Children and Families Affected by Parental Substance Use Disorders (SUDs)

In the United States, about 1 in 8 children ages 17 or younger are living in households with at least one parent who has a substance use disorder. While these 8.7 million children will not all experience abuse or neglect, they are at increased risk for child maltreatment and child welfare involvement compared to other children.¹ The children who are at a greater risk may be affected by trauma due to parental neglect, the results of their own prenatal substance exposure, chaotic environments, or removal by child welfare professionals. Policies and procedures that encourage parents to enter substance use treatment and consider their parenting role as a part of their recovery process help to reduce the effects of parental substance use disorders on their children. Services for children that address their medical and developmental needs and experiences of trauma and reestablish trusting bonds with their families are critical.

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  Policy and Practice Resources

  • Infants with Prenatal Substance Exposure and Their Families: Five Points of Family Intervention
    (PDF 10 MB)

    National Center on Substance Abuse and Child Welfare (NCSACW), 2020

    This technical assistance tool is for collaborative teams to learn about the Five Points of Family Intervention and identify major points in time in which their agencies can improve outcomes for infants with prenatal substance exposure, pregnant and parenting women with substance use disorders, and their families. The tool provides examples of policy and practice strategies at each of the intervention points that child welfare, substance use treatment, healthcare, and other community agencies can employ to effectively serve this population.

    View Document Reasonable and Active Efforts, and Substance Use Disorders Toolkit
  • Reasonable and Active Efforts, and Substance Use Disorders Toolkit
    (PDF 379 KB)

    National Quality Improvement Center for Collaborative Community Court Teams (QIC-CCCT), American Bar Association Center on Children and the Law, and the Tribal Law and Policy Institute (2020)

    This toolkit was designed for professionals working with families in or at risk of entering the child welfare system. QIC-CCCT developed the toolkit to help address some of the challenges in making reasonable and active efforts and related judicial findings in cases involving substance use. Judicious application of reasonable and active efforts statutes can assist parents and children in receiving needed services that may improve permanency outcomes. The toolkit provides definitions, statutory requirements, examples of reasonable and active efforts, and a resource guide for further reading. It is also included as a resource on the Child Welfare Information Gateway.

    View Document Reasonable and Active Efforts, and Substance Use Disorders Toolkit
  • Understanding Substance Use Disorders—What Child Welfare Staff Need to Know
    (PDF 627 KB)

    National Center on Substance Abuse and Child Welfare, 2019

    National Center on Substance Abuse and Child Welfare developed a three-part, technical assistance (TA) resources tool, titled Child Welfare Practice Tips, for child welfare professionals to learn more about substance use disorders. NCSACW is a TA resource center jointly funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Children’s Bureau (CB), Administration on Children, Youth and Families (ACYF), U.S. Department of Health and Human Services. This tool spotlights five quick tips for child welfare professionals to use when in the field, working with families affected by substance use disorders.

    See Also

    • Engagement of Families Tips (PDF 566 KB)
    • Tip for Screening and Assessment (PDF 605 KB)

    View Document Understanding Substance Use Disorders—What Child Welfare Staff Need to Know
  • Children Living With Parents Who Have a Substance Use Disorder

    Substance Abuse and Mental Health Services Administration, 2017

    Specific information about the prevalence of children living with a parent who has a substance use disorder is included in this report. Also included is information about common outcomes for these families and research about the types of services that may be needed to support their well-being.

    Visit Website Children Living With Parents Who Have a Substance Use Disorder
  • Parental Substance Use and the Child Welfare System
    (PDF 413 KB)

    Child Welfare Information Gateway, 2014

    Created for child welfare workers and related professionals, this resource provides information on parental substance use disorders and child maltreatment. It describes strategies for prevention, intervention, and treatment, including examples of effective programs and practices.

    View Document Parental Substance Use and the Child Welfare System
  • HRSA's Home Visiting Program: Supporting Families Impacted by Opioid Use and Neonatal Abstinence Syndrome
    (PDF 451 KB)

    Health Resources and Services Administration, 2018

    Essential information about the opioid epidemic, opioid use disorder, and neonatal abstinence syndrome is the focus of this resource. The report presents relevant research and highlights promising efforts underway in several states on home-visiting programs and their state partners in early childhood, public health, and substance misuse and mental health treatment.

    View Document HRSA's Home Visiting Program: Supporting Families Impacted by Opioid Use and Neonatal Abstinence Syndrome
  • State-Level Policy Advocacy for Children Affected by Parental Substance Use

    State Policy, Advocacy and Reform Center, 2014

    This advocacy guide provides data demonstrating that substance use is a key factor in a high percentage of families involved with child welfare. The guide outlines eight barriers to addressing parental substance use in the child welfare system, summarizes five levers for advocates aiming to move beyond pilot projects to systems change, and highlights policy and practice innovations that advocates can promote.

    Visit Website State-Level Policy Advocacy for Children Affected by Parental Substance Use

• Related Online Trainings, Videos, and Webinars

  • A Framework for Intervention for Infants with Prenatal Exposure and Their Families
    (PDF 451 KB)

    National Center on Substance Abuse and Child Welfare, 2017

    This webinar introduces the Five Point Framework and identifies points of intervention for comprehensive reforms that prevent prenatal exposure and respond to the needs of pregnant women, mothers, their families, and their infants. The five points of intervention are pre-pregnancy, prenatal, identification at birth, postpartum, and infancy through adolescence.

    Watch Video A Framework for Intervention for Infants with Prenatal Exposure and Their Families
  • Generational Issues Affecting Recovery: From Childhood to Grandparenthood

    The National Association for Children of Addiction, 2016

    A discussion of mental or substance use disorders that often affect several generations of the same family is the focus of this video, which also explores issues that affect recovery in families.

    Visit Website Generational Issues Affecting Recovery: From Childhood to Grandparenthood
  • Family Partnerships that Support Change and Healing

    Institute for the Advancement of Family Support Professionals, 2016

    Designed to promote a deeper understanding of the effect of substance use and domestic violence on children and families, this self-paced module helps professionals examine what to look for, how to determine next steps, and how to support families through behavioral change.

    Visit Website Family Partnerships that Support Change and Healing
  • Nurturing Program for Families in Substance Abuse Treatment and Recovery
    (PDF 451 KB)

    National Center on Substance Abuse and Child Welfare, 2014

    This webinar discusses practical issues concerning the implementation of the Nurturing Program for Families in Substance Abuse Treatment and Recovery program, which was adapted to address the specific needs of families affected by parental substance abuse. The curriculum focuses on the effects of substance abuse on families, parenting, and the parent–child relationship.

    Watch Video Nurturing Program for Families in Substance Abuse Treatment and Recovery
  • Understanding and Treating Caregiver Substance Abuse and Trauma: A Focus on the Family

    The National Child Traumatic Stress Network, 2012

    The speakers in this webinar describe the connection between caregiver trauma and substance use disorders, effects on children, and the challenges experienced by families when substance use disorders and trauma are present. Four different models of intervention in the areas of parenting, substance abuse, and trauma are presented.

    Visit Website Understanding and Treating Caregiver Substance Abuse and Trauma: A Focus on the Family

• State and Local Examples

  • Regional Partnership Grants to Increase the Well-Being of, and to Improve the Permanency Outcomes for, Children Affected by Substance Abuse: Highlights of Grantee Implementation, 2012–2017
    (PDF 489 KB)

    National Center on Substance Abuse and Child Welfare, 2017

    Regional Partnership Grant (RPG) programs develop collaborative systems and outcomes specific to their specific project strategies. This document presents a range of activities and interventions implemented by RPGs, including peer recovery coaching, family-centered substance use disorder treatment, parenting and family strengthening programs, services to pregnant and postpartum women, Medication-Assisted Treatment, and in-home parenting and child safety support for families.

    View Document Regional Partnership Grants to Increase the Well-Being of, and to Improve the Permanency Outcomes for, Children Affected by Substance Abuse: Highlights of Grantee Implementation, 2012–2017
  • Intervention IDEAs for Infants, Toddlers, Children, and Youth Impacted by Opioids
    (PDF 343 KB)

    U.S. Department of Education, Office of Special Education Programs, 2018

    This issue brief includes an overview of risk factors and symptoms associated with opioid use disorders and a list of interventions that can improve outcomes for children and teens affected by opioid exposure. Geared for parents, schools, and programs, each entry includes a description of the intervention, examples of associated actions, and quality indicators that can be expected when the intervention is implemented successfully.

    View Document Intervention IDEAs for Infants, Toddlers, Children, and Youth Impacted by Opioids
  • Approaches to Supporting Families Affected by Opioid Use
    (PDF 204 KB)

    The Center of Excellence for Infant and Early Childhood Mental Health Consultation

    Innovative efforts to support families affected by opioid misuse in early childhood service settings are presented in this document. These efforts include using evidence-based screening tools, conducting brief interventions to help women reduce their use of alcohol and other drugs, facilitating referrals to family-centered treatment and recovery services, and addressing the social and emotional needs of infants and young children in families affected by substance use.

    View Document Approaches to Supporting Families Affected by Opioid Use
  • State Strategies to Meet the Needs of Young Children and Families Affected by the Opioid Crisis
    (PDF 979 KB)

    National Academy of State Health Policy, 2018

    This report presents state strategies to support young children and families affected by the opioid epidemic, available state and federal funding sources for effective initiatives, and key considerations for states working to improve services and outcomes for this vulnerable population.

    View Document State Strategies to Meet the Needs of Young Children and Families Affected by the Opioid Crisis
  • Sobriety Treatment and Recovery Teams (START)

    California Evidence-Based Clearinghouse for Child Welfare

    START is an intensive, integrated program for families affected by substance use and child maltreatment. The program pairs Child Protective Services workers with family mentors (peer support employees in long-term recovery). START services focus on maintaining children in the home, ensuring child safety and permanency, and identify natural supports with goals of parental sobriety and capacity.

    Visit Website Sobriety Treatment and Recovery Teams (START)

• Additional Resources

  • TIP 39: Substance Abuse Treatment and Family Therapy

    Substance Abuse and Mental Health Services Administration, 2015

    Information about substance misuse treatment relevant to family therapists is the focus of this document, which explains stages of motivation, treatment, and recovery; clinical decision-making; supervision; cultural considerations; funding; and research.

    Visit Website TIP 39: Substance Abuse Treatment and Family Therapy
  • Behavioral Health for Pregnant and Postpartum Women and Their Families: Tools for Treatment

    Addiction Technology Transfer Center of Excellence (ATTC) Center of Excellence

    This web-based, mobile-friendly toolkit serves as a clearinghouse for training curricula, training calendars, treatment provider tools, webinars, self-paced online courses, and opportunities to link with experts and innovative family-centered treatment programs and resources.

    Visit Website Behavioral Health for Pregnant and Postpartum Women and Their Families: Tools for Treatment