Linkages among Child Welfare, Juvenile Justice, Mental by rzp12713


									September 2003

 Linkages among Child Welfare, Juvenile Justice, Mental Health,
                and Alcohol and Other Drugs

           Funded by a Robert Wood Johnson Foundation Grant
 “Integrated Systems of Care: To Improve the Quality of Care for the Most
              Vulnerable Children, Youth and their Families”

The following annotated bibliography contains several articles/books/reports/etc.
on the intersections among child welfare, juvenile justice, mental health, and
substance abuse. The author developed a table of contents chart to help the reader
pick those article annotations they are most interested in reading. The top
(horizontal) of the chart shows each of the four issues: child welfare, juvenile
justice, mental health, and substance abuse. The side (vertical) of the chart shows
the four issues plus policy, researched programs, practice, cost benefit, impactors,
parental substance abuse and mental health, and youth substance abuse and mental

   • Policy – the article included recommendations for federal or state
        mandates, changes to current laws, the impact of mandates on services,
        and/or child welfare services mandates.
   • Researched program – the article included an evaluation study of a specific
        program or statistical analysis around a study question.
   • Practice – the article featured information that could impact service
        delivery or introduced a new type of program or practice.
   • Cost benefit – the article sited costs and expenditures for current services
        or highlighted cost savings through a particular program or practice.
   • Impactors – the article discussed TANF, welfare policies, and other
        mandates that affect the family besides the four main issues of child
        welfare, juvenile justice, mental health, and substance abuse.
   • Parental substance abuse and mental health – the article’s main topic was
        on the parent’s issues with substance abuse and/or mental health.
   • Child substance abuse and mental health – the article’s main topic was on
        the child’s issues with substance abuse and/or mental health.
   • Family involvement – the article discussed individual adult, child, or
        family issues but also highlighted family strengths.

Using the Chart Example: If the reader was interested in policy articles on child
welfare and substance abuse they should find on the left side of the chart “policy”
and match it to the top column for “child welfare” and “substance abuse.” The
article’s authors are listed in alphabetical order and will be easy to locate in the
annotated bibliography.
                Child Welfare            Juvenile Justice               Health                            AOD
                                         Anderson, 2000.            Ackerson, 2003.                Anonymous, 1999.
                                         Anonymous, 1999.           Adams, et al, 1998.            Annual Report to Congress,
                                         Annual Report to           Anderson, 2000.                Executive Summary, 1998.
                                         Congress, Executive        Anonymous, 1999.               Blending Perspectives,
                                         Summary, 1998.                                            1999.
                                                                    Annual Report to
                                         Glisson, et al, 2002.      Congress, Executive            Connecting Child
                                         Luongo, 2000.              Summary, 1998.                 Protective Services, 2001.
                                         Physician Leadership on    Bazelon Center for Mental      Gregoire & Schultz, 2001.
                                         National Drug Policy,      Health Law, 2000.              Gruber, et al, 2001.
                                         2002.                      Blending Perspectives,         Luongo, 2000.
                                         Pietrowiak & White,        1999.                          McAlpine, et al, 2001.
                                         2003.                      Farmer, et al, 2001.           McNichol & Tash, 2001.
                                         Schwartz, et al, 1999.     Glisson, et al, 2002.          Metsch, et al, 2001.
                                         Wiig, et al, 2003.         Gruber, et al, 2001.           Millar & Stermac, 2000.
 Child                                                              Luongo, 2000.                  Physician Leadership on
Welfare                                                             Marsenich, 2002.               National Drug Policy,
                                                                    McNichol & Tash, 2001.         2002.
                                                                    Metsch, et al, 2001.           Rubinstein, 2003.
                                                                    Nicholson, et al, 2001.        Semidei, et al, 2001.
                                                                    Physician Leadership on        Sun, et al, 2001.
                                                                    National Drug Policy,          Wilens, et al, 1995.
                                                                    2002.                          Young & Gardner, 2002.
                                                                    Pietrowiak & White, 2003.      Young, et al, 1998.
                                                                    Ro & Shum, 2001.
                                                                    Simms, et al, 1999.
                                                                    Vinson, et al, 2001.
                                                                    Wilens, et al, 1995.
                                                                    Zima, et al, 2000.

                Anderson, 2000.          Child Welfare League       Anderson, 2000.                Anonymous, 1999.
                Anonymous, 1999.         of America, 2002.          Anonymous, 1999.               Annual Report to
                Annual Report to                                    Annual Report to               Congress, Executive
                Congress, Executive                                 Congress, Executive            Summary, 1998.
                Summary, 1998.                                      Summary, 1998.                 Braithwaite, 2001.
                Glisson, et al, 2002.                               Center for Court               Callahan & Patrick, 2001.
                Luongo, 2000.                                       Innovation, 2001?              Center for Substance
                Physician Leadership                                Cocozza & Skowyra,             Abuse Treatment, 1999.
                on National Drug                                    2000.                          Cocozza & Skowyra,
                Policy, 2002.                                       Ford, et al, 2003.             2000.
                Pietrowiak & White,                                 Foster, et al 2001.            Foster, et al, 2001.
                2003.                                               Glisson, et al, 2002.          Kraft, et al, 2001.
                Schwartz, et al, 1999.                              Liddle, et al, 2002.           Liddle, et al, 2002.
Juvenile        Wiig, et al, 2003.                                  Luongo, 2000.                  Luongo, 2000.
 Justice                                                            Muck, et al, 2001.             McElrath, et al, 2002.
                                                                    Physician Leadership on        Muck, et al, 2001.
                                                                    National Drug Policy,          Physician Leadership on
                                                                    2002.                          National Drug Policy,
                                                                    Pietrowiak & White, 2003.      2002.
                                                                    Prescott, 1997.                Prescott, 1997.
                                                                    Shelton, 2002.                 Shelton, 2002.
                                                                    Stevens & Morral, eds.,        Shenk & Zehr, 2001.
                                                                    2003.                          Stevens & Morral, eds.,
                                                                    Teplin, et al, 2002.           2003.
                                                                                                   Teplin, et al, 2002.
                                                                                                   Treating Teens, 2003.

      Linkages Annotated Bibliography                   Page 2                     Research to Practice Initiative

      Funded by Robert Wood Johnson Foundation                                Child Welfare League of America
                 Child Welfare             Juvenile Justice                Health                                   AOD
                 Ackerson, 2003.           Anderson, 2000.             Angold, et al, 2002.                 Anonymous, 1999.
                 Adams, et al, 1998.       Anonymous, 1999.            Hatcher & Scarpa, 2002.              Annual Report to
                 Anderson, 2000.           Annual Report to            Hoagwood, 2001.                      Congress, Executive
                                           Congress, Executive                                              Summary, 1998.
                 Anonymous, 1999.                                      Moore, et al, 2002.
                                           Summary, 1998.                                                   Black, et al, 1998.
                 Annual Report to                                      Zaff, et al, 2002.
                 Congress, Executive       Center for Court                                                 Blamed and Ashamed,
                 Summary, 1998.            Innovation, 2001?                                                2000.
                 Bazelon Center for        Cocozza, & Skowyra,                                              Blending Perspectives,
                 Mental Health Law,        2000.                                                            1999.
                 2000.                     Ford, et al, 2003.                                               CASAWORKS for
                 Blending Perspectives,    Foster, et al, 2001.                                             Families, 2001.
                 1999.                     Glisson, et al, 2002.                                            Chandler & Meisel, 2002.
                 Farmer, et al, 2001.      Liddle, et al, 2002.                                             Clark, 2001.
                 Glisson, et al, 2002.     Luongo, 2000.                                                    Cocozza & Skowyra,
                 Gruber, et al, 2001.                                                                       2000.
                                           Muck, et al, 2001.
                 Luongo, 2000.                                                                              Deas & Thomas, 2002.
                                           Physician Leadership on
                 Marsenich, 2002.          National Drug Policy,                                            Foster, et al, 2001.
                 McNichol & Tash,          2002.                                                            Gruber, et al, 2001.
                 2001.                     Pietrowiak & Whilte,                                             Jayakody, et al, 2000.
                 Metsch, et al, 2001.      2003.                                                            Killeen & Brady, 2000.
                 Nicholson, et al, 2001.   Prescott, 1997.                                                  Liddle, et al, 2002.
                 Physician Leadership      Shelton, 2002.                                                   Luongo, 2000.
                 on National Drug          Stevens & Morral, eds.,                                          Malekoff, 2000.
                 Policy, 2002.             2003.
                                                                                                            McNichol & Tash, 2001.
                 Pietrowiak & Whilte,      Teplin, et al, 2002.
                 2003.                                                                                      Metsch, et al, 2001.
                 Ro & Shum, 2001.                                                                           Muck, et al, 2001.
                                                                                                            Physician Leadership on
Behavioral       Simms, et al, 1999.
                                                                                                            National Drug Policy,
  Health         Vinson, et al, 2001.                                                                       2002.
                 Wilens, et al, 1995.                                                                       Prescott, 1997.
                 Zima, et al, 2000.                                                                         Prescott, 2001.
                                                                                                            Prescott, 1998.
                                                                                                            Report to Congress, 2002.
                                                                                                            Shelton, 2002.
                                                                                                            Shulman, et al, 2000.
                                                                                                            Stevens & Morral, eds.,
                                                                                                            Substance Abuse and
                                                                                                            Mental Health Services
                                                                                                            Administration, 2003.
                                                                                                            Teplin, et al, 2002.
                                                                                                            Uziel-Miller & Lyons,
                                                                                                            Wilens, et al, 1995.

       Linkages Annotated Bibliography                       Page 3                         Research to Practice Initiative

       Funded by Robert Wood Johnson Foundation                                    Child Welfare League of America
            Child Welfare            Juvenile Justice                Health                              AOD
            Anonymous, 1999.         Anonymous, 1999.            Anonymous, 1999.
            Annual Report to         Annual Report to            Annual Report to
            Congress, Executive      Congress, Executive         Congress, Executive
            Summary, 1998.           Summary, 1998.              Summary, 1998.
            Blending Perspectives,   Braithwaite, 2001.          Black, et al, 1998.
                                     Callahan & Patrick,         Blamed and Ashamed,
            Connecting Child         2001.                       2000.
            Protective Services,
                                     Center for Substance        Blending Perspectives,
                                     Abuse Treatment, 1999.      1999.
            Gregoire & Schultz,
                                     Cocozza & Skowyra,          CASAWORKS for
                                     2000.                       Families, 2001.
            Gruber, et al, 2001.
                                     Foster, et al 2001.         Chandler & Meisel, 2002.
            Luongo, 2000.
                                     Kraft, et al, 2001.         Clark, 2001.
            McAlpine, et al, 2001.
                                     Liddle, et al, 2002.        Cocozza & Skowyra,
            McNichol & Tash,                                     2000.
                                     Luongo, 2000.
                                                                 Deas & Thomas, 2002.
                                     McElrath, et al, 2002.
            Metsch, et al, 2001.
                                                                 Foster, et al 2001.
                                     Muck, et al, 2001.
            Millar & Stermac,
                                                                 Gruber, et al, 2001.
            2000.                    Physician Leadership on
                                     National Drug Policy,       Jayakody, et al, 2000.
            Physician Leadership
            on National Drug                                     Killeen & Brady, 2000.
            Policy, 2002.            Prescott, 1997.
                                                                 Liddle, et al, 2002.
            Rubenstein, 2003.        Shelton, 2002.
                                                                 Luongo, 2000.
            Semidei, et al, 2001.    Shenk & Zehr, 2001.
                                                                 Malekoff, 2000.
            Sun, et al, 2001.        Stevens & Morral, eds.,
                                                                 McNichol & Tash, 2001.
AOD         Wilens, et al, 1995.
                                                                 Metsch, et al, 2001.
                                     Teplin, et al, 2002.
            Young & Gardner,
                                                                 Muck, et al, 2001.
            2002.                    Treating Teens, 2003.
                                                                 Physician Leadership on
            Young, et al, 1998.
                                                                 National Drug Policy,
                                                                 Prescott, 1997.
                                                                 Prescott, 2001.
                                                                 Prescott, 1998.
                                                                 Report to Congress, 2002.
                                                                 Shelton, 2002.
                                                                 Shulman, et al, 2000.
                                                                 Stevens & Morral, eds.,
                                                                 Substance Abuse and
                                                                 Mental Health Services
                                                                 Administration, 2003.
                                                                 Teplin, et al, 2002.
                                                                 Uziel-Miller & Lyons,
                                                                 Wilens, et al, 1995.

  Linkages Annotated Bibliography                      Page 4                      Research to Practice Initiative

  Funded by Robert Wood Johnson Foundation                                   Child Welfare League of America
             Child Welfare             Juvenile Justice                     Health                                   AOD
                Anonymous,             Anonymous, 1999.                 Anonymous, 1999.                    Anonymous, 1999.
                1999.                  Braithwaite, 2001.               Bianco & Wells, eds.,               Black, et al, 1998.
                Blending               Ford, et al, 2003.               2001.                               Blending Perspectives, 1999.
                Perspectives,                                           Black, et al, 1998.
                1999.                  Luongo, 2000.                                                        Braithwaite, 2001.
                                       McElrath, et al, 2002.           Blending Perspectives,              Clark, 2001.
                Briar-Lawson,                                           1999.
                1998.                  Physician Leadership on                                              Connecting Child Protective
                                       National Drug Policy,            Clark, 2001.                        Services, 2001.
                Brindis, et al,
                2002.                  2002.                            Ford, et al, 2003.                  Luongo, 2000.
                Bruner, 2000.          Pietrowiak & White,              Horwitz, et al, 2002.               Malekoff, 2000.
                                       2003.                            Luongo, 2000.
                Connecting Child                                                                            McElrath, et al, 2002.
                Protective             Prescott, 1997.                  Malekoff, 2000.                     McNichol & Tash, 2001.
                Services, 2001.        Schwartz, et al, 1999.           Marsenich, 2002.                    Physician Leadership on
                Edwards, et al,        Shelton, 2002.                   McNichol & Tash, 2001.              National Drug Policy, 2002.
                2000.                  Shenk & Zehr, 2001.              Physician Leadership on             Prescott, 1997.
                Leon, 1999.            Stevens & Morral, eds.,          National Drug Policy,               Prescott, 1998.
                Luongo, 2000.          2003.                            2002.
                                                                                                            Report to Congress, 2002.
                Marsenich, 2002.       Teplin, et al, 2002.             Pietrowiak & White, 2003.
                                                                                                            Rubenstein, 2003.
                McNichol & Tash,                                        Prescott, 1997.
                2001.                                                                                       Semidei, et al, 2001.
                                                                        Prescott, 1998.
                Physician                                                                                   Shelton, 2002.
                                                                        Report to Congress, 2002.
                Leadership on                                                                               Shenk & Zehr, 2001.
                National Drug                                           Shelton, 2002.
                                                                                                            Stevens & Morral, eds., 2003.
                Policy, 2002.                                           Simms, et al, 1999.
                                                                                                            Substance Abuse and Mental
                Pietrowiak &                                            Stevens & Morral, eds.,             Health Services
                White, 2003.                                            2003.                               Administration, 2003.
                Rubenstein, 2003.                                       Substance Abuse and                 Teplin, et al, 2002.
                Schwartz, et al,                                        Mental Health Services
                                                                        Administration, 2003.               Young & Gardner, 2002.
Policy          1999.
                                                                                                            Young, et al, 1998.
                Semidei, et al,                                         Teplin, et al, 2002.
                Simms, et al,
                Walter & Petr,
                Whittaker &
                Maluccio, 2002.
                Young & Gardner,
                Young, et al,

     Linkages Annotated Bibliography                          Page 5                           Research to Practice Initiative

     Funded by Robert Wood Johnson Foundation                                            Child Welfare League of America
                 Child Welfare            Juvenile Justice                     Health                                    AOD
                   Annual Report to       Annual Report to                  Annual Report to                  Annual Report to Congress,
                   Congress,              Congress, Executive               Congress, Executive               Executive Summary, 1998.
                   Executive              Summary, 1998.                    Summary, 1998.                    Blamed and Ashamed, 2000.
                   Summary, 1998.         Center for Substance              Blamed and Ashamed,               CASAWORKS for Families,
                   Glisson, et al,        Abuse Treatment, 1999.            2000.                             2001.
                   2002.                  Ford, et al, 2003.                Bianco & Wells eds.,              Center for Substance Abuse
                   Gregoire &             Foster, et al, 2001.              2001.                             Treatment, 1999.
                   Schultz, 2001.                                           CASAWORKS for
                                          Glisson, et al, 2002.                                               Chandler & Meisel, 2002.
                   Gruber, et al,                                           Families, 2001.
                   2001.                  Liddle, et al, 2002.                                                Clark, 2001.
                                                                            Chandler & Meisel
                   Leon, 1999.            Muck, et al, 2001.                2002.                             Eisen, et al, 2000.
                   Marsenich, 2002.       Stevens & Morral, eds.,           Clark, 2001.                      Foster, et al, 2001.
                                          2003.                                                               Gregoire & Schultz, 2001.
                   McAlpine, et al,                                         Ford, et al, 2003.
                   2001.                  Treating Teen, 2003.                                                Gruber, et al, 2001.
                                                                            Foster, et al, 2001.
                   Metsch, et al,                                           Glisson, et al, 2002.             Hoffman, 2002.
                   2001.                                                                                      Johnson, et al, 1998.
                                                                            Greenberg, et al, 1999.
                   Semidei, et al,                                                                            Killeen & Brady, 2000.
                   2001.                                                    Gruber, et al, 2001.
Researched                                                                  Gutierrez-Mayka, et al,           Liddle, et al, 2002.
Programs           Sun, et al. 2001.
                                                                            2000.                             McAlpine, et al, 2001.
                   Vinson, et al,
                   2001.                                                    Killeen & Brady, 2000.            Metsch, et al, 2001.
                   Young & Gardner,                                         Koyangi & Semansky,               Muck, et al, 2001.
                   2002.                                                    2003.                             Semidei, et al, 2001.
                                                                            Kutash, et al, 2002.              Shulman, et al, 2000.
                                                                            Leung & DeSousa,                  Stevens & Morral, eds., 2003.
                                                                                                              Sullivan, et al, 2002.
                                                                            Liddle, et al, 2002.
                                                                                                              Sun, et al, 2001.
                                                                            Marsenich, 2002.
                                                                                                              Treating Teens, 2003.
                                                                            Metsch, et al, 2001.
                                                                                                              Uziel-Miller & Lyons, 2000.
                                                                            Muck, et al, 2001.
                                                                                                              Whiteside-Mansell, et al, 1999.
                                                                            Shulman, et al, 2000.
                                                                                                              Williams, et al, 1999.
                                                                            Stevens & Morral, eds.,
                                                                            2003.                             Young & Gardner, 2002.
                                                                            Uziel-Miller & Lyons,
                                                                            Vinson, et al, 2001.
                   Edwards, et al,        Liddle, et al, 2002.              Black, et al, 1998.               Black, et al, 1998.
                   2000.                  Stevens & Morral, eds.,           Kutash, et al, 2002.              Liddle, et al, 2002.
                   Lewandowski &          2003.                             Liddle, et al, 2002.              McAlpine, et al, 2001.
                   GlenMaye, 2002.
  Practice         McAlpine, et al,
                                                                            Stevens & Morral, eds.,           Stevens & Morral, eds., 2003.
                                                                            2003.                             Werner, et al, 1999.

                   Brindis, et al,        Center for Substance              Foster, et al, 2001.              Cavanaugh, 2002.
                   2002.                  Abuse Treatment, 1999.            Kataoka, et al, 2002.             Center for Substance Abuse
                   Physician              Foster, et al 2001.               Physician Leadership on           Treatment, 1999. Foster, et al,
                   Leadership on          Kraft, et al, 2001.               National Drug Policy,             2001.
                   National Drug                                            2002.                             Kraft, et al, 2001.
                   Policy, 2002.          Physician Leadership on
                                          National Drug Policy,             Simms, et al, 1999.               Physician Leadership on
Cost Benefit       Simms, et al,          2002.                                                               National Drug Policy, 2002.
                   1999.                                                    Stevens & Morral, eds.,
                                          Press & Washburn,                 2003.                             Stevens & Morral, eds., 2003.
                                          Stevens & Morral, eds.,

        Linkages Annotated Bibliography                          Page 6                            Research to Practice Initiative

        Funded by Robert Wood Johnson Foundation                                           Child Welfare League of America
               Child Welfare            Juvenile Justice                     Health                                   AOD
                 Anonymous, 1999.       Anonymous, 1999.                  Anonymous, 1999.                  Anonymous, 1999.
                 Bazelon Center for     Teplin, et al, 2002.              Bazelon Center for                CASAWORKS for Families,
                 Mental Health                                            Mental Health Law,                2001.
                 Law, 2000.                                               2000.                             Chandler & Meisel, 2002.
                 Briar-Lawson,                                            CASAWORKS for                     Clark, 2001.
                 1998.                                                    Families, 2001.
                                                                                                            Jayakody, et al, 2000.
                 Bruner, 2000.                                            Chandler & Meisel,
                                                                          2002.                             McAlpine, et al, 2001.
                 Farmer, et al,
                 2001.                                                    Clark, 2001.                      Metsch, et al, 2001.
                 Leon, 1999.                                              Farmer, et al, 2001.              Semidei, et al, 2001.
                 Marsenich, 2002.                                         Jayakody, et al, 2000.            Sun, 2000.
                 McAlpine, et al,                                         Marsenich, 2002.                  Teplin, et al, 2002.
                 2001.                                                                                      Uziel-Miller & Lyons, 2000.
  TANF                                                                    Metsch, et al, 2001.
                 Metsch, et al,                                           Simms, et al, 1999.
                                                                          Teplin, et al, 2002.
                 Semidei, et al,
                 2001.                                                    Uziel-Miller & Lyons,
                 Simms, et al,
                 Whittaker &
                 Maluccio, 2002.

                 Anonymous, 1999.       Anonymous, 1999.                  Anonymous, 1999.                  Anonymous, 1999.
                 Blending                                                 Blending Perspectives,            Blending Perspectives, 1999.
                 Perspectives,                                            1999.                             Clark, 2001.
                 1999.                                                    Clark, 2001.                      Gregoire & Schultz, 2001.
                 Gregoire &                                               Gruber, et al, 2001.
                 Schultz, 2001.                                                                             Gruber, et al, 2001.
                                                                          Jayakody, et al, 2000.            Jayakody, et al, 2000.
                 Gruber, et al,
                 2001.                                                    Killeen & Brady, 2000.            Killeen & Brady, 2000.
                 McAlpine, et al,                                         McNichol & Tash,                  McAlpine, et al, 2001.
                 2001.                                                    2001.
                                                                                                            McNichol & Tash, 2001.
                 McNichol & Tash,                                         Metsch, et al, 2001.
                                                                                                            Metsch, et al, 2001.
                 2001.                                                    Prescott, 2001.
                                                                                                            Prescott, 2001.
                 Metsch, et al,                                           Shulman, et al, 2000.
                 2001.                                                                                      Semidei, et al, 2001.
 Parental                                                                 Uziel-Miller & Lyons,
                                                                                                            Shulman, et al, 2000.
Substance        National Center on                                       2000.
                 Addiction and                                            Wilens, et al, 1995.              Sun, et al, 2001.
Abuse and        Substance Abuse,                                                                           Sun, 2000.
 Mental          1999.
                                                                                                            Uziel-Miller & Lyons, 2000.
  Health         Semidei, et al,
                 2001.                                                                                      Werner, et al, 1999.
                 Sun, et al, 2001.                                                                          Whiteside-Mansell, et al, 1999.
                 Wilens, et al,                                                                             Wilens, et al, 1995.
                 1995.                                                                                      Young & Gardner, 2002.
                 Young & Gardner,                                                                           Young, et al, 1998.
                 Young, et al,

      Linkages Annotated Bibliography                          Page 7                            Research to Practice Initiative

      Funded by Robert Wood Johnson Foundation                                           Child Welfare League of America
                Child Welfare            Juvenile Justice                     Health                                    AOD
                  Luongo, 2000.          Braithwaite, 2001.                Blamed and Ashamed,               Blamed and Ashamed, 2000.
                  Physician              Center for Substance              2000.                             Braithwaite, 2001.
                  Leadership on          Abuse Treatment, 1999.            Cocozza & Skowyra,                Center for Substance Abuse
                  National Drug          Cocozza & Skowyra,                2000.                             Treatment, 1999.
                  Policy, 2002.          2000.                             Deas & Thomas, 2002.              Cocozza & Skowyra, 2000.
                                         Ford, et al, 2003.                Ford, et al, 2003.                Deas & Thomas, 2002.
                                         Kraft, et al, 2001.               Liddle, et al, 2002.              Eisen, et al, 2000.
                                         Liddle, et al, 2002.              Luongo, 2000.                     Hoffman, 2002.
                                         Luongo, 2000.                     Muck, et al, 2001.                Kraft, et al, 2001.
 Youth                                   McElrath, et al, 2002.            Physician Leadership on           Liddle, et al, 2002.
                                         Muck, et al, 2001.                National Drug Policy,
Substance                                                                  2002.                             Luongo, 2000.
Abuse and                                Physician Leadership on                                             McElrath, et al, 2002.
                                         National Drug Policy,             Prescott, 1997.
 Mental                                  2002.                             Prescott, 1998.                   Muck, et al, 2001.
 Health                                                                                                      Physician Leadership on National D
                                         Prescott, 1997.                   Shelton, 2002.
                                                                                                             Policy, 2002.
                                         Shelton, 2002.                    Stevens & Morral, eds.,
                                                                           2003.                             Prescott, 1997.
                                         Shenk & Zehr, 2001.
                                                                           Teplin, et al, 2002.              Prescott, 1998.
                                         Stevens & Morral, eds.,
                                         2003.                                                               Shelton, 2002.
                                         Teplin, et al, 2002.                                                Shenk & Zehr, 2001.
                                         Treating Teens, 2003.                                               Stevens & Morral, eds., 2003.
                                                                                                             Teplin, et al, 2002.
                                                                                                             Treating Teens, 2003.
                                                                                                             Williams, et al, 1999.
                  Adams, et al,          Ford, et al, 2003.                Adams, et al 1998.                Blamed & Ashamed, 2000.
                  1998.                                                    Bianco & Wells, eds.,             Center for Substance Abuse
                  Blamed &                                                 2001.                             Treatment, 1999.
                  Ashamed, 2000.                                           Blamed & Ashamed,                 Gregoire & Schultz, 2001.
                  Briar-Lawson,                                            2000.                             Gruber, et al, 2001.
                  1998.                                                    Ford, et al, 2003.                Williams, et al, 1999.
                  Bruner, 2000.                                            Gruber, et al, 2001.
                  Gregoire &                                               Hanson, et al, 2001.
                  Schultz, 2001.
                                                                           Kutash, et al, 2002.
                  Lewandowski &
                  GlenMaye, 2002.                                          Marsenich, 2002.
  Family                                                                   Vinson, et al, 2001.
                  Gruber, et al,
Involvement       2001.
                  Marsenich, 2002.
                  Moore, 2002.
                  Vinson, et al,
                  Walter & Petr,

       Linkages Annotated Bibliography                          Page 8                            Research to Practice Initiative

       Funded by Robert Wood Johnson Foundation                                             Child Welfare League of America
Ackerson, B. J. (2003). Parents with serious and persistent mental health illness:
Issues in assessment and services. Social Work, 48, 187–194.

This article examined the literature on mentally ill parents and addressed conceptual
issues in assessment and services. Social work and mental health journals often do not
include research on parents with mental illnesses, except in discussions of pathology.
Very little research exists on their desire to be good parents. Workers overlook parents
with mental health issues for many reasons: the changing nature of service delivery (more
women with mental health issues are not being placed in mental hospitals); the
professional community, which may assume that parenting is stressful and not highly
valued by people with mental illnesses; that these parents are caught in the gap between
the child welfare and mental health systems; that child welfare assessments cannot
distinguish between mental health issues and other types of behavioral problems; the lack
of differentiation in mental health literature between men and women with regard to
illness and treatment; and the erroneous assumption that the treatment and service needs
for mentally ill parents are the same as for those without children.

Many mentally ill parents face a greater risk of termination of parental rights due to
inadequate or inappropriate assessment methods and professional bias. Proper
assessments for parents with mental illness are based on specific parenting knowledge
and skills. Comprehensive assessments include severity of illness, assessment of
strengths and competencies, in-home and out-of-home observations, and level of social
support available. Most of the literature focuses on mothers’ mental illnesses; little
research exists on fathers’ mental illnesses, and none on parents as a group.

Adams, J., Biss, C., Muhammad, V. B., Meyers, J., & Slaton, E. Learning from
colleagues: Family/Professional partnerships moving forward together. (1998).
Alexandria, VA: National Peer Technical Assistance Network’s Partnership for
Children’s Mental Health.

The authors of this report reviewed existing perspectives on children’s mental health and
the role of families in treatment, offered a new direction for systems of care, and
provided the processes and skills needed to advance the relationships between
professionals and families in the system.

Families and professionals are afraid of working together on the child’s mental health
issues. The authors found that both sides are afraid of losing power and control, having
responsibility without authority, losing their personal and professional identity and value,
being seen as incompetent, being isolated, and hurting the child.

Partnerships between families and professionals, however, can help families that hurt
their children, stop professionals who hurt children, find resolutions for poverty, and end
racism and discrimination in the service system. The role of family members in helping
the child includes bringing knowledge about the family’s strengths, an emotional
investment, and an ability to monitor progress to the treatment. Families need
nonauthoritarian help; training; information in a timely fashion; and safety, access, and

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Funded by Robert Wood Johnson Foundation                       Child Welfare League of America
respect. Professionals bring to the partnership a body of knowledge, legitimacy, a code of
ethics, and control over certain resources. They need to identify strengths in the families,
promote inclusion, have empathy, and evaluate the situation to suggest changes.

Anderson, J. A. (2000). The need for interagency collaboration for children with
emotional and behavioral disabilities and their families. Families in Society, 81, 484–

This article reviewed the federal definitions for emotional and behavioral disorders in
children and described how variations in the eligibility criteria affect the ability of child-
serving agencies (e.g., child welfare, special education, juvenile justice, and mental
health) to work together to meet the needs of children and families. Each system uses its
own definitions and criteria, which hinders their ability to provide the full range of
services needed by children. The criteria often focus specifically on the mission of the
agency, such as school functioning within an education system. These variations and
discrepancies in criteria often result in underidentification of emotional and behavioral
disorders. A few places have implemented solutions to this problem.

The article presented some steps for developing interagency system definitions. The
article presented the Dawn Project in Marion, Indiana, as an example of an intraagency
collaboration designed to serve children and youth with emotional and behavioral
disabilities. The Dawn Project provides a coordinated, community-based system of
services for children and families. It is funded by the child welfare, juvenile justice,
education, and mental health systems and is administered by a private, nonprofit care-
management organization.

Angold, A., Erkanli, A., Farmer, E. M. Z., & Fairbank, J. A. (2002). Psychiatric
disorder, impairment and service use in rural African American and white youth.
Archives of General Psychiatry, 59, 893–909.

Featured in this article was a study of psychiatric disorders between rural African
American and white youth. The goal of the study was to determine the need for and use
of mental health services. The final sample consisted of 920 families randomly selected
from four North Carolina counties through a rigorous process that began with 4,500
eligible youth. After assessment, 21% of all participating children were found to have one
or more diagnoses according to the Diagnostic and Statistical Manual of Mental
Disorders (DSM, 4th ed.). Most common diagnoses were disruptive behavior disorders,
compared with affective or anxiety disorders. Overall, little difference existed between
the ethnicities in the prevalence of psychiatric disorders. At a younger age, more boys
than girls showed psychiatric diagnoses. Rates leveled as both sexes became older, due to
rising levels in psychiatric diagnoses in girls as they aged. Schools were the largest
provider of mental health services. Almost all youth in the study had medical insurance,
whether private or public. Very few youth used mental health services, however, even if
diagnosed with a psychiatric disorder.

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Funded by Robert Wood Johnson Foundation                         Child Welfare League of America
Annual report to Congress on the evaluation of the Comprehensive Community Mental
Health Services for Children and Their Families Program, executive summary. (1998).
Atlanta, GA: Macro International.

This document was an annual report to Congress on the Comprehensive Community
Mental Health Services for Children and Their Families Program, which provides grants
to states, communities, territories, and Native American tribes. The goal of each grant is
to improve and expand local systems of care to meet the needs of children and
adolescents with serious emotional disturbances and their families. The grantor promotes
a system-of-care model based on three principles: Mental health services should be
driven by the individual’s needs, services should be community-based and collaborative,
and the programs need to be responsive and sensitive to cultural contexts and other
characteristics of the populations served.

This report contained evaluation findings from the third year of five-year grants to 22
grantees. The authors collected information through August 1998 for agencies that had
received their first year of funding in 1993 or 1994. The authors based the findings on a
sample of children assessed at intake, six months, one year, and annually for as long as
they were in the program. Positive findings included reduction of behavioral and
emotional problems and improvement of both clinical functioning and school attendance.
Children who received continuous care showed more positive behavioral changes
compared with children with a service gap of more than 30 days. Overall, children who
received home-based intensive services showed greater reductions in functional
impairment compared with children who did not receive in-home services. The children
and families in these programs came from very diverse backgrounds and areas of the
country. Most children had been exposed to at least one risk factor, such as physical or
sexual abuse, and more than 65% of families had experienced one family risk factor, such
as mental illness or family violence.

Anonymous. (1999). Beyond boundaries of child welfare: Connecting with welfare,
juvenile justice, family violence, and mental health systems. Spectrum: The Journal
of State Government, 72(1), 14–18.

The issue of drug dependence and treatment crosses child welfare, juvenile justice,
mental health, and welfare reform systems and is related to child abuse and child poverty.
Agencies within these systems have been involved in the identification, assessment, and
treatment of problems among children and families affected by substance abuse.
Problems can arise when the systems have overlapping cases, as each has different goals,
targets for and types of intervention, and time constraints. The majority of literature and
training materials addressing alcohol and other drugs (AOD) and family violence
problems has showed differences in systems, although it often ignores child welfare.
Thus, discussions about successful outcomes across the boundaries of AOD, child
welfare, and family violence must clearly define the outcomes for each group and allow
flexibility for different perspectives on the needs of children and families.

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Funded by Robert Wood Johnson Foundation                      Child Welfare League of America
Bazelon Center for Mental Health Law. (2000). Relinquishing custody: The tragic
result of failure to meet children’s mental health needs. Washington, DC: Author.

Approximately half of the states in the United States ask parents to choose between
obtaining mental health treatment for their child or retaining legal custody of the child.
This dilemma occurs because of limits in private health care, and, at times, public plans
deny needed services. This report reviewed the long history of custody relinquishment for
mental health services and offered recommendations for preventing this dilemma.
Children’s mental health services are offered erratically and through different agencies
that often do not share information with each other. Erroneous interpretation of the
federal Foster Care and Adoption Assistance Program (Title IV-E) has led to the custody
relinquishment loophole.

There are two federal initiatives to prevent custody relinquishment: One is an appended
document for the Children’s Bureau clearly stating that state custody of children with
mental health problems is not necessary, rather, they should receive placement and care.
The second initiative is a pair of Medicaid programs. States are responding to the
problem as well. Some are instituting mandatory policy changes to help children gain
access to mental health services without having to become wards of the state. The authors
recommended enforcement of federal entitlements under the Individuals with Disabilities
Education Act (IDEA) and Medicaid, expansion of children’s eligibility for Medicaid,
and creation of a system of care for children with mental health needs.

Bianco, C., & Wells, S. M. (Eds.). (2001). Overcoming barriers to community
integration for people with mental illnesses. Washington, DC: U.S. Department of
Health and Human Services.

This report assessed the availability of community-based services for individuals with
mental health needs. It included information on barriers and strategies to finding
appropriate services. Research has indicated that with the proper combination of housing,
treatment, and supports, people with mental illnesses can succeed in the community.
Despite this, thousands languish in psychiatric facilities.

Barriers to community treatment include lack of income support, affordable housing,
employment, and access to health care. Furthermore, people with mental illnesses
encounter fragmented services, financial barriers, discrimination, and staffing shortages
at community-based mental health clinics. Successful community-based treatments
should include least restrictive settings, access to services, empowerment, flexibility, and
family and other supports.

The report concluded with recommendations for the government and private partners in
creating positive, community-based services, including continued research, increased
number of affordable houses, facilitated entry into treatment, revised federal programs,
enhanced interagency initiatives, reduced stigma, and creation of culturally appropriate

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Funded by Robert Wood Johnson Foundation                       Child Welfare League of America
Black, D. R., Tobler, N. S., & Sciacca, J. P. (1998, March). Peer
helping/involvement: An efficacious way to meet the challenge of reducing alcohol,
tobacco, and other drug use among youth? Journal of School Health, 87.

The authors explored peer-helping programs for youth as an important resource in
minimizing the use of AOD among middle-school students. The authors focused on the
results of a meta-analysis of 120 school-based prevention programs, then featured two
best practice programs and offered suggestions for designing and implementing peer-led
programs. The results of the 120 adolescent drug prevention programs showed that
interactive peer interventions are statistically superior to lecture programs led by teachers
or researchers. The authors cautioned that the study may have limited generalizability do
its sample of middle-school students, who often have a lower incidence of drug use.

In the two featured model programs, the authors concluded that the peer-led approach
achieved better results than programs led by professionals. The authors offered
recommendations for improving programs using peer helpers. They suggested that
focusing on alcohol and tobacco products would glean the greatest results, given the
prevalence among students. They also suggested that researchers should identify target
populations so limited resources can be applied to those who need it most. Finally, they
suggested that the Lay Opportunities—Collaborative Outreach Screening Team (LO-
COST) model for peer health education be used with peer helpers. This model combines
recruitment strategies, systematic use of interventions, and collaboration between
professionals and volunteers. The model capitalizes on incorporating and using peers as
primary service providers who are trained and supervised by subject matter experts.

Blamed and ashamed: The treatment experienced of youth with co-occurring
substance abuse and mental health disorders and their families. (2000). Alexandria,
VA: Federation of Families for Children’s Mental Health.

This report presented findings from a two-year study of youth with co-occurring
disorders and their families. This qualitative study gave youth and parents the opportunity
to reflect on their experiences and identify concerns and successes so that others might
learn from them. The sample included youth and families from California, Georgia,
Illinois, Kansas, Maine, New Mexico, Virginia, West Virginia, and Washington, DC.
Youth were from various ethnic and socioeconomic groups and were between the ages of
13 and 28. All had spent some time living in substance abuse or mental health treatment
facilities. Findings indicated that youth rarely got the kinds of help they needed and that
services were fragmented. Recommendations based on the families’ experiences included
peer-to-peer support for both youth and families, accurate and useful information for
youth and families, and combined treatment for families.

Overall, youth asked that they be involved in their own treatment plans. Additional
recommendations for service providers included listening carefully to the youth and their
families; treating them with respect; involving youth; including families and inviting
them into the treatment process; individualizing treatments; delivering useful and helpful
information on illness, treatment, aftercare, and funding; and creating public awareness

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Funded by Robert Wood Johnson Foundation                       Child Welfare League of America
campaigns for schools, families, and youth groups. Recommendations for family
members included becoming involved, staying involved, and becoming educated.
Recommendations for youth included speaking up and obtaining reliable information.
Finally, recommendations for the Substance Abuse and Mental Health Services
Administration (SAMHSA) included providing peer support, facilitating information
dissemination, and supporting collaboration.

Blending perspectives and building common ground: A report to Congress on
substance abuse and child protection. (1999). Washington, DC: U.S. Department of
Health and Human Services.

For caseworkers in the field, it is difficult to assess when a substance-using parent has
received a sufficient amount of treatment to be able to care for his or her children again.
Relapse is always a concern. Adoption and Safe Families Act (ASFA) timelines have
made it more difficult for parents to receive enough treatment before their children need
to be returned to them or they risk termination of parental rights. Congress mandated
ASFA on the scope of the problem of parental substance abuse in the child welfare
population, types of services provided, effectiveness of services, and recommendations
for legislative changes. It is estimated that 11% of U.S. children live with at least one
parent who abuses drugs or alcohol. Children with a substance-abusing parent are more
likely to be younger, suffer from chronic neglect, are from families with more problems
overall, are more likely to be placed in foster care, and remain in foster care longer
compared with other children in out-of-home placements.

Substance-abusing families are more likely to exhibit other problems, such as mental
illness, HIV, and domestic violence. Research has shown that children of substance
abusers have poorer developmental outcomes and are at risk of substance abuse
themselves. Key differences in the approaches of child welfare and substance abuse
services include definition of the client, outcomes, and conflicting responses to setbacks.
Legal and policy environments of the two different systems can also act as a
communication barrier. Joint efforts to work with child welfare families suffering from
substance abuse must include: prevention, strengthened training and identification skills,
enhanced risk assessment, increased availability of substance abuse services, client
retention, improved time lines, and support for ongoing recovery. The federal
government recognized the need to take a leadership position in building bridges between
the two different services.

Braithwaite, J. (2001). Restorative justice and a new criminal law on substance
abuse. Youth & Society, 33, 227–248.

This article discussed the possibility of restorative justice contributing to successful
substance abuse treatment for youth. Restorative justice did not adequately serve
juveniles with substance abuse problems. This article detailed needed research and
development in the area. The author asked: Based on the tenets of restorative justice, is
substance abuse an injustice? Restorative justice within a family is key, especially when

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Funded by Robert Wood Johnson Foundation                       Child Welfare League of America
loved ones have been wronged by the substance abuser. The author said the key reason
prevention programs fail is a lack of motivation on the part of the substance abuser.

The key issues and problems with using the restorative justice model for substance abuse
are: The family of the substance abuser shares their plight with the group and tries to seek
help, and attention is quickly diverted from the family of the juvenile to restoring peace
for those against whom the youth has committed crimes. Restorative justice needs to
incorporate the needs of the substance abuser’s family. Families fear open discussion
because of the illegality of the drug use. That argument is moot, however, because the
police are already involved due to the youth’s crime. Also, families are ashamed at the
drug use of their child. Many do not want to openly admit that their child is a substance
abuser. Admitting shame in a restorative justice model can bring relief to a family.
Restorative justice for substance abusers only works if the underlying substance abuse is
brought into the discussion and not just the immediate crime at hand (i.e., burglary).

Briar-Lawson, K. (1998). Capacity building for integrated family-centered practice.
Social Work, 43, 539–549.

This article examined historical trends in social work and how they may inform today’s
practice. Specifically, the authors examined capacity building and the reinvention of the
welfare state. Today, despite what policymakers or agency directors claim, families are
rarely engaged in the creation of policies or programs that directly affect them. Newer
and more positive programs for families need to have indigenous experts as primary
service providers; missions that promote innovations in social welfare; new theories on
the use of human resources; more focus on economic, employment, and income issues;
more collaboration; and advocacy for social security.

Brindis, C., Park, E., Ozer, E. M., & Irwin, C. E., Jr. (2002). Adolescents’ access to
health services and clinical preventive health care: Crossing the great divide.
Pediatric Annals, 31, 575–585.

Adolescents need access to prevention and primary care services, particularly because the
most common, costly, and serious health problems are potentially preventable. The seven
categories of common risk behaviors are drug and alcohol abuse, unsafe sex, violence,
injury-related behavior, tobacco use, inadequate physical activity, and poor dietary habits.
These health issues, which are largely social and behavioral, account for 70% of
adolescent deaths. Adolescents often engage in more than one risk behavior, with
estimates of 25% of 7th through 12th graders engaging in at least two risk-related
behaviors. Certain types of health problems also occur more frequently in adolescents
who are low income, people of color, or immigrants.

Recommendations from national health organizations include annual preventive visits
and education and counseling on health-damaging behaviors. It is estimated that the
implementation of preventive services could save several billion dollars a year. Research
has identified a number of barriers to adolescents’ access to health care and preventive
services, including lack of insurance coverage, inability to meet co-payments,

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Funded by Robert Wood Johnson Foundation                      Child Welfare League of America
confidentiality concerns, timeliness of appointments, and lack of professionalism among
clinicians. The authors suggested recommendations to better meet the health care needs
of adolescents, including education of health care professionals and the general public
about the importance of access to care, adequate funding and compensation for
preventive services, and implementation of innovative approaches to improve health care
delivery for adolescents.

Bruner, C. (2000). Social services systems reform in poor neighborhoods: What we
know and what we need to find out. Des Moines, IA: National Center for Service
Integration Clearinghouse.

In the past 20 years, agencies and programs at every level have been trying to collaborate
across systems. At the federal level, government departments collaborate on several
programs for children and families. Also, the federal government encourages state and
local collaborations by offering funds through demonstration projects, resource centers,
and grants. The federal government provides technical assistance to states and
communities that desire new strategies on improving the lives of those they serve.
National and local foundations also provide money for cross-system collaborations. This
collaborative work has unearthed three issues: deficiencies of the current system,
identification of elements needed to reform the system, and identification of the process
through which reform can be achieved. The current system is too rigid, problem focused,
and fragmented to truly help clients in need.

Elements of system reform should include public education, consumer participation,
accountability, and leadership. The stages of reform include bringing stakeholders to the
table, building trust and ownership, strategic planning, taking action, and deepening the
work. The author described five theories of change: investment in prevention, integration
of social services, transformation of front-line practice, establishment of accountability,
and creation of grassroots capacity.

Callahan, J., & Patrick, F. (2001). Adolescent portable therapy (APT) for the juvenile
justice system. New York City: U.S. Department of Justice.

This article described the APT model the Vera Institute and the New York City
Department of Juvenile Justice developed. The model combines elements of the most
promising cognitive-behavioral and family-centered therapies. Both of these approaches
have been shown to be effective with young drug abusers. By identifying heavy drug
users and giving detention centers a new option, the organizations hope the model will
allow treatment at the earliest possible moment. In addition, the model offers treatment
providers the authority to follow the adolescents from agency to agency to allow for
continuity of care and eliminate breaks in treatment.

The groups will test the model in a three-year demonstration program that serves
approximately 130 juveniles each year. The goal is to demonstrate a significant reduction
in substance abuse; prevent delinquent and criminal behavior; and improve the physical,
mental, social, and educational well-being of the adolescents. The need for this model

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Funded by Robert Wood Johnson Foundation                      Child Welfare League of America
stems from research that shows that adolescents who use drugs occupy nearly half the
beds in urban detention centers. In addition, one of five adolescents was deemed a heavy
user, taking drugs at least 30 times in a 30-day period. Most cities lack a reliable way to
identify heavy drug users, provide enough services to treat them, and continue treatment
as these adolescents move through the system and back into their communities.

CASAWORKS for Families: A promising approach to welfare reform and substance-
abusing women, A CASA white paper. (2001). New York: National Center on
Addiction and Substance Abuse at Columbia University.

The National Center on Addiction and Substance Abuse at Columbia University (CASA)
designed CASAWORKS. The goals of the program are to simultaneously provide drug
and alcohol treatment and job training. Other services include parenting and social skills,
family violence prevention, and health care. CASAWORKS helps women on welfare
with substance abuse problems. Preliminary research indicated that women in the
program who were tracked for a year showed increases in abstinence from AOD. The
program showed a 60% increase in those who no longer used alcohol, a 20% increase in
those who no longer used marijuana, and a 34% increase in those who ceased cocaine
use. Employment rates more than doubled for those who were tracked for 12 months
(18% were employed at intake and 42% were employed at 12 months).

Historically, poorer families face more difficult problems and are less likely to get needed
services. Research has linked substance abuse and poverty, abuse, violence, and mental
health issues. To be successful, the program required collaboration between welfare
agencies, employers, substance abuse treatment, mental health, social services, job
training, literacy, and work placement services. At the time of this article, CASAWORKS
was operating in ten cities in nine states.

Cavanaugh, D. A. (2002). Financing a system of care for adolescents with substance
use disorders: Opportunities and challenges. Working paper. Washington, DC:

This paper identified issues in treatment financing for adolescents with substance abuse
disorders. The findings informed the discussion at the Center for Substance Abuse
Treatment/Robert Wood Johnson Foundation Summit on Adolescent Substance Abuse
Treatment, September 26–27, 2002. The paper discussed the existing need for adolescent
substance abuse treatment, examined how programs fund the current adolescent
substance abuse treatment systems, and discussed issues in private and public insurance
and public non-insurance-based funding.

Currently, very little information specific to the financing of adolescent substance abuse
treatment exists. The number of children, adolescents, and families affected by substance
abuse has sharply increased since the 1990s. Unfortunately, availability of and financing
for substance abuse prevention, assessment, and treatment has not kept pace with the
needs of young people. Data from large national studies have few subanalyses focused on
the adolescent population. Research shows a number of ways that treatment for

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Funded by Robert Wood Johnson Foundation                      Child Welfare League of America
adolescents’ substance use disorders may be financed through the public and private

Each financing mechanism has its own requirements and limitations. The adolescent
substance abuse treatment system is an example of a patchwork approach to funding a
system of care. These funding sources are often independent, and designers must develop
a framework to examine financing across programs, such as Medicaid/Children’s Health
Insurance Program, juvenile justice, and private health insurance. The article proposes
questions and unresolved issues that present challenges.

Center for Court Innovation. (n.d.). Rethinking the revolving door: A look at mental
illness in the courts. New York: Author.

People with mental illnesses involved in the court system face several challenges. A
recent study found that approximately 16% of the national prison and jail population
suffer from some mental illness. Before arriving in the criminal justice system, these
individuals have often fallen through the safety net of families, hospitals, and
community-based treatment. Once they reach the courts, defendants with mental illnesses
pose a significant challenge for judges. The judges typically lack the tools necessary to
perform meaningful assessments and the connections with mental health providers to
know what types of services are available.

Standard case processing methods are neither efficient nor effective in dealing with
defendants with mental illnesses. Therefore, state court systems have begun to test new
approaches in working with these clients in an effort to protect communities and prevent
defendants with mental illnesses from repeatedly returning to court.

This monograph sought to provide practitioners with an overview of mental health and
the courts, a description of the model projects currently being tested in a number of
jurisdictions, and an outline of some of the concerns that stakeholders have raised. One
suggestion was the creation of mental health courts. They have provoked a variety of
responses from stakeholders in the criminal justice and mental health arenas. As mental
health courts move forward, they will test three ideas: exploring the connection between
defendants’ symptoms of mental illness and their criminal conduct, aiming to evaluate
whether coercion helps improve accountability by engaging defendants with mental
illnesses in long-term treatment, and investigating the issues surrounding system

Center for Substance Abuse Treatment. (1999). Strategies for integrating substance
abuse treatment and the juvenile justice system: A practice guide, executive summary.
Washington, DC: U.S. Department of Health and Human Services.

This document featured the most promising practices in substance abuse treatment for
juvenile offenders. It highlighted programs that link several services together to address
the issues of substance-abusing juveniles. Juvenile offenders who receive effective drug
treatment while in custody are less likely to reoffend. These drug programs are also cost-

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Funded by Robert Wood Johnson Foundation                      Child Welfare League of America
effective over time. This guide offered several core principles on which solid, effective
programming should be based: using researched models, screening juveniles as soon as
possible, developing individualized treatments, creating overarching case management,
involving the family, and creating systems of care for the youth as they transition into
different settings. Programs have used three successful models with youth in the juvenile
justice system: strengths-based, restorative justice, and multisystemic therapy. Effective
practices for substance-abusing youth in the justice system include planning,
collaboration, staffing and training, information sharing, and program evaluation.

Chandler, D., & Meisel, J. (2002). CalWORKS project research: Alcohol & other
drug, mental health, and domestic violence issues: Effects on employment and welfare
tenure after one year. Sacramento, CA: California Institute for Mental Health.

CalWORKS is the California implementation of Temporary Assistance to Needy
Families (TANF). It is a collaborative effort between the California Institute for Mental
Health, Children and Family Futures, and the Family Violence Fund. This study
highlighted research on the effects of AOD, mental health, and domestic violence on
employment success for a sample of women receiving TANF. The researchers randomly
selected the sample from single female heads of household in two California counties
(Kern and Stanislaus). Women were between 18 and 59, spoke either English or Spanish
fluently, and were interviewed on two separate occasions. More women in each county
were employed at the second interview.

Of the total sample, 15% reported impaired functioning on at least 5 of the last 30 days
due to mental health issues. Of the combined sample, 18% had two or more psychiatric
diagnoses. Those in need of AOD services were significantly less likely to have worked
at least 26 hours per week. (CalWORKS minimum weekly hours of work is 26 hours.)
Serious domestic violence impaired many women’s ability to work 26 hours per week.
Having more than one impairment (AOD, domestic violence, or mental health) severely
curtailed the ability to work a full week. Those with sustained mental health impairment
were more likely to never working a full week.

Researchers solely attributed failure to work at all in the second year of the study to
mental health issues. Having any of the issues raised the probability of job loss. At the
second interview, those with one of the impairments were more likely to not have a job
and not receive cash assistance. Other significant barriers to employment included: health
problems, lack of a drivers license, no home of own, low self-esteem, few work skills, no
work year before first interview, fewer school grades completed, and race other than
African American.

Child Welfare League of America. (2002). Child maltreatment and juvenile
delinquency: Raising the level of awareness. Washington, DC: Author.

Researchers have found that people who were abused or neglected as children are 59%
more likely to have been arrested as a juvenile. This monograph detailed the mission,
values, and goals of the Juvenile Justice Division of the Child Welfare League of

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Funded by Robert Wood Johnson Foundation                      Child Welfare League of America
America (CWLA). The objectives of the division include educating CWLA members
about the connection between the child welfare and juvenile justice systems, reducing the
incidence of juvenile delinquency nationwide, and decreasing the reliance on
incarceration for accused or adjudicated youth. It also detailed current trends in juvenile
justice and child welfare, as well as specific action steps for future work in the Juvenile
Justice Division. Since its inception in 2000, the Juvenile Justice Division has initiated
the National Advisory Committee on Juvenile Justice with broad national representation,
developed informational publications, and presented workshops and training seminars at
conferences. In addition, CWLA is providing a model effort to build strategic
partnerships to integrate child-, youth-, and family-serving agencies in the state of
Maryland. The process requires that jurisdictions demonstrate a comprehensive and
strategic community planning deliberation to establish prioritized needs before applying
for and gaining access to state and federal funding sources.

Clark, H. W. (2001). Residential substance abuse treatment for pregnant and
postpartum women and their children: Treatment and policy implications. Child
Welfare, 80, 179–198.

This article highlighted preliminary data from a national cross-site evaluation of
residential treatment projects for substance-abusing pregnant and postpartum women and
their children. From 1993 to 1995, the federal government awarded five-year grants to
program sites. This article featured preliminary findings from 24 of the sites.

Researched programs for women with substance abuse issues were crucial, because
women tend to suffer worse health problems due to AOD abuse and many of these
women are single mothers. They have low incomes, poor educations, few job skills, and
abusive partners. Their children are more likely to suffer from abuse or neglect.

The sites in this study offered comprehensive services and residential treatment for up to
12 months. The programs provided traditional counseling, relapse prevention, and self-
help services. They also helped women connect with prenatal and postnatal medical care,
therapy, parenting training, employment training, legal assistance, and many other
services. Children received medical services, therapy, and help with developmental
delays. Data for this article were for 1,847 women who had complete case files at the
time. The median age was 29, 42% entered the program pregnant, 40% were postpartum,
and 18% were postpartum but did not have custody. Of the sample, 49% were African
American, 32% white, 9% Hispanic, 4% Asian, and 4% American Indian or Alaska

The study identified alcohol and cocaine as the substances most used. Most children were
younger than 4 years of age. The sample reported two infant deaths. This was lower than
what women had reported in the past. Women who had been in the program more than
one month had fewer premature births. For the 1,428 who completed exit interviews,
35% had completed their scheduled treatment, 34% left on their own initiative before
finishing, 15% left for rules infractions, and 16% left for other reasons. These discharge
numbers were equivalent to other studies. Postpartum women stayed in treatment the

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Funded by Robert Wood Johnson Foundation                      Child Welfare League of America
longest. At six-month follow-up, 32% of the women who had completed the program
reported AOD use, down from 90% at pretest. Preliminary results indicated that
providing substance-abusing mothers with early, targeted services helped reduce medical
and law enforcement costs.

Cocozza, J. J., & Skowyra, K. R. (2000). Youth with mental health disorders: Issues
and emerging responses. Juvenile Justice, 7(1), 3–13.

Many people are concerned about the mental health needs of youth in the juvenile justice
system, as a result of a number of factors, including increased recognition that youth in
the general population have mental health problems, use of the criminal justice system to
serve adults with psychiatric problems, and shift of the juvenile justice system from
treatment and rehabilitation to punishment. Although the literatures lacks research on the
prevalence and types of mental illness in the juvenile justice population, the authors
encountered significant evidence to support four findings. First, youth in the juvenile
justice system, compared with those in the general population, experience substantially
higher rates of mental health disorders. Second, a high percentage of youth in the juvenile
justice system have a diagnosable mental disorder. Third, it is reasonable to estimate that
at least one of every five youth in the juvenile justice system has serious mental health
problems. Fourth, many youth in the juvenile justice system have co-occurring mental
health and substance abuse disorders. In the juvenile justice system, many of these
disorders are never accurately diagnosed for a variety of reasons. The authors believed
that whenever possible, young people with serious emotional disorders should be diverted
from the juvenile justice system or, at minimum, be placed in appropriate treatment

Connecting child protective services and substance abuse treatment in communities: A
resource guide. (2001). Washington, DC: APHSA.

The authors developed this guide to inform child welfare and substance abuse treatment
agencies about promising practices, collaboration ideas, tools for collaboration, and
resources. No clear estimates of how many children come into out-of-home care due to
parental substance abuse exist, but many in the field believe that the number is quite high.

The Adoption and Safe Families Act (ASFA) time frames are often at odds with
substance abuse recovery time frames. This means that the parent is still trying to
successfully recover while the child welfare agency needs to find a safe, permanent home
for the child.

The substance abuse recovery field often uses the community as a powerful tool in aiding
those with addictions. The child welfare field does not use the community in the same
fashion. In 2001, the National Association of Public Child Welfare Administrators and
the National Association of State Alcohol and Drug Abuse Disorders conducted a survey
of all 50 states and the District of Columbia to find providers working collectively in
child welfare and substance abuse. Characteristics of the community-based programs
included an emphasis on the client in the context of the family, gender- and culture-

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Funded by Robert Wood Johnson Foundation                      Child Welfare League of America
specific treatment, a holistic approach to the client, services provided in the community
where the clients lived, and flexible funding from multiple sources. The best funding
resources for collaborative projects could potentially come from the federal government,
from foundations and private grants, and through personal contacts. To work together,
agency staff need to have cross-disciplinary training, good screening and assessment
tools, shared information, confidentiality, joint formal processes, safety planning, and
mandated treatment.

The authors made recommendations for successful collaborations: targeting insightful
leadership, identifying strengths and needs, addressing bureaucratic hurdles, cross-
training staff, viewing the project as a joint venture, and having a plan for sustainability.

Deas, D., & Thomas, S. (2002). Comorbid psychiatric factors contributing to
adolescent alcohol and other drug use. Alcohol Research & Health, 26, 116-121.

The authors of this article discussed numerous factors that contribute to adolescent
substance use, including psychological, psychiatric, peer, environmental, and family
factors. Substance use among adolescents has been linked to car crashes, suicide,
delinquency, criminal behaviors, and psychological difficulties. Psychological factors
include the link between substance use and high novelty seeking, low harm avoidance,
and high reward dependence; the link between aggressiveness and initiation and
continuation of substance use; and the link between stressful or traumatic events with
substance use. Some studies have linked substance use to experiencing or witnessing
physical or sexual assault. Psychiatric factors include a link between a psychiatric
disorder and substance use as twin outcomes of another predisposing factor. Depression,
anxiety, conduct disorder, and attention deficit/hyperactivity disorder are all linked to
substance abuse on different levels. Peer factors influence a youth’s choice about
substance use. They are more likely to use substances if their friends are also.
Environmental factors include being homeless, having low socioeconomic status, and
living in urban areas. Family factors include the ability of a family to protect their at-risk
child; the more likely chance an adolescent will use drugs if they live in a single-parent
home than a two-parent home, even if one parent is a substance user; and youth born into
larger sibling groups. There is also a genetic link for at-risk youth.

Edwards, R. W., Jumper-Thurman, P., Plested, B. A., Oetting, E. R., & Swanson, L.
(2000). Community readiness: Research to practice. Journal of Community
Psychology, 28, 291–307.

This article examined community-level readiness to change or implement programs of
prevention in response to a variety of issues. The researchers developed a community
readiness model as a practical research tool to match treatment and control communities
for randomized studies. It can be difficult to implement prevention programs in
communities. For example, attitudes toward certain behaviors may differ across
neighborhoods. Where one community views a behavior as problematic, another views
the behavior as commonplace. More difficulty comes from a lack of resources and
changing political climates. Communities experience stages of readiness: No

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Funded by Robert Wood Johnson Foundation                        Child Welfare League of America
awareness—problem is not recognized; denial—nothing needs to be done locally; vague
awareness—general feeling a problem exists, but no motivation to fix it; preplanning—
identifiable leaders picked, but no action yet; preparation—planning is focused;
initiation—action under way as a new effort; stabilization—programs are running but
need evaluation; confirmation/expansion—original efforts modified or expanded; and
professionalization—highly trained staff and effective evaluations exist. Before
implementing a program, it is recommended that developers interview key informants.
The most effective community interventions involved multiple systems and used within-
community resources.

Eisen, M., Pallitto, C., Bradner, C., & Bolshun, N. (2000). Teen risk-taking:
Promising prevention programs and approaches. Washington, DC: Urban Institute.

This book featured prevention programs and practices for adolescents. The goal was to
bridge the gap between research and practice. The most serious risk taking by adolescents
includes fighting, substance abuse, suicide, and sexual activity. All of these activities are
preventable. Programs to prevent high-risk behavior are gaining in popularity both in
schools and communities. This book reviewed 51 evaluated problem behavior
interventions. The researchers selected a subset of 21 programs based on demonstrated
rigor, results, and delivery model. The book gave an update on adolescent risk taking,
common elements of successful programs, moving from research to practice, prevention
readiness assessment, and profiles of the 51 programs. Common elements of success
identified in the subset of 21 programs included: being theory- or skills-based, having
targeted behavioral goals, having a written curriculum and trainer feedback, being of
substantial duration and intensity, and having multiple-component interventions.

Farmer, E. M. Z., Burns, B. J., Chapman, M. V., & Philips, S. D. (2001). Use of
mental health services by youth in contact with social services. Social Service Review,
75, 605–624.

This article reported on a comparison of three groups of children, those with a history of
foster care placement, those in contact with department of social services but never
placed, and those from impoverished families who never had contact with social services,
and their mental health service needs and use. All three groups exhibited mental health
needs, but children in foster care or in contact with social services were more likely to
receive treatment. Data were from a longitudinal study primarily conducted in the rural
southeastern United States. In this area, social services, mental health, juvenile justice,
education, and general medical agencies had been working on cross-collaboration.

The final samples included 142 children in foster care, 218 children known to social
services but not in care, and 419 children in impoverished families but never in care. All
children were 9, 11, or 13 years old, and 82% were white. During three years of data
collection, 30% of youth showed both a psychiatric diagnosis and significant functional
impairment, 42% had significant functional impairment but no psychiatric diagnosis, and
5% had a psychiatric diagnosis with no functional impairment. For youth not in foster
care but impoverished, use of mental heath services was far lower than children in

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Funded by Robert Wood Johnson Foundation                       Child Welfare League of America
contact with social services. Impoverished children were less likely to have a psychiatric
diagnosis and functional impairment. Impoverished children with mental health needs,
however, were less likely to receive treatment.

Ford, J., Gregory, F., McKay, K., & Williams, J. (2003). Close to home: A report on
behavioral health services for children in Connecticut’s juvenile justice system.
Farmington, CT: Connecticut Center for Effective Practice of the Child Health and
Development Institute of Connecticut.

Excluding conduct disorder, 60% of males and 66% of females in juvenile detention
suffer from one or more mental health conditions. Children are more likely to reoffend if
their have at least one of the following risk factors: substance abuse, poor self-control, or
family dysfunction.

This report illustrated Connecticut’s new initiative for youth in the juvenile justice system
in need of mental health care. In 2002, Connecticut was noncompliant in meeting the
behavioral health needs of the youth in juvenile detention. The state began a three-year
plan to provide coordinated services to youth in detention. Identified service gaps
included the absence of behavioral health screening at intake, lack of funding and training
to care for youth with behavior problems, problems with insurers, and the absence of
effective service collaboration. This report found that earlier screening and
comprehensive assessment would detect problems before children ended up in juvenile
detention, enable better treatment matches, make more efficient use of court-based
evaluations, and assist in making better choices about resource allocation. The report also
highlighted research findings. Some of the results indicated that positive outcomes were
linked to simultaneous treatments.

The authors conducted a survey to determine successful outcomes, which included
engagement of parents, enhancement of personal well-being, aftercare, evaluation by a
psychiatrist, access to vocational resources, staffing capacity, collaboration, sustained
services, and sufficient staffing and funding. The report ended with several
recommendations: establish screening tools; view families as clients, not just children;
make a wide range of evidence-based practices available; mandate use of core services;
improve data collection; coordinate systems; create effective reimbursement systems;
establish early identification of problems; create gender- and culture-specific
programming; and correct problems within the juvenile justice system.

Foster, E. M., Kelsch, C. C., Kamradt, B., Sosna, T., & Yang, Z. (2001).
Expenditures and sustainability in systems of care. Journal of Emotional and
Behavioral Disorders, 9(1), 53–62.

The Comprehensive Community Mental Health Services for Children and Their Families
Program, is a collaborative effort implemented across the country. The program serves
children with many mental health needs. Researchers found that expenditures were rather
high, but further analysis revealed that the costs were within a normal range based on

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Funded by Robert Wood Johnson Foundation                        Child Welfare League of America
other data. Many of the individuals seeking treatment experienced severe problems that
warranted higher expenditures.

This report covered work at three sites: Santa Barbara, CA; Wai’anae Coast, HI; and
Milwaukee, WI. Analyses covered a three-year period, from 1996 through 1998. The
researchers collected descriptive data, budget data, and service use and billing data.
Children across sites did not vary; most were of color and in families with annual
incomes of less than $25,000. The children exhibited severe emotional and behavioral
problems. Many children came from families with a history of substance abuse or mental
illness. Majority ethnicity and service patterns differed by site. Children in the
Milwaukee site had most prior contact with an inpatient facility. The three programs in
this study had similar budgetary expenditures to similar programs. Each program was
required to become more self-sufficient by the end of the three-year grant period.
Funding was found by contracting services to other child-serving agencies in the area.

Glisson, C., Hemmelgarn, A. L., & Post, J. A. (2002). The shortform assessment for
children: An assessment and outcome measure for child welfare and juvenile justice.
Research on Social Work Practice, 12, 82–106.

The Shortform Assessment for Children (SAC) is a tool to monitor the mental health and
psychosocial functioning of children in the child welfare and juvenile justice systems.
The tool identifies internalizing and externalizing behaviors. This article described the
design and purpose of the instrument. The authors found that many case managers do not
assess the mental health of the children they serve. There was a need for a short, easy-to-
use mental health assessment form that could better serve the children’s overall needs.
When compared, many children served separately by either the child welfare or juvenile
justice system had many similar characteristics and mental health problems. Ultimately,
many would be served by both systems.

Research has found that the child welfare and juvenile justice systems are not adequately
prepared to deal with children with mental health issues. The systems tried to respond to
the need for mental health assessment, but tools were too long and complicated for
caseworkers to use properly.

The researchers designed the SAC instrument to aid caseworkers. It is unique, in that it is
short, charts internalizing and externalizing behaviors, works for preadolescent children
and adolescents, and can be used with parents and teachers. The tool was tested on 3,790
children ages 5 through 18 when they were placed in custody of the children’s service
system, including juvenile justice and child welfare. Using the sample scale for parents
and teachers allows the caseworker to interpret findings across informant, age, and

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Funded by Robert Wood Johnson Foundation                      Child Welfare League of America
Greenberg, M. T., Domitrovich, C., & Bumbarger, B. (1999). Preventing mental
disorders in school-age children: A review of the effectiveness of prevention programs.
Available from

This report identified issues and themes in mental health disorders of school-age children
and families, programs that reduce externalizing and internalizing disorders, state-of-the-
art programs in the prevention of mental disorders in school-age children, elements that
contribute to program success, and suggestions to improve programs quality. Mental
disorders in children are complex; they very rarely stem from a single cause. Risk factors
for childhood mental health disorders include biological, social, and ecological factors.
Developmental risk factors may be related to maladaptive outcomes. A focus on
protective factors may lower childhood mental disorders and may improve the overall
competence of children.

This report reviewed mental disorder prevention programs for children between the ages
of 5 and 18. The programs had to have well-defined study designs, clear goals and
specifications for the sample, and outcome measures. This review examined more than
130 programs, and 34 met the criteria. Of the 34 programs, 14 were considered universal
programs (for children, families, and schools). These programs showed positive
outcomes in specific symptoms of psychopathology (i.e., aggression) or commonly
accepted risk factors associated with psychopathology (i.e., impulsiveness). The universal
programs taught cognitive strategies to improve social and emotional competence,
created change in the school or family ecology, and had the necessary duration and
intensity. The researchers identified ten programs as successful for treating conduct
disorders. These worked in a variety of settings: with children only, with families, or in
multiple contexts. Multicomponent programs were most successful.

The reviewers identified ten programs that addressed internalizing disorders. These
programs taught children to alter and use effective cognitive and behavioral coping
strategies. Overall, the researchers found short-term programs had limited success,
ongoing intervention was necessary, targeting multiple negative outcomes was feasible,
interventions should address multiple environments, no single program component works
by itself, and community buy-in is important.

Gregoire, K. A., & Schultz, D. J. (2001). Substance-abusing child welfare parents:
Treatment and child placement outcomes. Child Welfare, 80, 433–452.

This study examined parental substance abuse for those who have children in the child
welfare system. The researchers examined several variables, including gender, prior
treatment, support, and court-ordered intervention. Findings showed that significant
others’ support was positively related to a parent’s successfully obtaining help. Court-
ordered intervention did not predict success or failure. Some organizations cite parental
substance abuse and poverty to be the two major factors associated with placement of
children in out-of-home care. Little research on effective programs for substance-abusing
child welfare parents exists.

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Funded by Robert Wood Johnson Foundation                      Child Welfare League of America
A sample of 167 child welfare parents, was used, who were referred for substance abuse
treatment between April 1990 and August 1993. The researchers conducted the study in
Lancaster County, PA. Agencies referred parents based on caseworker suggestion; the
study did not use an assessment tool. The researchers collected data from caseworkers.
Most parents identified alcohol or cocaine as the drug most often used. At a nine-month
follow-up, 39% of 142 clients referred for treatment were still sober. More males had
significant other’s support than did females in treatment. Overall, a significant number of
the parents did not complete the treatment. Women were more likely to have a significant
other who was also a substance abuser. Therefore, they probably received less support.
Substance-abuse programs should include the whole family. Findings from this study
indicated that the support of a significant other was the key to successful addiction

Gruber, K. J., Fleetwood, T. W., & Herring, M. W. (2001). In-home continuing care
services for substance-affected families: The bridges program. Social Work, 46, 267–

This article highlighted a program that blended substance abuse recovery work and
family preservation for substance-abusing parents and their children. The Bridges
Program, an in-home recovery program, helped families avoid relapse by addressing
individual actions and cognitions, individual recovery action steps, family actions and
cognitions, and family recovery action steps. Parents with substance abuse problems
often face difficult choices between receiving needed help and maintaining their families.
The Bridges Program addressed these two issues and taught parents how to work on
substance abuse challenges while preserving their family. An in-home social work
clinician met with the family four to six hours each week for 8 to 12 weeks. A major
concern when working with substance-abusing parents is the strong link between
substance abuse and child maltreatment. Other research cites that children of substance-
abusing parents are more likely to experience psychological, cognitive, and behavioral
problems. In substance-abusing homes, researchers find less parental control and
oversight for children’s activities. The article highlighted other in-home programs for
substance-abusing parents and their children, including Project Connect in Rhode Island
and Save Haven Program in Detroit. The authors note limitations of this study, including
having only preliminary qualitative data to support the work of the Bridges Program.

Gutierrez-Mayka, M., Joseph, R., Sengova, J., Uzzell, J. D., Contreras, R.,
Friedman, R. M., et al. (2000). Evaluation of systems reform in the Annie E. Casey
Foundation Mental Health Initiative for Urban Children: Summary of findings and
lessons learned. Tampa, FL: University of South Florida, Louis de la Parte Florida
Mental Health Institute, Department of Child and Family Studies.

The Annie E. Casey Foundation developed the Mental Health Initiative (MHI) in 1993 to
improve community mental health services to achieve positive outcomes for children. It
also designed MHI to save money in the long run while delivering culturally and family-
sensitive services in high-poverty communities. MHI was a five-year project, and during
that time, several national developments had implications for the well-being for children

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Funded by Robert Wood Johnson Foundation                      Child Welfare League of America
and families the MHI program, including health care financing, welfare reform, the
Comprehensive Community Mental Health Services for Children and Their Families
Program, ASFA, and changes in juvenile justice. Four states received grants to
implement MHI plans (Miami, Florida; Boston, Massachusetts; Houston, Texas; and
Richmond, Virginia). MHI broadened the traditional population served to include at-risk
children, focus on prevention and early intervention, deliver services in nontraditional
settings, and emphasize parent education and involvement. Each site also had
neighborhood governance that provided administrative oversight and fiscal
accountability. Evidence of success at each of the four sites included increased local
leadership, implementation of family-centered services, changes in policies, and changes
in the way information was used. The authors conducted a qualitative evaluation to
describe the different stages of implementation.

Hanson, L., Deere, D., Lee, C. A., Lewin, A., & Seval, C. (2001). Key principles in
providing integrative behavioral health services for youth children and their families:
The Starting Early Starting Smart experience. Washington, DC: Casey Family
Programs and the U.S. Department of Health and Human Services, Substance
Abuse and Mental Health Services Administration.

This purpose of this report was to assist policymakers and program administrators in
replicating Starting Early Starting Smart (SESS). The goal of SESS was to integrate
behavioral health services into accessible environments where children are likely to go,
such as pediatric health care and early childhood educational settings. No set SESS
protocol exists for replication. Each site develops its own program plan for its specific
population, setting, and community. SESS services need to be comprehensive and
responsive, culturally competent, strengths based, and family centered. Required
behavioral health services components for a SESS site include family support, advocacy,
and care coordination; substance abuse prevention and treatment; mental health services;
and family and parenting services. Overall, implementation of a SESS program needs to
include community assessment; family involvement; collaboration; staff support,
training, and supervision; and recruitment and retention of SESS participants.

Hatcher, J. L., & Scarpa, J. (2002, June). Encouraging teens to adopt a safe, healthy
lifestyle: A foundation for improving future adult behaviors. Child Trends Research
Brief .

In this report, the authors summarized experimental research studies of health-related
behaviors in adolescents. Many of the most common causes of illness and death in the
United States are influenced by behaviors such as tobacco use, physical activity, and diet.
Studies have shown that teens’ positive and negative behaviors carry over to adulthood.
Therefore, it is imperative that programs are established to promote healthy behaviors
and reduce the risk of disease.

The authors studied several health-related programs geared to adolescents. The programs
focused on smoking, exercise and nutrition, sleep, and injury prevention. Among the
programs found to succeed in helping teens adopt a healthy lifestyle were those that took

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Funded by Robert Wood Johnson Foundation                      Child Welfare League of America
a multifaceted approach to promoting positive health behaviors, incorporating
psychosocial and behavioral components, instead of only distributing information.
Research showed that programs should work to achieve desirable healthy behavior
changes that last over time, not just in the short term. This is a challenge among
adolescents. In addition, programs that aim to prevent injury among teens are most
effective when they reach adolescent males, address risky behaviors, and are
comprehensive. The authors recommended that programs focus specifically on
adolescents, conduct longitudinal and experimental research, and address causes of

Hoagwood, K. (2001). Evidence-based practice in children’s mental health services:
What do we know? What aren’t we putting it to use? Washington Watch, 84–87.

Most programs and practices in mental health services for youth are not based on
research, despite the fact that over the past decade, research on children’s mental health
has doubled. One of the problems is that no consensus exists about the definition of
evidence-based practice. Some agencies and organizations are working to create agreed-
on criteria for evidence-based practice. Little evidence-based help exists for severe, co-
occurring mental health problems. Much of the evidence is specific to discrete treatments
for discrete disorders, whereas most children present with several problems. Finally, the
evidence base has not shown how to best coordinate services among several providers.
Studies are taking place, however, on how to remove barriers to services and increase
family participation.

Evidence-based practices have been able to show that psychosocial interventions for
children in research-based settings can successfully reduce symptoms. The use of case
managers for children with mental health issues reduces the need for psychiatric
hospitalizations. School-based mental health research has shown that behavior
modification and management strategies can have lasting results. Other research has
shown that behavioral consultation helps reduce the number of children placed in special
education classes. Researchers have performed few studies on psychotropic medications.
What research exists has shown that clinical trials with medication management are more
successful than medications delivered in the community.

Hoffman, J. P. (2002, May). The community context of family structure and
adolescent drug use. Journal of Marriage and Family, 64, 314–330.

This article examined the relationship between family structure and adolescent drug use.
It also examined different types of communities in which families reside to identify risk
or protective factors at the community level. Family structure exerts a significant effect
on some types of adolescent behaviors, such as drug use. One finding is that two-parent
families are more likely to be able to afford to live in better neighborhoods than single-
parent families. Therefore, community may play an important part in either protecting or
exposing youth to at-risk behaviors.

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Funded by Robert Wood Johnson Foundation                      Child Welfare League of America
The researcher gathered data for this study from a National Educational Longitudinal
Study of students slated to graduate from high school in 1992. The researcher conducted
the study with the same sample twice, two years apart, to examine trends. Independent
variables included family structure, parent-child interaction, parental attachment, and
residential mobility. Control variables included sex and race. Community-level variables
included urban, suburban, or rural residence; women-headed households; number of
unemployed men; percentage of families below the poverty line; and community
homogeneity. The outcome variable was adolescent drug use.

The results indicated that adolescents living with a single mother, single father, or
stepparent, or in another family type, reported significantly more drug use than
adolescents living with birthmothers and birthfathers together. The community variables
of joblessness and poverty were independently related to adolescent drug use.
Longitudinally, adolescents who lived with a single father were at a more significant risk
of drug use than other family situations. This may be attributed to the idea that older
adolescents with difficult and problem behaviors may be sent to live with their fathers.
Surprising results included a positive relationship between drug use and parental
supervision and a relationship between decreased drug use and school dropout. Possible
explanations included that adolescents who use drugs may have prompted more parental
attention and supervision because of their actions and youth who drop out of school may
initially use more drugs but then decrease use after taking on more adult responsibilities
through work or family formation.

Horwitz, S. M., Kelleher, K., Boyce, T., Jensen, P., Murphy, M., Perrin, E., et al.
(2002). Barriers to health care research for children and youth with psychosocial
problems. Journal of the American Medical Association, 288(12), 1508–1512.

Most children and adolescents with behavioral or emotional problems are identified and
treated by their primary care physicians. Given this phenomenon, federal agencies have
incorporated an emphasis on primary care for children and adolescents into their research
planning. The purpose of this study was to determine the extent to which this emphasis is
realized in the research portfolios of federal agencies. The authors completed a
comprehensive examination of the U.S. Department of Health and Human Services
research portfolio to determine the proportion of research addressing the behavioral and
emotional issues of children and adolescents in primary care settings. The authors rated
abstracts obtained through a cross-sectional review by whether they targeted primary
care, examined behavioral or emotional issues, and examined or altered a facet of
primary care.

Results showed that the research portfolios varied significantly among 24 institutes and
agencies that listed funded research in April 2001. The agency with the largest portion of
its portfolio dedicated to children was the National Institute for Child Health and Human
Development (21%). The agencies with the smallest portion of their portfolios dedicated
to children were the National Institute of General Medical Sciences (0.5%) and the
Human Genome Project (1.7%). Of the agencies, 54% did not have funded research on
children, adolescents, or youth and primary care, with four agencies funding almost 70%

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Funded by Robert Wood Johnson Foundation                      Child Welfare League of America
of the research in this area. Furthermore, of the 63 projects involving children,
adolescents, or youth and primary care, only 21 addressed emotional or behavioral issues.
The authors conclude that despite the fact that federal agencies have put increased
emphasis on children and youth in primary care settings who have emotional or
behavioral issues, agencies are conducting very little funded research.

Jayakody, R., Danziger, S., & Pollack, H. (2000, August). Welfare reform, substance
use, and mental health. Journal of Health Politics, Policy and Law.

This article examined substance abuse and mental health problems among single mothers
and how they related to receipt of welfare services. The authors analyzed data from the
1994 and 1995 National Household Survey of Drug Abuse and found that 195 welfare
recipients met the criteria for a DSM-III-R psychiatric disorder. Research results
suggested that mental and behavioral health problems were barriers to self-sufficiency.

The development of the Personal Responsibility and Work Opportunity Reconciliation
Act required welfare recipients to be employed within two years of receiving aid. The
government also has a five-year lifetime limit on federally funded aid. An exemption
exists for up to 20% of a state’s caseload. The difficult question becomes, who should be
exempt? Many statutes are punitive against those with substance abuse problems. Mental
health disorders among welfare recipients have received less attention than substance
abuse problems.

Recent research suggests that approximately 40% of welfare mothers report high levels of
depressive symptoms. The final data set for the study showed that 16% of all single
mothers experienced at least one disorder in the past year. Depression was the most
common disorder. Compared with single mothers, single welfare mothers experienced
more problems with substance abuse involving marijuana and cocaine. Welfare recipients
were also more likely to experience depression and agoraphobia. The authors stated they
did not find evidence of widespread substance use among welfare recipients. States are
contemplating mandatory drug testing for welfare recipients. This would not address the
bigger problems of finding and administering effective integrated services to assist
welfare recipients who have drug-related problems. The data did suggest that more
welfare recipients suffer from mental health problems. Welfare-to-work programs need to
address mental health concerns of people on welfare.

Johnson, K., Bryant, D. D., Collins, D. A., Noe, T. D., Strader, T. N., & Berbaum, M.
(1998). Preventing and reducing alcohol and other drug use among high-risk youths
by increasing family resilience. Social Work, 43, 297–317.

The authors of this study examined the effects of a community-based program designed
to delay onset and reduce frequency of AOD use among high-risk youth ages 12 to 14 by
strengthening family resilience. The program was implemented in church communities in
rural, suburban, and inner-city settings. Components of this study included
parent/guardian and youth training, early intervention services, and case management
services. The results showed that the program produced positive direct effects on family

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Funded by Robert Wood Johnson Foundation                     Child Welfare League of America
resilience. The evaluation also found positive moderating effects on delayed onset of
AOD use among youth. The authors offered implications important to social work
practice, including churches as social systems from which to launch prevention efforts,
integrative parent-youth training, effective education, social skill development, and
supplementing a parent-youth training model with alternative activities, which can
produce sustained gains in strengthening family resilience.

Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet needs for mental health
care among U.S. children: Variation by ethnicity and insurance status. American
Journal of Psychiatry, 159, 1548–1555.

This article reported on a study of rates of use and unmet mental health needs of children
and adolescents in the United States. The authors examined three national data sets for
disparities in unmet needs (defined as having a need for mental health evaluation but not
using any services in a one-year period). These data sets were the National Health
Interview Survey, National Survey of American Families, and Community Tracking

Results showed that in a 12-month period, 20% to 23% of children ages 3 through 5 and
6% to 9% of children and adolescents ages 6 through 17 used mental health services. Of
the children ages 6 to 17 who needed mental health services, nearly 80% did not receive
care. The authors determined that the rate of unmet needs was greater among Latino
children than white children and among uninsured than publicly insured children. These
findings revealed that most children who need a mental health evaluation do not receive
services. In addition, the use of mental health services was extremely low among
preschool-age children. The authors suggested that further research needed to be
conducted to clarify reasons for high rates of unmet needs in specific groups.

Killeen, T., & Brady, K. T. (2000). Parental stress and child behavior outcomes
following substance abuse: Residential treatment—Follow-up at 6 and 12 months.
Journal of Substance Abuse Treatment, 19, 23–29.

Treatment options are growing for alcohol- or drug-addicted mothers. An important issue
in the treatment of women who use substances during pregnancy is the inability to
differentiate the effects of particular substances, because the majority of women use more
than one substance. Interventions that are becoming popular are residential treatment
programs specifically designed to address the unique needs of alcohol- or drug-addicted
mothers and their children.

The purpose of this study was to assess the effectiveness of a residential substance abuse
treatment program on reducing parental stress and improving the children’s behavioral
outcomes. The program included interventions geared for both the mothers and children.
The authors collected data on 35 women and 23 children at admission, every 6 months
during participation in the program, and 6 and 12 months following discharge. The
information collected on the women who participated in the program included drug and
alcohol use, psychosocial functioning, and parenting stress. The assessments completed

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on the children included information on psychomotor, cognitive, and emotional

The results revealed that mothers who graduated from the program had significantly
better outcomes at follow up. Specifically, from admission to the six-month follow-up,
graduates had better levels of psychosocial functioning and lower levels of stress related
to being a parent. At the 12-month follow-up, graduates indicated that since admission,
they had lower levels of overall stress, stress related to characteristics of the child, and
stress related to being a parent. At the 6- and 12-month follow-ups, nongraduates of the
program were doing more poorly than when they were admitted to the program. From
admission to six months after discharge, children of graduates of the program had
improved behavior scores. Specifically, their behavior scores improved from the clinical
to normal range. The children whose mothers did not graduate from the program had
behavior scores that remained in the clinical range from admission to six months after
leaving the program. The findings of this program evaluation revealed that a residential
substance abuse program for alcohol- or drug-addicted mothers resulted in better
outcomes for the mothers who completed the program and their children.

Koyangi, C., & Semansky, R. (2003). No one’s priority: The plight of children with
serious mental disorders in Medicaid systems—A report on six focus groups in two
states. Washington, DC: Bazelon Center for Mental Health Law.

The authors of this report received funding to conduct a study on whether Medicaid-
eligible children received an expanded range of services in their communities. The
authors conducted focus groups with 68 parents and 86 children in New York and
Oregon. The authors chose these states because they had a relatively strong mental health
benefit for children in their Medicaid rules. The states implemented their Medicaid
programs differently. Oregon had a managed care Medicaid program, and New York had
a fee-for-service program.

Although both states claimed to have a wide variety of services for children with mental
health issues, parents in both states claimed that they only had access to basic medical
and therapy services. Parents, through persistent advocacy, received a full complement of
services and reported satisfaction with the treatment. Overall, parents reported serious
problems when they attempted to access needed services, including systems that were
only crisis oriented, public agencies that ignored parents’ plea for help, service delays,
having no education on child’s mental health needs, and having no access to community
rehabilitation services. When services were available, parents found that there were too
few child psychiatrists available, case managers were poorly trained, and therapy was

Recommendations included access to effective home- and community-based services,
availability of mobile crisis teams, early intervention, education of and participation by
parents, school-based identification and services, interagency collaboration, coordination
and case management, and parental involvement in policy decisions.

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Kraft, M. K., Vicary, J. R., & Henry, K. L. (2001). Bringing justice to adolescent
substance abuse treatment. Youth & Society, 33, 133–142.

Today, youth initiate drug and alcohol use at early ages. Despite prevention programs,
young people still use these substances, and many go on to have serious addiction
problems. Research has found that juvenile delinquency and substance abuse are linked,
and drug-using youth increasingly dominate the juvenile justice system. Many of these
youth end up in residential facilities. The Center for Substance Abuse Treatment
estimates, however, that only 1 in 16 youth actually receive any treatment services for
their addictions. This is despite the fact that substance abuse treatment provides cost
savings in terms of crime, posteducational achievement, and morbidity and mortality.
Restorative justice is a unique way of thinking about crime, because it recognizes the
whole community as being damaged by crime and that the punishment ensures the
community is made whole again.

Kutash, K., Duchnowski, A. J., Sumi, W. C., Rudo, Z., & Harris, K. M. (2002). A
school, family, and community collaborative program for children who have
emotional disturbances. Journal of Emotional and Behavioral Disorders, 10(2), 99–

The education system has a history of addressing the needs of children with emotional
disturbances by providing the majority of mental health services. In an effort to improve
outcomes for children with emotional disturbances, a school-based intervention called the
School, Family, and Community Partnership (the Partnership Program) was developed,
implemented, and evaluated. The Partnership Program aimed to increase family
involvement in the children’s education and increase access to supportive services in the
community. A major component of the Partnership Program was the development of a
team around the student and family that included school personnel. The team developed a
plan for the student that addressed strengths, limitations, and needs; identified barriers to
meeting the needs; and included action plans. A second major component consisted of a
12-hour training program for school personnel, community representatives, and parent
advocates in the Partnership Program. The authors took measurements of knowledge
before, immediately after, and six months after training.

Results showed that the 10 school staff members who participated in the training had
increased their knowledge prior to the training and that this increase in knowledge was
sustained for six months. Students in this study were from two middle schools and in
special classes in compliance with IDEA. Twenty-three students were in the participating
group and 24 were in the comparison group at the start of the study. The researchers took
measures of student behavior and academic functioning before the program and 12 and
18 months after entry into the program. In addition, they took measures of program
implementation and fidelity.

Results showed that there were differential attrition rates between the target and
comparison schools. Furthermore, the authors found differences between the students
who left and those who remained at the comparison school. Students who left had more

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reported behavioral problems, and their parents reported significantly less satisfaction
with school services. Because of the differential attrition rates, the authors completed
analyses only for students in the participating school. Students in the participating school
who remained in the program showed a significant decrease in discipline referral rates
and a trend toward improvement in behavioral and emotional problems. In addition, more
than half the students received mental health services, although the school or school
personnel supplied most services. Overall, the Partnership Program was unable to meet
the goal of increasing access to and use of mental health services from outside agencies.
This difficulty in accessing mental health services may have been a contributing factor to
the lack of improvement in emotional functioning.

Leon, A. M. (1999). Family support model: Integrating service delivery in the
twenty-first century. Families in Society, 80, 14–29.

This article featured the family support model, an integrated service delivery model that
combined social work values with quality, community-based, and outcome-based
services to children and families. In the past, workers rendered services based on a
deficits model, which highlighted a client’s problems and did not address their strengths.
Social work has always tried to use a strengths-based model for their clientele. The
family support model empowered clients. The integration of services is essential for
families in need. Historically, families have had to go from center to center to receive
services. Many ended up frustrated and needs went unmet.

Orange County, Florida, was the community highlighted for this study. In 1996, after
research suggested that their services were fragmented, the county adopted the family
support model. The county created a request for funding, and communities could apply
for funding to create a neighborhood family center collaborative. The collaborative
offered activities and meal programs for the elderly, health screenings, after school
programs, drug education, case management, job training programs, meals on wheels,
tutoring, counseling services, and home visitation. Services varied from site to site,
depending on need.

Those who implemented the family support model believed it was successful because it
included services across the life span, a strengths-based perspective, integration of
services, collaboration, neighborhood-based services, local government fiscal support,
measurable goals and objectives, and identification of community strengths. The
communities conducted some outcomes research, but results were not rigorous. Finally,
the report listed recommendations for agencies or communities wanting to adapt the
family support model. These recommendations included having one key funding agency,
having local government fiscal support without interference, engaging the community in
which the model will be implemented, having services reflect the needs of the
community, and expecting some resistance.

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Leung, D., & DeSousa, L. (2002). A vision and mission for peer support—
Stakeholder perspectives. International Journal of Psychosocial Rehabilitation, 7, 5–

The Canadian Mental Health Association project used peer support to decrease social
isolation of people recovering from mental illness. According to the literature, peer
support is used for people with mental illnesses in three ways: mutual support groups,
consumer-run services, and employment of consumers as mental health providers.
Despite the different models of peer support available, very few people participate in any
of them. The authors conducted interviews with 15 stakeholders who provided or had
experience with peer support networks.

Results indicated that no common mission or vision of peer support services existed.
Common themes in missions included fostering self-help and independence, encouraging
role models, creating ownership, and creating positive environments for interaction.
Barriers to participation in peer support services included lack of transportation, lack of
child care, limited time, and limited income. Gaps in the field were leadership, funding,
and the ability to address diversity of needs.

Lewandowski, C. A., & GlenMaye, L. F. (2002). Teams in child welfare settings:
Interprofessional and collaborative processes. Families in Society, 83, 245–256.

This article reported on team-based service delivery in child welfare. The ventures were a
combination of public and private partnerships and in some instances included family
participation. Many in child welfare see the need for greater cross-system collaboration to
better meet the needs of families with multiple problems. Effective collaborative efforts
across services requires the team members to have an awareness of their partners’ duties
and to respect differences and celebrate agreements. One study found that styles of
teamwork, educational background, and role specificity were all associated with level of
commitment. Specifically, social workers tended to collaborate more effectively than
nonsocial workers. In recent years, more state child welfare agencies have contracted
with private providers for some specialized services. Few research studies exist on public
and private collaborations in child welfare. Anecdotally, many workers find it to be a
positive experience.

The authors distributed a survey to child welfare teams in Sedgwick County, Kansas.
Respondents included 165 social workers, law enforcement officials, law employees, and
medical workers. Most were employed at a private child welfare agency, some at a public
agency, and others at a community organization. The authors collected data between
April and October 1999.

According to the survey, families were not fully engaged in the team process, although
most team members expressed a desire and willingness for family participation.
Community organization team members felt less favorable toward cross-service
collaborations. Findings also indicated that private agencies might have a more positive
perception of their own contributions than public agencies’ perceptions of private

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agencies’ contributions. The authors listed recommendations for future practice,
including engaging families in the process more and having more communication
between service providers with clear roles and responsibilities.

Liddle, H. A., Rowe, C. L., Quille, T. J., Dakof, G. A., Mills, D. S., Sakran, E., et al.
(2002). Transporting a research-based adolescent drug treatment into practice.
Journal of Substance Abuse Treatment, 22, 231–243.

This article highlighted the transfer of multidimensional family therapy (MDFT) as a
researched treatment into practice in an agency. Few examples of moving programs such
as MDFT from a clinical setting into the field exist. Clinical models can successfully
move into the practice arena if there is staff buy-in and a demonstrated readiness to
change. MDFT was a good candidate for moving from research to practice because of
promising research results and a built in capacity to adapt. Planners designed MDFT as a
research-based family therapy program for use with adolescent drug abusers.

This study detailed the transfer from the university setting to a day-treatment clinic.
Goals of this study included exploring the effect of disseminating MDFT, integration by
providers, and changes in outcomes for youth in the program. The authors designed the
study to be implemented over four years. The sample included 150 adolescents at the
agency between ages 13 and 17 who met DSM-IV criteria for substance abuse, were at
risk for residential treatment, and had a parent willing to participate. Fifty youth
participated in the baseline study. Workers implemented MDFT in seven steps that
included staff contributions to the process and establishment of new priorities. MDFT
staff found that technology transfer to an agency was not simple. MDFT staff spent
months working with and training the agency staff on the new program. Change was not
immediate, and a long transitional period took place between the “old way” and the “new
way.” This article only detailed the first phases of the technology transfer. MDFT and
agency staff did see an improvement in staff buy-in and patients’ response to the new

Luongo, P. F. (2000). Partnering child welfare, juvenile justice, and behavioral
health with schools. Professional School Counseling, 3, 308–319.

This article argued that collaborations do not use evidence-based knowledge in their
attempts to give adequate services to families in need. Newer and better information
would enhance community-based efforts to ensure child safety and well-being.
Behavioral health services are not considered core services for funding, despite research
that indicates behavioral health services are key for children. Studies show that children
who are expelled from school or who are aggressive and violent have an overwhelming
need for mental health services. Estimates are that 60% to 70% of all parents with
children in out-of-home care are substance abusers. These children are in great need of
behavioral health programs. Furthermore, 40% to 60% of all youth in the juvenile justice
system have a diagnosable mental health disorder. Most juvenile justice centers focus on
accountability, not on treatment of mental health issues.

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Today, more people recognize that school, juvenile justice, and abuse and neglect
overlap. For example, evidence suggests that some children receiving special education
services from school are also involved in either the child welfare or juvenile justice
system. It is sometimes difficult to determine which service a child needs first or if the
needs should be dealt with simultaneously. Another critical factor to be considered is the
home as an equal institution in the matrix and not as a separate piece. Unfortunately,
sharing of information across institutions does not happen often. The initial problem is
that each institution only considers its own goals to achieve success. For example,
schools are primarily designed to teach children and keep them safe. If schools broadened
their mission, they would be able to incorporate components from other institutions, such
as child welfare and juvenile justice, because some children in the school would have
contact with the other systems. Some onsite collaborations are occurring in schools in
which probation officers work at the school with guidance counselors and drug treatment
counselors. Together, they are able to address youths’ education needs, substance abuse
treatments, and well-being.

Malekoff, A. (2000). Bureaucratic barriers to service delivery, administrative
advocacy, and Mother Goose. Family in Society, 81, 304–314.

The author of this article described a five-year administrative advocacy effort to address
the negative consequences of categorical (funding by diagnosis) government funding on
the development of integrated, comprehensive mental health and substance abuse
services for youth and their families. The authors recounted the advocacy process through
fictional stories to demonstrate the adverse consequences of categorical funding. In one
example, youth needing outpatient alcoholism, substance abuse, and mental health
services were limited in their ability to receive comprehensive services when workers
gave them labels or diagnoses. These labels prevented many clients with similar needs
from participating in services together. It was also discovered that some categories
allowed for Medicaid reimbursement, whereas others did not. This system denied access
for some children and created additional work for staff, who often had to complete
paperwork in triplicate to satisfy the various categorical requirements. The author stated
that funding by diagnosis limits the services that clients can receive and creates additional
stressors on staff.

Marsenich, L. (2002). Evidence-based practice in mental health services for foster
youth. Sacramento, CA: California Institute for Mental Health.

This report highlighted relevant literature on mental health services for youth in the
context of the California foster care system. The goals of the report were to highlight
evidence on mental health services for potential model development, to encourage
integration of research in program development, to dispel myths about foster children’s
mental health needs, and to recommend improvements in mental health service delivery
to foster children.

Today, children in California’s foster care system are more likely to be younger, of an
ethnic minority group, and have experienced abuse or neglect compared with the foster

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population in the past. The growing number of children in foster care may be related to
parental drug and alcohol addictions, poverty, homelessness, AIDS, and domestic
violence. Research has suggested that 35% to 85% of children entering care have
significant mental health problems. Children in the foster care system have higher rates of
mental health service use. The typical foster child who uses mental health services is
older, is male, is in traditional foster care, and was removed from his or her own home
due to physical or sexual abuse. Children with behavioral and emotional problems are
less likely to be reunified or adopted. The children least likely to ever exit out-of-home
care are those with externalizing disorders and very young children with developmental

Effective models for children in need of mental health services are wraparound strategies
and therapeutic foster care. The researcher identified service delivery as a barrier to
treatment when staff across services did not collaborate effectively. Foster parents want
to be seen as part of the service delivery team. Youth receiving care asked for more
knowledge about their treatment and wanted their opinion solicited. Overall, child
welfare and mental health services need to find common goals for working with children
in need of mental health services. Recommendations from the report included evidence-
based treatments, specialized training, and involvement of foster parents and youth in
service development.

McAlpine, C., Marshall, C. C., & Doran, N. H. (2001). Combining child welfare and
substance abuse services: A blended model of intervention. Child Welfare, 80, 129–

This article highlighted an intervention program based on a partnership between child
welfare services (CWS) and adult addiction services (AAS) in Montgomery County,
Maryland. Researchers developed this blended model to combine the institutions’
mandates to better serve children and families. A goal of the partnership was to address
the requirements of the Adoption and Safe Families Act (ASFA). ASFA requires that
agencies must file paperwork to terminate parental rights if a child has been in out-of-
home care for 15 of the last 22 months. Concerns about this mandate have risen because
substance-abusing parents may need several months of treatment and do not want to lose
their children because they sought help. Child welfare and substance abuse treatment
programs are trying to work together to address parents’ treatment needs and provide a
safe, stable environment for children.

The federal mandates on substance abuse do little to encourage parents to seek treatment;
most mandates are designed to remove children from the home. Also, many CWS
workers do not have adequate training in substance abuse. On the other hand, AOD staff
work on a completely different set of issues in the family than child welfare workers.

There are some legal and policy issues that impede collaboration between CWS and
AOD workers, including crisis environment of child protective services (CPS), shortages
of workers, confidentiality agreements, and timing. Researchers have highlighted four
timeframes that affect CPS work and can make collaboration with AOD more difficult:

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child welfare mandates on permanence, pace of addiction recovery, children’s
developmental timelines, and time limits for welfare. In 1997, CWS and AAS in
Montgomery County, Maryland, started a taskforce for better interagency collaboration.

The taskforce found that substance abuse is a complex problem that needs an organized
response, some families had chronic substance abuse issues that had not been adequately
addressed earlier, and a coordinated effort by CWS and AAS would be a benefit to
consumers and staff. A substance abuse liaison was placed within the CWS department
and was made available for consultation on any and all casework. Preliminary analysis
showed a positive relationship between CWS workers and the AOD liaison. CWS
workers showed a greater willingness to learn about AOD and volunteered for trainings.

McElrath, Y. T., McBride, D., Vander Waal, C. J., & Ruel, E. (2002). Integrating
criminal justice, treatment and community agencies to break cycle. Corrections
Today, 64(5), 78–83.

This article provided a brief overview of the extent and nature of the relationship between
drugs and crime and reviewed research on effective treatment interventions that break the
cyclical nature of the relationship. It also presented data from a national survey of
community prosecutors, which investigates treatment programs and services available for
processing juveniles arrested on drug charges. This work was supported by a grant from
the Robert Wood Johnson Foundation as part of the foundation’s ImpacTeen initiative. In
2000, ImpacTeen interviewed prosecutors in 173 communities to determine the
availability of programs for processing juvenile drug offenders that included treatment
options. The survey also investigated sentencing severity for juvenile marijuana
possession offenses.

Results showed that both inpatient and outpatient treatment services were available in
nearly all the communities (99% and 93%, respectively.) Aftercare programs were
available in 88% of the communities. The availability of methadone maintenance
programs was low (11% of communities). Researchers stated that although communities
have treatment options available, the quality of services is unknown. For nearly four
decades, federal government agencies have conducted extensive research to document the
extent and nature of the relationship between drug use and criminal behavior. This
research has provided a basis for policy and programmatic interventions that break the
drugs-crime cycle. Many of these research efforts have included an acknowledgement of
the theoretical perspective in understanding the cycle between crime and drugs.

McNichol, T., & Tash, C. (2001). Parental substance abuse and the development of
children in family foster care. Child Welfare, 80, 239–256.

The authors examined cognitive skills and behaviors of 268 school-age children in family
foster care. Children born to drug-addicted parents usually show no visible signs of the
abuse. As these children grow, however, subtle signs of the drug abuse become apparent
in cognitive, academic, speech, and language delays. Many of these issues require special
services and interventions. Children of substance-abusing parents are often removed from

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the home. Their outcomes after removal sometimes do not improve. Children who end up
in long-term foster care face higher incidences of unemployment and insufficient
education. Adoptive parents of children born to substance abusers reported difficulties in
cognitive, behavioral, and learning skills.

This study sampled children from agencies in southern California representing many
ethnic groups. The study divided children into three groups: Group 1: those exposed to
drugs before birth; Group 2: those in substance-abusing families; and Group 3: those who
had no indications of parental substance abuse and were in out-of-home care for other
reasons. The researchers did not include alcohol abuse in this study. Children exposed to
drugs prenatally scored significantly lower on IQ tests compared with the other two
groups, however, children with prenatal drug exposure improved the most by the second
assessment. Teachers identified children with prenatal exposure as having more
internalizing problems, social problems, and overall problems. These same children were
also placed in foster care at a significantly younger age than the other two groups. Boys
were more likely to be placed in another out-of-home setting than girls. Further analysis,
however, indicated that boys and girls did not significantly vary in their cognitive and
behavioral scores. Caseworkers must select appropriate foster homes for these children
and ensure that they receive needed mental health services.

Metsch, L. R., Wolfe, H. P., Fewell, R., McCoy, C. B., Elwood, W. N., Wohler-
Torres, B., et al. (2001). Treating substance-using women and their children in
public housing: Preliminary evaluation findings. Child Welfare, 80, 199–220.

This article highlighted a program in Key West, Florida, for substance-abusing women
and their children. The study assessed all family members and offered appropriate
treatment. Preliminary results of 1996 through 1998 data showed that women who had
their children with them while in treatment tended to remain drug-free compared with
women that did not have their children with them.

Research has shown that long-term residential treatment for drug or alcohol use has
positive effects on reducing reliance on social and health welfare programs and improves
functioning in lifeskills and vocational areas. The most positive results come from
residential treatments targeted to specific needs of individual clients.

The Key West Housing Authority created the SafePort program in 1992. The program
used a public housing complex as the site, which allowed families to stay together while
the mother received treatment. The program has three phases: Phase I lasts for three
months and works with the family to understand the addiction process and learn to adjust
to a drug-free lifestyle. Phase II lasts for three months. Residents continue counseling and
receive skills training in a variety of life and vocational areas. Phase III lasts for six
months and focuses on assisting residents with their new skills and helps them to learn to
be self-sufficient. During Phase III, residents must hold a full-time job. While the mother
is in treatment, the children receive developmental services onsite. Not every woman who
participated in the program was able to bring her children with her. This created a natural
comparison group for the study.

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The study included 40 women, 14 of whom never had their children with them at
SafePort. The researchers interviewed them at intake and at a six-month follow-up. Most
of the women in the study were white (65%), 27.5% were African American, and 7.5%
were Hispanic. Of the 22 women who entered the program with their children, 18%
reported drug use at the six-month follow-up, compared with 79% of the 14 women who
never had their children with them. The four women whose children joined them during
treatment were using drugs again at follow-up. Slight differences, mostly medical and
anxiety based, existed among the three groups of women. Overall, the small samples
limited the effect of the findings.

The authors listed three suggestions for future directions based on their research: (1)
researchers need to examine the treatment components to determine which are best
related to positive outcomes, (2) research must determine when it is best to reunite
children with parents in treatment programs, and (3) research must determine the effect of
family-centered treatments on children.

Millar, G. M., & Stermac, L. (2000). Substance abuse and childhood maltreatment:
Conceptualizing the recovery process. Journal of Substance Abuse Treatment, 19,

This article explored the dual, related issues of adulthood substance abuse and childhood
maltreatment. The prevalence of women in treatment for addiction who experienced
childhood abuse is staggering. It is estimated that 15% to 57% of the clinical sample
report maltreatment, versus 4% to 27% of the general population. Clinical literature has
failed to explore the ways that individuals, particularly women, cope with and recover
from these experiences.

This study attempts to address this gap in knowledge by documenting and describing a
selection of the recovery tools women employ in healing from their addiction and abuse
experiences. Respondents had completed a minimum of three years of chemical-free
living and self-identified as survivors of prolonged childhood sexual abuse. The women
participated in semistructured interviews to detail their recovery process.

Results showed support for a multifactorial process of recovery, specifically, strategies
aimed at affect regulation, development of new self-concept, and forging of more
adaptive attachment styles. The study emphasized women’s struggle to confront and
relinquish their presentation of false fronts. This study represented the beginning steps of
further understanding of the process of recovery from adulthood addiction and childhood

Moore, K. A., Chalk, R., Scarpa, J., & Vandivere, S. (2002, August). Family
strengths: Often overlooked, but real. Child Trends Research Brief.

This research brief sought to address the gap between the multiple problems that affect
families and family resilience. The authors defined the concept of family strengths,
discussed what research says about what makes for strong families, and examined several

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measures of family strengths in two national surveys. The review of the data suggests that
levels of important family strengths are quite high in contemporary families. The levels
of closeness, concern, caring, and interaction are higher than some may believe. On a
national youth survey, four out of five young adolescents reported that they enjoy
spending time with their parents. More than half reported that they turn first to a parent
for help in solving a problem. Almost three-quarters reported that they eat dinner with
their families five or more days each week. These data suggested a link between family
strengths and child well-being.

The research also suggested that many families are prospering and strong and that
families facing challenges are doing an excellent job of raising children and supporting
each other. By focusing solely on problem behaviors, research studies tend to overlook
the successful coping strategies that families use to manage the multiple stresses of daily

Muck, R., Zempolich, K. A., Titus, J. C., Fishman, M., Godley, M. D., & Schwebel,
R. (2001). An overview of the effectiveness of adolescent substance abuse treatment
models. Youth & Society, 33, 143–168.

This article examined current approaches to adolescent substance abuse treatment and
summarized research on the effectiveness of these models. In the past, adolescent
treatments were based on adult treatment models and did not consider the unique needs of
youth. At the time of this article, most youth received treatment in outpatient settings.
More current approaches follow four main modalities: 12-step, behavioral or cognitive,
family-based, and therapeutic communities. The 12-step approach, modeled on
Alcoholics Anonymous, is the most widely used. This approach views chemical
dependency as a disease that must be managed throughout one’s lifetime. Components
include action steps, group therapy, individual counseling, lectures, family counseling,
written assignments, recreational activities, participation in aftercare, and attendance of
AA meetings. Studies have shown that completers have a significantly higher rate of
abstinence than noncompleters.

Results after one year were mixed. The behavioral treatment approach focuses on the
underlying cognitive processes, beliefs, and environmental cues that could be associated
with a youth’s use of drugs and alcohol. The treatment teaches youth coping skills to
remain drug free. Substance abuse is viewed as a learned behavior. Incremental goals are
established for the youth to work through. Some research has shown that the behavioral
treatment approach showed a 73% decrease in drug use for participants, compared with
9% in a comparison treatment. Attendance at school and work also increased
significantly for youth in the treatment group. The family-based treatment approach
focuses on adolescent functioning as it is related to parents, siblings, and extended
family. It also examines patterns of communication and interaction. Therapists encourage
open dialogue among family members and try to reframe the youth’s behaviors to help
the family gain new insight. Compared with other treatments, family-based therapy has
decreased a youth’s problem behaviors at six-month and one-year follow-ups.
Multidimensional family therapy is a strong family-based model. Multisystemic therapy

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received mixed results. The therapeutic community model is a long-term residential
service for youth with severe substance abuse and related problems. Length of stay is
usually 15 months. The purpose of this treatment is to tend to the youth psychologically
and physically. Studies indicate positive outcomes for youth in this type of program, and
results are more likely to hold at follow-up.

Overall, researchers have performed few studies on the effectiveness of drug treatment
strategies for youth. In the past few years, the Center for Substance Abuse Treatment has
begun to build an evidence base on what works for adolescents.

National Center on Addiction and Substance Abuse at Columbia University. (1999).
No safe haven: Children of substance-abusing parents. New York: Columbia
University Press.

This report was a comprehensive analysis of the connection between substance abuse and
child maltreatment. It exposed how child welfare agencies and family courts struggle to
handle the critical decision of child custody when a parent is a drug or alcohol abuser.
The National Center on Addiction and Substance Abuse conducted a two-year analysis
targeting professionals who work in child welfare and family courts. The researchers
asked about perceptions of the extent of substance abuse problems, how professionals
decide who will care for children in cases involving substance abuse, and changes the
respondents believe would benefit children.

Key responses included: 71.6% cited substance abuse as one of the top three causes for
the dramatic rise in child maltreatment, 79.6% reported that substance abuse contributed
to at least half of all cases of child maltreatment, and 75.7% said that children of
substance-abusing parents were more likely to enter foster care. CASA reviewed
technical articles, books, and reports covering medical, social science, legal, and
substance abuse literature relevant to child maltreatment; conducted case studies; and
interviewed caseworkers, judges, and other professionals. Based on the information,
CASA made the following recommendations: Preventing substance abuse should be the
top priority, child welfare officials must change the way the system does business,
treatment options must be available for parents, child welfare professionals must have
substance abuse training, and child welfare and family court officials need to collect
better data and evaluate the outcomes of their efforts.

Nicholson, J., Biebel, K., Hinden, B., Henry, A., & Stier, L. (2001). Critical issues for
parents with mental illness and their families. Rockville, MD: Center for Mental
Health Services, Substance Abuse and Mental Health Services Administration.

The authors of this report compiled available information on parental mental illness, the
effect of the illness on the family, misinformation, services, and innovative programs. A
lack of data exists on adults with mental illnesses who bear and care for children. Most
research is on small samples of mothers in the public sector with severe mental illnesses
and other stressors such as poverty. Parents with mental illnesses have the same needs as
other parents but also experience illness-related needs, the stigma associated with mental

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illness, a lack of strengths-based assessments, ineligibility for program participation, and
a lack of integration across systems. Research does indicate that children of mentally ill
parents are more likely to experience psychological problems. Few studies have focused
on the resilience of some children of parents with a mental illness. Many policies and
practices have ramifications for parents with mental illnesses including ASFA timelines,
employment timelines, managed care organization benefits that overlook mental
illnesses, and increased unresponsiveness of state mental health agencies.

Selected recommendations included identifying factors that contribute to parents’ success
and reduce the risk to their children, conducting research on child abuse and neglect
among families with mental illnesses, reviewing and modifying existing practices and
policies as needed, replicating effective programs, and educating communities about
mental illness.

Physician Leadership on National Drug Policy. (2002). Adolescent substance abuse:
A public health priority—An evidence-based, comprehensive, and integrative
approach. Providence, RI: Author.

This book featured the newest data on prevention, prevalence, treatment, and the juvenile
justice system, based on a 2001 convention of physicians to discuss adolescent substance
abuse. Research has shown that rates of adolescent substance abuse, although leveling
off, are still very high. Studies have indicated that the younger an adolescent is at onset of
drug activity, the more likely it is that the child will continue to heavily abuse drugs in
adulthood. The greatest risk factors for becoming a substance abuser include availability
of drugs in community, family history of substance abuse, learning disabilities, and
associating with people who have problem behaviors. Many youth seek treatment for
their problems, but an even greater number do not. Young substance abusers are at a
greater risk than adult users because youth tend to ingest more and binge frequently.
Treatment for youth is more difficult due to their developmental stage and immaturity.
Children with both public or private medical insurance can face barriers to treatment.
Children who receive Medicaid are often limited to acute care treatment, and adolescents
with private insurance often find a lack of comprehensive services coverage.

Pietrowiak, D., & White, K. D. (2003). Child welfare and juvenile justice: Federal
agencies could play a stronger role in helping states reduce the number of children
placed solely to obtain mental health services (Report No. GAO-03-397). Washington,
DC: U.S. General Accounting Office.

Reports have stated that many children are placed in the child welfare or juvenile justice
systems for mental health treatment. These are children with severe mental illnesses
whose parents have difficulty finding community resources to help them. Many federal
laws require that state and local agencies provide mental health services to children in
least restrictive settings. In other words, children have the right to receive services in their
communities, not in residential settings, unless that is the only way their needs can be
met. Although the law does not call for the relinquishment of parental rights if the child is
placed with child welfare agencies due to mental illness, time frames in which a child

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must be placed in a permanent setting exist, and in some cases, this has led to termination
of parental rights.

The authors for this report surveyed state child welfare directors in all states and the
District of Columbia. They also surveyed juvenile justice officials in 33 counties and 17
states with the largest populations of children younger than 18. Six states (Arkansas,
California, Kansas, Maryland, Minnesota, and New Jersey) were subject to more intense
research due to their diversity in population, laws, and administration. The authors
studied each state’s laws and regulations for voluntary placement and relinquishment of
parental rights; they interviewed officials, caseworkers, and parents in child-serving
agencies as well as judges in five states.

Findings indicated that children came from diverse backgrounds. The seriousness of the
child’s mental illness placed great strains on the family’s ability to function. Many
parents placed their child in the child welfare or juvenile justice system because their
health insurance had limited mental health services. Most communities lacked residential
placement facilities, and officials felt that federal mandates on placing children in least
restrictive settings limited the number of residential placements. Many of the state
officials in the six states believed that community settings were a better option for
families with a mentally ill child. Problems occurred due to differing eligibility
requirements among agencies, Medicaid payment eligibility, and misunderstandings
among service providers as to what their role should be in relation to other agencies.
Newer, community-based programs for families with a mentally ill child exist; however,
researchers have done few studies on program success.

The authors recommended that a tracking system be created to determine the number of
children in out-of-home care for mental issues and that the Secretaries of the U.S.
Department of Health and Human Services (DHHS) and Department of Education, and
the attorney general, encourage states to evaluate their child mental health programs,
make changes to appropriately address children’s needs, and establish a working group.

Prescott, L. (1997). Adolescent girls with co-occurring disorders in the juvenile justice
system. Delmar, NY: GAINS Center.

This article focused on the increasing number of adolescent girls with co-occurring
disorders in the justice system. It included discussion of prevalence rates, trends, risk
factors, characteristics, future challenges, and creative redirections for adolescent girls
with co-occurring disorders. Nearly one-quarter of all juvenile arrests between 1989 and
1993 were of females, a 55% increase from four years prior. Studies have shown that
more than half of adolescents in juvenile justice who receive mental health services have
a dual disorder. The risks for females involved in the juvenile justice system include
abuse and victimization, substance abuse, difficulty in school, and gang-related activities.
In addition, 20% of females in the juvenile justice system have been sexually or
physically abused. Abuse makes the youth 50% more likely to suffer from depression.
The authors suggested that changes in service systems could benefit these girls. They
suggest that creating future partnerships that would lead to lowering recidivism,

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improving rehabilitation programs, and positively affecting justice management

Prescott, L. (1998). Improving policy and practice for adolescent girls with co-
occurring disorders in the juvenile justice system. Delmar, NY: GAINS Center.

This report focused on the mental health and substance abuse recovery needs of
adolescent girls in the juvenile justice system. The GAINS Center convened a meeting in
December 1997 to facilitate a multidisciplinary dialogue with national, state, and local
experts. The goal of this meeting was to stimulate a broader understanding of the needs of
adolescent females with co-occurring disorders and provide recommendations for both
policy and practice. Some of the recommendations that emerged out of this meeting were
the creation of gender-specific programs and practices, design of strengths-based
assessments that ascertain the stress levels of the youth, development of interventions
with family and community supports, increased availability of single-sex residential
placements, development of written training materials, and expansion of research to
include longitudinal data.

Prescott, L. (2001). Consumer/survivor/recovering women: A guide for partnerships in
collaboration. Delmar, NY: Policy Research Associates.

In 1998, SAMHSA awarded grants to 14 study sites for the Women, Co-Occurring
Disorders and Violence Study. The goal of the five-year study was to evaluate the effect
of integrated service systems on women with co-occurring disorders with a history of
physical or sexual abuse and their children. The goals of this guide were to articulate a
framework of integrating consumer/survivor/recovering (CSR) women into project
activities, enhance and promote dialogue about CSR integration efforts, contribute to the
current knowledge base, promote awareness, and provide recommendations. Integrating
CSR women into project activities provided these women with role models, promoted
specific skills and recovery, increased self-esteem and a sense of hope, cultivated self-
efficacy, and decreased isolation and stigma. Barriers to integration included access,
disclosure and stigma, finances and time, relevance and information, training, language,
competence, and boundaries.

Strategies and recommendations for integrating CSR women included creating accessible
organizational environments for integration, using proactive planning for organizational
changes, defining and using the values of empowerment, adapting policies to prevent
barriers to services, providing comprehensive training, approaching CSR women as
resource exports, creating clear communications, tailoring the meeting environment,
sponsoring fun activities, hiring and compensating CSR women, creating opportunities
for the women, increase the number of role models, and creating innovative and socially
valued roles.

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Press, E., & Washburn, J. (2002). The at-risk-youth industry. Atlantic Monthly,
290(5), 38–40.

This article explored the implications of the privatization of prisons and treatment centers
for juveniles. Private companies that run prisons and treatment centers for juveniles have
failed to rehabilitate children. In August 2000, the National Center for Children in
Poverty at Columbia University released a study showing that despite the country’s
economic boom, 13 million American children were living in poverty—3 million more
than in 1979. As the number of children living in poverty increased, so did the number of
juveniles involved in dependency and delinquent courts. In the mid-1990s, the number of
large multistate for-profit companies providing care for at-risk youth increased. These
companies were unable to obtain capital from investors or policymakers, however,
because of their tax-exempt status, which put them at a disadvantage. Nonprofit
organizations have resources available to them that for-profits do not have. Resources
such as volunteers, charitable donations, and freedom from investor demands are
invaluable to this sector. Because of these factors and the difficulty of making a profit,
private, for-profit treatment centers for at-risk youth have been nearly eliminated.

Ro, M., & Shum, L. (2001). Forgotten policy: An examination of mental health in the
U.S. Battle Creek, MI: W.K. Kellogg Foundation.

Approximately 20% of the U.S. population suffers from a mental health or substance
abuse problem in any given year. Less than one-third receive treatment. Barriers to
treatment include a lack of health insurance, high cost of prescriptions, and stigma about
mental health problems. Certain population groups in the United States more likely to
have less access to needed mental health services—the working poor, low-income
populations, racial and ethnic minorities, and rural communities.

The authors presented 15 strategies for improving current mental health services,
including reducing stigma, eliminating financial barriers, addressing prescription costs,
integrating services, supporting mental health workers, targeting the needs of vulnerable
populations, enhancing school-based services, supporting school violence prevention
programs, addressing needs of children in the foster care system, expanding insurance
coverage, addressing housing needs, addressing employment needs, addressing
criminalization problems, promoting mental health among the elderly, and fixing
deficiencies in nursing homes.

Rubinstein, G. (2003). Safe & sound: Models for collaboration between child welfare
& addiction treatment systems. Washington, DC: Legal Action Center.

This report provided background information on parental addiction and the child welfare
system, discussed ASFA timelines, presented case studies that address the issues, and
presented a model for addressing addiction in child welfare families. Children born to
parents with addiction problems are at a greater risk for developmental delays and later
alcohol and drug problems than children born to families without addictions. ASFA
timelines can conflict with the recovery process for parents who have sought help.

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Recovery often takes years, but ASFA was designed to terminate parental rights more
quickly for children in out-of-home care.

The article profiled two local collaborations among the addiction treatment, child
welfare, and family court systems, a county-administered system in Cuyahoga County,
Ohio, and a state-administered system in Cook County, Illinois. Both collaborations
featured local planning and monitoring, identification of funding for needed services,
information sharing and continuing communication, development of criteria for
assessments, cross-training, and evaluation.

Schwartz, I. M., Weiner, N. A., & Enosh, G. (1999). Myopic justice? The juvenile
court and child welfare systems. Annals of the American Academy of Political and
Social Science, 564, 126–141.

This article examined the histories of the child welfare and juvenile justice systems and
argued that both had failed in their core missions to protect, rehabilitate, and care for
children. The authors believed that institutional survival became more important than
serving the needs of children. Unaddressed tension exists between those who feel that the
juvenile court should be a treatment, supervisory, and rehabilitation facility and those
who believe it is for punishment. What the court fails to see is the larger family dynamics
behind children who are status offenders. Juvenile courts have also reacted to real or
imaginary rising levels of juvenile violence. Therefore, they are at times extremely
punitive and at other times more likely to push rehabilitation. The juvenile court is rarely
connected to child welfare in the media. Most child removals from their homes must be
approved by the juvenile court. Many state child welfare agencies have been successfully
sued in recent years for mismanagement and, at times, for not protecting children in their
care. These child welfare agencies are directly tied to the juvenile courts that oversee the
placement of children in out-of-home care.

It is difficult to ask the juvenile court to oversee the actions of child welfare agencies,
given budget constraints and caseloads for both institutions. In some states, the court has
fewer powers and can only rubberstamp agency decisions. Overall, the court system and
child welfare agencies have a symbiotic relationship, which can be an issue. Monitoring
of one or both systems is difficult because of their loosely defined relationship. The
juvenile court is well placed, however, to aid children of dependency cases to not become
future status offenders and delinquents. The child welfare system should limit itself to its
most important tasks: stability, permanence, reunification, and adoption. Overall, both the
court and child welfare must reexamine the necessity of status offender distinction. Often,
the status offender is a child trying to remove himself or herself from a situation that is
dangerous or neglectful. The authors called for more research on the relationship between
child welfare and juvenile justice and analysis of examples from other countries that have
successfully blended the two systems.

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Semidei, J., Radel, L. F., & Nolan, C. (2001). Substance abuse and child welfare:
Clear linkages and promising responses. Child Welfare, 80, 109–128.

The authors of this article examined the effect of substance abuse on child welfare.
Specifically, the authors examined the prevalence of substance abuse in child welfare
families, the effect of substance abuse on child welfare practice, how certain policies
affect parental substance abuse, and promising strategies for addressing families’ needs.
Few states collect data on how many children come into care for abuse or neglect who
have substance-abusing parents. Children who come into care from substance-abusing
families enter care at younger ages, remain in care longer, and suffer from severe neglect.
Although some of these children go home or to a relative, many end up being adopted.

Substance abuse in the home makes predicting harm to a child more difficult to calculate.
Parents in early recovery have a greater chance of relapse than parents who have been in
recovery for a longer time. Many child welfare workers are not equipped to provide
services to substance abusers, or they workers have great difficulty locating needed
services. Certain federal policies have established mandatory limits on the length of time
a child can spend in out-of-home care. These timelines sometimes make substance abuse
recovery difficult. Two programs featured in this article showed promise for substance-
abusing families in the child welfare system.

Shelton, D. (2002). Failure of mental health policy–incarcerated children and
adolescents. Pediatric Nursing, 28, 278–281.

This article presented an overview of the difficulties and disparities in accessing mental
health services for juveniles. Workers struggle to balance community safety and access to
mental health services for youth in the juvenile justice system. Many juvenile justice
facilities have become mental hospitals for severely troubled youth. Research has shown
that approximately 50% of youth in contact with the juvenile justice system suffer from at
least one mental health problem, often coupled with a learning disability or substance
abuse disorder. Viewed historically, mental health treatment can be cost prohibitive
compared with juvenile justice. Therefore, systems have shifted from mental health
services to punitive actions.

Children with signs of mental health problems experience fragmented services. Often, the
initial problems are not dealt with, and the child comes to the attention of the courts. If
the child needs services from a variety of agencies, the system is not set up so that the
lead agency can easily follow the child through each service. The philosophies of the
mental health system and the juvenile justice system are markedly different. The mental
health system is interested in discovering the root of the problem and creating behavior
modifications, whereas the juvenile justice system is more interested in punishment and
damage repair. As of 2002, legislators introduced several bills into Congress to address
disparities between the juvenile justice system and the mental health system, as well as
better linkages with schools.

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Shenk, B. T., & Zehr, H. (2001). Restorative justice and substance abuse: A path
ahead. Youth & Society, 33, 314–328.

New dialogues are being established between restorative justice and substance abuse
treatment for youth. The authors explored paths of potential discussion and possible
pitfalls along the way. The first step is a mutual understanding of restorative justice and
its similarities and differences from retribution.

Restorative justice strives to restore wholeness to an entire community, not just the
victims of the crime. This allows for the idea that the offender has also been harmed in
some way in an earlier stage of his or her life and needs restoration as well. Guilt and
shame often spur the youth to seek out others like them for self-identity. By addressing
his or her past problems in a restorative justice format, the youth is forced to confront his
or her substance use and what the root causes of the behavior may be. To see real
progress in a restorative justice format, shame and humiliation must be removed for both
the juvenile and the victim. The path toward restoration for both the victim and the
juvenile will not be a straight path. Those involved in the process must be understanding
and patient as they work together.

Shulman, L. H., Shapira, S. R., & Hirshfield, S. (2000). Outreach developmental
services to children of patients in treatment for substance abuse. American Journal
of Public Health, 90, 1930–1933.

This article featured a model of developmental service delivery for children of substance-
abusing parents. Children of substance-abusing parents are often least likely to receive
needed services, generally due to the parents’ continued substance use or the parents’
being overwhelmed by their own recovery efforts. The children in this study were
children of parents in an outpatient methadone clinic. The authors assembled a
multidisciplinary team of professionals to evaluate the patients’ children. After
evaluation, the team made recommendations for educational and medical interventions.
In the first three years of intervention, the team examined 100 children. Children ranged
in age from 8 months to 12.10 years and were of various ethnicities.

Evaluations showed that 50% of children were in the borderline range of intellectual
functioning, 19% showed mental retardation, 68% had a variety of speech or language
impairments, 16% had emotional or behavioral disorders, and 83% had nutritional or
medical disorders. Follow-up data indicated that 59 of the children were receiving
services, 18 were not eligible, 6 were not receiving services, and 17 children had
unknown status. All the children in the program had special needs.

Simms, M. D., Freundlich, M., Battistelli, E. S., & Kaufman, N. D. (1999). Delivering
health and mental health care services to children in family foster care after welfare
and health care reform. Child Welfare, 78, 166–183.

The authors of this article explored the potential results from changes in the delivery of
health care and welfare services to families in need. The authors predicted that more

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children would enter the child welfare system with significant physical, mental, and
developmental problems. Within the last decade, the government has reduced welfare,
food stamps, and disability benefits for families with children. Rising costs of health care,
coupled with the failure of Medicaid payments to keep pace, have resulted in fewer
doctors being willing to accept Medicaid families.

States are placing more poor families in managed care organizations (MCOs). MCOs
focus heavily on preventative care and accept patients for a fixed sum of money per
enrollee. MCOs also make it more difficult to receive specialized treatments. Some in the
field, however, believe MCOs are better equipped to spot potential disorders in young
children. Children in out-of-home care are often of poorer health than similar
counterparts that live at home. Child welfare workers cannot always obtain medical
backgrounds for children in care of the agency. Therefore, foster parents are left with the
task of figuring out if the child needs any physical or mental health attention. With newer
changes in mandates that require children to be freed for adoption more quickly, the
number of children with special needs will continue to rise.

Recommendations included portability of medical coverage for children, continuous
eligibility, coordination among case managers, governance systems that clearly outline
standards and procedures, and a flexible system for rural and urban areas with statewide
data systems.

Stevens, S. J., & Morral, A. R. (Eds.). (2003). Adolescent substance abuse treatment
in the United States. Binghamton, NY: Hawthorne Press.

A growing number of youth have substance abuse problems. These young people are not
likely to seek help on their own; rather, their parents or the criminal justice system place
them in treatment programs. Most programs for youth with substance abuse problems are
actually adult programs patterned on adult abuse and needed treatment length. There are
few models with demonstrated effectiveness for youth. The Center for Substance Abuse
Treatment (CSAT) responded in three ways: collaboration with others to fund researched
studies, funding of a multisite demonstration, and setting up of a model program to help
with evaluation of other programs.

The programs detailed in this book were part of the Adolescent Treatment Model (ATM)
program that funded evaluation of programs, the third prong of CSAT’s new initiative.
The age of first use continues to decline, and evidence shows that many youth are not
“outgrowing” substance use as previously believed. Many youth with substance abuse
problems also exhibit other mental health problems, such as conduct disorder, attention
deficit/hyperactivity disorder, oppositional defiant disorder, and reactive attachment
disorder. Studies have found that more than 75% of youth entering treatment for
substance abuse have one or more of these psychological conditions. Researchers have
compiled several studies on adolescent drug and alcohol use. Most programs were for
adults, with only slight modifications.

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In the 1970s, programs began to change for youth, incorporating more assessments,
creating more flexibility, using younger and better educated staff, and placing less
emphasis on confrontation. Goals of CSAT ATM programs were to identify programs,
create manuals about the programs, evaluate services, determine program effectiveness
and cost, collaborate on cross-site comparisons, and disseminate the results. This book
featured different types of programs, including outpatient treatment, outpatient family
therapy, short-term and intensive inpatient programs, moderate-term residential
programs, moderate step-down programs, and modified therapeutic community

Substance Abuse and Mental Health Services Administration. (2003). Strategies for
developing treatment programs for people with co-occurring substance abuse and
mental disorders (Publication No. 3782). Rockville, MD: Author.

People with co-occurring mental health and substance abuse problems need a wide range
of services from substance abuse and mental health systems, primary health care,
criminal justice, and social services. Therefore, it is difficult for one system of care to
adequately meet the needs of these people. This publication identified strategies for the
development of effective treatment programs for people with co-occurring disorders. The
project also identified barriers to service, proven strategies that providers use, strategies
to integrate systems, and specific trainings and competencies. Promising approaches
included using replicable strategies, employing strong leadership, and involving key
stakeholders. This project found that client variables, such as ethnicity and geographic
location, did not appear to have a significant effect on treatment success. The program
also found that provider variables did not by themselves predict success or failure.
Finally, the researchers made several recommendations, including incorporating the
power of networking, developing pathways to easier information sharing, increasing
funding, strengthening systems of care, fostering workforce development, creating road
maps for others to follow, and establishing new approaches to funding.

Substance Abuse and Mental Health Services Administration, U.S. Department of
Health and Human Services. (2002). Report to Congress on the prevention and
treatment of co-occurring substance abuse disorders and mental disorders. Executive
summary. Available from

In 2002, the Substance Abuse and Mental Health Services Administration (SAMHSA)
provided Congress with a comprehensive report on the treatment and prevention of co-
occurring substance abuse and mental health disorders. According to the report, 7 to 10
million individuals in the United States have at least one mental health disorder as well as
an alcohol or drug use issue.

The report stressed that people with co-occurring disorders can and do recover when
provided with appropriate treatment and support services. The report also found that there
are many systemic barriers to appropriate treatment and support services for people with
co-occurring disorders, such as eligibility criteria for treatment, funding sources, and

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limited resources for mental health and substance abuse treatment. The report identified
the need for various federal, state, and local agencies; researchers; people in recovery;
and families to work together to create a system in which both disorders are addressed as
the primary diagnosis.

SAMHSA has constructed a five-year action plan that includes the follow steps: They
will create a new SAMHSA-funded state incentive grant for co-occurring disorders, to
help enhance state infrastructure and treatment centers, and establish a national co-
occurring disorders prevention and treatment technical assistance and cross-training
center. They will then increase federal agency collaboration within the U.S. Department
of Health and Human Services to enhance research attention to co-occurring disorders,
create collaborations to explore reimbursement, convene a national summit on co-
occurring disorders, and disseminate successful strategies for appropriate use of the
Substance Abuse Prevention and Treatment and Community Mental Health Services
Block Grants.

Sullivan, E., Mino, M., Nelson, K., & Pope, J. (2002). Families as a resource in
recovery from drug abuse: An evaluation of La Bodega de la Familia. New York:
Vera Institute of Justice.

The program featured in this article was implemented in 1996 in New York City and
offered help to families of substance abusers by providing family case management and
other services to supplement probation, parole, or pretrial supervision. The goal of the
program was to increase the success of substance abuse treatment programs, reduce the
use of incarceration, and reduce the harms that drug addition can have on a family.
Designers added a research component to the program to evaluate changes from pre- to
posttest and at six-month follow-up. Researchers collected data on physical and mental
health, family functioning, and social support. They also used a comparison group. The
authors recruited participants between January 1999 and July 2000. Through participation
in the program, families were able to access significantly more medical and social
services than the comparison group. They also felt significantly more emotional and
material support. Substance users participating in the program saw a decline in drug use
from 80% to 42%. Over a six-month period, program participants had fewer arrests and
convictions than the comparison group. The program, La Bodega de la Familia, offers
workshops, referral resources, and support groups. They also offer more intensive
services, such as family case management, advocacy, and crisis intervention.

Sun, A. (2000). Helping substance-abusing mothers in the child-welfare system:
Turning crisis into opportunity. Families in Society, 81, 142–151.

It is estimated that 40% to 80% of all families in the child welfare system have alcohol or
other drug problems connected with the abuse and neglect of their children. This article
integrated interviews with eight substance-abusing mothers in the child welfare system
and existing literature describing the journey of mothers in the child welfare system who
are drug abusers. The authors interviewed eight mothers ranging in age from 22 to 40
years of age. Their children ranged in ages from 2 weeks to 12 years. A major finding

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across the group was that all of them were eager for a mainstream (“normal” and
“meaningful”) life. It was this desire for the mainstream that propelled them to comply
with case plans and receive treatment. A common theme was a sense of feeling
overwhelmed. The women spoke of the demands placed on them and the difficulty they
faced in achieving their goals. They spoke of caseworkers who were not empathetic, who
did not understand addiction, and who created unrealistic case plans. The authors noted
that although they garnered important information from these qualitative interviews,
these women were just a small sample among thousands of substance-abusing women
who have entered the child welfare system.

Sun, A., Shillington, A. M., Hohman, M., & Jones, L. (2001). Caregiver AOD use,
case substantiation and AOD treatment: Studies based on two southwestern
counties. Child Welfare, 80, 151–177.

This article highlighted the results from two studies on AOD use. The first study took
place in a Nevada county and involved caregiver AOD and CPS case substantiation; the
second compared CPS-involved and noninvolved females in AOD treatment in San
Diego, California. Study I examined whether AOD families were more likely to have
substantiated CPS cases, be associated with certain categories of referral, or experience
differing levels of effect on substantiation among different categories of referral. They
study also determined if certain variables could predict indication of caregiver AOD use.

The researchers collected data between June 1998 and December 1999. The final sample
was 2,756 families and was 56.7% white, 17.9% African American, 17.1% Hispanic, and
8.3% other. Approximately half of the families were single-parent homes. There was a
significant relationship between indication of caregiver AOD and case substantiation.
Drug-abusing families were 96% more likely to have substantiated cases than families
without indication of AOD use. Alcoholic families were not significantly different than
families without AOD indication. African American and Hispanic families were more
likely to have substantiated cases than white families. The second study examined what
happened to AOD-abusing women once they began treatment. The study compared
women only in treatment with women in treatment and with CPS involvement. The
researchers collected the data for the second study after the first study. The sample was
26.2% Latina, 19% African American, 49.2% white, and 5.6% other. Almost all the
women in the sample indicated this was their first time in treatment (97%). Many in the
sample used two or more drugs, usually alcohol and something else. More women in the
CPS group were Latina, they were significantly younger, they reported fewer prior
arrests, they had more children, and they had lived in the area for a shorter period of time.
CPS-involved women were significantly more likely to report methamphetamines as their
primary drug of choice. Significantly fewer CPS women finished their treatment; they
were more likely to be referred elsewhere for continued treatment. The more children a
woman had was directly significantly related to CPS involvement.

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Teplin, L. A., Abram, K. M., McClelland, G. M., Dulcan, M. K., & Mericle, A. A.
(2002). Psychiatric disorders in youth in juvenile detention. Archives of General
Psychiatry, 59, 1133–1152.

This article reported on the growing number of youth in juvenile detention and the
absence of data on potential psychiatric disorders in this population. The authors contend
that there are too few quantitative studies on psychiatric disorders among youth in the
juvenile justice system, and those studies that are available are often significantly flawed.
This study included 1,829 male and female youth between 10 and 18 years old, randomly
sampled on intake into the Cook County Juvenile Detention Center between November
1995 and June 1998. The sample included African Americans, non-Hispanic whites, and

The most common findings among all youth were substance abuse disorders and
disruptive behavior disorders. Non-Hispanic white males had the highest incidence of
disorders, and African American males had the lowest incidence. Hispanic males had
higher rates of anxiety and separation disorders compared with non-Hispanic whites.
Non-Hispanic females had the highest rates for any disorder, and African American
females had the lowest except for conduct disorders and disruptive behavior disorders.
Hispanic females had the highest rates of generalized anxiety disorder.

Overall, the study showed that a large number of youth with psychiatric disorders are in
the juvenile justice system. Excluding conduct disorder, 60% of males and 66% of
females met diagnostic criteria. The authors suggested three directions for future
research: studies of patterns in comorbidity, studies on females in the juvenile justice
system, and longitudinal studies. Overall, the juvenile justice system is ill-equipped to
provide mental health treatment to youth in its care.

Treating teens: A guide to adolescent drug programs. (2003). Washington, DC: Drug

Substance use is a growing problem for youth. Many teens need treatment but few
actually receive it. Programs designed for adults are often used for youth but are not
adequate to address their developmental needs. Because treatment can be cost
prohibitive, families are sometimes forced to place their children in the juvenile justice
system for the youth to obtain substance abuse treatment. This publication helps parents,
counselors, doctors, probation officers, judges, and other concerned adults make more
informed choices when helping a substance-abusing teen. The guide featured 144
programs and featured in-depth profiles of seven very promising models. Very little
quantitative data are available on successful approaches to reducing adolescent substance
use. This publication featured programs that had nine key elements—assessment and
treatment matching, comprehensive and integrated approach, family involvement,
developmental appropriateness, engagement of teens, qualified staff, gender and cultural
competence, continuing care, and treatment outcomes. Each program featured in the
publication included information on national accreditation, services offered, length of
stay, and capacity.

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Uziel-Miller, N. D., & Lyons, J. S. (2000). Specialized substance abuse treatment for
women and their children: An analysis of program design. Journal of Substance
Abuse Treatment, 19, 355–367.

This article examined 36 substance abuse treatment programs for women and their
children. The programs offered a wide range of services, including mental health and
medical treatments. The authors found that the programs’ services varied widely and that
not all programs were truly comprehensive. Women have special needs, and many
substance abuse treatment programs are designed for men; therefore, they probably
cannot meet the needs of women. These needs include higher rates of psychological
distress, socioeconomic problems, trauma, and complications associated with pregnancy
and parenting. Comprehensive services should include medical and health services,
substance abuse and psychological counseling, lifeskills training, and other social

This review found 36 substance abuse treatment programs specifically designed for
women. The authors found three types of programs. Type 1 included women, parenting
or not, who were more likely to be residential. Type 2 programs, although similar to Type
1, were more likely to be outpatient services with case management and linkage of
services and for pregnant and parenting women. Type 3 programs predominantly served
pregnant and parenting women and were less comprehensive in services.

The typical woman who needed any of these substance abuse treatment services was
young, was a person of color, had not graduated from high school, had little work history,
and was supported by public assistance. She was likely to have grown up in an abusive
home, be in an abusive relationship, and have two children. Few programs were
culturally sensitive. Culturally sensitive programs could potentially increase the success
of the treatment. The greatest failure of programs was to adequately address the needs of
women who were not currently parenting. Some programs did not serve substance-
abusing women who had older children. Despite the limitations, this review does
demonstrate the growing number of substance abuse treatment programs for women.

Vinson, N. B., Brannan, A. M., Baughman, L. N., Wilce, M., & Gawron, T. (2001).
The system-of-care model: Implementation in twenty-seven communities. Journal of
Emotional and Behavioral Disorders, 9(1), 30–42.

This study documented the process of implementing a system of care model across 27
sites between 1993 and 1994 throughout the United States. The researchers collected
qualitative data from each site on 16 attributes for an ideal system of care. No site was
able to fully implement the model. A federal grant under the Comprehensive Community
Mental Health Services for Children and Their Families Program funded the project. The
system of care model addresses mental health services for children and includes the
following principles: attention to individual needs, strengths-based, involvement of
families, cross-agency collaboration, and least restrictive settings.

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The assessment detailed in this report had three goals: to describe the service systems, to
track each program’s status, and to examine the actualization of system of care principles
in each site. All sites worked to expand their array of services. All sites reported capacity
issues in attempting to implement all services. The most popular services across sites
were respite care, behavioral aides, family support groups, parent aides, support, and
family advocacy. Each agency had a different type of oversight structure. Although some
oversight mechanisms limited involvement of one group or another, all agencies reported
a positive effect on their service system governance and management. All sites moved
toward individualized case planning with positive results. Families were involved in their
own case planning at various levels in each site. All sites tried to incorporate strategies
and staff members for cultural competence. Over the course of the five-year grant, sites
showed a positive increase in goals and vision, community-based models, and service

Walter, U. M., & Petr, C. G. (2000). A template for family-centered interagency
collaboration. Families in Society, 81, 494–504.

This article detailed needed aspects for successful interagency collaborations. Key to
their success is a shared values base and a focus on family-centered principles. The
authors attempted to link together family-centered services and interagency collaboration
and believed that family-centered values should be the core of successful interagency
collaborations. Interagency collaboration is most often defined as having stakeholder
involvement, common goals, shared responsibilities, shared rewards, shared resources,
shared authority, shared evaluations, shared structures, and shared visions and values.
The first step in integrating family-centered services and interagency collaboration is to
recognize the major elements of family-centered practice. This practice involved
choosing the family as the smallest unit to work with, encouraging the family using
proactive decisionmaking, grounding work in a strengths-based model, and ensuring
cultural sensitivity. An interagency collaborative would then create an advisory panel of
experts in the field to guide the adaptation of family-centered services. Front-line staff
must be empowered to help families beyond strident mandates. The advisory panel would
also work to ensure that agency services evolved to empower both workers and families.

Werner, M. J., Joffe, A., & Graham, A. V. (1999). Screening, early identification,
and office-based intervention with children and youth living in substance-abusing
families. Pediatrics, 103, 1099–1112.

This article documented the need for health professionals to recognize associated health
problems or concerns in children of substance-abusing parents and have the ability to
assist these families in seeking treatment options. According to a recent study, 33% of
Americans stated they have an alcoholic family member. Because of its high prevalence,
health care providers should expect to encounter families affected by alcohol on a daily
basis. By identifying these families early, health care professionals can provide
invaluable information and influence.

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The authors stated that for families affected by alcohol to be identified, health care
professionals need to take the necessary steps to recognize the abuse of alcohol or other
drugs. These steps include obtaining family alcohol or drug use frequency during routine
history taking, conducting a screening versus an assessment, and effectively interviewing
children, youth, and families. Many health care professionals are not adequately taught
these skills. The authors suggested that training begin during undergraduate education
and be reinforced by role modeling. By acquiring skills and conducting thorough
screenings, health care professionals can serve as excellent resources to children and
families dealing with alcoholism and drug abuse.

Whiteside-Mansell, L., Crone, C. C., & Conners, N. A. (1999). The development and
evaluation of an alcohol and drug prevention and treatment program for women
and children. Journal of Substance Abuse Treatment, 16, 265–275.

This article reported on a study of the Arkansas Center for Addictions Research,
Education, and Services (AR-CARES) as it evolved over a five-year period. The program
provided comprehensive substance use prevention and treatment. Clients were low-
income pregnant and parenting women and their children. In the past, most drug
treatment programs were designed for and provided to men.

In 1989, Congress appropriated money for substance abuse demonstration projects for
pregnant and parenting women. Women face unique barriers in attempting to obtain
services, including shame and guilt, opposition to treatment by family and friends,
accessibility of child care, and sexual harassment. These women also have unmet needs
related to parenting, education, health care, and vocational training. Many children born
to substance-abusing mothers experience physical, mental, psychological, or educational
disabilities. Nurturing environments for drug-exposed infants, however, can have a
positive effect on their development.

AR-CARES provides residential and outpatient treatment and leadership to improve care
for addicted women and their children. The model was designed as 4 half-hour sessions,
5 days per week, lasting 12 weeks. They included 9 to 12 women at a time. Barriers to
success of the program included lack of transportation, lack of child care, and lack of
safe, drug-free housing. The program was able to obtain 13 on-campus residences for
families in treatment. The average length of stay in treatment was 15 months, with some
leaving after 4 weeks and some staying 2 months or longer. By having the clients living
onsite, staff were able to deliver more services. The staff also created their own day care
center and bought their own van for transportation. Both women in the program and a
comparison group showed decreases in alcohol and drug use after the birth of their child.
More women in the program ceased cigarette smoking after the child was born, compared
with women in the comparison group. Birth outcomes for the two groups were similar,
however, children of program participants had higher birth weights and higher gestational
ages. Women in the treatment group had less premature labor and infection. No
differences existed in cognitive scores of children in either group, possibly due to the
inability to assess the children in the nonparticipating group as often. Overall, input from
staff and clients allowed the program to evolve over time.

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Whittaker, J. K., & Maluccio, A. N. (2002). Rethinking “child placement”: A
reflective essay. Social Service Review, 76, 108–134.

This article examined child placement as a potentially detrimental variable by itself,
without including important aspects, such as healthy child development and improved
family functioning. The article then traced the concept of child welfare through its
infancy to modern definitions. Scholars in the child welfare field predict the coming
demise of the child welfare system, based on newer statutes, mandates, and funding

There are five major concerns for the child welfare system as it now stands:
overinclusion, underinclusion, capacity, service delivery, and service orientation. The
child welfare system has had dual missions and roles—sometimes, to protect children
from abusive and neglectful parents, and at other times, to provide a support system to
vulnerable families. The answer is not to pit services against each other (i.e., out-of-home
care funding vs. family support funding).

Recommendations for improvement of the child welfare system included renewed
experimentation with kinship care, renewed commitment to involving parents of a child
in out-of-home care, expanded respite options, development of creative residential
services, refined and tested measures of child well-being, development of whole-family
care, creation of a check and balance sheet for services, examination of developmental
outcomes of children in shared care, personalization of out-of-home care settings, and
redesigned group care capacities.

Wiig, J., & Widom, C. S. (2003). Understanding child maltreatment & juvenile
delinquency: From research to effective program, practice, and systemic solutions.
Washington, DC: CWLA Press.

This monograph detailed a growing body of research showing the connection between
child maltreatment and juvenile delinquency. In 2000, nearly 879,000 children were
victims of child abuse and neglect. Although juvenile crime has declined recently, the
level of crimes committed by youth remains high. The research presented in this
monograph provided undeniable evidence that victims of childhood maltreatment often
enter the juvenile justice system and become future serious and violent offenders. In a
recent survey of public juvenile justice agencies, less than 10% had developed any
collaborative program to address the population of delinquent offenders with previous
individual or family histories of child maltreatment.

The authors described an array of program, practice, and systemic efforts for developing
responses to juvenile crime and coordinating the child welfare and juvenile justice
systems. These efforts can be the foundation for practitioners and policymakers in
reducing the risk of maltreatment and sustaining declines in juvenile delinquency
nationwide. The Child Welfare League of America will lead these efforts by continuing
to raise the national level of awareness regarding the connection between child
maltreatment and juvenile delinquency, through disseminating information; organizing

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symposiums that bring together practitioners, administrators, and policy makers from
both child welfare and juvenile justice; and collaborating with other national
organizations to provide workshop presentations and keynote addresses.

Wilens, T. E., Biederman, J., Kiely, K., Bredin, E., & Spencer, T. J. (1995). Pilot
study of behavioral and emotional disturbances in the high-risk children of parents
with opioid dependence. Journal of the American Academy of Child and Adolescent
Psychiatry, 34, 779–785.

This article reported on a preliminary study of behavioral and emotional problems in
children of opioid-dependent parents. There are few studies and programs targeted to
early intervention for children of opioid- or methadone-dependant parents. Children of
parents with psychoactive substance use disorders (PSUD) are more likely to experience
PSUD as they grow older, attention-deficit/hyperactivity disorder (ADHD), oppositional
and conduct disorders, depression, anxiety, and somatic disorders. These results were
based on studies of children of alcoholics.

The preliminary study for this article used the Child Behavior Checklist to screen
children in the sample. The sample was composed of children ages 4 through 18 who
either lived with or had close contact with their opioid-dependent parents in an outpatient
methadone clinic. A comparison group of boys with and without ADHD was also

Children in the treatment group showed higher levels of dysfunction than children in the
comparison group. They also had significant internalizing and externalizing behavior
scores and higher rates of delinquent behavior. Previous research has shown that children
with ADHD or conduct disorders are at a higher risk of later substance abuse and
dependence. The results of this study are similar to other studies on children of parents
with alcohol or substance abuse problems.

Williams, J. H., Ayers, C. D., Abbott, R. D., Hawkins, J. D., & Catalano, R. F.
(1999). Racial differences in risk factors for delinquency and substance use among
adolescents. Social Work Research, 23, 241–256.

The authors of this article explored racial differences among youth at risk of delinquency
and substance abuse. Studies have looked at environmental factors that influence
substance use and protective factors that shield youth from risky behaviors. Few studies
have examined racial differences in risk factors. The authors incorporated theoretical
ideas such as social bonding, social learning, and differential association. Social bonding
includes attachment, commitment, involvement, and beliefs. Social learning implies that
the acquisition of normal or deviant behaviors depends on rewards and punishments.
Differential association implies that the behavior comes from interaction with others.

This study had two purposes: Longitudinally examine racial differences in at-risk
behaviors, and conduct a cross-sectional study of the relationship between race and
predictors of use. White youth had a more liberal attitude about alcohol use compared

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with African American youth. These beliefs are correlated with higher alcohol use among
white youth. White youth are also more influenced by peer use than African American
youth are. Youth who have more effective family management, discipline, and
communication are less likely to use alcohol. Studies have found that African American
youth from families with poor family management were more likely to use alcohol or
drugs. Youth who are not committed to their educations are more likely to have substance
use problems. Poor academic performance is also linked to substance use.

The longitudinal study for this article had a final sample of 567 white and African
American youth and their parents. More African American youth were from poorer
families and single-parent homes than white youth were. This study showed that for
delinquent behavior, low academic and social skills were a significant predictor for both
groups of youth. For substance-using behavior, low academic and social skills and peer
and sibling influence were significant predictors for both groups. The findings indicated
that universal prevention planning and interventions can work. Despite these findings, the
researchers caution that culture and race should demand appropriate attention when
working with youth in a particular target population. They found that white youth were
more susceptible to influences from peers and siblings for substance-abusing behaviors.
Family interactions and dynamics had a strong influence on youth substance use. The
authors suggested that this finding indicates the need for better family support systems,
parenting courses, and preservation services.

Young, N. K., & Gardner, S. L. (2002). Navigating the pathways: Lessons and
promising practices in linking alcohol and drug services with child welfare (SAMSHA
Publication No. SMA-02-3639). Rockville, MD: Center for Substance Abuse
Treatment, Substance Abuse and Mental Health Services Administration.

The authors recognized that several previous reports discussed substance abuse and child
welfare. This report was different, in that it offered lessons learned, emphasized
substance abuse treatment, and discussed policy changes. The goals of this report
included informing substance abuse treatment facilities about policy changes,
documenting current state and local policies, highlighting models, and providing
guidance for implementing useful models to help parents who have substance abuse
problems. This report featured seven programs that developed strong ties between alcohol
or drug treatment and CWS.

In the past, child welfare agencies were not equipped to help substance-abusing parents,
although they knew that a majority of their caseload was families affected by it. Actual
numbers are difficult to obtain, however, and many publications can only estimate how
many child welfare families have substance abuse issues. There must be a better method
of distinguishing between casual users, abusers, and addicts. One report found that 60%
of substance users in the child welfare system were addicted to drugs.

This report also highlighted the “four clocks” of substance abuse and child welfare, but
added a “fifth clock.” The four standard clocks are the TANF timetable, child welfare
system timetable, recovery process, and developmental timetable for children. The fifth is

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time needed for agency staff to respond to the other four clocks. The report featured the
challenges to substance abuse, and child welfare service linkages from the substance
abuse treatment side include competing demands, different tracking systems, waiting
lists, women and children as a priority, attitudes toward clients, and a capacity gap.
Challenges from the child welfare perspective include effectiveness of substance abuse
treatment, information systems that hide alcohol or drug use, lack of response to referrals,
and confidentiality concerns.

Programs featured in this report as linking successfully relied on 10 principles:
underlying values, daily screening of clients, daily client engagement, daily services to
children, joint accountability, information sharing, budget sustainability, training and
staff development, working with courts, and working with communities and other

Young, N. K., Gardner, S. L., & Dennis, K. (1998). Responding to alcohol and other
drug problems in child welfare: Weaving together practice and policy. Washington,
DC: CWLA Press.

This book drew on a framework of policy and practice for child welfare based on a case
study of the Sacramento County Alcohol and Other Drug Treatment Initiative. This
program built bridges between the child welfare and substance abuse treatment systems.
The need for this guide was born out of the realization that many families who come into
contact with child welfare have a history of substance abuse. With new time limits set by
TANF, these families face the challenge of receiving rapid treatment or losing their
children permanently. Therefore, the success of the child welfare system depends on the
success of other systems.

The authors cite barriers to success as the “four clocks”: child welfare deadlines for
permanence, TANF time limits, different time tables for AOD treatment and recovery,
and developmental timetables of children. The authors also suggested streamlining
services among different agencies. Families in the child welfare system that need
substance abuse treatment are often subjected to multiple assessments that usually ask the
same questions repeatedly. This also makes more work for agency staff. The book
features nine models of blended assessments and shares the pros and cons of each model.

The book ends with a detailed set of recommendations based on the authors’ review of
programs and practices. These recommendations included developing an action agenda,
proper training of staff and staff buy-in, strengthening child welfare and substance abuse
program connections while developing other connections in the community, improving
the capacities of the child welfare system and substance abuse system before attempting
to gain more funding, and pushing for federal policy reform.

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Zaff, J. F., Calkins, J., Bridges, L. J., & Margie, N. G. (2002, September). Promoting
positive mental and emotional health in teens: Some lessons from research. Child
Trends Research Brief.

A significant minority of teens and preteens suffer from anxiety disorders, depression,
other mood disorders, behavioral problems, and drug or alcohol addiction. This report
discussed a review of nearly 300 research studies on teens’ mental health and emotional
well-being. The review suggested that mental health programs that use comprehensive,
integrated approaches are most effective in preventing problems such as conduct
disorder, ADHD, and AOD use. Cognitive-behavioral therapy, drug therapy, and
community-level strategies appear to help reduce mental health disorders, including
depression and anxiety. Further evaluation studies are needed on the efficacy of drug
therapy and other approaches for adolescents. In addition, research suggests that starting
prevention programs early may ward off a number of mental and behavioral problems in
adolescents and young adults.

The authors’ review of the research also found that programs aimed at improving one
aspect of teens’ emotional well-being may also have positive effects on other aspects of
their lives. Homes and schools that are emotionally positive and provide support for
adolescents’ autonomy and achievement may boost teens’ psychological and emotional

Zima, B. T., Bussing R., Freeman, S., Yang, X., Belin, T. R., & Forness, S. R. (2000).
Behavioral problems, academic skill delays and school failure among school-aged
children in foster care: Their relationship to placement characteristics. Journal of
Child and Family Studies, 9, 87–103.

This article explored the reasons behind the large number of children in foster care who
exhibit behavioral problems, poor academic achievement, and school failure. Agencies
need to plan how to address the rising number of children entering foster care with
emotional and behavioral problems, coupled with the shift of mental health services in
the public sector to managed care.

This study used Los Angeles County data for children ages 6 to 12 years old, living in
out-of-home care between July 1996 and March 1998. The researchers randomly selected
children from acute care (6 to 12 months) and chronic care (12 months or more). They
interviewed the foster parents, foster children, and children’s teachers. The final samples
included 302 children and 268 teachers. Demographic data for the sample showed that
80% of children were of color, 63% of foster parents had at least graduated from high
school, the average stay in foster care was three years, and 62% were in kinship care.
Overall, 69% of the children showed behavioral problems, academic delays, or school
failure. Being male was a significant predictor for having behavioral problems or
academic skills delay. Foster parents were more likely to identify children in therapeutic
foster care as having a behavioral disorder. Children with longer stays in foster care were
more likely to have been suspended or expelled from school. Teacher and foster parents
ratings of each child did not match. This may be due to testing instruments.

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