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Protecting Children in Substance-Abusing Families
User Manual Series (1994)

Author(s):  U.S. Department of Health and Human Services Kropenske, Howard, Breitenbach, Dembo, et al.

Year Published:  1994

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You are in section: Table of Contents Preface Acknowledgments 1 - Introduction 2 - Identifying Alcohol and/or… 3 - Chemically Involved Parents:… 4 - Children of Chemically… 5 - Reporting Child Maltreatment… 6 - Comprehensive Family… 7 - Juvenile Court Involvement… 8 - Innovative Approaches to… Conclusion Appendix I - The Nature of… Appendix II - Sample Medical… Appendix III - Sample Interagency… Notes Glossary of Terms Selected Bibliography Other Resources Table 1 - Hospital Form For… Table 2 - Sample Interagency… Table 3 - Assessment/Intervention… Table 4 - Assessment/Intervention… Table 5 - Assessment/Intervention… Table 6 - Major Substances of…

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Juvenile Court Involvement with Chemically Involved Families

CASE VIGNETTE: Following the initial assessment, Child Protective Services (CPS) was sufficiently concerned about Timmy's safety to take the case to court. In spite of the maternal grandmother's cooperation during the assessment process, she became extremely upset just prior to the court proceedings because of her loss of control over her family and the entire situation. The involved professionals, however, were able to reassure her, and she agreed before the judge to assume responsibility for her grandson. Lisa, on the other hand, remained angry. She initially refused to complete the treatment program mandated by the court to enable her to be reunited with her child. Only after 5 years of court involvement, multiple attempts at drug treatment, a shift from PCP and cocaine use to use of heroin and cocaine, a second pregnancy, separation from her children's father, and a period of incarceration followed by intensive residential treatment did Lisa finally attain sobriety.

The preceding chapters have discussed the problem of parental substance abuse and its impact on families as well as the need for a comprehensive assessment of all family members and caregivers. Whether or not child endangerment is substantiated, strong interdisciplinary case management and coordination of services are needed in order to improve the complex situations of families reported to CPS with substance abuse problems.

Although only a small percentage of substantiated child abuse and neglect cases go to court,²² those that do are heard exclusively in the juvenile courts civil proceedings. One exception, however, is severe physical abuse or neglect or sexual abuse by a substance-abusing parent. In such cases, criminal prosecution may be concurrent with juvenile court proceedings.

In addition, there have been isolated attempts to criminally prosecute pregnant substance-abusing women and women who have delivered drug- or alcohol-affected newborns. In general, however, criminal prosecution is not a common legal intervention in child maltreatment cases that involve either prenatal or parental substance abuse. Rather, such cases are usually brought before the civil court, where the aim is protection of the child while the parent is in treatment.

In making decisions regarding the juvenile court's involvement in drug- and alcohol-related dependency cases, four guiding principles have proven useful:

• Parental substance abuse is detrimental to the well-being of a child and may create a substantial risk of harm.
  
  
• Reasonable efforts must be made to provide the services necessary to keep a child in the home.
  
  
• The authority of the juvenile court may be necessary to gain the parents' cooperation in obtaining/receiving services, including the treatment of substance abuse.
  
  
• Out-of-home placement should be ordered only on demonstrating a substantial risk of harm if the child remains in the parent's custody or if there is a likelihood that the parent will flee the jurisdiction of the court with the child.²³

This chapter focuses on the legal issues affecting juvenile court involvement in determining a child's overall safety in cases in which parental substance abuse has been identified. As the reader will note, many of these same issues are addressed throughout the assessment process. In addition, this chapter provides guidance regarding permanency planning for children of substance-abusing parents in cases in which it has been determined that, despite reasonable efforts and following a realistic period of time, termination of parental rights is indicated. Because State laws, policies, and procedures vary with respect to legal intervention and permanency planning, it is important for professionals to be familiar with the requirements specific to their States.

Considerations of the Juvenile Court in Cases of Parental Substance Abuse

In considering the level of protection needed by children in chemically involved families and the treatment services required by their parents, a number of factors typically are weighed by the juvenile court. These include the child's health, development, and educational status; the child's age; parental history of alcohol or other drug abuse and substance abuse treatment; parenting profile; safety of the home; family supports; and treatment resources.²⁴ Decisions regarding the family's functioning and progress must be based on the comprehensive assessment information contributed by a variety of disciplines and agencies, as described in the previous chapters. The following guidelines are recommended for professionals who are providing reports and testimony specifically for the juvenile court.

Child's Health, Development, and Educational Status

Reports containing specific information regarding a child's medical, developmental, and educational needs provide guidance for the court in determining the level of caregiving skills required to meet the child's needs. If a child has special needs, the court considers the caregiver's ability to provide this specialized care before releasing the child into the care of parents, extended family members, or foster parents. Testimony or court reports should specify:

• the child's general health status, medical care requirements, and special care needs;
  
  
• in the case of newborns, toxicology screen results and/or the presence or absence of withdrawal symptoms and/or signs and symptoms that are consistent with prenatal drug or alcohol exposure;
  
  
• the child's developmental status and educational needs–for a child with disabilities, this includes the individual family service plan (IFSP) for an infant or preschool-aged child or the individual education plan (IEP) for a school-aged child (Note: In 1977, Public Law 94-142, the Education for All Handicapped Children law, specified that IEP's should be provided for children with disabilities, in the least restrictive environments. In 1987, Public Law 99-457, the Education of the Handicapped Amendment, mandated the individual family service plans (IFSP's) be developed for children from birth to 3 years of age);
  
  
• school attendance patterns and records; and
  
  
• known behavioral problems or emotional disorders.

Child's Age

The child's age is an important factor in making a decision regarding the child's custody. Infants and preschoolers are highly dependent on their parents to meet basic needs and provide protection from harm. Furthermore, until children reach school age, they often are "invisible" to social service and educational agencies. Thus, abuse or neglect may go unnoticed. In preparing reports for the court, professionals should note:

• ages of all dependent children within the home,
  
  
• availability of day care or preschool services that could provide daily monitoring of the child's care as well as developmental and social enrichment, and
  
  
• availability of supportive and therapeutic in-home services.

Parental History of Substance Abuse and Treatment

The parent's record of substance abuse and treatment can provide information that assists the court in evaluating the degree of risk to the child as well as the parent's treatment needs and level of commitment to dealing with his/her substance abuse problem. The more severe and extensive the history of parental substance abuse, the more serious the threat may be to a child's safety. Professionals providing information for the court should include descriptions of:

• the parent's substance abuse problem (substances abused, length of abuse, and frequency of use);
  
  
• the parent's typical behavior when under the influence (e.g., violent, absent, or dazed and bizarre);
  
  
• parental participation in substance abuse treatment (attendance patterns, level of involvement in treatment, and indicators of progress);
  
  
• parental acknowledgment of alcohol and/or other drug abuse as a problem;
  
  
• urine toxicology results (a series of results is preferable to a single report); and
  
  
• behavioral indicators of sobriety or continued alcohol and/or other drug use.

Parenting Profile

The juvenile court is interested in information that demonstrates parents' concern for their children's welfare as well as their ability to provide protection and proper care. Agency reports or testimony from neighbors, family, or others should include information relevant to:

• records of prior child abuse and neglect allegations and investigations;
  
  
• significant physical or mental health impairments that interfere with the parents' ability to care for their children;
  
  
• parents' perceptions of the impact of their substance abuse on family life and parenting;
  
  
• parents' participation in parenting education classes or response to in-home instruction (attendance patterns, level of involvement, and indicators of progress);
  
  
• observations of parent-child interactions;
  
  
• parents' behavior toward their children when using drugs or alcohol; and
  
  
• visitation patterns, if a child is in out-of-home care.

Home Environment

The condition of the family home environment is critical to determining a child's need for protection. Obviously, the use, sale, or manufacture of drugs by parents or others within the home will significantly impact the child's safety. Furthermore, the risk to the child is also increased when homelessness or lack of food and basic necessities are the consequences of a parent's use of family resources to purchase drugs or alcohol. The court is particularly interested in the following types of information concerning the home environment:

• indications of illegal activity or violence within the home;
  
  
• environmental conditions within the home (hygiene, food, furnishings, and the functioning of utilities);
  
  
• steps taken by parents to remedy environmental hazards;
  
  
• household composition; and
  
  
• relationship of other adults in the household to the child and parent, their responsibility for child care, and their knowledge of and involvement with the parent's substance use.

Family Supports

The strength of the family's support system can be pivotal in providing protection for the child, maintaining the family unit, and supporting the parent's treatment. When communicating with the juvenile court, professionals should include information relevant to:

• willingness and ability of extended family members and significant others to help with the care of dependent children who remain in parental care;
  
  
• extended family's ability to provide care and protection for the child if out-of-home care is required; and
  
  
• family involvement with church, temple, or other community groups.

Treatment and Support Services

The juvenile court depends on child welfare, health and mental health care, substance abuse treatment, and educational professionals to assess the treatment needs of children and parents, identify appropriate treatment resources, and to provide evaluations of the progress made by parents and children in treatment. In communicating with the juvenile court, it is important that professionals specify:

• specific treatment needs, including the recommended frequency and duration of treatment;
  
  
• available and appropriate resources (e.g., treatment for pregnant or postpartum women and their infants and children or treatment programs for clients who require medical supervision);
  
  
• involvement and progress in treatment (patterns of attendance, level of participation and indicators of progress);
  
  
• a description of therapeutic and supportive services provided for the family, including housing; day care; transportation; clothing; food stamps; child support and the Women, Infants, and Children (WIC) program;
  
  
• outreach efforts made to engage resistant clients in treatment; and
  
  
• documentation that noncompliance with treatment is not related to waiting lists, cultural or language barriers, or transportation problems.

Special Issues Affecting Legal Interventions with Chemically Dependent Families

With respect to chemically dependent families, there are a number of special issues that professionals need to consider throughout dependency proceedings. These issues relate to reasonable efforts, realistic time frames, termination of parental rights, and permanent placement.

Reasonable Efforts

States receiving Federal funds for foster care must make reasonable efforts to prevent unnecessary placement of children out of the home and to return children to their homes as early as possible. With respect to reasonable efforts, the question of removing the child from the home in cases of parental substance abuse depends on the potential danger to the child and the services that could be provided to the family in order to minimize child endangerment. Before initiation of foster care, both the mother and the father should be carefully evaluated with respect to their ability to provide care and protection for the child. If it is determined that neither parent can adequately care for a child, the extended family should then be evaluated as alternate caregivers.

Placing a child in foster care should only be considered when parental or extended family supervision cannot provide adequate protection for the child. In such cases, it is preferable for the foster care setting to be in close proximity to the parent to prevent a change of school or day care for the child and to facilitate the visitation plan. In cases of prenatal substance abuse, the availability of a residential treatment program for the mother, infant, and any other children should be explored as an alternative to foster care.

In some States, a positive toxicology screen at birth is considered indicative of child abuse or neglect. In this situation, making reasonable efforts to prevent placement of the infant at birth may require that the State offer adequate prenatal care to all pregnant women as well as substance abuse treatment to meet the unique needs of pregnant substance abusers. In recognition of this requirement, many communities are moving toward developing comprehensive preventive prenatal services.

Reasonable efforts to keep families intact in cases of parental substance abuse might include:

• assisting the parent in obtaining substance abuse treatment services;
  
  
• providing home-based services to build family skills;
  
  
• assisting parents to relocate out of an environment where drug or alcohol use is pervasive;
  
  
• providing financial assistance and child care while parents are in treatment;
  
  
• assisting parents in obtaining supportive services such as Aid to Families With Dependent Children (AFDC), Social Security Income (SSI), food stamps, and child support; and
  
  
• when a child is in foster care, encouraging frequent visitation in a homelike atmosphere.

Careful documentation of all efforts made to support the mother's and the father's parenting should be made to avoid legal delays if parental rights subsequently must be terminated.

Realistic Time Frames

A child's initial development and subsequent mental health are greatly influenced by the quality and stability of their early relationships. On the other hand, chronic substance abuse is a serious health disorder that frequently requires long-term treatment before sobriety can be attained. Professionals must weigh both of these factors as they make decisions about family treatment plans and reasonable goals for family members. Often, this is one of the most challenging dilemmas faced by professionals serving substance-abusing families.

Professionals need to move quickly and effectively to provide a safe and permanent home for infants and young children whose parents' alcohol or other drug abuse has resulted in foster care placement. Intensive reunification efforts should be made at the beginning of placement to give the parent the support needed to enter and engage in treatment and to resume parenting responsibilities. Out-of-home care for up to 2 years, depending on State laws, is generally used as a time line standard for terminating parental rights and attempting to place a child in a safe, caring, and permanent home. However, strict time frames pose special problems for addicted or alcoholic parents when treatment resources are scarce. Furthermore, a high recidivism rate for even the best treatment programs suggests that a parent with complex, long-term health and social problems must be seriously committed to change in order to resume parenting responsibilities within a reasonable period of time.

Courts recognize the importance of balancing reasonable efforts to reunite a chemically involved family against the child's need for timely placement in a stable, long-term living situation. For substance-exposed children, the unique conditions that exist when parents are addicted may increase the need for stability and continuity. Thus, realistic time frames are especially important.

Termination of Parental Rights

In most cases when reasonable efforts and realistic time frames have not succeeded in enabling a substance-abusing parent to function as an adequate caretaker for a child, a petition should be filed for termination of parental rights. Terminating parental rights is the most serious decision made in any juvenile proceeding. It usually results in completely severing all ties between the birth parents and their child. Only after termination proceedings are completed can a child be released for adoption. Not only do the birth parents lose custody forever, but unless adoptive parents choose to maintain a relationship, birth parents also forfeit the right to correspond, visit, or have any communication with the child.

The most common grounds for termination of parental rights in cases involving parental substance abuse are abandonment, willful nonsupport, severe or chronic physical abuse or neglect, chronic parental mental or physical illness rendering the parent incapable of caring for the child, willfully leaving the child in foster care for an extended period of time without responding to reasonable efforts for reunification, and severe alcohol or drug dependency that endangers the child's welfare.

With regard to termination of parental rights, there are several special considerations that arise in cases involving chemically dependent parents:

• Jurisdiction. Jurisdiction is the legal power to act. Filing a petition within the county where the child resides initiates termination proceedings and establishes personal jurisdiction over the child. A summons with a copy of the petition must be served on the parents, wherever they reside, and, in some States, on older children, as well. This process can be complicated when a substance-abusing parent does not have a permanent or known address. However, the agency can provide proof that diligent efforts were made to serve the parent at the last known address and/or by publication.
  
  
• Parental Notice. The parent has the right to receive notice of the hearing and contest the petition by filing an answer or appearing in court. The substance-abusing parent may have special needs regarding notice. Because the parent may be disoriented when under the influence of drugs or alcohol or may have residual mental impairment even when sober, child welfare caseworkers should make special efforts to ensure that the parent is aware that termination of parental rights is pending. These special efforts may include visiting the parents and reading them the legal notice as well as explaining the implications of termination and encouraging the parents to request legal representation. Additionally, it may be helpful to discuss termination with parents in the presence of another, sober family member.
  
  
• Burden of Proof. Evidence of the harmful effects of parental substance abuse on the child must be presented to support the petition to terminate parental rights. Clear, cogent, and convincing evidence must be presented to meet the heavier burden of proof in termination cases. This burden can be met by submitting in court accurate records of the assistance offered by staff of social service agencies, health care providers, day care centers, schools, substance abuse treatment programs, and mental health agencies. Records of parents who have attended drug or alcohol treatment programs receiving Federal funds can be obtained through a specific court order from the juvenile court judge. The order will specify the need for the confidential use of these records in determining disposition in cases of termination of parental rights.
  
  
• Insufficient evidence (such as parental alcoholism or drug addiction with nothing more or a poor record of service delivery) impedes the termination procedure and may indicate the need to redouble efforts at reunification.
  
  
• Child's Interest. In some States, an adoptive home must be located before termination of parental rights; in other States, the first order of business following termination is to begin looking for an appropriate adoptive placement. Finding an adoptive placement for the special needs substance-exposed child is a challenge all professionals need to bear in mind from the time a case is opened.
  
  
• Appeal. Any party to a termination proceeding may appeal a termination decision within the number of days allowed by statute. Pending the appeal, a child can be placed in the proposed adoptive placement to minimize the emotional trauma that children experience related to multiple placements and caregivers. Continuity of placement and caregiver attachment is important for all children. Every effort should be made to limit the possible number of moves the child must make and the length of stay in temporary care.

Permanent Placement

Seeking termination of parental rights is the natural and legal outcome of parental failure to respond to reunification and treatment services.

When a child is permanently removed from the custody of a substance-abusing parent, there are several permanent placement options. These include adoption, legal guardianship, and long-term foster care. Consideration should be made to locate this permanent placement within the child's own racial, ethnic, and religious group. The object of permanency planning is to select the option that maximizes the child's opportunities for healthy social, emotional, and cognitive development. Although children from substance-abusing families may pose special obstacles, nevertheless attempts should be made to place all permanently removed children, including prenatally substance-exposed infants, in settings that can accommodate their emotional and physical needs and that are respectful of their cultural backgrounds.

Adoption

Adoption is the first placement choice when children cannot be cared for by their birth parents and when parental ties are legally severed. In many cases, relatives, significant others, or foster parents may be ideal adoptive parents.

Adoption workers need to carefully sort out the financial impact of adoption (e.g., in some cases, foster care funds or Medicaid for the child may no longer be available). In many cases, to encourage adoption, State and Federal Governments provide monthly supplements and Medicaid coverage, although the supplement generally is less than the foster care payment. Health coverage is especially helpful for those substance-affected children who have preexisting disabilities and who might not qualify for coverage under their new adoptive parents' insurance.

Finally, whether the adoptive parents are family members, significant others, or strangers to the child, long-term supportive services (including counseling and educational programs) should be available to the adoptive parents as well as the child.

Guardianship

Legal guardianship provides adult protection to a child who is deprived of the natural guardianship of his/her parents. The guardian has the right to custody, the right to make decisions for the child, and the right to represent the child in legal actions. The guardian is not responsible for support and education of the child, except on the basis of resources available through public programs such as AFDC or SSI.²⁵

Unlike adoption, guardianship does not require termination of parental rights. Thus, parents can retain the right to visit, consent to adoption, and provide support. This may be a viable alternative for children whose parents have become sober during the period required for reunification efforts but who still suffer incapacity that leaves them unable to manage the responsibilities of full-time child rearing. This option leaves open the possibility of continued parental involvement with the child. It is suggested for parents who have meaningful relationships with their children but, because of their disability, are unable to provide around-the-clock care.

The permanence of legal guardianship allows attachment to the guardian and eliminates the continuous threat of separation that is often experienced by children in foster care. It often gives children the continuity and stability they need. If termination has occurred and the agency has not been able to place a child in an adoptive home, guardianship is a good alternative.

Long-Term Foster Care

Long-term foster care is an option that keeps a child in the custody of the State. For an older child, long-term foster care can also provide a continuous noncustodial relationship with the birth parent if that is what the child desires, and if it is in the child's best interest for the relationship with the parent to continue. Although long-term foster care is designed to provide a stable foster care home, it can result in multiple moves. Such moves are difficult for any child, since early experiences that promote attachment and trust are directly related to better mental health in later life.

In working with caregivers, it is important for the professional to bear in mind the fact that long-term foster parents may need ongoing family support to help them continue to successfully cope with the emotional and behavioral problems displayed by some substance-affected toddlers and older children.

As older adolescents prepare for release from the foster care system (which can happen as early as 18 years of age for those who are no longer in school), it is the responsibility of the CPS worker to develop an appropriate emancipation plan that will promote a smooth transition from foster care into independent living.

Summary

Any professional who works extensively with families is very likely to encounter a problem related to alcohol and/or other drug abuse on the part of a family member at some point in time. If a substance-abusing family member is the primary caregiver for a young dependent child or children, involved professionals need to become concerned about the welfare and safety of children in the household. Not infrequently in cases of chronic substance abuse on the part of a parent or other primary caregiver, the juvenile court may become involved. Once this happens, a range of interventions may occur. In some cases, court intervention leads to better conditions and rehabilitation of the family unit. However, in extreme situations it may result in termination of parental rights, with the aim of affording the child a permanent family in which to grow.

Throughout this process, involved professionals need to be aware that chemical dependency is a serious health disorder that may result from multiple causes, including traumatic and stressful life events, intergenerational patterns of substance abuse, genetic predisposition, etc. Although it is not uncommon for society to view this condition as resulting from causes that lie primarily within the substance-abusing individual's control, professionals need to be aware that this is rarely the case. Substance abuse is a complex problem requiring a wide range of interventions. The juvenile court system can be viewed as one such intervention in that it can help ensure safety for children and encourage substance-abusing family members to begin moving toward recovery.

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You are in section: Table of Contents Preface Acknowledgments 1 - Introduction 2 - Identifying Alcohol and/or… 3 - Chemically Involved Parents:… 4 - Children of Chemically… 5 - Reporting Child Maltreatment… 6 - Comprehensive Family… 7 - Juvenile Court Involvement… 8 - Innovative Approaches to… Conclusion Appendix I - The Nature of… Appendix II - Sample Medical… Appendix III - Sample Interagency… Notes Glossary of Terms Selected Bibliography Other Resources Table 1 - Hospital Form For… Table 2 - Sample Interagency… Table 3 - Assessment/Intervention… Table 4 - Assessment/Intervention… Table 5 - Assessment/Intervention… Table 6 - Major Substances of…

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Updated on December 10, 2007