Systems and Policy Issues

This webpage identifies the major literature in the field of prevalence and systems planning: systems and policy issues. The time frame is from January 2000 through December 2014.

Albert, V., Klein, D., Noble, M., Zahand, E., & Holtby, S. (2000). Identifying substance abusing delivering women: Consequences for child maltreatment reports. Child Abuse & Neglect, 24(2), pp. 173-183.

The major objective of this study was to determine how and the extent to which SB2669, which requires the identification of substance abusing delivering women, affected the number of children reported for abuse or neglect in seven high prevalence California counties. The results suggest that the effects of SB2669 on the number of child maltreatment reports are mixed. On an aggregate level, SB2669 is associated with a decrease in child maltreatment reports in two of the participating counties. This decrease may be due to conscientious implementation of the legislation in these counties. This mixed finding is expected mainly because SB2669, although mandated, was never enforced. Moreover, from the process component of the study we learned that the implementation practices of this legislation vary substantially between and even within counties’ hospitals. A decrease in maltreatment reports in the presence of SB2669 is not necessarily the most desirable outcome in the light of what we know about the relationship between substance abuse and child maltreatment. Law makers need to rethink the purpose of the law and provide the necessary language, tools and training to ensure that the goals of identifying substance abusing mothers and their families are met. Provisions also need to be made that somehow enforce this legislation. These provisions could lessen county-level and hospital-level variability in implementing the law.

Allen, D. A., Hyde, J. & Leslie, K. L. (2012). “I don’t know what they know”: Knowledge transfer in mandated referral from child welfare to early intervention. Children and Youth Services Review, 34(5), pp. 1050-1059.

In this article, authors argue that knowledge transfer within and between child welfare and Early Intervention (EI) services is a primary systems barrier to, and potential facilitator of, EI referral and service use for maltreated young children. Findings highlight the importance of facilitating knowledge transfer within and between human service organizations, a process that requires an understanding of the various attributes of each participating system. This paper contributes to current knowledge by considering both intra- and inter-system barriers to knowledge transfer, extending examinations of mandated referral to consider downstream service provision, and informing future actions taken to address the developmental needs of young children in child welfare.

Arria, A. M., Derauf, C., LaGasse, L. L., Grant, P., Shah, R., Smith, L., Haning, W…Lester, B. (2006, January). Methamphetamine and other substance use during pregnancy: Preliminary estimates from the Infant Development, Environment, and Lifestyle (IDEAL) Study. Maternal and Child Health Journal, 10(3), pp. 1-10.

The purpose of this study was to estimate the prevalence and correlates of alcohol, tobacco, and other substance use-including methamphetamine-during pregnancy. The sample consisted of the first 1632 eligible mothers who consented to participate in a large-scale multisite study focused on prenatal methamphetamine exposure. Results indicated that 5.2% of women used methamphetamine at some point during their pregnancy. One quarter of the sample smoked tobacco, 22.8% drank alcohol, 6.0% used marijuana, and 1.3% used barbiturates prenatally. Less than 1% of the sample used heroin, benzodiazepines, and hallucinogens. Tobacco smokers and illicit drug users were more likely to be single and less educated, have attended less than 11 prenatal visits, and utilize public financial assistance. The authors concluded that his is the first large-scale investigation to report the prevalence of methamphetamine use during pregnancy in areas of the United States where methamphetamine is a notable concern and that follow-up research is ongoing to investigate the outcomes associated with prenatal methamphetamine exposure. The authors also concluded that given that this research extends and confirms previous findings showing that high-risk groups of pregnant women can be identified on the basis of basic demographic characteristics, targeted interventions are greatly needed to reduce serious adverse outcomes associated with prenatal alcohol and tobacco use.

Bellini, C. & Gleason, M. M. (2012). Building a treatment safety net for children in child welfare programs. Journal of the American Academy of Child & Adolescent Psychiatry, 51(9), pp. 855-857.

This article aims to address the knowledge and critical gaps in knowledge about child psychiatry treatment approaches for children in child welfare. The authors propose approaches to decrease the gaps in knowledge and increase the ability to promote quality care as that knowledge base is developed. The use of psychiatric medications in the CW population has come under increasing scrutiny by policy makers, the U.S. Congress, and the media. In 2011, the Government Accountability Office (GAO) released a five-state study of psychotropic medication use for children in foster care. The prescribing rates ranged from 20% to 40%, reflecting rates 2.7 to 4.5 times that seen in non-foster care Medicaid populations in every age group, with higher rates of concomitant medications and few written guidelines for the use of these medications.

Boles, S. M., Young, N. K., Dennis, K., & DeCerchio, K. (2012). The Regional Partnership Grant (RPG) program: enhancing collaboration, promising results. Journal of Public Child Welfare, 6(4), pp. 482-496, DOI: 10.1080/15548732.2012.705239

This article reviews the accomplishments of the 53 Regional Partnerships Grants (RPGs), representing the broadest federal program ever launched to increase the well-being, permanency, and safety outcomes of children who were in or at risk of being placed in out- of-home placement as a result of a parent’s or caregiver’s methamphetamine or other substance abuse. While not designed as a cross-site evaluation, the collaborative achievements from data collected on a cohort of 7,100 RPG participant families, including 12,227 children and 8,321 adults, suggest improved linkages, strengthened collaboration, and improved outcomes among child welfare agencies, treatment agencies, family courts, and other service providers.

Brecht, M. L., Anglin, M. D., & Dylan, M. (2005). Coerced treatment for methamphetamine abuse: Differential patient characteristics and outcomes. American Journal of Drug and Alcohol Abuse, 31(2), pp. 337-356.

This article assesses the relationship of perceived legal pressure for treatment entry to treatment outcomes for a sample of 350 MA-using clients from a large county publicly-funded substance abuse treatment system. Approximately half the clients reported legal pressure to enter the index treatment episode. Those reporting pressure were younger, less likely to have received residential treatment, and had longer treatment episodes than those not reporting pressure. Outcomes did not differ significantly in simple comparisons between the pressured and non-pressured groups; however, when client and treatment characteristics were controlled, the short term outcome of relapse within 6 months was worse for those reporting legal pressure. Outcomes did not differ by source of pressure. Such results offer optimism for individuals and socially-beneficial outcomes of the growing policy emphasis for substance abuse treatment of MA and other drug users through drug court and other CJS jurisdictions.

Brown, V. B., Harris, M., & Fallot, R. (2014). Moving toward trauma-informed practice in addiction treatment: A Collaborative Model of Agency Assessment. Journal of Psychoactive Drugs, 45(5), pp. 386-393. DOI: 10.1080/02791072.2013.844381

This article describes an agency self-assessment process that combines a trauma-informed assessment, a NIATx process of “walking-through” and use of the Institute of Healthcare Improvement’s Plan-Do-Study-Act (PDSA) cycles, and a user-friendly format. The trauma-informed assessment is designed to address issues of safety of clients and staff members, reduction of re-traumatization, consistency in practice, and client empowerment. The article describes how the assessment process can be—and has been—used to develop an Action Plan, including trainings and the identification of “trauma champions”; i.e., staff who will continue to spread trauma-informed changes and new evidence-based practices throughout the agency.

Child Welfare Services Stakeholders Group. (2003, September). CWS Redesign: The future of California's child welfare services. Sacramento, CA: California Department of Social Services. Available online at:

The Child Welfare Services (CWS) Redesign is the long-term strategic plan that sets in motion a series of actions across the state of California to bring the new vision of child welfare services to every county. The Redesign represents an unprecedented effort to proactively examine what works and what needs improvement about California’s child welfare system. The CWS Redesign objectives include: partnering to prevent child abuse and neglect; acting early to preserve and strengthen families; broadening efforts to restore family capacity; strengthening alternatives to rebuild permanent families for children; systematically preparing youth for success in adulthood; affecting change through workforce excellence; strengthening interagency partnerships at the State and Local levels; expanding and restructuring child welfare financing; and achieving better outcomes through accountability. The Redesign also recognizes that substance abuse has profound effects on child abuse and neglect. In relation to AOD issues, the Redesign proposes strengthening community partnerships, having a differential intake system, workforce investments including cross-training, accountability, and funding reforms. This document includes important information on the implementation of the Redesign, particularly in relation to developing evidence-based AOD practices, and progress on its implementation to date.

Chor, B. K., McClelland, M. G., Weiner, A. D., Jordan, N. & Lyons, S. J. (2012). Predicting outcomes of children in residential treatment: A comparison of a decision support algorithm and multidisciplinary team decision model. Children and Youth Services Review, 34(12), pp. 2345-2352.

This study compares two models of decision-making, a multidisciplinary team approach and an objective decision support algorithm, and assesses outcomes when the two models either concur or not. Concordant decisions predicted greater clinical improvement than discordant decisions, but no differences were found in length of stay in placement. Policy implications for the decision-making process in child welfare are discussed.

Christian, S. (2004, September). Substance-exposed newborns: New Federal law raises some old issues. Washington, DC: National Council of State Legislatures. Available in PDF at:

This paper describes the new federal law, provides an overview of existing state reporting laws, discusses the role of child protective services, and highlights the importance of prevention. State legislators who are called upon to enact legislation to comply with the new CAPTA notification requirement will have an opportunity to re-examine their states’ response to drug and alcohol use by pregnant women, including efforts to identify and treat such women as soon as possible after conception and to provide appropriate services to children who are born exposed to substances in utero. An appendix contains the text of state laws that require reporting of substance-exposed newborns.

Coll, K. M., Stewart, R. A., Morse, R., & Moe, A. (2010). The value of coordinated services with court-referred clients and their families: An outcome study. Child Welfare, 89(1), pp. 61-79.

This study assessed the effectiveness of building partnerships with community resources and systems for court-referred clients and their families through a participant outcome evaluation. Specific variables studied included change in substance abuse patterns, family well-being, child safety, and recidivism. Results from pre-post testing revealed that a model with a single case coordinator who collaborated across service providers was particularly effective with court-referred clients and their families for increasing family intimacy and child well-being and for decreasing family danger and conflict. Discussion and recommendations are included.

DiLorenzo, P., White, C. R., Morales, A., Paul, A., & Shaw, S. (2013). Innovative cross-system and community approaches for the prevention of child maltreatment. Child Welfare, 92(2), pp. 161-178.

This conceptual paper describes the principles of community based family approaches for the prevention of child maltreatment and briefly describes four initiatives that are providing comprehensive, community-based prevention focusing on safety and well-being. The authors make the argument that community-based approaches can be successful but take commitment, resources and effort to build and sustain these child maltreatment prevention strategies.

Dothan, D., Schmidt, L., & Henderson, S. (2005). From enabling to bootstrapping: welfare workers' views of substance abuse and welfare reform. Contemporary Drug Problems, 32(3), pp. 429-442.

In the United States, a trope of "deservingness" shapes policy related to public aid and substance abuse. In recent decades, poor people with substance use problems have increasingly been seen as "undeserving.” Federal welfare reform, passed in the mid-1990s, is an important exemplar of this trend. Welfare reform empowered line workers to directly and indirectly withhold aid from people with substance use problems. This paper uses in-depth interviews with workers to explore their views of these new policies. Results indicated that workers generally applauded welfare reform's renewed attention to deservingness, including program emphases on client self-sufficiency and personal accountability and policies that time-limited cash aid and mandated working. They felt that these changes allowed them to stop "enabling" substance abuse and to encourage clients with alcohol and drug problems to bootstrap their way into jobs. Workers' embrace of these policy changes appears likely to shape how substance abuse problems are addressed within the welfare system.

Drabble, L. (2007). Pathways to collaboration: Exploring values and collaborative practice between child welfare and substance abuse treatment fields. Child Maltreatment, 12(1), pp. 31-42.

Although recent research has highlighted the importance of "bridging the gap" between child welfare and substance abuse treatment delivery systems, few studies examine specific factors that may facilitate such collaboration. This study examined similarities and differences in values and perceived capacity for collaboration between substance abuse and child welfare fields based on survey data from more than 350 respondents in 12 California counties. Results indicated that although respondents across disciplines held similar values in some areas, such as priorities for services, significant differences between respondents from child welfare and substance abuse fields were found in other areas, including values and beliefs about drug use and drug-using parents, funding; and planning and measurement of outcomes. Respondents from counties with a strong history of collaboration were more likely to report institutionalized collaborative practices in several areas, from use of multidisciplinary teams for case planning to use of multiyear budgeting to plan for integrated services. The author concludes that areas of commonality between child welfare and alcohol and drug treatment fields may provide a rich opportunity for building on a sense of shared purpose and identifying problems to be overcome in the process of collaboration.

Drake, B., Jonson-Reid, M., & Sapokaite, L. (2006). Re-reporting of child maltreatment: Does participation in other public sector services moderate the likelihood of a second maltreatment report? Child Abuse & Neglect, 30(11), pp. 1201-1226.

This study uses administrative data to track the first re-reports of maltreatment in a low-income, urban child welfare population (n = 4957) while controlling for other public service involvement. Service system involvement is explored across the following sectors: Child Welfare, Income Maintenance, Special Education, Juvenile Court, and various forms of Medicaid-reimbursed medical or mental health care. This study builds knowledge by adding the services dimension to an ecological framework for analyses and by following recurrence for a longer period of time than prior investigations (7.5 years). Key results included a lower rate of re-reporting among children with parents who were high school graduates and/or permanently exited from the first spell on AFDC; and for children in families that received less intensive in-home services compared to those not receiving services, receiving intensive in-home, or foster care services. Findings show higher rates of re-reporting for children with Medicaid mental health/substance abuse treatment records. The authors conclude that caretaker characteristics and non-child welfare service use patterns had a strong association with the likelihood of a child being re-reported to the child welfare agency, these cases should be more heavily attended to by child welfare workers. High rates of service sector overlap suggest that interagency ties and cooperation should be strengthened. The lower risk associated with less intensive in-home services compared to un-served cases may indicate under-identification of in-home service eligibility following a first report of maltreatment.

Duarte, C. S., & Summers, A. (2013). A three-pronged approach to addressing racial disproportionality and disparities in child welfare: The Santa Clara County example of leadership, collaboration and data-driven decisions. Child Adolescent Social Work Journal, 30(1), pp. 1-19. DOI: 10.1007/s10560-012-0279-8

This article outlines strategies and tools used to begin reducing disproportionality within the child welfare and juvenile dependency court system, using San Jose’s experience as an example. Some of the key approaches to addressing disproportionality include ensuring a systems approach (creating a Cross Agency Systems Team that prioritizes services for parents and children in various systems, e.g., mental health, substance abuse, etc.); addressing disproportionality from multiple perspectives and examining the roles’ of caseworkers, supervisors, service providers, judges, and attorneys; gaining community and system stakeholder buy-in by maintaining momentum and providing opportunities for dialogue about the complex issues facing families of color; using a data-driven approach to inform ongoing initiatives and changes in policy and practice (e.g., closely examining policies and practices such as the frequency of recommendations to by-pass reunification services); and implementing changes in practice at multiple levels including child welfare and on the bench. The examination of San Jose’s approach reveals challenges, successes, and lessons learned.

Edwards, L. J. (2012). Representation of Parents and Children in Abuse and Neglect Cases: The Importance of Early Appointment. Juvenile and Family Court Journal, 63(2), pp. 21-37.

This article discusses the importance of appointing legal representatives for parents and children in child protection cases, prior to the commencement of any court hearings. The authors briefly discuss representation in child abuse and neglect cases, then addresses the nature of initial or shelter care hearing, and discusses the importance of legal representation at the initial hearing. The authors recommend that presiding judges appoint attorneys and GALs simultaneously with the filing of an abuse and neglect petition and before any court hearings occur.

Fang, X., Brown, S. D., Florence, S. C. & Mercy, A. J. (2012). The economic burden of child maltreatment in the United States and implications for prevention. Child Abuse and Neglect, 36(2), pp. 156-165. DOI: 10.1016/j.chiabu.2011.10.006

This article presents estimates of the average lifetime costs per child maltreatment victim and aggregate lifetime costs for all new child maltreatment cases incurred in 2008 using an incidence-based approach. The estimated average lifetime cost per victim of nonfatal child maltreatment is $210,012 in dollars, including $32,648 in childhood health care costs; $10,530 in adult medical costs; $144,360 in productivity losses; $7,728 in child welfare costs; $6,747 in criminal justice costs; and $7,999 in special education costs. The estimated average lifetime cost per death is $1,272,900, including $14,100 in medical costs and $1,258,800 in productivity losses. The total lifetime economic burden resulting from new cases of fatal and nonfatal child maltreatment in the United States in 2008 is approximately $124 billion with sensitivity analysis showing the total burden is estimated to be as large as $585 billion. Compared with other health problems, the burden of child maltreatment is substantial, indicating the importance of prevention efforts to address the high prevalence of child maltreatment.

Frey, L., LeBeau, M., Kindler, D., Behan, C., Morales, M. I., & Freundlich, M. (2012). The pivotal role of child welfare supervisors in implementing an agency’s practice model. Children and Youth Services Review, 34(7), pp. 1273-1282. DOI: 10.1016/j.childyouth.2012.02.019

In this article, the authors synthesize the literature around child welfare supervision and practice model implementation and explore the fundamental role of the supervisor in child welfare generally and practice model implementation in particular. The authors draw on the permanency practice model developed by Casey Family Services, a private foster care agency in New England and Baltimore, and the supervisory model that that agency developed to implement its permanency practice model. Authors make the case that the supervision model and the practice model should parallel each other with the values and principles that inform the practice model applying to supervision, and argue that practice model implementation is facilitated when the agency supervision model is aligned with its practice model.

General Accounting Office. (2003). Foster care: States focusing on finding permanent homes for children, but long-standing barriers remain. Testimony of Cornelia M. Ashby, Director of Education, Workforce, and Income Security Issues presented before the Subcommittee on Human Resources Committee on Ways and Means. Washington, DC: Author. Available online at:'Foster%20care:%20States%20focusing%20%20and%20GAO

In response to concerns that some children were languishing in temporary foster care, Congress enacted the Adoption and Safe Families Act of 1997 (ASFA) to help states move children in foster care more quickly to safe and permanent homes. Representative Wally Herger, Chairman of the House Ways and Means Subcommittee on Human Resources asked the Government Accounting Office to review (1) changes in outcomes for children in foster care since ASFA was enacted, (2) states' implementation of ASFA's fast track and “15 of 22” provisions, (3) states' use of two new adoption related funds provided by ASFA, and (4) states' initiatives to address barriers to achieving permanency. In her testimony, Director Ashby provided background information on foster care and AFSA. She also reported that limited data are available to measure changes in the outcomes and characteristics of children since AFSA, other than their being an increase in adoptions. Director Ashby also discussed that some states have reported court-related issues that hinder the use of the fast track provision for more children and that some states do not file termination of parental rights on many children. New AFSA adoption-related funds were most commonly used to recruit adoptive families and provide post adoption services. States are also developing practices in response to long-standing barriers (i.e., a lack of adoptive families, placing children across jurisdictions, poor access to services) that continue to hamper efforts to promote permanency for foster children.

Gilbert, N. (2012). A comparative study of child welfare systems: abstract orientations and concrete results. Children and Youth Services Review, 34(3), pp. 532-536. DOI: 10.1016/j.childyouth.2011.10.014

A comparative analysis of child welfare systems in 10 countries identifies three broad functional orientations – child protection, family service and child development – around the problem definition, mode of intervention and role of the state: The changes in policies and practices since the mid-1990s suggest the possibility of functional convergence among these systems with moderate versions of the child protection and family service orientations incorporated within the more comprehensive approach of child development. An analysis of administrative data on one important outcome reveals that over the last decade nine of the 10 countries experienced an increasing rate of out-of-home placements. A critical examination of the data illustrates the necessity of determining how the rates are calculated, what is included in these counts and what the numbers signify to fully comprehend the implications of this trend.

Green, B. L, Rockhill, A., & Burrus, S. (2002, November). What helps and what doesn't: Providers talk about meeting the needs of families with substance abuse problems under AFSA: Summary of findings. Portland, OR: NPC Research, Inc.

This report presents results from a research study designed to understand how child welfare; substance abuse treatment; and the legal system including judges, referees, lawyers, and others are (or are not) working together to meet the needs of substance-abusing families involved with child welfare. Features of the systems themselves that were seen as particularly helpful included Family Decision Meetings; cross-system trainings; outreach workers and other means of providing wraparounds services; having appropriate substance abuse treatment available to clients; appropriate judicial and child welfare authority to mandate services; and frequent judicial monitoring. Several other issues also emerged as areas of effective practice that were remarkably consistent across the three systems: having positive, supportive relationships with families; advocacy for parents; communicating clearly and frequently with parents; collaboration across the three systems; and knowledge and experience with substance abuse issues and with AFSA. When these elements are in place, parents are better able to make timely progress.

Guerrero, G. E. (2012). Workforce diversity in outpatient substance abuse treatment: The role of leaders' characteristics. Journal of Substance Abuse Treatment, 44(2), pp. 208–215.

Although the outpatient substance abuse treatment field has seen an increase in referrals of African American and Latino clients, there have been limited changes in the diversity of the workforce. This discordance may exacerbate treatment disparities experienced by these clients. Program leaders have significant influence to leverage resources to develop staff diversity. Analysis of panel data from 1995 to 2005 showed that the most significant predictors of diversity were the characteristics of leaders. A high percentage of African American staff was positively associated with managers' tenure, but inversely related to licensed directors. Diversification of the field has increased, yet efforts have not matched increases in client diversity. Implications for health care reform legislation seeking to improve cultural competence through diversification of the workforce are discussed.

Heflinger, C. A., & Hoffman, C. (2008). Transition age youth in publicly funded systems: Identifying high-risk youth for policy planning and improved service delivery. Journal of Behavioral Health Services & Research, 35(4), pp. 390-401.

Youth with Serious Emotional Disturbances (SED) face many challenges as they approach the transition to adulthood and adult services. This study examines publicly funded transition-age youth in order to describe the numbers and type of youth in need of policy and service planning in one state. Using Medicaid enrollment and claims/encounter data, youth with high risk of transition difficulties were identified in the following groups: SED, state custody/foster care or risk of custody, users of intensive or frequent mental health services, or having diagnoses of major mental disorders, conduct disorders, or developmental disabilities. Almost one quarter of all enrolled 14 to 17-year olds met criteria for at least one of the high risk groups, and three-quarters of these were youth with SED. High risk youth are described, with greater detail on those with SED, and implications for policy, services, and research are discussed.

Howell, J. C., Kelly, M. R., Palmer, J., & Magnum, R. L. (2004). Integrating child welfare, juvenile justice, and other agencies in a continuum of services. Child Welfare, 83(2), pp. 143-156.

This article presents a comprehensive strategy framework for integrating mental health, child welfare, education, substance abuse, and juvenile justice system services. The comprehensive framework consists of a continuum of six levels of prevention programs, interventions, and sanctions, moving from least to most restrictive, followed by aftercare. The authors propose an infrastructure of information exchange, cross-agency client referrals, a networking protocol, interagency councils, and service integration models. The authors also provide information on financing integrated service delivery. Information contained in this article can assist community planning teams with developing an infrastructure and formulating a long-term strategic plan to improve integration of all youth-serving systems.

Jones, L. (2005). The prevalence and characteristics of substance abusers in a child protective service sample. Journal of Social Work Practice in Addictions, 4(2), pp. 33-50.

The purpose of this research was to identify characteristics of substance abusers in a child protective services caseload. The random sample of 443 children was drawn from an urban county from all children with a substantiated abuse case; data was drawn from these files. Sixty-eight percent of the children had mothers who abused alcohol or drugs, and 37 percent of them had mothers who abused both. Substance abuse, service contacts, public assistance, homelessness, and household conditions in the service plan were all associated with child removal from the home. These findings suggest that the risks associated with substance abuse are not necessarily ameliorated with social work intervention.

Jones, D., Macias, R. L., Gold, P. B., Barreira, P., & Fisher, W. (2008). When parents with severe mental illness lose contact with their children: Are psychiatric symptoms or substance use to blame? Journal of Loss & Trauma, 13(4), pp. 261-287.

This study compared parental psychiatric symptom severity, and the absence or presence of severe substance abuse, as predictors of contact with minor children for a representative sample of adults with diagnoses of serious mental illness (N = 45). Child contact and psychiatric symptom severity were measured during regularly scheduled 6-month research interviews over a total 30-month period following each participant's entry into the project. Severe substance abuse was documented as present or absent for the 6-month interval preceding each interview. Results revealed that incidence of severe substance abuse was repeatedly associated with less frequent parent-child contact, even after controlling for psychiatric symptoms, diagnosis, gender, age, ethnicity, and socioeconomic status. Neither psychiatric diagnosis nor symptom severity predicted frequency of child contact when substance abuse was taken into account. Mental health agencies offering parenting classes for adults with serious mental illness should incorporate substance use interventions to reduce loss of child custody and strengthen parent-child relationships.

Knight, K. D., Becan, E. J. & Flynn, M. P. (2012). Organizational consequences of staff turnover in outpatient substance abuse treatment programs. Journal of Substance Abuse Treatment, 42(2), pp. 143–150. DOI: 10.1016/j.jsat.2011.10.009

The purpose of this study was to examine the impact of staff turnover on perceptions of organizational demands and support among staff who remained employed in substance abuse treatment programs. Results from a series of multilevel models documented that counselors working in programs that had previously experienced high staff turnover perceived higher demands and lower support within their organization, even after controlling for other potentially burdensome factors such as budget, census, and individual measures of workload. Two individual-level variables, caseload and tenure, were important determinants of work environment demands but were not related to supportive work relationships. Findings suggest that staff turnover increases workplace demands, decreases perceptions of support, and underscores the need to reduce stress and minimize subsequent turnover among clinical staff.

Lee, E., Esaki, N., & Greene, R. (2009). Collocation: Integrating child welfare and substance abuse services. Journal of Social Work Practice in the Addictions, 9(1), pp. 55-70.

This article presents findings from a process evaluation of a pilot program to address parental substance abuse in the child welfare system. By placing substance abuse counselors in a local child welfare office, the collocation program was designed to facilitate early identification, timely referral to treatment, and improved treatment engagement of substance-abusing parents. Frontline child welfare workers in 6 of the 7 pilot sites endorsed the program as they found that the collocated substance abuse counselors provided additional resources and facilitated case processing. Findings suggest that clearly defined procedures and sufficient staffing of qualified substance abuse counselors could lead to better programs.

Legal Action Center. (2003). Safe and sound: Models for collaboration between the child welfare and addiction treatment systems. Washington, DC: Author.

This report examines policy and practice issues affecting the child welfare and treatment systems. A background on the problem of addiction in the child welfare system is provided, including resources and effectiveness of the treatment system. This report also includes a discussion of the Adoption and Safe Families Act (ASFA), in particular making “reasonable efforts”, permanency hearings, and termination of parental rights. Implications for families at risk for involvement or involved in the child welfare system because of parental addiction is included. The report presents case studies of how two localities (Cook County, Illinois, and Cuyahoga County, Ohio) are addressing addiction in their child welfare systems, and also presents a model for addressing the needs of addicted parents involved in the child welfare system based on case study findings.

Lester, B.M., Andreozzi, L., & Appiah, L. (2004). Substance use during pregnancy: Time for policy to catch up with research. Harm Reduction Journal, 1(1), pp. 5-50.

The purpose of this review is to summarize policy research findings in the area of maternal prenatal substance abuse to: 1) inform and advance the field; 2) identify future research needs; 3) inform policy making; and 4) identify implications for policy. This review is a systematic analysis of existing data findings on maternal drug use during pregnancy for determining the best policy among the alternatives for dealing with drug using mothers and their children. This article address the issues of efficacy (which policies work), economics (cost), and politics. New policies are also examined for their fit with existing policies and laws, the social impact, ethical issues, and the feasibility of implementation and administration. Several general policy recommendations are offered here addressing the critical issues. The authors hope that by focusing on these fundamental issues and ultimately detailing statistics, policymakers throughout the United States will consider the course of action that views both pregnant mother and fetus/child as humanely as possible.

Libby, A. M., Orton, H. D., Barth, R. P., Webb, M. B., Burns, B. J., Wood, P., & Spicer, P. (2006). Alcohol, drug, and mental health specialty treatment services and race/ethnicity: A national study of children and families involved with child welfare. American Journal of Public Health, 96(4), pp. 628-631.

The authors used data on a national sample of children involved with child welfare systems to compare American Indian caregivers with White, Black, and Hispanic caregivers in their need for, and receipt of, specialty alcohol, drug, and mental health treatment. The authors found that American Indian caregivers were significantly less likely to receive services than were Hispanic caregivers but not significantly less likely than were White or Black caregivers. Child placement, child age, and caregiver psychiatric comorbidity were significantly associated with service receipt. The authors suggest that racial and ethnic disparity exists in referral to, and receipt of, specialty services for alcohol, drug, and mental health problems.

Lundgren, L. M., Schilling, R. E., & Peloquin, S. D. (2005). Evidence-based drug treatment practice and the child welfare system: The example of methadone. Social Work, 50(1), pp. 53-63.

This article examined the extent to which methadone maintenance is discussed in the child welfare and social work literature and the extent to which child welfare policies mention and recommend this treatment method as a treatment alternative for drug-dependent parents. Findings were derived from a review of 15 social work journals published from 1996 through 2002, and from a review of child welfare policies in 27 states to determine the extent to which methadone maintenance is mentioned as a treatment for women with minor children. The social work literature illustrated the following themes: the need to better integrate child welfare and substance abuse treatment services; the need to provide gender-specific treatment; the need for social workers to be better educated about substance abuse issues; the common occurrence of relapse among drug-using populations; and different types of treatment available. Missing from these journals were discussions of the merits of methadone maintenance as a substance abuse treatment option for heroin-dependent individuals, including parents. The review of state policies indicated that methadone maintenance is not specified or recommended as a treatment approach for child welfare workers to consider for opiate-using parents. The authors believe that methadone maintenance improves the welfare of children and reduces parental drug use and that failure to mention its potential utility appears to contradict current substance abuse treatment practices and policy recommendations by organizations such as the World Health Organization and the National Institutes of Health.

Marshall, J. M., Huang, H., & Ryan, J. P. (2011). Intergenerational families in child welfare: Assessing needs and estimating permanency. Children and Youth Services Review, 33(6), pp. 1024-1030. DOI: 10.1016/j.childyouth.2011.01.004

This study compares 1,196 caregivers and 2,143 children from first and second generation child welfare-involved families. Second generation families experience significantly more risk factors at the time of case opening. Second generation families are half as likely to be reunified as compared with first generation families. Much of the empirical literature on intergenerational child maltreatment focuses on the mechanisms that explain how maltreatment is transmitted across generations. Few studies have examined child protective service outcomes associated with intergenerational families. The current study addresses this gap in the literature. This study compares 1,196 caregivers, most of whom are single African American females, and 2,143 children from first and second generation child welfare-involved families. All families have a history of substance abuse. The authors sought to understand how first and second generation families differ with regard to social and economic status indicators, as well as whether intergenerational child welfare involvement is associated with permanency outcomes. Findings indicate that second generation families experience significantly more risk factors at the time of case opening, and are two-thirds as likely to be reunified as compared with first generation families. The singular effects of generation status disappeared, however, once the interaction between mental health diagnosis and second generation status was entered into the model, suggesting that it is not just being intergenerationally involved in the child welfare system that reduces the chance of reunification, but rather second generation caregivers have more mental health problems that are associated with a lower likelihood of reunification.

Maschi, T., Hatcher, S. S., Schwalbe, C. S., & Rosato, N. S. (2008). Mapping the social service pathways of youth to and through the juvenile justice system: A comprehensive review. Children & Youth Services Review, 30(12), pp. 1376-1385.

The purpose of this review was to detail the human or social service needs and service use patterns (i.e., healthcare, education, social services, child welfare, mental health, and substance abuse) that influence youth's entry and prolonged involvement with the juvenile justice system. What emerged from the literature was a pattern of service needs and prior service usage that placed youth at risk of juvenile justice involvement. Extralegal factors, such as individual characteristics (e.g., race/ethnicity, gender, and mental health and trauma histories) and social/environmental characteristics (e.g., family conflict, unmet service needs, and prior social service use) influenced how youth traveled across the sectors of care. The authors present a social justice systems model that depicts the varied service pathways that youth may concurrently or sequentially travel across the social and justice systems of care. The paper concludes with a discussion of the implications for practice, policy, and research.

McAlpine, C., Marshall, C. C., & Doran, N. H. (2001). Combining child welfare and substance abuse services: A blended model of intervention. Child Welfare, 80(2), pp. 129-149.

Service integration is critical to working effectively with substance abusing parents and providing intensive time-limited reunification services to children and families. Based on this premise, the local child welfare services and adult addiction service agencies in Montgomery County, Maryland developed an initiative to address the requirements of the Adoption and Safe Families Act (ASFA) while meeting the needs of families and the community of providers. A blended model of intervention was determined to be the best strategy to achieve the dual mandates of child welfare and the treatment providers. Drawing from criminal justice, systems theory, social work, and addiction treatment, the approach made use of graduated sanctions or levels of intensity in providing services, engaging client participation, and engendering motivation. This article proposes strategies at client and organizational levels to understand the process of adaptation to ASFA and to guide planning for blending services.

McConnella, J. K., Ridgelyb, S. M. & McCartya, D. (2012). What Oregon’s parity law can tell us about the federal Mental Health Parity and Addiction Equity Act and spending on substance abuse treatment services. Drug and Alcohol Dependence, 124(3), pp. 340– 346 DOI: 10.1016/j.drugalcdep.2012.02.006

This study aims to provide evidence on the effect of comprehensive parity on utilization and expenditures for substance abuse treatment services by looking at Oregon’s parity law which is among the most comprehensive including coverage of benefits for the treatment of alcohol and other drug use disorders, as well as restricting management of the behavioral health benefit. Oregon’s experience suggests that behavioral health insurance parity that places restrictions on how plans manage the benefit may lead to increases in expenditures for alcohol treatment services but is unlikely to lead to increases in spending for other drug abuse treatment services.

McCrea, J. S., Scannapieco, M., Leake, R., Potter, C. C., & Menefee, D. (2014). Who's on board? Child welfare worker reports of buy-in and readiness for organizational change. Children and Youth Services Review, 37(1), pp. 28–35.

This study views the extent to which staff buy-in for an organizational innovation in child welfare (CW) relates to implementation progress. The study occurs during implementation of a statewide practice model that was supported with technical assistance from the Mountains and Plains Child Welfare Implementation Center (MPCWIC) and framed around the National Implementation Research Network model. Results show that implementation progress was higher among smaller agencies, and agencies with lower levels of job stress. Qualitative themes centered on staff inclusivity in project design, communication, and supervisor support. Findings highlight the need to adapt implementation strategies in urban and rural locales, and to attend strongly to staff selection, supervision, and inclusion during implementation. Addressing job stress may help bolster implementation.

McCrystal, P., Percy, A., & Higgins, K. (2008). Substance use among young people living in residential state care. Child Care in Practice, 14(2), pp. 181-192.

This paper reports on substance use trends of young people living in residential state care during three annual data-sweeps when aged 14, 15 and 16 years. A repeated cross-sectional research design was utilized in the research. The findings suggest some similarities for lifetime prevalence rates for tobacco and alcohol use for those living in residential state care with a group of same-age young people not living in residential state care who participated in the research. However, solvent abuse and cannabis use was higher among those living in care. More frequent substance use was reported by the residential care sample for all substances at each stage of the study. These findings suggest that young people living in state care continue to merit higher levels of vigilance from researchers and policy-makers in order to fully understand this behavior and develop appropriate prevention initiatives to meet their needs regarding potential drug problems.

McFarland, B. H., Gabriel, R. M., Bigelow, D. A., & Walker, R. D. (2006). Organization and financing of alcohol and substance abuse programs for American Indians and Alaska Natives. American Journal of Public Health, 96(8), pp. 1469-1477.

Although American Indians and Alaska Natives have high rates of substance abuse, few data about treatment services for this population are available. The authors used national data from 1997-2002 to describe recent trends in organizational and financial arrangements. Using data from the Indian Health Service (IHS), the Substance Abuse and Mental Health Services Administration, the National Institute on Alcohol Abuse and Alcoholism, the Henry J. Kaiser Family Foundation, and the Census Bureau, the authors estimated the number of American Indians served by substance abuse treatment programs that apparently are unaffiliated with either the IHS or tribal governments. The authors compared expected and observed IHS expenditures. Results indicated that half of the American Indians and Alaska Natives treated for substance abuse were served by programs (chiefly in urban areas) apparently unaffiliated with the IHS or tribal governments. IHS substance abuse expenditures were roughly what we expected. Medicaid participation by tribal programs was not universal. The authors concluded that many Native people with substance abuse problems are served by programs unaffiliated with the IHS. Medicaid may be key to expanding needed resources.

McNichol, T., & Tash, C. (2001). Parental substance abuse and the development of children in family foster care. Child Welfare, 80(2), pp. 239-256.

The purpose of this study was to examine the impact of parental substance abuse on the development of 268 children in family foster care and to document their verbal and nonverbal skills and behavioral characteristics. In addition, this study analyzed changes in these skills and characteristics after a period of time in family foster care and examined where the children were subsequently placed. As a group, the children in family foster care presented with low average cognitive skills and made significant improvement in cognitive functioning during placement. The children with prenatal exposure to drugs scored significantly lower in cognitive skills at the beginning of placement but made significantly more progress than the other children during placement. Behavior ratings by the foster parents and teachers revealed that 29% of the children had scores in the significant range, and the children exposed prenatally to drugs had a higher incidence of behavior problems at school compared to family foster care peers. Policy implications focus on selection, training, and support of foster families, increased mental health services, early identification of needs, individualization of intervention programs to nurture hidden cognitive potential and address specific acting-out behavior problems, comprehensive planning that includes the child’s functioning and behaviors at school, and additional funding of research on the causes and treatment of substance abuse and methods of improving outcomes for children in family foster care.

National Association of State Alcohol and Drug Abuse Directors, Inc. (2005, August). Alcohol research on prenatal alcohol exposure, prevention, and implications for state AOD systems (State Issue Brief No. 2). Washington, DC: Author.

This is the second in a series of State Issue Briefs prepared by the National Association of State Alcohol and Drug Abuse Directors primarily for distribution to State Alcohol and Other Drug (AOD) Agencies through support from the National Institute on Alcohol Abuse and Alcoholism. This Brief is not intended to be a comprehensive review of the science around the topic but rather a compilation of selected findings in the area of prenatal alcohol exposure, prevention, and an exploration of the implications for administrators of AOD treatment systems. This Brief includes a the following areas: definitions and diagnoses, prevalence, effects of prenatal alcohol exposure, prevention approaches and their effectiveness, implications for State AOD prevention and treatment systems, and future research.

Noble, A., Klein, D., Zahnd, E., & Holtby, S. (2000). Gender issues in California's perinatal substance abuse policy. Contemporary Drug Problems, 27(1), pp. 77-120.

This article examines gender issues that arose when California created and passed a law related to substance -exposed infants in 1990. The law intended to clarify whether prenatal alcohol and drug use was a reportable form of child abuse. The authors conducted 32 interviews with those who created the law and those who implemented part of the law, creating a model protocol. The authors also collected documents related to the overall project, such as the final report, the model protocol itself and comments on a draft protocol, and then minutes of meeting. Three gender issues arose in interviews with the law's framers and the protocol developers. First, the discourse about the law and the process of the law's creation was a divisive one. Members took sides as being either "pro-woman" or "pro-child" These positions were also respectively aligned with a further division: one was either "pro-treatment" or "pro-protection.” Second, there were issues related to drug testing and the purposes of such testing. Drug test results were, and continue to be, turned over to child welfare agencies. Child welfare workers have the difficult task of balancing parents’ and children’s interests within the legal guidelines.

Patrick, S. W., Schumacher, R. E., Benneyworth, B. D., Krans, E. E., McAllister, J. M., & Davis, M. M. (2012). Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. Journal of the American Medical Association, 307(18), pp. 1934

The objective of this study was to determine the national incidence of NAS and antepartum maternal opiate use and to characterize trends in national health care expenditures associated with NAS between 2000-2009. According to the findings of the study, between these years, there was a substantial increase in the incidence of NAS and maternal opiate use in the United States, as well as hospital charges related to NAS.

Proctor, E. (2012). Implementation science and child maltreatment: methodological advances. Child Maltreatment, 17(1), pp. 107-112. DOI: 10.1177/1077559512437034

This issue’s articles persuasively make the case for evidence-based practices in the child welfare system. The authors argue that the quality of care across the social services is substandard, and perilously so in publicly funded settings, such as those that serve child maltreatment and thus child welfare needs implementation science to meet the needs of the population it serves.

Putnam-Hornstein, E., Wood, J. N., Fluke, J., Yoshioka-Maxwell, A., & Berger, R. P. (2013). Preventing Severe and Fatal Child Maltreatment: Making the Case for the Expanded Use and Integration of Data. Child Welfare, 92(2), pp. 59-75.

In this article, the authors examine risk factors for severe and fatal child maltreatment identified from studies based on official maltreatment data, emergency department and hospitalization records, death certificates, and CDRT findings. The authors argue that administrative data can be used to generate information toward better understanding and greater prevention of nonfatal and fatal child maltreatment through: 1) enhanced surveillance, 2) improved decision-making, and 3) cost-effective perspective research and evaluation. After review and reflection upon what is known, the authors consider how integrating this information can advance efforts to protect children, providing examples where the use and linkage of multiple sources of data may enhance surveillance, improve front-end decision making, and support cost-effective research and evaluation.

Robertson, S. A. & Haight, W. (2012). Engaging child welfare-involved families impacted by substance misuse: Scottish policies and practices. Children and Youth Services Review, 34(10), pp. 1992-2001.

This study explores Scottish child welfare policies, beliefs and practices for engaging substance-involved families in child welfare services. Scottish approaches for engaging families are highly focused on child well‐being and relationship characteristics, prevention, resilience and recovery. Many of the strategies being used in Scotland are designed to change a deeply embedded problem of substance misuse, and considerable effort and resources have been targeted for long-term change. These initiatives are important to examine because, if successful, they may be helpful for understanding relational characteristics in other cultural contexts particularly those using holistic and differential approaches in child welfare.

Rockhill, A., Green, B. L., & Furrer, C. (2007). Is the Adoption and Safe Families Act influencing child welfare outcomes for families with substance abuse issues? Child Maltreatment, 12(1), pp. 7-19.

The Adoption and Safe Families Act (ASFA) was designed to promote more timely permanent placements for children in the child welfare system. To date, however, available data have said little about whether ASFA is meeting its intended goals. This study looks at the impact of ASFA on parents struggling with substance abuse issues. The authors compared child welfare outcomes, pre- and post-ASFA, for children of more than 1, 900 substance-abusing women with some treatment involvement. After the implementation of ASFA, children in this study spent less time in foster care, were placed in permanent settings more quickly, and were more likely to be adopted than remain in long-term foster care. These outcomes were apparent even controlling for case and family characteristics. The authors conclude that the outcomes suggest that ASFA was able to accelerate (at least to a limited degree) the permanency process for children who might have otherwise remained in foster care, while at the same time, it did not unduly hinder the efforts of substance-abusing parents to have their children returned to them.

Ryan, J. P., Marsh, J. C., Testa, M. F., & Louderman, R. (2006). Integrating substance abuse treatment and child welfare services: Findings from the Illinois Alcohol and Other Drug Abuse Waiver Demonstration. Social Work Research, 30(2), pp. 95-107.

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.

Sandler, I. N., Knox, P., & Braver, S. L. (2012). Collaboration of Prevention Science and the Family Court. Administration and Policy in Mental Health, 39(4), pp. 291–300. DOI: 10.1007/s10488-011-0367-7.

This paper describes 27 years of collaborative activities between a team of researchers at the Arizona State University Prevention Research Center (ASU PRC) and the Maricopa County Family Court Division of the Superior Court. The authors credit the expertise of the family court and prevention science for providing the foundation in which the missions of each can be advanced through collaborative activities. Four kinds of collaborative activities are described. Some of the lessons learned from the collaboration include mutual benefits of each activity, the benefit of complementary perspectives, the cumulative value of collaborations over time, the key role of the local key champion, and the societal benefit from the synergistic roles of university-based research and the family courts.

Sakai, C., Lin, H., & Flores, G. (2011). Health outcomes and family services in kinship care: Analysis of a national sample of children in the child welfare system. Arch Pediatric Adolescent Med, 165(2), pp. 159-165. DOI: 10.1001/archpediatrics.2010.277

To comprehensively assess family services, health, and health care outcomes for US children in kinship care vs. foster care. A 3-year prospective cohort study. National Survey of Child and Adolescent Well-Being. The sample consisted of 1,308 US children entering out-of-home care following reported maltreatment. Kinship care vs. foster care. Baseline caregivers’ support services and the children’s behavioral, mental health, and health service use outcomes 3 years after placement. Kinship caregivers were more likely than foster caregivers to have a low socioeconomic status but reported significantly fewer support services (caregiver subsidies, parent training, peer support, and respite care). Kinship care was associated with a lower risk ratio (RR) of continuing behavioral problems (RR=0.59; 95% confidence interval [CI], 0.41-0.80), low social skills (RR=0.61; 95% CI, 0.40-0.87), mental health therapy use (RR=0.45; 95% CI, 0.27-0.73), and psychotropic medication use (RR=0.46; 95% CI, 0.24-0.82) but higher risk of substance use (RR=1.88; 95% CI, 0.92-3.20) and pregnancy (RR=4.78; 95% CI, 1.07-17.11). Kinship caregivers received fewer support services than foster caregivers. Children in kinship care fared better with behavioral and social skills problems, mental health therapy use, and psychotropic medication use. Adolescents in kinship care may be at higher risk for substance use and pregnancy.

Semidei, J., Radel, L. F., & Nolan, C. (2001). Substance abuse and child welfare: Clear linkages and promising responses. Child Welfare, 80(2), pp. 109-128.

This article examines the prevalence of substance abuse among families involved with the child welfare system; the impact of substance abuse on child welfare practice; and how both the Adoption and Safe Families Act of 1997 and welfare reform legislation intensify the need to address parental substance abuse effectively. The article also includes promising strategies for addressing substance abuse among child welfare clients, such as Delaware’s Title IV-E Waiver Demonstration and Family Drug Courts.

Stahmer, A. C., Leslie, L. K., Hurlburt, M., Barth, R. P., Webb, M. B, Landsverk, J., & Zhang, J. (2005). Developmental and behavioral needs and service use for young children in child welfare. Pediatrics, 116(4), pp. 891-900.

The purpose of this study was to determine the level of developmental and behavioral need in young children entering child welfare (CW), estimate early intervention services use, and examine variation in need and service use based on age and level of involvement with CW by using a national probability sample in the United States. As part of the National Survey of Child and Adolescent Well-Being, data were collected on 2813 children under 6 years of age for whom possible abuse or neglect was investigated by CW agencies. Results indicate that both toddlers (41.8%) and preschoolers (68.1%) in CW have high developmental and behavioral needs; however, few children are receiving services for these issues (22.7% overall). Children that remain with their biological parents have similar needs to those in out-of-home care but are less likely to use services. Children under 3 years of age are least likely to use services. Children referred to CW have high developmental and behavioral need regardless of the level of CW involvement. The authors conclude that mechanisms need to be developed to address disparities in access to intervention.

Tregeagle, S., & Mason, J. (2008). Service user experience of participation in child welfare case management. Child & Family Social Work, 13(4), pp. 391-401.

This paper reports the findings of a qualitative study of Australian service users' experiences of participation when using the case management systems, Looking after Children and Supporting Children and Responding to Families. Findings indicate that the majority of service users reported positive experiences of participating in the use of these systems. However, participatory relations were often slow to develop and frequently involved conflict. Some service users used their power to control the flow and accuracy of information, or resisted workers in other ways. Some children and young people were excluded from the opportunity to participate because the systems did not have a ‘text-based’ format to ‘ensure’ that this process occurred. These findings indicate that case management systems did not result in relationships which consistently informed the intervention in a way that the systems' authors had envisaged. Service users did not necessarily take up the openings offered to them and workers did not necessarily comply with the systems' obligations. The findings cause us to question the assumptions that power can be bestowed or withdrawn, in the way suggested by these case management systems.

Twomey, J. E., Soave, R., Gil, L., & Lester, B. M. (2005). Permanency planning and social service systems: A comparison of two families with prenatally substance exposed infants. Infant Mental Health Journal, 26(3), pp. 250-267.

This article introduces an innovative program developed to work with families in which substance use during pregnancy leads to Child Protective Services involvement. The Vulnerable Infants Program of Rhode Island (VIP-RI) was established to facilitate permanency planning for substance-exposed infants by focusing on the interface of social service systems with one another and with the families affected by perinatal substance use. Permanent placement within the time frame mandated by federal legislation places increased pressures on parents and the social service systems designed to provide them with assistance. The Vulnerable Infants Program of Rhode Island promotes collaboration, coordination, and communication among social service systems engaged with families of substance-exposed infants. The Vulnerable Infants Program of Rhode Island works to increase the efficacy of social service systems in order to optimize the resources that are available to a family in their attempts at reunification with their infant. Case examples illustrate the complexities of the families of substance-exposed infants, the breadth of social service systems that become involved with these families, and the vastly different placement outcomes that substance-exposed infants may experience.

What babies get tested for drugs: A system that is 'ripe for bias' (2009). Alcoholism & Drug Abuse Weekly, 21(2), pp. 3-3.

The article reports on the absence of infant drug test in the state laws in the U.S. Physician Joseph P. Ryan, the Cook County child welfare population representative, has revealed that most patients tested come from poor sector since no law has been implemented on testing issue. The National Advocates for Pregnant Women (NAPW) executive director, Lynn M. Paltrow, has perceived mothers losing child custody to be inefficient in addiction recovery of mothers for separation is one of the policies.

Young, N. K., S. M. Boles, et al. (2007). "Parental substance use disorders and child maltreatment: Overlap, gaps, and opportunities.” Child Maltreatment, 12(2), pp. 137-149.

There are relatively few empirically sound studies or nationally representative data on the number of children in Child Welfare Services (CWS) who are affected by their parents' substance abuse or dependence. The two systems that could systematically monitor this population, CWS and substance abuse treatment, are not required to capture the data elements that would identify families in both systems. The studies that are based on CWS populations or parents in treatment indicate that there is a substantial overlap in client populations. This review provides a summary of the available data; provides estimates of the overlap between populations, including the number of infants born each year with prenatal substance exposure; and suggests important opportunities to close the data gap between the systems. The findings underscore both the need for obtaining accurate data within the systems and the opportunities for states to improve their cross-system data efforts as part of their outcome monitoring.

Zimmer, M. H., & Panko, L. M. (2006). Developmental status and service use among children in the child welfare system: A national survey. Archives of Pediatrics & Adolescent Medicine, 160(2), pp. 183-188.

This study estimated the prevalence of developmental delay and service use among children in the child welfare system and identified factors that influence developmental delay and use of these services. Subjects were children aged 0 to 10 years (n = 4324) and their caregivers, who were interviewed within 60 days of a report being made to the child welfare system. The sample was part of the National Survey of Child and Adolescent Well-Being. Children's development was measured directly using standardized assessment tools. Three questions from the caregiver interviews estimated receipt of developmental services. Prevalence of developmental delay and service use by age group, type of maltreatment, type of placement, race, sex, and income were reported. The authors found that younger children aged 0 to 2 and 3 to 5 years had higher rates, 33% and 36%, respectively, of developmental delay than school-aged children (13%). Despite their high prevalence of developmental delay, children aged 0 to 2 years were less likely to receive developmental services than preschool-aged children or school-aged children. The authors conclude that rates of developmental delay are high and developmental services are underused, particularly by young children in the child welfare system. In addition, the authors suggest that strategies for overcoming barriers to using early intervention services should be implemented.

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