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Substance Abuse and Chronic Neglect

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  1. Substance Abuseand Chronic Neglect Dee Wilson, MSW Northwest Institute for Children and Families June 18, 2008 Neglect: The Hidden Cost of Meth and Other Substance Abuse Deschutes County Summit

  2. The profile of child welfare families and of children entering the foster care system changed dramatically in the 1980s: Neglect, substance abuse, high rates of infant place -ments and placements of pre-school children, long length of stay in out-of-home care, reduced rates of reunification, and high rates of re-entry into care resulted in large increases in states’ foster care populations.

  3. Oregon’s Statutory Definition ofChild Neglect Negligent treatment or maltreatment of a child, including but not limited to the failure to provide adequate food, clothing, shelter or medical care that is likely to endanger the health or welfare of the child. ORS 419B.005 Reporting of Child Abuse (1)(F)

  4. There were 18 child deaths as reported in the Oregon Department of Human Services 2005 Status of Children Report.

  5. COMPARISON OF CLACKAMAS COUNTY & OREGONBY TYPE OF ABUSE

  6. Operational definition of chronic neglect is… “neglect cases with multiple referrals to child protective services in which there is a clear pattern of inadequate parenting over an extended period of time.”

  7. Spectrum of Neglectful Parenting • Situational neglect • Sporadic neglect • Chronic neglect • Chronic maltreatment

  8. (Loman, 2006)

  9. Single Framevs. Entire Film

  10. Possible effects of substance abuse on parenting behaviors • Unreliable and inconsistent in providing basic care and feeding, hygiene, supervision, protection from danger, medical care, education; increased risk of accidents. • Physically and/or emotionally unavailable for lengthy periods of time. • Frequently irritable, cranky, harsh with children. (Kroll & Taylor, 2003)

  11. Possible effects of substance abuse on parenting behaviors • Exercises poor judgment (from standpoint of children’s needs) in use of resources, choice of friends and associates, exposing children to danger – risk management. • Exacerbates family conflict and family violence, and may lead to physical abuse and emotional abuse. • Insistence on secrecy, denial of use of illegal drugs. (Kroll & Taylor, 2003)

  12. Possible effects of substance abuse on parenting behaviors • Children may have access to drugs, drug paraphernalia, or meth factory. • Parental involvement in criminal behavior. • Social isolation, gradual loss of non-substance-abusing relatives and friends. (Kroll & Taylor, 2003)

  13. Methamphetamine Abusers Binge + Crash = Lack of Supervision

  14. Who are these families? • Young mothers • Several children • Severe long-term poverty • History of exposure to violence • Co-occurring mental health disorders • Criminal histories • Serious cognitive impairments (20%) • Very young children • 20% enter foster care 0-1 yrs

  15. Why is Treatment Rate Low? Recent studies indicate that no more than 50% of parents ordered into substance abuse treatment through dependency actions are entering and completing the programs

  16. Substance Abuse Parent Engagement Motivation Mental Health

  17. Indicators of Demoralization • Poor self care • Lack of concern with physical environment • Inability to take practical steps which would improve the situation • Apathy in the face of threat

  18. Indicators of Demoralization • Cannot “regroup” in the face of adversity • Accepts demeaning behavior and attributions • Unresponsive to offers of help • Hopeless/helpless

  19. A recent California study found that: • 45% of child welfare involved parents were on probation or parole. • 43% of child welfare involved and non-child welfare involved adults had been in 2 or more prior treatment episodes. (Grella et al, 2006)

  20. Women in Substance Abuse Treatment • Women 2x Rate of Depression as Men • 1/3 Women in Substance Abuse Treatment have Clinical Depression • 2-4x Higher Partner Violence • Rates of Trauma and PTSD Under Diagnosed • 80% Co-morbidity for those with PTSD • Vast Majority history of physical/sexual abuse

  21. …helplessness and paralysis becomes a habitual way of responding to stressful stimuli…. (Solomon & Siegel, 2003)

  22. Substance Abuse Mental Health Poverty Trauma Violence What is the Connection?

  23. Dynamics Chronically Maltreating Families • Family Breakdown • Moral Collapse • Disintegration of Extended Family Ties • Disintegration of Community Connections

  24. “There is something all-encompassing about neglect – a qualitative shift in the experience of living – that needs to be considered, independently and coterminously with other types of abuse.” (Kroll & Taylor, 2003)

  25. “Neglect is not simply about the physical environment but also includes the totality of the child’s experience. It will not necessarily be visible… but it may be palpable in the sense that neglected children can exude a sense of being uncared for on many levels, and this can communicate itself to those around them.” (Kroll & Taylor, 2003)

  26. Effects of Chronic Neglect / Chronic Maltreatment on Children’s Development, Emotional Well Being, and Mental Health: • Attachment • Cognitive development / language delay • Affect regulation • Social self confidence, social competence • Perseverance in problem solving • Empathy / conscience • Conduct disorders / delinquency

  27. Do we have a concept of“Good Enough Parenting? • Dependability in providing basic care • Ensuring safety • Providing emotional warmth • Providing stimulation and education adequate to allow normal development • Providing guidance and boundaries • Stability of caregiving (Dept of Health, 2000)

  28. Indicators of Positive Changewith Young Children • Enjoyment of the infant • Sensitive and responsible caregiving • Engagement with the child in mutually satisfying interactions • Ability to provide appropriate and interesting activities to enhance the child’s development (Howard, 1994)

  29. Indicators of Positive Changewith Young Children • Most of all: The child’s needs come first in the parent’s heart and mind • Reliable in fulfilling responsibilities and taking care of basic needs • Makes good use of available resources; asks for help as needed • Honest and candid regarding one’s actions (Howard, 1994)

  30. Indicators of Positive Changewith School Age Children • Can cope with child’s negative behavior and emotions • Enjoys being with child • Proud of child’s achievements and talents • Increased ability to set limits on child behavior without hitting, yelling, ignoring, or abandoning (Howard, 1994)

  31. Indicators of Positive Changewith School Age Children • Reliability in keeping promises and visiting child • Increased recognition of past history of CA/N • Increased contact with persons supportive of positive changes • Lack of violence in interpersonal relationships (Wilson, 2000)

  32. Indicators of Positive Changewith School Age Children • Increased motivation to change following relapse • Increased self esteem • Increased self-efficacy (Wilson, 2000)

  33. Treatment completion is a means to an end, not the end itself. Recovery is a Process

  34. Treatment is not protection. Children and parents will often need continued support and services for long periods of time.

  35. “Parenting stress may continue to pose a significant threat to maintaining sobriety even after initial reunification.” Stressors include: • Coping with children’s feelings and behaviors • Feeling overwhelmed by demands and needs • Inadequate emotional support • Lack of adequate support services • Substance use by other family members (Carlson et al, 2006)

  36. Stressors include: • Abusive relationships • Contentious relationship with CPS/CWS • Threat of possible removal • Social stigma directed to parents who have lost custody of children • Financial strains / housing (Carlson et al, 2006)

  37. Finances Influence the Likelihood of Timely and Successful Reunification (Wells & Guo, 2004)

  38. Thoughtful Reunification Decisions Should Take into Account: • Where parents are in the recovery process • The extent and quality of supportive services

  39. Reunification & Re-Entry Given the difficulties which substance-abusing families present, why is there a renewed interest in reunification?

  40. Questions? Promising PracticesAfter the Break