Drug Testing in Child Welfare

Drug testing is a tool that can be used 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 biologic sources, such as urine, saliva, sweat, hair, breath, blood, and meconium to identify specific substances or their metabolites in an individual’s system. However, drug tests do not provide sufficient information for substantiating allegations of child abuse or neglect or for making decisions about the disposition of a case. The most effective way to identify a substance use disorder or determine if a child is at risk for maltreatment or neglect is to use a combination of screening and assessment tools inclusive of safety and risk assessments, 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 the sole determining factor in the removal of a child from the home or to determine parental visitation.

The resources on this page 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 best practices for using drug testing in child welfare.

Policy and Practice Resources

Drug Testing in Child Welfare: Practice and Policy ConsiderationsDrug 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, 2013

This report highlights 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. The 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.

Chapter 9: Drug Testing in TIP 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment ProgramsChapter 9: Drug Testing in TIP 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs (PDF 2 MB)
Substance Abuse and Mental Health Services Administration, 2012

This Treatment Improvement Protocol chapter offers a detailed description of medication-assisted treatment for addiction to opioids, including comprehensive maintenance treatment, detoxification, and medically supervised withdrawal. The chapter discusses screening, assessment, and administrative and ethical issues.

Behavior Modification 101 for Drug Courts: Making the Most of Incentives and SanctionsBehavior Modification 101 for Drug Courts: Making the Most of Incentives and Sanctions(PDF 919 KB)
Douglas B. Marlowe, 2012

This fact sheet reviews evidence-based practices for behavior change in drug court settings to achieve improved outcomes and cost savings. The resource recommends drug testing at least twice a week through the last phases of the program to ensure greatest efficacy.

The National Drug Court Institute's (NDCI) Benchbook Chapter 6: The Fundamentals of Drug TestingThe National Drug Court Institute's (NDCI) Benchbook Chapter 6: The Fundamentals of Drug Testing (PDF 330 KB)
Paul Cary, 2011

This chapter outlines the use of drug testing in the therapeutic court setting to provide data on participant behavior, allowing the court to direct the intervention strategies and monitor progress. The resource highlights the fundamental components needed for developing and maintaining a successful drug-testing program to assist participants in achieving their recovery goals.

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 MB)
National Drug Court Institute, 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

Practice Guidelines: Drug TestingPractice Guidelines: Drug Testing (PDF 54 KB)
State of Arizona, Department of Child Safety, 2016

The guidelines discuss the process 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.

Guidelines for Identifying Substance-Exposed NewbornsGuidelines for Identifying Substance-Exposed Newborns (PDF 888 KB)
The Arizona Statewide Task Force on Preventing Prenatal Exposure to Alcohol and Other Drugs, 2016

These guidelines were created to address the growing epidemic of prenatal exposure to alcohol and other drugs, they provide best practice resources for combatting the issue, improve the ability of health care providers to effectively identify at-risk pregnancies and substance-exposed newborns, standardize recommendations in screening, treatment and management.

Guidelines for testing and reporting drug exposed newborns in Washington State
Washington State Department of Health, 2015

These guidelines provide consistent guidance related to maternal and newborn screening and testing and reporting drug-exposed newborns to Washington State Department of Social and Health Services Children’s Administration. 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 White PaperDrug Testing White Paper (PDF 109 KB)
Kentucky In-depth Technical Assistance Project, 2011

This report, created by the Kentucky In-Depth Technical Assistance Practice Guidelines workgroup provides basic information on drug testing, as well as recommendations on the use of drug test results and other indicators of substance use. The paper gives 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 402 KB)
Iowa Children’s Justice State Council, 2011

These guidelines offer 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 (RSVP)

RSVP created this drug screening protocol for use by Recovery Specialists in the first 90 days of treatment.

Additional Resources

Clinical Drug Testing in Primary Care TAP 32: Clinical Drug Testing in Primary Care
Substance Abuse and Mental health Service Administration, 2012

This Technical Assistance Publication provide guidance on implementing drug testing for clinical practitioners such as physicians, nurse practitioners, and physician assistants in primary care offices and community health center 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

These tables present information on the detection period, advantages, and disadvantages of the different types of drug testing specimen collected (urine, sweat, oral fluid, hair, blood, eye scanning/pupilometer).

Related Research Articles

Akin, B. A., Brook, J., & Lloyd, M. H. (2015). Examining the role of methamphetamine in permanency: A competing risks analysis of reunification, guardianship, and adoption. American Journal of Orthopsychiatry, 85(2), 119-130. From http://dx.doi.org/10.1037/ort0000052(accessed August 17, 2017).

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, From http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03898.x/full.

Goodman, D. J., & Wolff, K. B. (2015). Screening for substance abuse in women’s health: A public health imperative. Journal of Midwifery & Women’s Health, 58(3)278-287.

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. From http://www.ncbi.nlm.nih.gov/pubmed/24932945 doi: 10.1016/j.drugalcdep.2014.05.001.

Terplan, M., & Minkoff, H. (2017). Neonatal abstinence syndrome and ethical approaches to the identification of pregnant women who use drugs. Obstetrics & Gynecology, 129(1),164.

Farst, K., Bolden, B. B. (2012). Substance-exposed infants and children: Forensic approach. Clinical Pediatric Emergency Medicine, 13(3), 221-228.

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