DFCS Online Policies & Procedures

  DFCS Online Policies & Procedures

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Handbook 3: Assessment Guides
3-7 Assessment of Drug and Alcohol Abuse
Assessment Guides
3-7 Assessment of Drug and Alcohol Abuse
Reference Points
Overview
Assessing the Level Of Endangerment
Direct Observations of Family Members
Conducting Interviews with Family Members
The Parent/Caregiver is Unavailable


Reference Points
Effective Date: 03/01/06
Last Updated: 6/12/08
 CWS/CMS Forms:
bullet Contact Notebook


Overview  

Substance abuse  plays a significant role in a high percentage of families who are supervised by our Department.  Although substance abuse may or may not have been the initial reason for referring a family, it is often the underlying cause or explanation for behaviors which have resulted in other allegations from general to severe neglect, physical or sexual abuse, and/or domestic violence to criminal activity, all of which place children at risk.

It is therefore imperative that social workers assess parents/caregivers for substance abuse, whether or not it is mentioned in the original allegation.  Without a clear understanding of the etiology of risk-producing behaviors, it is difficult to provide appropriate interventions and/or formulate appropriate case plans. 

It is sometimes difficult to determine if a person is involved in using/abusing alcohol or drugs simply by observing the individual.  There are many drugs, both legal and illegal, that a person may abuse.  Each drug may have a different effect on the person's behavior or demeanor.  Many drugs are taken in combination (poly-drug use).  An individual may also be suffering from a mental illness (dual-diagnosis).  In addition, a person may be suffering from a physical or medical condition which may produce similar behaviors (e.g., slurred speech).  As a result, it is important to gather as much information from as many sources as possible in order to to make an accurate assessment. 

Social workers should evaluate the referral and information sources as part of their assessment.  Although relatives and non-custodial parents may have a wealth of information, they may be influenced by custody issues or old conflicts, rather than true concern for the welfare of the child.  In contrast, mandated reporters, such as law enforcement, medical or drug personnel, may provide an already substantiated baseline of fact regarding the client's use of drugs/alcohol from which to begin the assessment. 

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Assessing the Level of Endangerment  

When assessing the level of endangerment:

Social Workers need to aware of how the parents' use of drugs and/or alcohol effects their ability to provide an appropriate, safe environment for their child(ren) and what influence it has on their ability to parent. 

The mere fact that a parent is abusing drugs or alcohol does not mean that a child should automatically be removed from the home.  A referral shall be kept open for the initial assessment and provision of services during which time a determination is made as to whether the parent can provide a sufficient and safe minimal level of care to the child. 

When making an assessment of a family in which drug or alcohol use is present, the social worker:

  • Includes in the assessment the:
    • Kinds, frequency, and amount of substance used
    • Accessibility of drugs and/or alcohol (and paraphernalia) to children in the home
    • Willingness of the parent to address his or her substance abuse
    • Ability of the family to acknowledge the risks posed by substance abuse
    • Availability of family or extended family support and the willingness and ability of family members to protect the children
  • Documents the assessment in the Contact notebook of CWS/CMS. 
    • Include both strengths and risks observed.
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Direct Observations of Family Members  

When a social worker observes parents, the following indicators of substance abuse should be assessed: 

  • poor physical appearance (clothing, hygiene)
  • reduced motor performance (poor balance, etc.)
  • lethargy or signs of stupor
  • slurred speech
  • the odor of alcohol on the breath
  • pinpoint pupils, or bloodshot eyes or inappropriate use of sunglasses to hide the eyes
  • difficulty in tracking conversation (misunderstanding questions, etc.)
  • excessive nervousness, emotional volatility, hostility, aggressiveness, and/or difficulty with impulse control
  • unusual effort to cover arms, legs (to hide needle marks)

 

When a social worker assesses for common signs of neglect in the child that may be a result of parental substance abuse, the social worker looks for the following conditions, behaviors, and information:

  • poor physical appearance (clothing hygiene)
  • gross thinness
  • unusual affect (e.g., unexplained fear, excessively polite or sullen, etc.)
  • lack of eye contact or excessive eye contact with the parent prior to responding to questions
  • children dressed inappropriately for weather
  • children often unsupervised
  • children asking neighbors for food, or coming to school unsupervised
  • children demonstrating behavioral or academic problems in school
  • the condition of the home
    • little to no food, clothing , furniture, and/or appliances
    • situations which are hazardous to health (e.g., broken windows, hanging electrical wires, extreme clutter, rotten food, etc.)
    • an abnormal number of bottles or cans of alcohol in the house or yard
    • an unusual number of people in the home or coming to the door, for which no reasonable explanation is given
    • no functioning utilities

Assessments are documented in a CWS/CMS Contact and include both strengths and risks observed.

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Conducting Interviews with Family Members  

When a social worker conducts interviews with family members

Other than direct observations, the interview is the basic tool by which the social worker obtains information about the family.  Although the social worker may have excellent interviewing techniques, a common characteristic of many substance abusers is manipulation and denial.  As a result, the degree of cooperation and/or truthfulness will vary from client to client.  As part of the assessment, the social worker needs to explore various socioeconomic issues with the client, which can reveal patterns of behavior, level of functioning, and possible stressors or supports. 

 

When a social worker conducts an interview with family members, elicit information in the following areas of concern: 

  • Does the family have sufficient income to meet its basic needs but has a pattern of unpaid bills, reflected in such things as evictions, repossessions, utility shut offs, missed appointments, lack of medical care, etc.?  Poor erratic or no employment history may also reflect dysfunction due to substance abuse.  These issues are not to be confused with a poor family that cannot meet primary financial responsibilities, has no health insurance, no money for or access to transportation, and/or no training or employment skills. 
  • Is a "significant other" a member of the household? By clarifying who is living in the home or has access to the child and parent, it may be determined if the relationship is conflicted, involves domestic violence, or that the "significant other" is also abusing drugs/alcohol and is a negative influence on, rather that a positive support to, the family.  In addition, significant stressors, such as divorce, separation or death, may contribute to substance abuse.
  • Is the family isolated, violent, and/or unstable moving frequently and unable to sustain housing?  All of these factors could reflect an underlying substance abuse problem.  Many substance abusing families do not have support systems in place with relatives, friends, religious and/or community organizations etc.,
  • Does the child have frequent school changes, unexcused absences, or tardies or is (s)he not enrolled in school?  Inability of the parent to follow through on required school meetings for special needs child may be a reflection of the parent's substance abuse. 
  • Does the family have missed required and routine medical and dental care (childhood immunizations, physical check-ups) as well as inability to deal with extra ordinary medical or mental health needs?  This may be an indicator of the parent's substance abuse.  

 

If a client acknowledges that (s)he has a problem with drugs/alcohol:

  • determine the client's ability and willingness to participate in treatment. 
  • evaluate any prior attempts at sobriety, the duration of use, frequency, and type of substance(s) used. 

 

When allegations involve an infant prenatally exposed to drugs/alcohol: 

  • obtain medical documentation, which may include, but is not limited to, toxicology screens and descriptions of specific symptoms or conditions in the newborn which are indicative of prenatal exposure (e.g., withdrawal, fetal alcoholism. etc.).
  • determine if the parent had any prior children who were prenatally exposed to drugs.

    Note:  An infant's prenatal exposure is not an automatic reason for removal and detention of that infant from the parent(s).  A thorough assessment must be completed to reach a decision which ensures the infant's safety, as well as the safety of any siblings residing in the home.  Consider the availability of other services (including Voluntary Family Maintenance, Differential Response, extended family support, etc.) that could adequately protect the child and prevent removal.

Assessments are documented in a CWS/CMS Contact and include both strengths and risks observed.

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The Parent/Caregiver is Unavailable  

When the parent/caregiver is unavailable: 

If at all possible, the assessment described in this policy should be followed.  However, there are some emergency situations (see examples below) that prohibit an extensive in-depth inquiry at the point of removal.  Children may be in imminent danger requiring immediate removal and the parent may be unavailable.  The child's immediate safety is the first priority and must be the focus for intervention by the social worker.

  • Referrals from law enforcement, when a parent has been arrested for criminal activity regarding the selling or the manufacturing of drugs, such as methamphetamine. 
  • A neighbor or relative calls, alleging that the parent has been gone for days, whereabouts unknown, and the child is alone in the residence; or the parent is in the home, but unconscious, or unable to function due to drug/alcohol intake and the child is present. 
  • School personnel refer a child who is to fearful to go home because of parent's longstanding substance abuse and the parent cannot be located. 
  • Hospital staff refers a newborn with a positive toxicology screen for drugs and the mother has left the hospital and her whereabouts are unknown.
  • Hospital staff or law enforcement refers a parent who has overdosed, resulting in death or serious medical complications. 
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