Parental substance abuse as a predictor of child maltreatment re-reports

Pergamon

Child Abuse & Neglect,Vol. 20, No. 12, pp. 1183-1193, 1996 Copyright© 1996Elsevier ScienceLtd Printed in the USA.All rights reserved 0145-2134/96 $15.00 + .00

PH S0145-2134(96)00114-7

PARENTAL SUBSTANCE ABUSE AS A PREDICTOR OF CHILD M A L T R E A T M E N T RE-REPORTS ISABEL W O L O C K School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA STEPHEN M A G U R A National Development and Research Institutes, New York, NY, USA

Abstract--This longitudinal study of child abuse and neglect cases closed after investigation examined the impact of parental substance abuse on family functioningand on subsequent referrals to child protectiveservices. The findings support the hypothesis that parental substance abuse would have a negative impact on family functioning, which, in turn, would result in a higher rate of re-repoits. As expected, substance abuse also had a direct impact on re-reports. It is critical that the child welfare system recognize and respond to parental substance abuse problems in these families through expanded and improved voluntary, and perhaps, mandatory services. Copyright © 1996 Elsevier Science Ltd Key Words--Parental substance abuse, Family functioning, Re-reports.

INTRODUCTION T H E P R E V E N T I O N OF re-reports of maltreatment is o f major concern to Child Protective Services (CPS) agencies (Baird, Wagner, & Neuenfeldt, 1991; English & Aubin, 1991). A related problem is that a majority of child maltreatment reports and re-reports of child maltreatment are closed out following investigation. Nationwide, such cases make up approximately 60% of all maltreatment reports (Besharov, 1990). A high proportion of these families are re-reported to CPS agencies; yet little is known about the problems experienced by these families and the level of risk posed to children. The need to conduct repeated protective service investigations is very costly for agencies already operating under severe resource limitations. It is possible that these re-reported families did not receive adequate services initially and were not monitored for a sufficient length of time. Given that, the problems which exist at the time of the first investigation may worsen, potentially increasing the risk of harm to children. Parental substance abuse, a growing problem among CPS cases, is of particular concern (Berkowitz, 1991; Daro & McCurdy, 1992; Magura & Landet, 1996). Not only does substance abuse have an adverse impact on family functioning (Bijur, Kurzon, & Overpeck, 1992; Davis, 1990; Kumpfer, 1987; Zuravin, 1988), but it has been identified as a key predictor o f re-reports of child abuse and neglect (McDonald, 1990). In many states, including New Jersey, the setting for the study reported here, parental substance abuse is not by itself a sufficient cause for mandatory protective services intervention. The present study examines This study was funded by a grant from the National Center on Child Abuse and Neglect (Grant #90-CA-1453). Received for publication June 12, 1995; final revision received May 3, 1996; accepted May 7, 1996. Reprint requests should be addressed to Isabel Wolock, Ph.D., School of Social Work, Rutgers, The State University of New Jersey, 536 George Street, New Brunswick, NJ 08903. 1183

1184

I. Wolock and S. Magura

the relationships among parental substance abuse, family functioning, and subsequent abuse/ neglect re-reports, for cases closed after initial CPS investigation. Two research questions guided the study: 1. Are closed cases in which there is parental substance abuse at greater risk for subsequent impaired functioning than other closed CPS cases? and 2. Are these families at increased risk for re-referral for child maltreatment?

Analytical Model The current research is a prospective longitudinal study of cases closed after initial child protective services investigation. Parental substance abuse and socioeconomic variables comprise two sets of independent or predictor variables; family functioning is the mediating variable; and re-reports to CPS is the dependent or outcome variable (see Figure 1). Consistent with the literature on the generally deleterious effects of parental substance abuse on families and their members, it was hypothesized that parental substance abuse would have a direct detrimental effect on family functioning and thus have an indirect relationship to rereports through family functioning. It was anticipated that substance abusing parents would encounter greater difficulties and crises in their lives than other closed cases, thereby affecting their capacity to provide adequate child care. Inappropriate behaviors associated with inadequate child care or child problems resulting from inadequate care, it was expected, would bring the families to the attention of community agencies and others, thus increasing the likelihood of their being re-reported to CPS. A direct relationship between parental substance abuse and re-reports also was expected. The more immediate consequences of the use of alcohol or other drugs might be unusual incidents or events, or bizarre parental behavior, which would make these families more publicly visible, hence increasing their risk of being re-reported to CPS. Furthermore, if a prior report had involved substance abuse, it is likely that the family would be under closer scrutiny and more likely to be reported, given new suspect behavior. Socioeconomic variables were hypothesized to have direct as well as indirect effects on rereports through family functioning. The association between socioeconomic variables and

Abuse Uarlables

D

Family Functioning

E

R

B

C

Protective Services Figure 1. Causal model.

Economic Uarlables

Parental substance abuse

1185

family functioning has been documented in the child maltreatment literature (Belsky, 1980; 1984; Garbarino & Sherman, 1980; Horowitz & Wolock, 1985; Pelton, 1985; U.S. Dept of Health and Human Services, 1988). Similarly, socioeconomic variables have been found to be significant predictors of re-reports or recurrence of maltreatment (English & Aubin, 1991).

METHODOLOGY

Subjects The research presented here was part of a larger longitudinal study concerned with the sequelae of parental substance abuse among CPS cases closed after investigation. The families were reported for maltreatment to five offices of the New Jersey CPS agency. The cases were closed for the following reasons: the incident was judged to be an isolated incident, it was of lesser severity, the situation triggering the report was resolved by the time the investigation was completed, and/or the family was receiving services from another community agency. Included also were cases in which the reported maltreatment was "unsubstantiated." This designation was used by the agency for cases in which workers suspected that child maltreatment had occurred but had insufficient legal evidence, in addition to cases which they judged to be unfounded. The families were reported to CPS between December 1988 and October 1989. A cohort of 239 families comprising both substance abusing and nonsubstance abusing parents were followed for an average of 2 years. Three interviews were completed with 88% or 211 of these families and two interviews (the first and third) with 90% or 214. These families remained in the study from the first to the third interview, a period of 17 to 32 months (X" = 24 months; SD = 3.6). In order to augment the substance abusing sample, 25 families or 10% of the study sample, selected from the original sample pool, were added close to the time of the third interview. Their late entry into the study meant that these families could be interviewed only once. The newly added families were similar to those who had been in the study continuously. There were no statistically significant differences between the two subgroups of families on number of months between the first report and third interview, whether they had been rereported to protective service, the types of situations for which they had been reported and diverse socioeconomic factors, including receipt of AFDC, ethnic background, education, family composition, and total number of children. The subjects in the present study are the 239 families who were interviewed at Time 3. An experienced professional research firm hired, trained, and supervised the interviewers.

Sources of Data The main data sources were the third administration of the Primary Caretaker Interview and two case record reviews. The first review covered case activity and material coinciding with the first and second interviews; the second review covered any additional case activity that had occurred by the time of the third interview.

Drug and Alcohol Abuse Caretaker substance abuse was identified from (1) self reported information provided in one or more of the interviews; and (2) information found in the first and second case record reviews. The personal interview accounted for 56%, or 74 of the 132 cases classified as substance abuse. Cases were also classified as substance abusing if the case record material indicated one or more of the following:

1186

I. Wolockand S. Magura

1. A report to CPS involved an alcohol/drug problem (61% or 81 of the cases). 2. The case record described a caretaker alcohol/drug problem (52% or 69 abuse cases). 3. A referral was made from CPS to a drug/alcohol program (12% or 29 abuse cases). 4. A report to CPS involved an infant's congenital drug problem (3% or 4 abuse cases).

substance abuse of the substance of the substance of the substance

Out of 10 possible criteria from interviews and case records for classification as a substance abuse case, a majority (60%) met two or more criteria. A single variable was created consisting of four categories: alcohol only, illicit drugs only, alcohol and illicit drugs, and no alcohol or illicit drugs. Three dummy variables were used in the analysis; no alcohol or drugs was the reference category.

Socioeconomic Variables Based on the third administration of the Primary Caretaker Interview, five socioeconomic variables were included: (a) parent's race/ethnic status; (b) whether or not AFDC was the primary source of income; (c) family structure (single vs. two-parent); (d) number of children under 18; and (e) perceived quality of the neighborhood. The criterion for selection of these variables was a statistically significant correlation either with the substance abuse variables or with CPS re-reports. The Quality of Neighborhood Scale (QNS) measured three domains of neighborhood environment as perceived by the respondent: the safety of the neighborhood, physical condition, and neighborhood cohesiveness (see Table 1). The convergent validity of the QNS was determined by its correlation with the 4 - i t e m Interviewer Observation Scale (lOS), comprised of interviewer observations of type of housing (public housing project vs. other), condition of building, the state of repair of the room in which the interview took place, and the condition of the neighborhood. The Pearson correlation of .6 between the QNS and lOS suggests that the QNS is an acceptably accurate assessment of neighborhood quality.

Family Functioning Following the conceptual framework of Geismar and Camasso (1993), family functioning is viewed as embracing the behavior of individual family members as well as member interactions in both expressive and instrumental domains. Consistent with this definition, an overall scale using six components was created: (a) parent's affective state; (b) social isolation; (c) family conflict; (d) behavioral problems of children; (e) parental difficulties; and (f) financial difficulties. Each of the scale components was determined using standardized self-reported measures. (Descriptive information about the component measures is shown in Table 1.) The six scales comprising family functioning were converted to z-scores and a factor analysis performed (principal components, varimax rotation). A single factor emerged and a mean score based on the standardized scores for the six scales was computed to represent overall family functioning (Cronbach alpha = .68). Higher scores represent better family functioning.

Maltreatment Re-reports Information on re-reports was obtained from the second case record review, thereby ensuring that the re-report data corresponded in time to administration of the third interview. All rereferrals were used whether or not they were substantiated. As commonly used, the term unsubstantiated is ambiguous and is often applied as an umbrella term for cases closed following a CPS investigation. As shown in this (Table 2) and other studies, maltreatment was

Parental substance abuse

1187

Table 1. Description of Scales

(Range) Mean

Cronbach Alpha

Source

Examples of Items

(SD)

Parent Affective State (14 items)a

Affect Scale (Bradburn, 1969)

(1-4) 3.09 (.48)

.87

Social Isolation (5 items)a

Adaptedfrom the Social Participation Scale (Wolock & Horowitz, 1977)

(0-5) 2.89 (1.02)

.48

Family Conflict (5 items)a

Adaptedfrom Family Conflict Subscale (Moos & Moos, 1982) Adaptedfrom Parent O u t c o m Interview e (Magura & Moses, 1986) One factor derived from Mother's Sense of Competence Scale from Parental Stress Index (Abidin, 1990) Adapted from Parent Outcome Interview (Magura & Moses, 1986)

Pleasedabout having accomplished something. All alone in the world. Depressed or very unhappy. Numberof contacts with relatives other than those in household. Numberof relatives you see or visit regularly. Frequency of getting together. We fight in our family. Family members get so angry they throw things. Usually is polite. Is often disrespectful to you. Sometimesbreaks things on purpose. Beinga parent is harder than I thought it would be. I have had more problems raising my children than expected.

(1-3) 2.5 (.45) (0-23) 3.24 (2.95)

.63

(1-5) 2.9 (.79)

.58

(1-3) 2.16 (.42)

.84

(1-2) 1.78 (.78)

.87

Scale

Children's Behavioral Problems (23 items)h Parenting Difficulty (3 items)a

Financial Difficulties (9 items)a

Neighborhood Quality Scale (10 items)~

Quality of Neighborhood Scale (Wolock & Horowitz, 1977)

Frequency of: Running out of money before the next check comes. Not being able to pay your rent. Not being able to pay your electric or heating bills. There's a lot of crime in the neighborhood. Most of the houses are pretty rundown. People in the neighborhood help each other out when there's trouble,

.87

a High scores represent more positive situations. bHigh scores represent more negative situations.

identified in m a n y closed cases, but the worker believes that there is insufficient legal evidence, or that there are ameliorating circumstances, which lead to a designation of " u n s u b s t a n t i a t e d . " G i o v a n n o n i (1989) discusses the lack of clarity surrounding the term substantiation. In her study the term substantiated had to be redefined as " o p e n e d for services." She notes that in as m a n y as half the " u n s u b s t a n t i a t e d " reports, some validated maltreatment had been found. Leiter, Myers, and Zingraff (1994) strongly argue in favor of using all reports of maltreatment, regardless of substantiation, for research purposes. In their large scale study they d o c u m e n t similar types and severity of school problems and delinquency for children with substantiated as compared with unsubstantiated maltreatment reports.

RESULTS

Description of Families Sociodemographics. As presented in Table 2, almost all the principal caretakers were women, mostly between the ages of 20 and 39. Half were Caucasian, with the rest of the sample made up of approximately equal proportions of Black and Hispanic respondents.

88

I. Wolock and S. Magura

Table 2. Characteristics of Sample % Gender Women Men Age of Respondent 18-19 20-25 26-29 30-39 40-49 50-59 60 and older Race/Ethnicity Caucasian Black Hispanic Other Family Compositiona One parent alone with minor child One parent with non-spousal adults Two-parent family Relationship of Children to Respondentb Own child Stepchild Grandchild Other relation Housing ~ House/apt. owned by respondent House/apt. rented by respondent Relative, friend, motel Work Status of Respondent Currently employed Unemployed-looking for work Not working-family support Not working-disabled Retired from work Student Other Welfare Recipient Yes No Years of Education Number of Children Type of Substance Abuse Alcohol only Drugs only Both alcohol and drugs No substance abuse

(N)

94 6

(224) (15)

1.3 13.4 16.3 41.8 18.4 7.9 .8

(3) (32) (39) (100) (44) (19) (2)

50.2 25.9 21.8 1.2

(120) (62) (52) (3)

36.1 29.0 34.9

(86) (69) (83)

87.0 2.6 6.1 4.2

(509) (15) (36) (25)

21.8 63.9 14.3

(52) (152) (34)

48,5 9.6 25.5 4.6 1.7 2.5 7.5

(116) (23) (61) (11) (4) (6) (18)

33.9 66.1

(81) (158) 0-16 1-8 (N) (52) (21) (59) (107)

% 21.8 8.8 24.7 44.7

Percent of Cases Reported Type of Maltreatment (Entire Period) Physical abuse Neglect Emotional abuse Sexual abuse Maltreatment Re-Reports None One Two to nine ~N's < 239 due to missing values. b Percentages are based on N = 586 children.

% 62.8 51.0 24.3 23.8 % 60.7 21.3 18.0

(N) (150) (122) (58) (57) (N) (145) (51) (43)

Mean = 11.2; S D = 2.7 Mean = 2.4; S D = 1.4

Percent of Reports "Substantiated" % 40.0 38.5 17.2 9.0

(N) (60) (47) (10) (5)

Parental substance abuse

1189

On average, parents had completed 11 years of schooling. Almost two-thirds of the families were headed by single parents, some living alone with their minor children and others living with other relatives. The average number of children was 2.4. Most of the children were the natural children of the respondent; others were step-children, grandchildren, or another relative. Most of the families lived in their own rented apartments or houses; a small proportion lived with a relative, friend, or in a motel. Approximately a third were receiving AFDC. Nearly half the parents were employed at the time of the interview. Most of those not working had interfering family responsibilities. Substance abuse. In slightly more than half the families one or both caretakers were identified as having a substance abuse problem; about one-third had drug problems, usually combined with alcohol problems (see Table 2). Maltreatment. As noted in Table 2, the most frequent type of referral was for physical abuse, with neglect ranking a close second. These forms of maltreatment appeared twice as often as emotional or sexual abuse. Substantiation for the four types of maltreatment was highest for physical abuse and neglect reports and lowest for sexual abuse reports. Re-reports. The second case record review identified the re-referrals that occurred up to the time of the third interview. As shown in Table 2, nearly two-fifths of the families were rereported during the follow-up period. Re-reports was treated as a dichotomous variable (none vs. one or more) in the analysis. Bivariate Analysis

Table 3 shows a cross tabulation of substance abuse by re-reports. As anticipated, the probability of a re-report is greatest where both alcohol and drug abuse is present and least likely where there is no known substance abuse. Testing the Model

In order to test the model presented in Figure 1, a series of multiple regression analyses were carried out. The direct effects of parental substance use, socioeconomic variables, and family functioning on re-reports (a dichotomous variable) were determined using logistic regression. Ordinary least squares regressions were employed to determine the effects of parental substance use and socioeconomic variables on the mediating variable, family functioning. Standardized beta coefficients were obtained for both types of analyses and statistically significant (p < .05, 2-tailed) and marginally significant coefficients (<.05 < p < .10, 2 -

Table 3. Maltreatment Re-Reports by Type of Substance Abuse

Number of Re-Reports

Drugsand Alcohol

AlcoholOnly

DrugsOnly

No Substance Abuse

(N)

One or More None Total (N)

57.6% 42.4 100.0 (59)

44.2% 55.8 100.0 (52)

47.6% 52.4 100.0 (21)

25.2% 74.8 100.0 (107)

(94) (145)

Pearson chi-square = 18.32, 3 df p = .0003.

(239)

1190

I. Wolock and S. Magura

tailed) are presented in Figure 2. (The latter are presented because the study's directional hypotheses would justify 1-tailed tests of significance as well.) Substance abuse. As shown in Figure 2, substance abuse has a direct effect on re-reporting as well as an indirect effect through family functioning. The statistically significant paths found from all three substance abuse variables to "re-reports" indicate that parental substance use of any kind results in an increased likelihood of a re-report to CPS. The effect of drugs and alcohol combined is particularly strong. The expected detrimental effect of substance abuse on family functioning also was supported. Parental use of both drugs and alcohol predicted poorer family functioning at a statistically significant level and parental use of alcohol alone predicted poorer family functioning at a marginally significant level. Socioeconomic variables. Socioeconomic variables emerged as less important than had been expected. Receipt of AFDC and quality of neighborhood were the only socioeconomic variables that had direct effects (statistically or marginally significant) on being re-reported. The impact of neighborhood on re-reports was indirect as well, mediated through family functioning. This was the single socioeconomic variable that had a significant path to family functioning.

I DrRgs::d Drugs Onlg

fllcohol Onlu

~

I N e i g h b o r h°,o o d I

The f o l l o w i n g vari ab l es w e r e Included in the regression, but had no significant direct paths to e i t h e r famll g f u n c t i o n i n g or r e - r e p o r t s : t o t a l n um ber of children, black, Hispanic, one vs. t w o p a r e n t famllg. * * p < .05

*.95 ( p < . ! 9 Figure 2. Multiple regression results.

Parental substance abuse

1191

Family functioning. As

hypothesized, poorer family functioning was directly related to rereports, thus supporting the hypothesis that the family situation mediates the impact of parental substance use on re-reports.

DISCUSSION Returning to the two questions asked at the outset, it appears that among these cases closed after investigation, parental substance abuse does greatly increase the likelihood of poorer family functioning and re-reports for maltreatment to the CPS agency--both directly and as mediated by family functioning. This is consistent with the literature cited earlier showing the detrimental effects of parental substance abuse on the parenting role, on children's behavior, and on family functioning. It also supports the vital importance of including parental substance abuse in agency risk assessment tools. The direct path from the substance abuse variables to re-reports suggests that the use of alcohol and illicit drugs may lead to some publicly visible parental behavior that is viewed by community reporters as endangering the welfare of the child. Or additionally, when a prior maltreatment report involved substance abuse, the family may be under closer scrutiny than when it did not. Even though these cases may not have been the most dramatic and severe in terms of substance abuse or maltreatment, it seems clear that families with a substance abusing caretaker which the agency decides do not warrant supervision, require greater attention than they are currently receiving. It appears that these children and their families are being underserved by the child welfare system and perhaps falling "between the cracks." The family situations in which these children are growing up are potentially detrimental and may lead to other types of poor outcomes for children such as mental health problems, poor school performance, or delinquency. These family conditions also may be associated with types of child abuse or neglect (e.g., emotional abuse, sexual abuse) that are less visible and thus less likely to be identified and reported. The very low rate of substantiation of sexual abuse is disturbing and requires greater attention. The findings highlight the broader issue of how CPS agencies are currently defining "harm" and "risk" to children. Are they applying too rigorous a standard in judging "harm" and "risk?" Severe child maltreatment accounts for only a small proportion of referrals to public child welfare agencies. However, sharply diminishing resources as well as media attention to the most dramatic situations has forced the public child welfare agency to reorder its priorities to deal primarily with the most severe physical and sexual abuse (Lindsey & Regehr, 1993). As Lindsey and Regehr (1993) point out: Historically, most children who come to the attention of public child welfare agencies have not been battered or sexually assaulted, but are victims of neglect or inadequate care. Given the new set or priorities, these children are now virtually left out of the system. (p. 510) The child welfare system must recognize and respond to the problems of families with substance abuse problems through expanded and improved voluntary and, perhaps, mandatory services. In addition, more creative means of follow-up monitoring of at-risk children, such as through school nurses or through home health visitors, might also be devised. There is a need for the establishment of policies and procedures to identify more accurately parental substance abuse during protective service investigations. The amount of time, effort, and skill that agencies and caseworkers expend in identifying a given problem depends largely on the importance imputed to the problem. This study suggests that there are insufficient organizational imperatives to identify parental substance abuse during investigations and, moreover, that caseworkers may be insufficiently trained in this regard. The findings further support the need for early intervention in families with indications of

1192

I. Wolock and S. Magura

parental substance abuse. The limited n u m b e r o f drug and alcohol p r o g r a m s targeted to child maltreating families are likely to serve only the heaviest substance abusers and/or the most severe maltreaters. Moreover, as Ahart and colleagues (1991) point out, there are serious deficiencies in the p r o g r a m s currently serving substance abusing families in the child protective services system. The e m e r g e n c y - d r i v e n practices o f the child welfare system m a y prevent families with chronic substance abuse p r o b l e m s from being linked with other appropriate c o m m u n i t y services. A s s e s s m e n t tools with which to measure p r o b l e m s and risks are inadequate. High caseloads severely limit the ability o f child welfare caseworkers and other providers to offer the intensive, long-term interventions often required by drug- and a l c o h o l - i n v o l v e d families. Finally, there is a lack o f treatment p r o g r a m s sensitive to w o m e n ' s needs, which more often than m e n ' s , involve poverty and lack o f e m p l o y a b l e j o b skills, single parenthood, and w e a k social supports (Finkelstein, 1994; W i l k e , 1994). To help counteract these barriers to treatment, more c o m p r e h e n s i v e p r o g r a m s must be established which include: staff that is trained and sensitive to issues o f pregnant w o m e n and mothers o f young and adolescent children; on-site child care; family and extended family involvement; access to prenatal, obstetric, and other health care for w o m e n , infants, and children; provision o f adequate physical, social, and interpersonal supports; and educational/ vocational assistance (Finkelstein, 1994; Finnegan, 1991; M a g u r a & Laudet, 1996). Acknowledgement--The authors wish to thank Leonard Feldman, Chief of the Bureau of Research and Evaluation of

NJDYFS; Tamara Avi Itzhak, Study Director; Audrey McDonald, Survey Director; the staff at the District Offices of NJDYFS; and the anonymous reviewers for a useful critique.

REFERENCES Abidin, R. R. (1990). The parental stress index (3rd ed.). Odessa, FL: Psychological Assessment Resources. Ahart, A., Rutsch, C., Morgan, C. H., & Kotler, M. (1991). Programs serving drug-exposed children and their families (DHHS Contract No. HHS-100-87-0039). Washington, DC. Baird, C., Wagner, D., & Neuenfeldt, D. (1991). Actuarial risk assessment and case management in child abuse and neglect. San Francisco, CA: National Council on Crime and Delinquency. Belsky, J. (1980). Child maltreatment: An ecological integration. American Psychologist, 35 (4), 320-335. Belsky, J. (1984). The determinants of parenting: A process model. Child Development, 55, 83-96. Berkowitz, S. (1991, April). Key findings from the state survey component of the study of high risk child abuse and neglect groups. Paper presented to National Center on Child Abuse and Neglect State Liaison Officers Meeting, Washington, DC. Besharov, D. (1990). Gaining control over child abuse reports. Public Welfare, 48 (2), 34-40. Bijur, P. E., Kurzon, M., & Overpeck, M. D. (1992). Parental alcohol use, problem drinking, and children's injuries. Journal of the American Medical Association, 267(23), 3166-3171. Bradbum, N. M. (1969). The structure of psychological well-being. Chicago, IL: Aldine. Daro, D., & McCurdy, K. (1992). Current trends in child abuse reporting and fatalities: NCPCA's 1991 annual 50 state survey. Chicago, IL: National Committee for Prevention of Child Abuse. Davis, S. K. (1990). Clinical dependency in women:A description of its effects and outcome on adequate parenting. Journal of Substance Abuse Treatment, 7, 225-232. English, D. J., & Aubin, S. (1991, January). Impact of investigations: Outcomes for child protective services: Cases receiving differential levels of services. Children's Services Research Project, Children, Youth, and Family Services, Olympia, WA. Finkelstein, N. (1994). Treatment issues for alcohol- and drug-dependent pregnant and parenting women. Health & Social Work, 19, 7-16. Finnegan, L. (1991, January 12-15). Clinical management of the pregnant, drug-dependent woman. Workshop presented at the NIDA Conference on Drug Abuse Research and Practice: An Alliance for the 21st Century, Washington, DC. Garbarino, J., & Sherman, D. (1980). High risk neighborhoods and high risk families: The human ecology of child maltreatment. Child Development, 51, 188-198. Geismar, L., & Camasso, M. (1993). The family functioning scale: A guide to research and practice. New York: Springer Publishing Company. Giovannoni, J. (1989). Unsubstantiated reports: Perspectives of child protection workers. Los Angeles, CA: School of Social Welfare, University of California. Horowitz, B., & Wolock, I. (1985). Material deprivation, child maltreatment, and agency interventions among poverty

Parental substance abuse

1193

families. In L. Pelton (Ed.), The social context of child abuse and neglect (pp. 137-184). New York: Human Sciences Press, Inc. Kumpfer, K. L. (1987). Special populations: Etiology with and prevention of vulnerability to chemical dependency in children of substance abusers. In B. S. Brown & A. R. Mills (Eds.), Youth at high risk for substance abuse (DHHS Publication No. ADM 87-1537) (pp. 1-72). Washington, DC: National Institute on Drug Abuse. Leiter, J., Meyers, K., & Zingraff, M. T. (1994). Substantiated and unsubstantiated cases of child maltreatment: Do their consequences differ? Social Work Research, 18(2), 67-83. Lindsey, D., & Regehr, C. (1993). Protecting severely abused children: Clarifying the roles of criminal justice and child welfare. American Journal of Orthopsychiatry, 63, 509-517. Magura, S., & Moses, B. S. (1986). Outcome measures for child welfare services. Washington, DC: Child Welfare League of America. Magura, S., & Laudet, A. B. (1996). Parental substance abuse and child maltreatment: Review and implications for intervention. Children and Youth Services Review, 18, 139-162. McDonald, T. P. (1990). Recurrence of maltreatment in relation to assessed risks. National Center on Child Abuse and Neglect Symposium on Risk Assessment in Child Protective Services, Washington, DC. Moos, R., & Moos, B. (1982). Family environment scale manual (2nd ed.). Palo Alto, CA: Consulting Psychologists Press, Inc. Pelton, L. H. (1985). Child abuse and neglect: The myth of classlessness. In L. H. Pelton (Ed.), The social context of child abuse and neglect (pp. 137-184). New York: Human Sciences Press, Inc. U.S. Department of Health and Human Services (1988). Study fittings. Study of National Incidence and Prevalence of Child Abuse and Neglect: 1988. Washington, DC: U.S. Government Printing Office. Wilke, D. (1994). Women and alcoholism: How a male-as-norm bias affects research, assessment, and treatment. Health & Social Work, 19, 29-36. Wolock, I., & Horowitz, B. (1977). Final report: Factors relating to levels of child care among families receiving public assistance in New Jersey, (Vols. I and II). ERIC; ED 144336 and ED148904. Arlington, VA: Documents Reproduction Service, P.O. Box 190. Zuravin, S. J. (1988, February). Child abuse, child neglect, and maternal depression: Is there a connection ? Research Symposium on Child Neglect, Washington, DC: National Center on Child Abuse and Neglect.

Rtsumt----Cette 6tude longitudinale de cas d'enfants maltraitts et ntgligts, cltturts apr~s enqutte examine l'impact de la toxicomanie parentale sur le fonctionnement de la famille et sur des signalements constcutifs aux agences de protection de l'enfance. Les donntes soutiennent l'hypoth~se que la toxicomanie parentale provoquerait un dysfonctionnement familial, qui ~ son tour donnerait lieu a un taux plus 61ev6 de re-signalements. Comme on pouvait s'y attendre, la toxicomanie a aussi un impact direct sur les re-signalements. I1 est indispensable que le syst~me de sant6 publique pour les enfants reconnaisse les probl~mes lits ~ la toxicomanie parentate dans ces familles et y rtponde par une aide volontaire 61argie et amtliorte et peut-~tre par des services obligatoires. Resumen--Este estudio longitudinal de casos de abuso y negligencia contra los nifios y nifias concluy6 despues que la investigaci6n examin6 el impacto del abuso de sustancia parental en el funcionamiento familiar y e n los referimientos subsiguientes a los servicios de protecci6n infantil. Los hallazgos apoyan la hip6tesis de que el abuso de sustancia parental tendrla un impacto negativo en el funcionamiento de a familia, el que, a su vez, resultaria en una tasa m~is alta de re-reportes. Como se esperaba, el abuso de sustancia tambitn tuvo un impacto directo sobre los re-reportes. Resulta crltico que el sistema de bienestar infantil reconozca y responda a los problemas de abuso de sustancia parental en estas familias a travts de mejores y m~is amplios servicios voluntarios, y quiz~is, obligatorios.