruns, E. J., Pullmann, M. D., Weathers, E. S., 

Wirschem, M. L., & Murphy, J. K. (2012). Effects of a 

multidisciplinary family treatment drug court on child 

and family outcomes: Results of a quasi-experimental 

study. Child Maltreatment, 17(3), 218-230.

Chaplin, T. M., & Sinha, R. (2013). Stress and parental 

addiction. In N. E. Suchman, M. Pajulo, & L. C. Mayes 

(Eds.), Parenting and substance abuse: Developmental 

approaches to intervention (pp. 3–23). NY: Oxford 

University Press.

Chasnoff, I. (2010). The mystery of risk: Drugs, alcohol, 

pregnancy, and the vulnerable child. Chicago, IL: NTI 

Upstream.

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway. 

Available online at https://www.childwelfare.gov/pubs/factsheets/parentalsubabuse.cfm
Parental Substance Use and the Child Welfare System https://www.childwelfare.gov

11

Child Welfare Information Gateway. (2012). Parental drug 

use as child abuse. Washington, DC: U.S. Department 

of Health and Human Services, Children’s Bureau. 

Retrieved from https://www.childwelfare.gov/

systemwide/laws_policies/statutes/drugexposed.cfm

Children and Family Futures. (2011). The collaborative 

practice model for family recovery, safety and stability. 

Irvine, CA: Author. Retrieved from http://www.

cffutures.org/files/PracticeModel.pdf

Correia, M. (2013). Substance abuse data in child welfare. 

Casey Practice Digest: Substance Use Disorders in 

Families With Young Children. Casey Family Programs, 

Issue 5.

DeCerchio, K., Rodi, C., & Stedt, E. (2014). Regional 

Partnership Grants: Enhanced collaboration, promising 

results. Children and Family Futures, Webinar, April 16, 

2014. http://www.cffutures.org/presentations/webinars/

regional-partnership-grant-enhanced-collaborationpromising-results

DiLorenzo, P. (2013). Caregivers with substance use 

disorders: The caseworker’s role in supporting 

recovery and preventing relapse. Casey Practice 

Digest: Substance Use Disorders in Families With 

Young Children. Casey Family Programs, Issue 5. 

Dube, S. R., Anda, R. F., Felitti, V. J., Croft, J. B., Edwards, 

V. J., & Giles, W. H. (2001). Growing up with parental 

alcohol abuse: Exposure to childhood abuse, neglect, 

and household dysfunction. Child Abuse & Neglect, 

25, 1627-1640.

Dubowitz, H., Kim, J., Black, M., Weisbart, C., Semiatin, J., 

& Magder, L. (2011). Identifying children at high risk for 

a child maltreatment report. Child Abuse & Neglect, 

35(2), 96-104.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. 

F., Spitz, A .M., Edwards, V., . . . Marks, J. S. (1998). 

Relationship of childhood abuse and household 

dysfunction to many of the leading causes of death 

in adults: The Adverse Childhood Experiences (ACE) 

Study. American Journal of Preventative Medicine,14, 

245-258.

Guttmacher Institute. (2014). State policies in brief: 

Substance abuse during pregnancy. Retrieved from 

https://www.guttmacher.org/statecenter/spibs/spib_

SADP.pdf

Hanson, R. F., Self-Brown, S., Fricker-Elhai, A. E., Kilpatrick, 

D. G., Saunders, B. E., & Resnick, H. S. (2006). The 

relations between family environment and violence 

exposure among youth: Findings from the National 

Survey of Adolescents. Child Maltreatment 11(1), 3-15.

Institute of Medicine and National Research Council. 

(2013). New directions in child abuse and neglect 

research. Washington, DC: The National Academies 

Press. Retrieved from http://www.iom.edu/

Reports/2013/New-Directions-in-Child-Abuse-andNeglect-Research.aspx

Marlowe, D. B., & Carey. S. (2012). Research update 

on family drug courts. Alexandria, VA: National 

Association of Family Drug Court Professionals. 

Retrieved from http://www.nadcp.org/sites/default/

files/nadcp/Reseach%20Update%20on%20Family%20

Drug%20Courts%20-%20NADCP.pdf

Marsh, J., & Smith, B. (2011). Integrated substance abuse 

and child welfare services for women: A progress 

review. Children and Youth Services Review, 33(3): 

466-72.

Najavits, L. M., Weiss, R. D., & Shaw, S. R. (1997). The 

link between substance abuse and posttraumatic 

stress disorder in women. The American Journal on 

Addictions, 6(4), 273-283. doi: 10.1111/j.1521-0391.1997.

tb00408.x

National Abandoned Infants Assistance Resource Center 

(AIA). (2012). Research to practice brief: Supporting 

children of parents with co-occurring mental illness and 

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway. 

Available online at https://www.childwelfare.gov/pubs/factsheets/parentalsubabuse.cfm
Parental Substance Use and the Child Welfare System https://www.childwelfare.gov

12

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway. 

Available online at https://www.childwelfare.gov/pubs/factsheets/parentalsubabuse.cfm

substance abuse. Retrieved from http://aia.berkeley.

edu/media/pdf/brief_supporting_children.pdf

National Data Archive on Child Abuse and Neglect. 

(2012). Adoption and Foster Care Analysis Reporting 

System. [Data file]. Ithaca, NY: Author.

National Institute on Drug Abuse. (2011). Prenatal 

exposure to drugs of abuse. Retrieved from http://

www.drugabuse.gov/sites/default/files/prenatal.pdf

National Organization on Fetal Alcohol Syndrome. (2012). 

FASD: What everyone should know. Retrieved from 

http://www.nofas.org/wp-content/uploads/2012/10/

NOFAS-FASD-What-Everyone-Should-Know-2012.pdf

Patrick, S. W., Schumacher, R. E., Benneyworth, B. D., 

Krans, E. E., McAllister, J. M., & Davis, M. M. (2012). 

Neonatal abstinence syndrome and associated health 

care expenditures: United States, 2000-2009. Journal 

of the American Medical Association (JAMA), 307(18), 

1934-1940.

Prevention First. (n.d.). Fetal alcohol spectrum disorder 

[website]. Retrieved from https://www.prevention.org/

Resources/FASD.aspx

Ryan, J. P., & Huang, H. (2012). Illinois alcohol and other 

drug abuse (AODA) IV-E waiver demonstration. 

Final evaluation report. Urbana-Champaign, IL: 

Children and Families Research Center. Retrieved 

from http://cfrc.illinois.edu/pubs/rp_20060101_

IllinoisAODAWaiverDemonstrationFinal

EvaluationReport.pdf

Staton-Tindall, M., Sprang, G., Clark, J., Walker, R., & 

Craig, C. (2013) Caregiver substance use and child 

outcomes: A systematic review. Journal of Social Work 

Practice in the Addictions, 13(1), 6-31. 

doi:10.1080/1533256X.2013.752272 

Testa, M., & Smith, B. (2009). Prevention and drug 

treatment. Future of Children, 19(2), 147-168.

Traube, D. (2012). The missing link to child safety, 

permanency, and well-being: Addressing substance 

misuse in child welfare. Social Work Research, 36(2), 

83-87.

U.S. Department of Health and Human Services. (1999). 

Blending perspectives and building common ground: 

A report to Congress on substance abuse and child 

protection. Washington, DC: U.S. Government Printing 

Office. Retrieved from http://aspe.hhs.gov/HSP/

subabuse99/subabuse.htm

U.S. Department of Health and Human Services, 

Children’s Bureau. (2014). Targeted grants to increase 

the well-being of, and to improve the permanency 

outcomes for, children affected by methamphetamine 

or other substance abuse: Third annual report to 

Congress. Retrieved from http://www.cffutures.org/

files/RPG%20Program_Third%20Report%20to%20

Congress.pdf

U.S. Department of Health and Human Services, 

SAMHSA, Office of Applied Studies. (2009). The 

NSDUH Report: Children living with substancedepending or substance-abusing parents: 2002-2007. 

Rockville, MD: Author.

U.S. Department of Health and Human Services, 

SAMHSA. (2013a). The NSDUH report, Data spotlight: 

6.8 million adults had both mental illness and 

substance use disorder in 2011. Rockville, MD: Author. 

Retrieved from http://www.samhsa.gov/data/sites/

default/files/spot111-adults-mental-illness-substanceuse-disorder/spot111-adults-mental-illness-substanceuse-disorder.pdf

U.S. Department of Health and Human Services, 

SAMHSA. (2013b). Results from the 2012 National 

Survey on Drug Use and Health: Summary 

of national findings. Rockville, MD: Author. 

Retrieved from http://media.samhsa.gov/

data/NSDUH/2012SummNatFindDetTables/

NationalFindings/NSDUHresults2012.pdf
Parental Substance Use and the Child Welfare System https://www.childwelfare.gov

U.S. Department of Health and Human Services, 

SAMHSA. (2014). Addressing fetal alcohol spectrum 

disorders (FASD). Treatment Improvement Protocol 

(TIP) Series 58. Rockville, MD: Author. Retrieved 

from: http://store.samhsa.gov/product/TIP-58-

Addressing-Fetal-Alcohol-Spectrum-Disorders-FASD-/

SMA13-4803

Wisdom, J., Pollock, M. N., & Hopping-Winn, A. (2011). 

Service engagement and retention for women with 

substance use disorders. Berkeley, CA: National 

Abandoned Infants Assistance Resource Center. 

Wilson, E., Dolan, M., Smith, K., Casanueva, C., & 

Ringeisen, H. (2012). NSCAW child well-being spotlight: 

Caregivers of children who remain in-home after 

maltreatment need services. Washington, DC: Office 

of Planning, Research and Evaluation, U.S. Department 

of Health and Human Services. Retrieved from http://

www.acf.hhs.gov/programs/opre/resource/nscaw-iichild-well-being-spotlight-caregivers-of-children-whoremain-in

Wulczyn, F., Ernst, M., & Fisher, P. (2011). Who are the 

infants in out-of-home care? An epidemiological 

and developmental snapshot. Chicago: Chapin 

Hall at the University of Chicago. Retrieved from 

http://www.chapinhall.org/sites/default/files/

publications/06_08_11_Issue%20Brief_F_1.pdf

Young, N. K., Gardner, S., Otero, C., Dennis, K., Chang, 

R., Earle, K., & Amatetti, S. (2009). Substance-exposed 

infants: State responses to the problem. Rockville, 

MD: Substance Abuse and Mental Health Services 

Administration. Retrieved from https://www.ncsacw.

samhsa.gov/files/Substance-Exposed-Infants.pdf

Suggested citation:

Child Welfare Information Gateway. (2014). Parental 

substance use and the child welfare system. Washington, 

DC: U.S. Department of Health and Human Services, 

Children’s Bureau.

U.S. Department of Health and Human Services 

Administration for Children and Families 

Administration on Children, Youth and Families 

Children’s Bureau