Improving Engagement with Parents who Abuse Substances
Until recently, most child welfare workers received little training to cope with substance abuse difficulties in their clients; many harbored dislike for engaging people with alcohol and other drug problems and felt hopeless about making any positive difference. A pilot study (Gregoire, 1994) found training can have a positive impact on caseworker attitudes about working with clients who are addicted.
Using Title IV-E funds, the state of Delaware embarked on a demonstration project that is similar to the design of the PTP (Semidei et al., 2001). They hired substance abuse counselors to be located in each of its child welfare offices. These counselors performed onsite substance abuse evaluations for child welfare clients, identified treatment resources, worked with clients during the referral process, and provided consultation to child welfare caseworkers on case planning. The project experienced problems in hiring staff and accessing appropriate treatment, particularly in the state’s rural areas. Consequently, closer ties needed to be built to the state’s substance abuse system, and internally, child welfare staff found they needed to work with clients for an average of six months, rather than the three months anticipated, to get a client solidly engaged in treatment. Outcomes at the end of the project indicated that 24% of clients were actively engaged in or had completed treatment (James Bell Associates, Children’s Bureau, 2006).
The Illinois AODA Waiver Demonstration Project also utilized “recovery coach” services of an AODA professional within the child welfare system who provided continuous, aggressive outreach efforts to engage and retain parents in substance abuse treatment and other services (Ryan, 2006). Outcomes indicated that 20% of clients completed all levels of substance abuse treatment. Families receiving recovery coach services were more likely to access substance abuse treatment and were 1.28 times more likely to achieve family reunification. The reunification rate for the control group receiving no “recovery coach” was 11.6%; for the demonstration group the rate was 15.5%.
Motivational interviewing (MI), developed by William Miller and Stephan Rollnick (2002), is a treatment approach for helping clients move through the Stages of Change and find internal motivation for change. The goal of treatment is to increase “change talk” and decrease “resistance talk.” The primary techniques are to 1) express empathy and accep- tance of clients’ feelings, 2) develop discrepancy (i.e., help clients identify how they are versus how they want to be), 3) roll with resistance by turning questions and problems back to clients, and 4) support self-efficacy (i.e., clients’ belief in their own ability to carry out and succeed at the task) (Miller & Rollnick, 2002).
Idaho Pre-Treatment Program