Integrating Substance Abuse Treatment and Child Welfare Services: Findings from the Illinois Alcohol and Other Drug Abuse Waiver Demonstration

Alcohol and other drug abuse is a major problem for children and families involved with public child welfare. Substance abuse compromises appropriate parenting practices and increases the risk of child maltreatment. A substantial proportion of substantiated child abuse and neglect reports involve parental substance abuse. Once in the system, children of substance-abusing families experience significantly longer stays in foster care and significantly lower rates of reunification. To address these problems, child welfare systems are developing service integration models that incorporate both substance abuse and child welfare services. This study provides an initial examination of the effectiveness of one service integration model that emphasizes the provision of intensive case management to link substance abuse and child welfare services. The authors used an experimental design and focused particular attention on two outcomes: access to substance abuse services and family reunification. The findings indicate that the families assigned to the experimental group used substance abuse services at a significantly higher rate and were more likely to achieve family reunification than were families in the control group. KEY WORDS: case management; families; reunification; substance abuse ********** The effective collaboration of multiple service systems to deal with parental alcohol and other drug abuse (AODA) continues to challenge government efforts to ensure family permanence and the safety and well-being of neglected and abused children. Research has documented the heavy toll that parental drug addiction exacts on families and children who come to the attention of state child protection authorities. According to Young and colleagues (1998), at least 50% of the nearly 1 million children indicated for child abuse and neglect in 1995 had caregivers who abused alcohol or other drugs. A 1994 report issued by the U.S. General Accounting Office (GAO) estimated that the percentage of foster home placements resulting in part from parental drug use rose from 52% to 78% between 1986 and 1991 in the cities of Los Angeles, New York, and Philadelphia (GAO, 1994). A 1998 GAO study of child protection systems in Los Angeles and Cook County, Illinois, documented that substance use was a problem in more than 70% of active foster care cases (GAO, 1998). If child welfare systems are to achieve desirable permanency and safety outcomes, the development of innovative service strategies and agency partnerships are necessary. Parental substance abuse often compromises appropriate parenting practices, creates problems in the parent--child relationship, and significantly increases the risk of child maltreatment (Famularo, Kincherff, & Fenton, 1992; Jaudes, Ekwo, & Van Voorhis, 1995; Kelleher, Chaffin, Hollenberg, & Fisher, 1994; Nurco, Blatchley, Hanlon, O'Grady, & McCarren, 1998). Once involved in the child welfare system, substance-abusing parents are more likely to experience subsequent allegations of maltreatment compared with non-substance-abusing parents (Smith & Testa, 2002). In addition to the increased risk of maltreatment, access to and engagement with treatment providers is often limited (Maluccio & Ainsworth, 2003). Consequently, children of substance-abusing parents remain in substitute care for significantly longer periods of time and experience significantly lower rates of family reunification relative to almost every other subgroup of families in the child welfare system (GAO, 1998). Access and Engagement Access to substance abuse treatment is limited for substance-abusing parents. Overall, in the United States approximately one-third of all individuals who need treatment receive it (Substance Abuse and Mental Health Services Administration [SAMHSA], 1997). The supply of treatment services for women with children is especially inadequate (Price, 1997). …