Family Reunification and Drug Use by Parents

1. Family Reunification and Drug Use by Parents Dr Frank Ainsworth and Adele Summers

2. The Drug Problem in Australia • The AIHW reported in their June 2000 publication: • between 6% and 11% of Australians have a hazardous or harmful drinking pattern. • approximately 23% of Australians reported using illicit drugs in the past 12 months. • the mean age of illicit drug users was 29 years, with 69% unemployed and 43% with a prison history. • anti-depressants were the most commonly used pharmaceutical drugs.

3. Child Care and Protection and Parental Drug Use - Australia • Few Australian attempts to determine the extent to which child abuse and neglect and substance abuse interact. • Angus and Hall (1996) - 22% of substantiated cases of emotional abuse in NSW (1994-95) resulted from parental substance abuse. • DHS Victoria (1994) - for 41.5% of cases there was concern about the contribution of substance abuse. • Elliot (2001)-Census of social workers’ caseloads from Cannington office found an average of 50% of cases included alcohol and/or drug use.

4. Child Care and Protection and Parental Drug Use - US. • In the US, 11% of children, 8.3 million children, live with at least one parent who is in need of treatment for an alcohol or illicit drug use problem (Huang et al, 1998). • At least 50% of substantiated child abuse and neglect reports in the U.S. involved parental alcohol or drug abuse (CWLA, 1998). • Children whose parents have substance abuse problems are younger, more likely to the victims of severe and chronic neglect and remain in care longer than other children in the system (DHHS, 1999).

5. Parental Substance Abuse and Family Reunification • Festinger (1994, 1996) - Key predictors of a child’s return to care were the parents’ lack of knowledge of child development, limited parenting skills, poor behaviour management skills and lack of social support. • Frame et al (2000) - Maternal substance abuse was associated with a manifold increase in the likelihood of a child’s re-entry to care. • There is an almost total absence of Australian studies of family reunification.

6. Departmental Managers, Supervisors and Clinical Staff • Estimates of the proportion of family reunification cases involving drug use were between 25% and 75%. • The majority of staff suggested the type and level of drug use was not important. The issue is the impact of drug use on parenting ability. • There was diversity in responses regarding the indicators for and against family reunification, the level of acceptable risk of repeated neglect or harm and the number of acceptable attempts at family reunification in parental drug use cases.

7. Non-Government Management Staff • There was a very high level of agreement regarding the indicators for and against family reunification in parental drug use cases. • All respondents agreed that some level of risk of repeated neglect or harm should be accepted. • All respondents agreed that there should be more than one attempt at family reunification.

8. Drug Agency Staff • The majority of respondents suggested that neglect was more prevalent in parental drug use cases than abuse and neglect was more difficult to work with than abuse. • There was a high level of agreement regarding the indicators for and against family reunification in parental drug use cases. • There was disagreement regarding the level of acceptable risk of repeated neglect or harm and the number of acceptable attempts at family reunification.

9. Departmental Direct Service Staff • The majority of respondents agreed that drug use by parents rarely occurs in isolation and these families have multiple issues. • Important indicators for family reunification were stated as a willingness by parents to work on their problems, parental appearance and satisfactory parent-child interactions. • Limitations of the current system were mentioned to be a lack of funding and foster carers willing to support increased contact between children and their natural parents.

10. Non-Government Direct Service Staff • Respondents agreed that drug use by parents is a issue that often occurs with other issues, commonly mental illness. • Limitations of the current system were stated as a lack of flexibility in drug treatment programs for parents to have contact with children, a lack of practical help for families, and the outdated Child Welfare Act. • Respondents agreed that more interagency training and interagency consultation is required.

11. Themes from the WA Consultations • All groups agreed that polydrug, heroin and amphetamine use are the most prevalent drugs used by parents. Marijuana use is of little concern. • All groups agreed that there needs to be greater collaboration between drug agencies and child welfare agencies. • There was agreement that neglect is more prevalent than abuse in drug use by parents cases. • There was agreement that parents do not need to be drug free to be able to protect their children.

12. Indicators for Family Reunification • The positive indicators for reunification in parental drug use cases were reported as: • the presence of a stable marital or de facto relationship not involving drug use, • a non-drug abusing family support system, • a non-drug abusing friendship network, • regular attendance at a drug treatment program, and • awareness of the impact of drug taking on the child.

13. Indicators Against Family Reunification • The indicators against reunification in parental drug use cases were reported as: • parental heroin or polydrug use at the point of the child’s admission to care, • presence of a stable or unstable marital or de facto relationship involving drug use, • parental mental health issues, • suspicion that others living in the household are using, selling or manufacturing illicit drugs, • child physical or mental health issues, and • a drug abusing friendship network.

14. The Level of Acceptable Risk • Responses to the question of what level of risk is acceptable in family reunification cases varied between 0% and 30% risk. • It was suggested that the standard was about ‘the balance of probabilities’ rather than being ‘beyond reasonable doubt’.

15. How Many Attempts at Reunification? • Three attempts at family reunification was commonly regarded as the number of times this approach to care should be considered. • Respondents recognised that full reunification was not necessarily the best option for all children. • Shared care was suggested as a better arrangement for some parents and children.

16. The Interstate Consultations • The issue of family reunification and parental drug use is a common issue across all Australian states and territories. • Mainstream services seem to be carrying the responsibility for these cases. • There is a move towards the use of risk assessment checklists/instruments, but none have been validated. • There appear to be no targeted family reunification projects for cases where drug use by parents is an issue. • Some states have made attempts to start to address the issue of parental substance abuse.

17. The Interstate Consultations • NSW: A departmental working group has held a number of meetings about parental drug abuse. The Departmental position is that this is a ‘case planning’ issue and court ordered treatment is unnecessary. • ACT: Drug and alcohol practitioners have been invited to case conferences for the last 6 months, but have as yet not attended. There is cooperation between health and child protection authorities in regard to urine analysis. • Victoria: There has been considerable joint working between health and human services, for example joint training and use of health facilities for court ordered parental urine testing.

18. New Service Models 1 • The recent Adoption and Safe Families Act (1997) in the US requires that permanency plans be subject to judicial review once a child has been in care for 12 months. • The state must file for termination of parental rights if a child has been in out-of-home care for 15 of the previous 22 months. • These time frames impose a need for accurate drug use assessments and immediate access to treatment services. • A number of service innovations have been developed in an attempt to address the problem.

19. New Service Models 2 • DHHS Sacramento: Requires all employees to be intensively trained in substance abuse and addiction, including how to use diagnostic tools. • New Jersey Division of Youth and Family Services: Use certified drug and alcohol counsellors to work in tandem with workers handling cases involving parental substance use. • Maryland Child Welfare Services: Three level model of practice to achieve treatment compliance by drug abusing parents. • Connecticut Department of Children and Families: Substance Abuse Family Evaluation (SAFE) project.

20. New Service Models 3 • Legal activists are attempting to work with child welfare agencies and drug agencies on this issue. • Techniques for challenging parental behaviour in order to generate treatment compliance and the use of sanctions when this is not forthcoming have been introduced. • Parental participation in a drug treatment program is a requirement prior to reunification. • Given the aggressive termination of parental rights approach in the U.S., where there is continuing substance abuse adoption is back on the child welfare agenda.

21. Towards a Model of Reunification Practice • Collaboration between drug agencies, the department and the non-government sector is imperative. • There is a case for the formalisation of a three phase model of family reunification. • There is a need to revise current methods of individualised service and to develop more empowering methods of reunification practice, such as parental peer groups and parallel activity based children’s groups.

22. Approach Intervention Agency involvement ____________________________________________________________ Phase 1 Persuasion/voluntary Casework State/NGO Phase 2 Direction/required Treatment/ State/NGO/DA Group program Phase 3 Compulsory/imposed Court order State/NGO/DA/ Court * NGO = Non government organisation, DA = Drug and Alcohol authority Threestage model of family reunification

23. Developing a Risk Index to Underpin the Practice Model • Instruments that can be used for family assessment purposes may be of use to family reunification workers. • ‘Assessment frameworks for children in need and their families’ package from the U.K. (DOH, 1999). • Family Assessment: Resiliency, Coping and Adaptation research and practice inventories (McCubbin et al, 1996). • There are also a number of substance abuse instruments. • Measures for Clinical Practice Vol 2 (Fisher and Corcoran, 1994). • Index of Drug Involvement (Hudson, 1996).

24. Developing a Risk Index to Underpin the Practice Model • There does not appear to be any published instruments that relate directly to family reunification. • An index could be constructed from responses to the questions given by the various groups interviewed for this project. • This index could be completed at regular intervals in order to track changes in the family.

25. Testing the Model of Reunification Practice • A small scale pilot project should be mounted testing the proposed model against existing practice. • Reunification cases could be randomly assigned to the Enhanced Reunification Service or Regular Reunification Service. • It would be possible to establish which types of families responded best to which service model.

26. Conclusion • A three-phase model of enhanced family reunification services is proposed. • Family assessment instruments and substance use assessment instruments may be of use. • Formulation and implementation of a risk index specific to drug use by parents cases may be possible. • There is a need for high-level commitment to policy and practice changes that embrace collaboration at both a policy and case level with drug agencies. • A plea for research on the topic of ‘family reunification and drug use by parents’.

27. Postscript 1 • A prospective 6-year study of children reunified from foster care (n=149, aged 7-12 years (Taussig et al, 2001). • Compared with youth not reunified - reunified youth showed more evidence of self-destructiveness, substance abuse, risk taking behaviours, arrests, suspensions, school drop-out, poor grades and pregnancies.

28. Postscript 2 • Poverty and unemployment are - more likely to lead to maltreatment among parents whose parenting capacity is weakened by factors such as - lack of support from a partner, a weak social network, psychological disorders, substance abuse, prior history of maltreatment, lack of parenting skills and the presence of a maladjusted or disabled child - but not otherwise (Weatherburn and Lind, 2001, p. 42)

29. Postscript 2 cont. • When using poverty, single parent families, crowded dwelling, neighbourhood delinquency, neglect and abuse as predictor variables the result is as follows. Neglect has a greater causal effect on juvenile participation in both property crimes and violent crime. For juvenile participation in property crime the coefficient is (0.55), for abuse it is (0.15). For juvenile violent crime the coefficient for neglect is (0. 44) and for abuse (0.07) (Weatherburn and Lind, 2002, p. 94).