Enhance Collaboration Among Medical, Behavioral, and Social Services for Mothers with SUDs

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Introductory Paragraph

Collaborative practice between the dependency court, child welfare, substance use treatment, and other services systems offers a multitude of practical strategies and solutions to improve outcomes for child welfare involved families affected by substance use disorders. Collaborative practice results in a wider realm of resources to address the complex needs of families than is traditionally available through one system. Families present with complex needs that the child welfare system cannot address alone. For instance, children affected by trauma and pre-natal substance exposure often require interventions and treatment, in addition to substance abuse and mental health treatment provided to parents. Emphasis on treatment interventions and supports that focus only on children or parents separately, often result in fragmented and uncoordinated care. Collaborative policies and practices are required to provide access to family-centered interventions that can address the multiple needs of families. Evidence is now emerging that collaborative policy and practice positively influence five core outcomes, or the 5Rs, for families in the child welfare system impacted by substance use disorders [1]:

  • Recovery: Parental recovery from substance use disorders
  • Remain at Home: More children remain in the care of parents
  • Reunification: Increased number and timeliness of parent-child reunification
  • Recidivism: Decreased incidence of repeat maltreatment
  • Re-entry: Decrease in number of children re-entering out-of-home care

There are examples of successful programs as well as tools and resources in sections below.

Key Information

A multi-team and community approach best serves families impacted by substance use disorders. This includes professionals building collaborative relationships and working together across agencies and resources to improve outcomes for families. When a parent has a substance use disorder the entire family is impacted.

In 1997, the Adoption and Safe Families Act (ASFA) was enacted to address child welfare cases that lingered in the court system while parents cycled in and out of treatment. The legislation created a need to find effective responses to substance abuse and maltreatment within families. Five national reports followed addressing the co-occurring issues of parental substance abuse and child abuse and neglect [2]. These reports are:

  • Responding to Alcohol and Other Drug Problems in Child Welfare: Weaving Together Practice and Policy (Child Welfare League of America, 1998)
  • Foster Care: Agencies Face Challenges Securing Stable Homes for Children of Substance Users (U.S. General Accounting Office, September 1998)
  • No Safe Haven: Children of Substance-Abusing Parents (The National Center on Addiction and Substance Abuse at Columbia University, 1999)
  • Healing the Whole Family: A Look at Family Care Programs (Children’s Defense Fund, 1998)
  • Blending Perspectives and Building Common Ground: A Report to Congress on Substance Abuse and Child Protection (Dept. of Health and Human Services, 1999)


The National Center of Substance Abuse and Child Welfare identifies a family-centered approach. This approach includes assessing the needs and well-being of family members and addresses the family in recovery as a whole system. The family centered approach maintains a family while providing supportive services such as parenting programs, resources surrounding child development, therapeutic clinical services.[3]

Some common characteristics and principles of the family-centered approach that include collaboration among systems and agencies are:[4]

  • Family-centered treatment is comprehensive. Family-centered treatment includes clinical treatment, clinical support, and community support services addressing substance use, mental health, physical health, and developmental, as well as social, economic, and environmental needs for women and their families.
  • Women define their families. Family is inclusive of the supportive network of relatives and others whom the woman identifies as part of her family. Treatment can focus on healthy attachment and relationships between parents and children and on women’s relationships with others. Family-centered treatment helps a family function as a unit.
  • Treatment is based on the unique needs and resources of individual families. The goals, interventions, type, length, frequency, location, and method of services vary depending on the strengths and needs of the family members.
  • Families are dynamic, and thus treatment must be dynamic. Treatment must be able to address evolving and changing family engagement. Everyone may not participate at the same time, stay the same length of time, or have the same motivations.
  • Conflict is inevitable, but resolvable. Multiple crises are the norm, not the exception. Families must juggle conflicting needs and priorities and balance the needs of members.
  • Meeting complex family needs requires coordination across systems. Most families with substance use disorders participate in multiple service delivery systems (e.g., child welfare, health, criminal justice, education). Coordination and collaboration prevents conflicting objectives and provides optimal support for family members.
  • Substance use disorders are chronic, but treatable. The treatment process is not an event but rather a gradual process that moves individuals and families toward lasting recovery. Treatment includes a broad continuum of programs and strategies designed to address dependence, ameliorate adverse consequences associated with substance use, return biopsychosocial functioning and reduce/eliminate substance use. Behavioral therapies, motivational enhancements, pharmacological interventions, and case management are common elements of treatment.
  • Services must be gender responsive and specific and culturally competent. Services must be grounded in and use the knowledge and skills that fit the background of individuals and families. Gender-responsive services recognize the unique characteristics of women’s initiation of use, effects of use, histories of trauma, cooccurring mental health and physical disorders, and other treatment issues including the primacy, importance, and continuity of relationships in women’s lives. Culturally competent services are embedded in the language, values, and experiences of a client’s culture.
  • Family-centered treatment requires an array of staff professionals as well as an environment of mutual respect and shared training. Organizational cultures that encourage learning, a team approach, and consultation are necessary for diverse staff members to work together.
  • Safety comes first. Maintaining a safe environment for all family members, in all client families, is essential. Programs must have policies for addressing inappropriate behavior in children, youth, and adults and protecting confidentiality. Maintaining trauma-informed and trauma-sensitive services and treatment milieu is of paramount importance.
  • Treatment must support creation of healthy family systems. Healthy family systems include structure, appropriate roles, and good communication that allow the family to function as a unit while concurrently supporting the needs of each individual member.

Relevant Research

Children Living with Parents Who Have a Substance Use Disorder[5] Research includes data and figures of how the entire family is impacted by substance use disorder.

A Report to Congress on Substance Abuse and Child Protection This report includes research as well as sources and information surrounding Federal, State and Local policy and funding. [6]

Family-Centered Treatment for Women With Substance Use Disorder[7]

Impactful Federal, State, and Local Policies

A Report to Congress on Substance Abuse and Child Protection. This report includes research as well as sources and information surrounding Federal, State and Local policy and funding.[8]


Substance Abuse Prevention and Treatment Block Grant[9]

Medicaid benefits for alcohol and substance use Medicaid benefits also include the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) to cover both prevention and treatment services for children and adolescents younger than age 21.[10]

Funding Family-Centered Treatment for Women[11]

State-Level Policy Advocacy for Children Affected by Parental Substance Use[12]

Major Federal Legislation Concerned With Child Protection, Child Welfare, and Adoption A Fact Sheet through May 2019[13]

Available Tools & Resources

Building Collaborative Capacity Series -National Center on Substance Abuse and Child Welfare, 2021 "The National Center on Substance Abuse and Child Welfare (NCSACW) developed the Building Collaborative Capacity Series to provide states and communities with strategies to create cross-systems collaborative teams, communication protocols, and practice innovations. These strategies aim to improve screening, assessment, and engagement to best serve families affected by substance use disorders (SUDs) and child welfare service involvement."[14]


Understanding Substance Use Disorder- A Resource Guide for Professionals[15] "This technical assistance tool focuses on providing a fundamental understanding of the substance use treatment and recovery process. Designed to equip professionals who refer parents to substance use treatment, the tool includes a list of questions that child welfare or court staff can ask treatment providers to begin establishing a collaborative relationship with their treatment agency. Professionals using this tool will be able to make informed referral decisions for services that are a good fit to meet the needs of parents and their families."

Transitioning to A Family-Centered Approach: Best Practices and Lessons Learned from Three Adult Courts[16]Case studies of adult drug courts that included a family-centered approach to treatment and recovery.

Implementation of Family-Centered Practice in Substance Use Disorder Treatment A Webinar provided by the National Center on Substance Abuse and Child Welfare[17]

Disrupting Stigma: How Understanding, Empathy, and Connection Can Improve Outcomes for Families Affected by Substance Use Disorders[18]

Training and Tutorials for Substance Use Treatment Professionals[19]The National Center on Substance Abuse and Child Welfare (NCSACW) provides web-based training resources to help professionals increase their knowledge and skills to work with families affected by substance use disorders and help build cross-systems collaboration across the various agencies serving these families.

Promising Practices

Models of collaborative intervention vary widely in approach. They include innovative strategies such as [20]:

  • Co-location of substance abuse specialists in child welfare offices or dependency courts
  • Family Drug Courts or Dependency Drug Courts
  • Collaborative case management and planning
  • Development of collaborative structures
  • Wraparound services
  • Improved cross-system communication protocols
  • Cross-agency training of staff


Project Nurture Health Share of Oregon
Program Highlights (NUR) [21]

  • Team-based approach to prenatal care that includes prenatal clinician, addictions specialist, mental health support, case management, peer support and parenting resources
  • Clinic and organizational leadership with program accountability and resources
  • Transparent, standardized process for screening and monitoring for substance use and for DHS involvement
  • Strong commitment to a planned, coordinated approach to the inpatient maternity stay, with protocols for pain management, DHS and social work involvement and discharge planning
  • Extended postpartum support lasting a full year, with pediatric care integrated with the mother’s care, ongoing addiction support, and peer support for parenting

Outcomes Being Tracked

  • Pre-term birth rates
  • Cost Savings

PCPCC SAN Webinar: Assessing the Practice with Patients and Families- Opportunities to Improve Patient and Family-Centered Care[22]A Webinar based on patient family-centered treatment and care

Sources

  1. https://ncsacw.samhsa.gov/files/Forum_Brief_FINAL_092314_reduced_508.pdf
  2. https://ncsacw.samhsa.gov/files/Forum_Brief_FINAL_092314_reduced_508.pdf
  3. https://ncsacw.acf.hhs.gov/topics/family-centered-approach.aspx
  4. https://www.samhsa.gov/sites/default/files/family_treatment_paper508v.pdf
  5. https://www.samhsa.gov/data/sites/default/files/report_3223/ShortReport-3223.html
  6. https://aspe.hhs.gov/reports/blending-perspectives-building-common-ground
  7. https://www.samhsa.gov/sites/default/files/family_treatment_paper508v.pdf
  8. https://aspe.hhs.gov/reports/blending-perspectives-building-common-ground
  9. https://www.samhsa.gov/grants/block-grants/sabg
  10. https://www.nashp.org/medical-necessity/
  11. https://www.samhsa.gov/sites/default/files/final_funding_paper_508v.pdf
  12. https://www.samhsa.gov/find-help/national-helpline
  13. https://www.childwelfare.gov/pubPDFs/majorfedlegis.pdf
  14. https://ncsacw.acf.hhs.gov/collaborative/building-capacity.aspx
  15. https://ncsacw.acf.hhs.gov/files/understanding-treatment-508.pdf
  16. https://www.ndci.org/wp-content/uploads/2016/05/Transitioning-to-a-Family-Centered-Approach.pdf
  17. https://www.youtube.com/watch?v=BM5mB1Pi0BY
  18. https://ncsacw.acf.hhs.gov/files/disrupting-stigma-brief.pdf
  19. https://ncsacw.acf.hhs.gov/training/default.aspx
  20. https://ncsacw.samhsa.gov/files/Forum_Brief_FINAL_092314_reduced_508.pdf
  21. https://www.healthshareoregon.org/health-equity/project-nurture#:~:text=A%20Center%20of%20Excellence%20model,pediatric%20care%20for%20their%20infant
  22. https://www.pcpcc.org/webinar/pcpcc-san-webinar-assessing-practice-patients-and-families-opportunities-improve-patient-and