Drug Testing in Child Welfare

Drug testing is one tool that child welfare workers often use to determine if a parent is using substances and to facilitate decision making with families affected by substance use disorders. Drug testing refers to the use of various biologic sources, such as urine, saliva, sweat, hair, breath, blood, and meconium to determine the presence of specific substances or their metabolites in an individual’s system. Drug tests, however, do not provide sufficient information for substantiating allegations of child abuse or neglect or for making decisions about the disposition of a case. The best way to identify a substance use disorder or determine if a child is at risk is to use a combination of screening and assessment processes that include a safety and risk assessment, clinical instruments, random drug testing, self-reports, and observations of behavioral indicators. Assuming there are no other safety concerns, a positive drug test or a series of positive drug tests should not be used as a condition of child visitation, particularly for supervised visitation. Visitation should not be taken away as a punitive response – team members should instead assess the adequacy of the treatment plan for continued use as a part of the response.

The guidelines and materials below provide an overview of the general best practice guidelines of drug testing in child welfare and across systems.

Contact us at ncsacw@cffutures.org or 1(866) 493-2758 to learn more about implementing substance abuse specialists or recovery coaches into your practice.

Policy and Practice Resources

Cover page of a guidebookDrug Testing in Child Welfare: Practice and Policy Considerations (PDF 92 KB)
Substance Abuse and Mental Health Services Administration. 2010

This document guides child welfare agency policymakers in developing practice and policy protocols regarding the use of drug testing in child welfare practice. This guidance describes the practice and policy issues that policymakers must address to include drug testing in the comprehensive assessment and monitoring that child welfare agencies provide.

Drug Testing: A White Paper of the American Society of Addiction Medicine (ASAM)Drug Testing: A White Paper of the American Society of Addiction Medicine (ASAM) (PDF 838 KB)

American Society of Addiction Medicine. October 2013
Recognizing that drug testing is vastly underutilized throughout health care, the American Society of Addiction Medicine (ASAM), the nation's largest organization of physicians specializing in the prevention and treatment of addiction, has produced this White Paper to highlight the wide range of applications in which drug testing can promote prevention, early detection, and lifelong recovery from addiction in the interests of individual and public health. This paper describes the uses of drug testing as a primary prevention, diagnostic, and monitoring tool to identify the presence or absence of drugs of abuse or therapeutic agents related to addiction management in multiple settings.

Drug Testing Reference Tables for Drug CourtsDrug Testing Reference Tables for Drug Courts (PDF 22 KB)
National Council of Juvenile and Family Court Judges, 2009

Table shows the detection period, advantages, and disadvantages of the different types of drug testing specimen collected (urine, sweat, oral fluid, hair, blood, eye scanning/pupilometer).

Drug Testing in a Drug Court Environment: Common Issues to AddressDrug Testing in a Drug Court Environment: Common Issues to Address(PDF 156 KB)
Office of Justice Programs Drug Court Clearinghouse and Technical Assistance Project, 2000

This paper addresses the most frequent issues associated with drug testing in drug court programs; it provides an overview for drug court program officials regarding the most critical topics related to the development and maintenance of a drug testing capability.

Urine Drug Concentrations: The Scientific Rationale for Eliminating the Use of Drug Test Levels in Drug Court ProceedingsUrine Drug Concentrations: The Scientific Rationale for Eliminating the Use of Drug Test Levels in Drug Court Proceedings (PDF 2.47 KB)
National Drug Court Institute, Volume IV, No. 1, 2004

The objective of this fact sheet is to provide drug court professionals with scientifically based justification for discontinuing the interpretation of urine drug levels in an effort to define client drug use behavior.

State and Local Examples

Drug Testing White PaperDrug Testing White Paper (PDF 109 KB)
Kentucky In-depth Technical Assistance Project, 2011

This document provides basic information on drug testing, as well as recommendations and, such as guidelines on the use of drug test results and other indicators of substance use, and considerations for determination of risk when a parent tests positive for prescription medications, including those prescribed for Medication Assisted Treatment.

Iowa Drug Testing Practice GuidelinesIowa Drug Testing Practice Guidelines (PDF 401 KB)
Iowa Children’s Justice State Council, 2011

This fact sheet offers information on understanding and evaluating drug testing procedures.

Connecticut RSVP Drug Screening ProtocolConnecticut RSVP Drug Screening Protocol (PDF 90 KB)
Connecticut Recovery Specialist Voluntary Program

Developed through the NCSACW In-Depth Technical Assistance Project, this document offers a protocol for drug screening developed for the Connecticut Recovery Specialist Voluntary Program (RSVP).

Guidelines for testing and reporting drug exposed newborns in Washington State“Guidelines for testing and reporting drug exposed newborns in Washington State”
Washington State Department of Health, 2014

The purpose of this 16-page document is to provide consistent guidance related to maternal and newborn screening and testing and reporting drug-exposed newborns to DSHS. These guidelines were developed in response to calls from hospital staff and hospital legal counsel about issues around reporting positive newborn toxicology screens and testing/consent issues.

Drug Testing Practice GuidelinesDrug Testing Practice Guidelines (PDF 155 KB)
State of Arizona, Department of Child Safety, 2016

These guidelines discuss the processes for drug testing parents involved with child welfare services, including the appropriate use of testing, how to determine testing frequency and schedules, and how to discuss drug screens with parents.

Additional Resources

Clinical Drug Testing in Primary Care “Clinical Drug Testing in Primary Care”
Substance Abuse and Mental health Service Administration, 2012

For clinical practitioners such as physicians, nurse practitioners, and physician assistants in primary care office and community health center settings. This publication provides information that will assist the practitioner in whether they would want to implement drug testing at their facilities and if they do, guidance on implementing drug testing.

Drug Testing for Welfare Recipients and Public Assistance“Drug Testing for Welfare Recipients and Public Assistance”
National Conference of State Legislators, 2016

This website includes federal rules permitting drug testing as part of the TANF block grant, states that have proposed legislation, and details on the previously mentioned states’ recent legislation.

Related Research Articles

Carrieri, M., Trevisan, A., & Bartolucci, G. B. (2001). Adjustment to concentration-dilution of spot urine samples: Correlation between specific gravity and creatinine. International Archives of Occupational and Environmental Health, 74, 63-67. Available from http://www.ncbi.nlm.nih.gov/pubmed/11196084

Dolan, K., Rouen, D., & Kimber, J. (2004). An overview of the use of urine, hair, sweat and saliva to detect drug use. Drug and Alcohol Review, 23, 213-217. Available from http://www.ncbi.nlm.nih.gov/pubmed/15370028

Price, J. W. (2013). Dilution of Urine Drug Tests: Is it random? Journal of Addiction Medicine, 7(6), 405-409. doi: 10.1097/ADM.0b013e3182a1d5f3. Available from http://journals.lww.com/journaladdictionmedicine/Abstract/2013/11000/Dilution_of_Urine_Drug_Tests___Is_It_Random_.5.aspx

Darke, S., & Burns, L. (2012). Commentary on Friguls et al. (2012): Illicit drugs and pregnancy – testing is not a substitute for good clinical rapport. Addiction, 107, 1480-1481. doi: 10.1111/j.1360-0443.2012.03898.x, Available from http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03898.x/abstract

Gryczynski, J., Schwartz, R. P., Mitchell, S. G., O’Grady, K. E., & Ondersma, S. J. (2014). Hair drug testing results and self-reported drug use among primary care patients with moderate-risk illicit drug use. Drug and Alcohol Dependence, 141, 44-50. doi: 10.1016/j.drugalcdep.2014.05.001. Available from http://www.ncbi.nlm.nih.gov/pubmed/24932945

Moeller, K. E., Lee, K. C., & Kissack, J. C. (2008). Urine drug screening: Practical guide for clinicians. Mayo Clinic Proceedings, 83(1), 66-76. doi: 10.4065/83.1.66. Available from http://www.ncbi.nlm.nih.gov/pubmed/18174009

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