Evidence-Based Drug Treatment Practice and the Child Welfare System: The Example of Methadone

The substance abuse field has identified a range of evidence-based substance abuse treatment approaches. Evidence-based approaches are those that have been shown, through carefully controlled and replicated research, to be efficacious or effective. These approaches have been articulated in National Institute on Drug Abuse (NIDA, 2000b) publications and on the NIDA Web site. Research literature, newsletters, and editorials aimed at providers of substance abuse treatment services have also articulated evidence-based approaches. Organizations serving large populations of substance-abusing clients need to be aware of evidence-based practices and use them when developing client service plans. One of the largest social services systems working with substance-abusing clients is the child welfare system. Child welfare agencies have become knowledgeable about substance abuse treatment, but relatively little is known about the extent to which child welfare practice remains current with advances in substance abuse practice. This study examines the extent to which methadone maintenance (MM) is discussed in the child welfare literature and broader social work literature, and the extent to which child welfare policies mention and recommend this treatment method. Why focus on MM as an evidence-based drug treatment practice? Briefly, we know that heroin-dependent women who are parents are likely to provide inadequate care to their children and may expose their family to drug-related violence (Schilling, Mares, & El-Bassel, 2003). The American Public Health Association (1997), NIDA (2000a, 2000b), the World Health Organization (WHO) (2001), Stimson, Des Jarlais, and Ball (1998), the Center for Substance Abuse Treatment (CSAT) (1999), and the Substance Abuse and Mental Health Services Administration (SAMHSA) (1999) identify MM as an effective treatment for heroin dependence. Many studies have shown that opiate-dependent individuals on MM are likely to exhibit reductions in HIV risk behavior and crime and violence and improvements in child rearing and employment (Kott, Habel, & Nottingham, 2001; see Sorensen & Copeland, 2000, for a review). Child welfare is arguably the practice arena most widely recognized as the domain of social workers. Social workers recognize the importance of their state-sanctioned roles in protecting children (Barth & Jonson-Reid, 2000). In this capacity, social workers are required to investigate the well-being of children who are thought to be in danger, make judgments about levels of risk, and recommend courses of action. Social workers who find evidence of abuse or neglect usually recommend some corrective action by parents. In most instances, family court judges accept all or some of these recommendations and stipulate that court sanctions, including removal of the child from the home, remain in effect until the parents at least partially complete a recommended course of action. Wielding considerable power in such matters, social workers make the initial judgment that a child is in danger. Social workers then make recommendations to the court based on their determination, through their own investigation and through assessments of mental health consultants, of the family deficits contributing to child maltreatment. Critical is the social worker's knowledge of optimal and available resources, services, supports, and treatments. In recent decades, parental substance abuse has been shown to be a large contributing factor in child maltreatment (Bays, 1990; Olsen, Allen, & Azzi-Lessing, 1996; Wolack & Magura, 1996). A National Institute of Mental Health (NIMH)-funded study found that substance abusers had three times the odds of committing physical abuse and neglect after controlling for social, demographic, and psychiatric variables (Chaffin, Kelleher, & Hollenberg, 1996). Another study found that more than three-quarters of state child protection administrators across the country reported substance abuse as one of the top two problems presented by their caseloads (Wiese & Daro, 1995). …