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Linda M. Buskala

Writing Sample - Child abuse and neglect and substance abuse are inextricably intertwined

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 “Child abuse and neglect and substance abuse are inextricably intertwined”

(Banks & Boehm, 2001, p.1).

Problem Statement

 

The statistics are overwhelming. The conclusion of a study done by the National Center on Addiction and Substance Abuse stated, “There is no safe haven for these abused and neglected children of drug-and alcohol-abusing parents. They are the most vulnerable and endangered individuals in America” (CASA, 1999). According to the U.S. Department of Health and Human Services, 8.3 million children in this country “live with at least one parent who abuses alcohol or other drugs” (1999, p.1) .

 

A study conducted by the National Center on Addiction and Substance Abuse found that children living in a household where at least one parent abuses alcohol or other drugs were “almost three

(3) times likelier to be abused and more than four (4) times likelier to be neglected than children of parents who are not substance abusers” (CASA, 1999). The National Center on Addiction and Substance Abuse at Columbia University states that a recent study estimated out of the “$24 billion that states spent to address different aspects of substance abuse, $5.3 billion (slightly more than 20 %) goes to child welfare costs  related to substance abuse” (CASA, 1999).

 

Problem Definition

 

In families where one or both parents are involved with alcohol or drug abuse, other problems also present themselves. Difficulties such as unemployment, mental illness, dysfunctional family dynamics, and higher than normal stress are prevalent in families where there is parental alcohol and drug abuse (USDHHS, 1999). Abuse of children, who are already susceptible to physical risk from the primary affects of alcohol and drugs, find themselves in escalating risk due to these circumstances. Children, vulnerable to abuse in these situations, also lose access to essential and basic necessities such as sustenance, protection, and nurturing (USDHHS, 2003). The impact of these losses to the children is immeasurable and often invisible, for a time. The huge toll on their physical, intellectual, social, and emotional outcomes, in addition to their being at greater risk for having a substance abuse problem is well documented.

 

Other behavioral problems commonly attributed to substance abuse and child abuse, says the National Child Protection Clearinghouse, are “hyperactivity, a ‘difficult’ temperament, impaired mother-child bonding, early sexual activity, criminal or runaway behavior, poor self-esteem, poor peer relations, social isolation and social deprivation...” (1996, p.3) Sadly, statistics show that “children from substance abusing families are more likely to be placed in foster care and are more likely to remain there longer than maltreated children from non-substance abusing families” (U.S. Department of Health and Human Services, 1999, p. 2).  

 

In households with parents who abuse alcohol or drugs there are a number of issues, which affect their ability to provide a family structure and basic parental behaviors. A few of these issues include the financial resources for family necessities are spent on alcohol and drugs. Additionally, in place of spending time with their children, parents are using alcohol or drugs or spending time in pursuit of the drugs. Also, while under the influence of the alcohol or drugs, they are not available to the children either mentally or physically. (USDHHS, 2003, p.1)

                                   

According to information collected through the National Child Protection Clearinghouse, there are a number of types of child abuse that have been discovered to have a direct link to substance abuse. These have been shown to be neglect and emotional abuse, parentification, in utero and post-natal violence, sexual abuse, physical abuse, chronic neglect, and child deaths (Tomison, 1996, Types of Abuse Section, pp. 9 – 14) . In a United States National Clinical Evaluation Study, they determined that “Substance abuse was identified in 61 percent of cases classified as emotional abuse, in 58 percent of physical abuse, 53 percent of neglect cases, 50 percent of sexual abuse and 39 percent of cases classified as high risk” (Tomison, 1996, Types of Abuse Section, 2). The problem of substance abuse and child abuse crosses all race, socio-economic status and gender lines. Culture does play a role to the extent of reporting of events due to denial

 

US Department of Justice, National Institute of Justice, Bureau of Justice Statistics report states “A longitudinal study of youth showed that as the frequency and severity of maltreatment increased, there were significant increases in the frequency of subsequent offending. Almost one third of women and 14 percent of men in the nation’s jails and prisons say they were physically or sexually abused as children, in contrast to 12 to 17 percent of women and 5 to 8 percent of men in the general population” (1998).

 

Tom Swope (personal communication, February 24, 2005) from Protective Child Services reported over 75% of the cases of child abuse and sexual abuse of a child he personally worked on were linked to drugs and alcohol use. Additionally, Tom Swope (personal communication, February 24, 2005) also found that the numbers of cases of Munchausen’s by proxy where the mothers would have their child seen for ADD and/or ADHD and would press for the child to have Ritalin. It would be discovered later through disclosure by the child or someone close to the family, that the child did not have ADD/ADHD at all; the mother was using the Ritalin as her drug of choice.

According to the U. S. Department of Health and Human Services (2002), Child victims frequently require long-term health and mental health care, as well as special education services, which are estimated to cost an additional $13 million per day. For those child abuse victims who eventually become involved in juvenile delinquency and adult criminality, society must spend nearly $176 million daily to prosecute, sentence, supervise, incarcerate and treat them. Finally, the lost productivity of those who were victims of child abuse or neglect is estimated at nearly $2 million per day. Thus, the total daily cost of child abuse and neglect is estimated to be nearly $258 million, which translates to about $1,500 for every American family (USDHHS, 2002).

 

Child welfare agencies face financial and service barriers daily in order to serve these children and their families. These barriers can include treatment resources that do not meet the needs nor are at the standards required. In addition, there is insufficient training on substance abuse for the child welfare caseworkers. A great disparity exists in the time required to put parental treatment plans into place and governmental policies and regulations concerning the time children can be in temporary care. These situations are intolerable when you consider the impact on the children’s development. (USDHHS, 2003, p. 2-3)                  

 

Intake

Criteria used to determine when to perform a Child Protection Assessment include the following:

■ Third-party reports are not acceptable, child protection intake must will make every effort to

   obtain information that is first-hand before a case can be assigned.

■ Persons reporting cannot report anonymously. Anonymous reports are accepted, but in-take

   must make every effort to have the person identify themselves.

■ Child protection reports are evaluated on referrals from persons who have a personal

    relationship with the alleged victim; such as related by blood, marriage, or adoption, of

    someone who lives in the same residence. This individual may also be a day care provider,

    caretaker, or foster parent.

■ Assessments will be done when the following conditions are reported to have happened in the

    past three years by persons who have a personal relationship with this child.

 

Physical Abuse  

■ An intentional (non-accidental) act resulting in a visible injury or an injury diagnosed by a

   physician (X-ray, etc.). An injury is defined as a visible mark or swelling lasting 24 hours at a

   minimum.

■ Discipline that results in an injury .

■ Any physical injury which cannot be explained by the child's medical history.

■ Cases reported by a physician for injuries that appear to be suspicious.

■ An injury to adolescents that is over thirty days old may be screened out from CPS assessment.

(Tom Swope, Personal Communication, 2005 and Department of Children and Family Services [DCFS], 2005)

 

Substance Abuse

The issues above address only half of the problem, the child abuse; there is also the issue of substance abuse. Child protection and Department of Children and Family Services staff use a substance abuse screening instrument that was created by DCFS. Screening can take place any time there is contact with the client, including but not limited to Juvenile Court, the DCFS office, or the client's home (DCFS, 2005).

As the DCFS staff completes a screening questionnaire, they are to note their visual observations of the parents and any statements that are made by the parents or other family members. No further assessment needed if the substance abuse screen does not show a need for further assessment, the staff will:

■ Document that the screening recommended no further assessment.

■ Place a completed copy of the paperwork in the client’s file.

 

If the substance abuse screen shows a need for further assessment, the staff will

■ Document the screening and a recommendation for substance abuse assessment.

 

(Tom Swope, Personal Communication, 2005 and DCFS, 2005)

 

Assessment

According to the Department of Children and Family Services “assessment drives decision-making. We make an assessment in order to make sound, well-grounded decisions. Neither service delivery nor problem solving can be effectively done without first doing an assessment” (Department of Children and Family Services [DCFS], 2005).

Assessments are used to determine:

■ the child is safe

■ how to help needed changes

■ what the child and family need immediately

■ if the services from the Department are what is necessary

■ at what point to become involved and at what point to not be involved

■ at what point to end the Department’s involvement in the case.

 

 

(Tom Swope, Personal Communication, 2005 and Department of Children and Family Services [DCFS], 2005).

 

Treatment Planning

 

In the CPS protocol, there are various levels of treatment:

At the first and lowest level, it is determined that the family is capable of getting help and no intervention is needed.

At the second level, it is still deemed a low risk to the child by the family will use community resources for support without the involvement of DCFS.  DCFS may be involved to the extent to link the family with these resources and ensure that they get the help they need. This may occur by contacting providers; being a family advocate; and helping the family with issues of transportation.

Each level from three up to six is with greater involvement of DCFS in assisting the family with from minimal intervention to full intervention. Risk levels are determined by assessments made by DCFS staff which include observations and investigations into the families challenges and needs. Even at these levels with substance abuse as a factor, the DCFS staff is encouraging family integrity unless these contributing factors are chronic, overwhelming, and severe in nature and the staff feels that the family does not have the strength to handle them without further intervention.

At this point, the case is at a level six, which is substitute care. At this level it means that there are risks and safety issues that are beyond the family’s ability to control. A decision is made to recommend removal of the child through the Juvenile Court system. The case is then opened for “permanency services” (DCFS, 2005). 

(Tom Swope, Personal Communication, 2005 and DCFS, 2005)

Service Coordination

 

Routine/Emergency Medical CareMedical care for the parent and/or a child to assist in controlling or managing safety or risk factors. Providers - physicians, nurses, public health nurses, and visiting nurses.

Routine/Emergency Mental Health- Mental health care (outpatient) for a parent and/or a child, necessary to control or manage a safety or risk factor. Providers- mental health workers.

Routine/Emergency Alcohol or Drug Abuse Services- Inpatient or outpatient services for the treatment of alcohol or drug abuse. Providers - mental health workers and hospital care staff

In-Home Health Care- Health related service that is provided in the home of the family. Providers - home health workers, visiting nurses, and public health nurses

Day Care- approved day care program. Providers - day care workers, family day care providers, relatives/friends, volunteers, baby-sitters, and caretakers.

Respite Care- Temporary supervision/care of a child in a child care type program. Providers -respite care workers, relatives or family friends.

Basic Parenting AssistanceProvided to the parents the service is to help the parents perform basic life skills. These services are for the expressed purpose of bringing control into the family for the safety of the child. Providers - homemaker, parent aide, relative/friend, volunteer, home-based worker.

Basic Home Management/Life SkillsHelps with basic parenting skills such as feeding, bathing, basic medical care and basic physical/emotional attention and supervision. Providers - homemaker, caretakers, mentors, parent aide, relative/friend, volunteer, home-based worker.

Individual or Family Crisis Counseling – Provided to control the crisis situation that is affecting the child’s safety. Providers - mental health workers, home-based worker or parent aide.

Financial ServicesAssistance to meet child's safety needs resulting from the lack of finances. Providers - economic support workers, Section 8, Norman contractors and DHS liaison.

Housing ServicesProviding for housing that would assist the family in meeting the child’s safety needs.  Providers - housing/shelter personnel, Section 8, Norman contractors and DHS liaison.

Chore Services – Help with general household tasks that the parents are unable to do. Providers homemaker, relatives/friends, and volunteers.

Transportation ServicesProviding the transportation to the necessary appointments and services for family and members of the family. Providers - volunteers, relatives/friends, home-based worker, transportation advocate, DHS liaisons.

Food/Clothing Service - The family needs help providing the basic food and clothing. Providers - volunteers, relatives/friends, food/clothing service personnel, DHS liaison and Norman contractors.

 

(Tom Swope, personal communication, 2005 and DCFS, 2005) 

Exit Issues – Termination of services.

Planning for the termination is a part of service planning. With a plan in place, the goal is to have the family supported to reach these goals and planned termination within the parameters of the treatment plan. This would also include when the child would be discharged from foster care or other departmental custody. The department at this time puts in place any ongoing care after termination. Before the case is closed the department will or have an agency inspect and/or review all safety issues which were put into place. An interview will take place of all of those who are the family’s support network. An interview ill be done and an observation of the child away from the parents; along with a review of medical, school, social service reports. A family meeting will be held and a petition of the court for termination of the case will be filed. The last item to be done is to provide the family with a plan that will help them ensure the health, safety and welfare of the child (DCFS, 2005).

The Adoption and Safe Families Act (ASFA) enacted into law in 1997, delineates very stringent timeframes in which social workers can continue to house a child in temporary placement. ASFA, if followed to the letter of the law, states that parental rights are to be terminated if a child has been in temporary placement for fifteen (15) of the past twenty-two (22) months. This timeframe is most often insufficient time to attain parental drug and alcohol treatment; even though, there are certain mandates in place for the purposes of prioritizing women in treatment facilities who are either pregnant and/or a parent. Parents, who are honestly making an effort to get help to keep their family intact, are in many cases, defeated before they have begun (National Clearinghouse on Child Abuse and Neglect Information, 2003, p.2).

 

Summary

 

The link between substance abuse and child abuse is becoming a critical issue in the safety and welfare of our nation’s youth; but these children are not just suffering at the hands of substance-abusing parents. These children are also suffering from a lack of understanding of the magnitude of the problem, funding, and resources. Various programs that have been put into place are continuing to be reworked and refined. Much more needs to be done if we are to make any headway in this national dilemma.

 

The frustration in showing the increasing numbers of children impacted by this issue, is the lack of current data. In addition there is an obvious difficulty in providing the needed services for these families in a manner that allows the family to have any hope of reunification. As Tom Swope, retired Social Worker for CPS, related to me in a personal interview that his experience was once kids were in the foster care system for any period of time, it was almost impossible to bring the family back to wholeness and wellness. He also stated that child abuse is an invisible problem plaguing our communities. It is his opinion that a large segment of the population is caught in the cycle of abuse; but the other half of the population has no idea that this is happening or to the extent that it is occurring. He feels another component of this is that many see the problem as affecting only drug addicts and criminals... the “folks from the other side of the tracks” and therefore is something that “doesn’t affect them”. Tom said, of course, this is a fallacy; these issues can affect every socio-economic level and do. He stated that until the uninformed and complacent population becomes more involved in appealing for additional funding for agencies, governmental and others that can help these families, the problem of child abuse will only grow and worsen (Tom Swope, Personal Communication, 2005).

 

Special, innovative measures are being explored and implemented in order to counteract the huge impact of the link between substance abuse and child abuse. In order for these to be successful, there must be solid, working partnerships between responsible agencies. According to the National Clearinghouse on Child Abuse and Neglect Information (2003), a few of the measures that are being studied are:  

Stationing addition counselors in child welfare offices. Giving mothers involved in the child welfare system priority access to substance abuse treatment slots. Developing or modifying dependency drug courts to ensure treatment access and therapeutic monitoring of compliance with court orders. Developing cross-system partnerships to ensure coordinated services (e.g., formal linkages between child welfare and other community agencies to address each family’s needs). Conducting cross-system training. Developing creative approaches to fund these efforts (e.g., using State of local funds to maximize child welfare funding for substance abuse-related services or using Temporary Assistance to Needy Families (TANF) funds to purchase substance abuse treatment (p. 2-3).

 

References

 

Banks, H. & Boehm, S. (2001, September). Substance abuse and child abuse. Children’s Voice Magazine, Washington, DC: Child Welfare League of America. Retrieved February 4,

 

      2005, from http://www.cwia.org/articles/cv0109sacm.htm

Bethea, L. (1999, March). Primary prevention of child abuse. American Family Physician, 59, 1-12. Retrieved February 4, 2005, from http://www.aafp.org/afp/990315ap/1577.html

      Columbia University, New York, National Center on Addiction and Substance Abuse.(1999). CASA* releases no safe haven report. Retrieved February 22, 2005 from http://www.casacolumbia.org/absolutenm/templates/PressReleases.asp?articleid=156&zoneid=49

Department of Children and Family Services. (2005). Webresources. Retrieved

February 22, 2005 from http://dcfswebresource.prairienet.org/

National Clearinghouse on Child Abuse and Neglect Information. (2003). Substance abuse and child Maltreatment. Retrieved February 1, 2005, from http://nccanch.acf.hhs.gov

Tomison, A. M.  (1996). Child maltreatment and substance abuse. Australian Institute of Family Studies, National Child Protection Clearinghouse. Retrieved February 20, 2005, from

            http://www.aifs.gov.au/nch/discussion2.html

U.S. Department of Health and Human Services. Administration for Children and Families. 2002 Chapter 3 Victims Child Maltreatment. Retrieved January 31, 2005, from http://www.acf.hhs.gov/programs/cb/publications/cm02/chapterthree.htm

U. S. Department of Health and Human Services.  Administration for Children and Families 1999. Blending Perspectives and Building Common Ground.  A Report to Congress on  Substance Abuse and Child Protection.  Retrieved January 31, 2005, from

 http://aspe.hhs.gov/hsp/subabuse99/subabuse.htm

U.S. Department of Justice Office of Justice Programs Bureau of Justice Statistics (2005). Crime and Victims Statistics. Retrieved February 29, 2005 from http://www.ojp.usdoj.gov/bjs/cvict.htm