Exploring Traumatic Influences

Forum on Public Policy

1

Assessing the Consequences For Children and Families When a Parent Has A

Problem With Substance Use and Abuse: Considerations For Social Workers

and Other Helping Professionals Dennis Kimberley, Professor, School of Social Work, Memorial University, Newfoundland , Canada

Dedicated to the memory of Margaret Cork and her forgotten children.

Introduction

“She was a crack ho who did lines on the way to birth me. I am better off where I be than back

with her, brud and dad.” 1

The intent of this paper is to contribute to scholarship, knowledge and public policy regarding

child maltreatment and parenting capacity within the context of parental substance use and

abuse. One goal is to give voice to the children who have moved to, or who are approaching, the

threshold for needing a type of protection that is neither governed by the best interest of the

parent (even by default) nor by fixation by professionals on an ideology of family preservation—

in the face of competing logical possibilities. In their best interest, many children and youth with

drug addicted parents, who present repeated risks with known harm, are now more likely to

require continuous care and a permanency plan (Brown and Hohman, 2006; Covey, 2007;

Hogan, 2007; Schmittroth, 1994).

Among the objectives of this analysis are included:

 to contribute to policy analysis and debate with respect to children’s protection programming and practices within the context of repeated parental substance use or

abuse, which pose imminent and highly likely risks and associated valid concerns with

parental capacity and child-youth care;

 to apply child risk-need-harm assessment knowledge, gained from the qualitative review of 50 cases from one clinical practice, that integrated assessments of parental capacity

and care issues associated with substance use, abuse and/or addictions—cases where

expert professional opinion was requested by the court and/or by children’s services;

 to explore the risk-need implications of parent capacity issues associated with co- occurring (concurrent) disorders - addictions and mental health;

 to analyze some program implications of treating parental addiction as a form of child maltreatment and of defining increasing numbers of children as in need of continuous out

of home care.

This policy-practice analysis relies on selected literature and on published studies and analyses

within some current and emerging contexts. Part of the analysis is informed an analysis of fifty

case files, exploring an available sample of expert assessment processes and classifications

associated with parental capacity and child-risk need—where parental capacity has been

repeatedly compromised by substance use, abuse and addictions. The analysis applied pre-

determined broad child-risk-need-harm dimensions, expanded upon within the context of

interpretations arising from the case content and findings from the literature, to enable

formulation of conclusions regarding how some drug effects, substance use and abuse, and/or

drug using lifestyle, interact with parental capacity and child risk-need-harm.

1 Statement of a young male who found himself “doing better” in continuous care and a 24/7 alternative living

arrangement. Quotes have been modified slightly and cases have been merged in order to ensure childrens’ voices

are heard and identifying information is not disclosed.

Forum on Public Policy

2

The context of child maltreatment associated with addictions-compromised parenting 2

Since the early 1900’s social workers and cognate disciplines responsible for the protection of

children have been concerned with the impact of parental substance use and abuse: on the safety,

well being and development of children and youth; on personal and social functioning of

parent[s]; as well as on the social functioning of the family (Richmond, 1917). Of note by the

1960’s were the findings that, even when the alcoholic parent became sober, children reported

their experiences of parental and family problems and risks had not changed significantly and

had sometimes become worse (Cork, 1969, 53-56). By the 1970’s treatment policies, programs

and practices expanded to enable family therapy supports for children of alcoholics (Aubertin

and Berlinguet, 1971; Bepko, 2002).

Following from Cork (1969), by the 1980’s, those writing from an adult children of

alcoholics perspective often emphasized the long term developmental and transgenerational

damage of being raised by a parent or parents who had problems with substance abuse; family,

group and self-help supports were offered for some children (Woititz, 1990). Some addictions-

related abuse, neglect and developmental damage was sufficiently serious that by the 1990’s it

was argued that parental alcoholism and/or drug addiction, justifiably, could be judged as being a

form of child maltreatment (Briere, 1992; Covey, 2007: 142). As well, some professionals and

courts have made a best interest case that repeated patterns of addicted mothers, putting unborn

and newborn children at risk (and causing predictable developmental damage, Chapman, Tarter,

Kirisci, and Cornelius, 2007) should result in children being apprehended at birth. The counter

point is typically advocacy for the mothers and accounting for child risk in terms of structural

and situational factors that contribute to the mothers’ addiction risks, versus assuming a primary

focus on individual parental responsibility and child-centeredness. This author has revisited the

issue of repeated parental relapse to substance use, abuse and/or addictions (after personalized,

social and economic supports have been offered) as posing sufficient risk and harm, as well as a

serious violation of the rights of children to have basic needs met, and concluded that child-

centered assessments may be more and more justified in defining substance addictions-

compromised parenting as a form of child maltreatment 3 —independent of any additional

compounding risks and harm with respect to sexual, physical, or emotional abuse and

exploitation. 4

While family support and preservation have been themes of child and family practice

since the early 1900’s, and while there was a major emphasis in the 1980’s and 1990’s on family

preservation as being in a child’s best interest, largely based on the impacts of parent-child-

parent attachment and separation dynamics on child development (Daniel, Wassell and Gilligan,

2 The words addicted and addiction are hereafter applied to refer to substance use, abuse and/or life style

patterns consistent with a general addictions paradigm, rather than repeating the complete phrase in the text. 3 It is disturbing to note that DUI laws do not require officers to prove reckless driving but arguments that

children’s protection social workers must observe acts of endangerment associated with parental addiction may be

put forward (Covey, 2007,140). 4 The author notes that intervention with women who have an FASD child is critical because of the likelihood

that “successive children with FASD demonstrate even more dramatic effects”. For a comprehensive analysis of

policy and program issues regarding substance use and abuse during pregnancy see: Basford, Thorpe and Williams

(2005)

Forum on Public Policy

3

1999), there was also a recognition that a threshold would be reached where the family

preservation goal could no longer be justified as being in the best interest of the child. Within the

context of a preference for family preservation, Steinhauer (1991) proposed applying a principle

in child placement decisions of “least harm”, but concluded that the family preservation goal

may have to be displaced by apprehension, protection, and permanency based on significant

known and expected risks and harm. Others have contributed to overcoming attachment

difficulties and risks after continuous care has had to be recommended (Archer and Hughes,

2003).

Under conditions where parental use, abuse and/or addiction to substances, and/or related

life-styles, create or exacerbate continued risk and harm, and are associated with a significant

violation of the child’s rights and related unmet needs, policy, program and practice bias in favor

of family preservation, must be challenged. Unfortunately, within the context of repeated and

continued addictions-compromised parenting, the best interest with the least harm, and the most

developmental benefit, for increasing numbers of children, is permanent out of home care—

sometimes with no contact with birth parents. In the current context, the realities of children’s

services is that child protection social workers often do not have a choice other than out of home

care, with more continuous and permanent placements being needed. From a policy-program

point of view protection and least harm options are becoming increasingly limited to placing

children—by design or default. (see for example, Barnard, 2007: 157 or Srikanthan, 2005). 5

Initially, this analysis takes a standpoint that minimizes attention to additional direct

concerns of child harm due to assessed or suspected physical abuse, sexual abuse, emotional

abuse or exploitation. As well, the recommendation to differentially assess addictions-

compromised parenting is put forward to promote child-centered evaluation of parenting

capacity that critically analyses the risks and impacts for the child that can be associated with

parent capacity concerns related to use, abuse, addiction and “addiction” lifestyle, relatively

independent of issues of poverty. Preventable poverty related to substance abuse, but not related

to non-addiction disability, illness, or parenting deficits in care and parenting knowledge or

skills, is among the main contributors to risk and harm. Within the context of this analysis, the

threshold for risk, harm and clinical significance is based on the standpoint of what the parent’s

substance use, abuse, addictions and related lifestyle imply if assessments focus on assistance

and special care needs and rights of children under the age of eighteen years (United Nations,

1989), versus parental rights.6

As one researcher concluded:

“It is perhaps ironic that in all the crowded attention on the parent with the drug

problem…there was very little discussion among the practitioners of the

5 While the author favors attempting family preservation in many instances, one study (Pidcock and Fischer,

1998)which hypothesized that children of parents in recovery would evidence significantly less addictive behavior

than those whose parents were not in recovery, failed to support the hypothesis. Also, addictions-compromised

mothers involved with children’s protection were found to be more likely to exhibit unsatisfactory discharges from

treatment than were substance abusing mothers not involved with children’s services (Hohman, Shillington and

Baxter, 2003). 6 Notwithstanding the exclusion of physical abuse, sexual abuse, emotional abuse and child exploitation from

the main thrust of the author’s analysis, it is recognized that all of these added risk-harm factors have been found to

be more highly correlated with, and exacerbated by, parental addictions and related lifestyles (Briere, 1992; Covey,

2007: 150; Kroll and Taylor, 2003).

Forum on Public Policy

4

children’s perspectives. For the most part their needs were assumed, and

considered to be best met through supporting the parent. This might be an

explicable dynamic, especially where children are very young, but it creates a

dangerous invisibility and reinforces their vulnerability.” (Barnard, 2007, p.150.)

The position in this analysis is that parental assessments must become more child-centered and

the voices of children must assume primacy.

Professionals’ assumptions about child care and parenting knowledge and skills deficits

may be misapplied when parenting deficits are more associated with addictions-compromised

parenting. For example, it may not be uncommon to have addicted parents who have adequate

education, adequate resources and/or “good enough” knowledge and skills with respect to child

development and child risk-need. Child risk-need issues may not be significantly related to skills

and knowledge deficits and problems regarding ability for care and parenting, as they are, for

example, related to parental distraction and self-centered motivation -sometimes framed within

the context of narcissism associated with addictions (Flores, 2004; Forrest, 1994). Providing

parent training services may have little relevance and/or few impacts with respect to risk-harm

reduction, or improved well-being for the children of addictions-compromised parents.

The following addictions-compromised parent capacity assessment dimensions may increase

effectiveness in estimating child risks and needs:

 the relatively direct impacts of substance use and abuse on parenting and the parent-

child-parent relationship (e.g. the increased risks of parental aggression with some drug

use patterns);

 the impacts of substance using lifestyle on parenting and the parent-child-parent

relationship (e.g. the child having to self-protect from impaired strangers in her home);

 the impacts of parental narcissism that compromises child centered care and parenting

(e.g. parental expression of empathy in the interest of manipulating the child); addictions-

compromised attachment and bond (e.g. the child receiving repeated double-bind

messages such as, “I love you with my life, …. leave me alone.”);

 and parent-centered motivation displacing child centered motivated parenting and care

(e.g. an impaired parent playing an adult movie so he/she and the six year old child can

have some “quality time” watching a movie together at 1a.m.).

What is important is that parenting capacity issues, directly related to addictions-

compromised parenting, must be addressed; these are seldom developed and refined in

standardized child or parenting assessments. For example, in the case above, the parent

reported staying home with the child and watching movies; without more depth of

exploration and analysis, a social worker risks concluding that the parent was being

responsibly attentive, was reinforcing attachment and was adequately supervising the child.

This example reinforces the necessity for child-centered observations of children and risk,

including in interaction with addictions-compromised parents, including independent

interviews with the children, to whom addictions-compromised parents have access, or have

care and parenting responsibilities.

Forum on Public Policy

5

Current policies and practices that promote parent effectiveness training and parent

capacity building (e.g. Cipani, 1999), in case of addictions-compromised parenting, may be

trying to change the wrong dimensions of parenting capacity such as the less complex area of

parenting knowledge and skills. Parent training practices may actually exacerbate the problems

and risks for children. An example is the case where a parent is cued to children’s protection

expectations regarding meals and nutrition and then presents an “illusion of change” that appears

as compliance while not acting in the spirit of the child-centered interests. In some cases parents

purchased and stored quality nutrition, yet the children did not have regular meals or receive the

food with needed regularity. The food may even be found to be well organized for display when

a follow up protection assessment is undertaken (one clue is an abundance of out of date food).

Goal displacement was common with parents whose patterns of addiction continue. For example,

some parents did not reason that obtaining, organizing, placing on the table for possible

consumption, and displaying food, was not their primary change goal with respect to child care

and the demonstration of improved parent capacity.

As well, from a child-centered perspective, parent training might mean active parent

coaching (in real time interaction with their children) from a social worker or behavior

management specialist, in order to manage a child who is disruptive and defiant (two of the

patterns associated with children’s coping with a mentally ill or addicted parent). It should be

recognized, though, that from the child’s perspective the impact on him or her is that of blaming

the child for the parent’s failure in recovery; by default, the child is given the responsibility to

change his or her behaviour, while the parent may change nothing. In short, typical programs for

parent training, as applied to addictions-compromised parenting capacity, are often be

misapplied, at best, and may add to risk and harm, at worst.

In the experience of the author, assessing and changing the parent-child-parent

relationship in terms of care and parent capacity could require much more complex and extended

in vivo observation and therapy inputs, observing the real time care and parenting as part of an

in-depth biopsychosocial assessment, as well as undertaking parental and family therapy and

coaching in real time—much beyond behavior management training for child and parent. For

addiction-compromised parents observed in vivo 7 with their children, informed by some

independent direct observations and interviews of some of the children, risk control and harm

management, as well as demonstrating strengths in meeting the needs of the children, required

much effort and commitment by parents to change and sustain change. Unfortunately for the

children, half of the assessment observations were made under conditions where parental energy

was directed to substances and the related addiction life-styles. Some parents were so impaired

cognitively and behaviourally while being observed for assessment and services planning, that

alternate care givers had to assume child-care and parenting responsibilities during access. In the

experience of the author, confidence levels in the parenting capacity and child risk-need

7 In most cases the author and other professionals associated with the parent capacity assessments observed the

parent(s) with their children, and some children on their own, for eight to twenty hours over four to seven

observation periods. The professionals came to have more confidence in these observations and judgments of

problems, risks, harm, strengths and need, than they did from parent interviews in clinic, or from observing and

interviewing children in a “less natural” controlled clinical setting.

Forum on Public Policy

6

assessments were increased with multiple direct observations over eight or more hours -

preferably over two or more weeks.

Parent’s relative lack of sustained success, in parental education and/or counselling-

therapy programs, associated with repeated return to parental use of a current range of disabling

substances such as cocaine, “crack”, methamphetamine, oxycodones, and ecstacy, cannot give

justice, policy, program and practice professionals much confidence in the relative likelihood of

successful family preservation in the best interest of child safety, meeting childrens’ needs, and

supporting normative biopsychosocial development. Even when highly drug involved parents

claim, with conviction, that their love for their children is paramount, and when they

vociferously “contemplate” child-centered change and promise sustained motivation, and even

when they have been given repeated “last chances” by children’s protection services and/or the

justice system, the likelihood of relapse and return to child risk and harm, most often, is greater

than is the likelihood of them sustaining action in the best interest of the child. 8 After successive

broken promises and parental failures, the “forgotten children”, then more skeptical of their wish

for a “cured” parent, would not have much confidence in effective and sustained parental

change; as one twelve year old stated to the learned protection and justice professionals, whom

she believed had not protected her and her sister well: “So which last chance is the last chance; I

thought the last chance was the last chance.” Child-centered parenting capacity assessments

could make protection, continuous care and permanency plan thresholds more effective in

controlling risk, reducing harm, ameliorating impacts, meeting developmental needs and

increasing well-being of children. 9

For those social workers who are responsible for foster care and adoptions placements, a

policy, program and practice movement towards planning for more continuous out of home care,

as a permanent plan for children and youth, would likely result in much apprehension and fear. 10

For foster parents and for those adopting highly damaged children and youth, the feeling is often

one of being overwhelmed and wishing to do more. Such intense feelings are often associated

with professionals being aware that older children, children with developmental deficits (e.g.

FASD) due to personal and family history, and those with addicted parents, would be at high risk

in terms of both adoption failures and foster family failures. One the other hand, with more

resources put in place to control risks (e.g. professionally supervised parental access) or to

ameliorate harm (e.g. therapeutic foster care), fostering may provide care and parenting with

relatively helpful outcomes (Dozier and Rutter, 2008); similarly, financial and service-supported

adoptions, for children at high risk, may be relatively successful. For some children even

8 Learning and ability to transfer information from a drugged state to an undrugged state (“dissociation”,

McKim, 2007, 37) may impair parents’ abilities to transfer parent capacity learning from an undrugged state to a

drugged state and vice versa. 9 Social justice demands that the well-being of children must be framed in such a way that parent-centered

expectations for the child’s resilience, adaptation and coping do not become a compromising substitute for child-

centered well-being. 10

Some foster care social workers expressed concern about finding sufficient placements able to help children

who brought with them complex issues of addictions-compromised parenting - especially when the child defined the

parent as non-abusive. Some adoption social workers were concerned with the added complexities of finding

placements for children that were exposed to addictions-compromised parenting - especially when the child may

have ingested drugs or have been exposed to hazardous chemicals.

Forum on Public Policy

7

alternate semi-independent, or independent, supported living arrangements provide more hope,

less harm, and less risk than do further attempts at family preservation. In applying all of these

placement options, the author has come to have confidence in an integrated “therapeutic foster

care” or “therapeutically supported adoption” type of model.

The literature suggests that therapeutic foster care has beneficial results in the best

interest of the child, albeit while being more costly than traditional foster care (Crosson-Tower,

2008). In the author’s clinical experience, a less costly version of therapeutic foster care, also

becomes an option with children at additional risk due to life experiences with, care from, and

parenting from, substance using-abusing parents. 11

Specifically, part of service planning may put

supports in place for traditional foster care families, or traditional adoptive families, that fully

integrates long term individual and family therapy, some of which may be undertaken in the

home. The policy, program and practice case being made here is for therapeutically supported

foster care and adoptive placements with integrated foster parent/adoptive parent development,

timely support, psychosocial education and in vivo integrated therapy with foster parents and

adoptive parents coached in assuming some roles as “surrogate therapists”—thus helping to

maintain and enhance strengths and treatment effect. The less ideal option is alternate and semi-

independent living arrangements, with multiple child-youth care-givers providing age-stage

appropriate and continuous support. Integrated therapy for the child and professional coaching

for paraprofessional care givers may simulate a therapeutic foster care model.

Use, Misuse and Addiction—A Child-Centered Perspective

The risks and impacts of substance use, misuse and abuse, and the presence of hazardous

materials in living spaces, have serious implications for the safety and developmental needs of

children, the personal and social functioning of parents, as well as on the social functioning of

their families. The nature of the effects of some drugs and the addicted parent’s lifestyle may

increase risks for children and their families. For example, methamphetamine, cocaine and crack

cocaine use, and other stimulants such as amphetamine may be associated with irritability,

agitation and aggression,and antisocial behavior [McKim, 2007] as well as impaired parental

patience, which has posed additional risks for physical and emotional abuse [Barnard, 2007].

Heroin abuse and sedative-hypnotics misuse may be associated with impaired capacity for

parental alertness, attention and supervision, but may be followed by irritability; benzodiazapines

are associated with confusion. Ecstacy, the love drug (methylenedioxymethamphetamine) is

associated with intoxication, increased libido and enhanced sexual pleasure and eroticization

[McKim, 2007] and has put children at risk for exposure to explicit sex and eroticization or, at

worst, sex abuse and sexual exploitation (see for example Famularo, Kinscherff and Fenton,

1992). The risks of exposure to family violence are exacerbated in families where substance use

and abuse is a compounding factor (Potter-Efron, Potter-Efron and Carruth, 1990; Barnard,

2007). In short, each drug, as used in moderate and high levels, and as associated with tolerance,

11

The author distinguishes between care and parenting in that a parent may provide food, shelter, clothing and

personal care while not providing adequate supervision, direction, coaching, safety, and optimal age-stage controls.

As well, with addicted and mentally disordered parents it is important to differentially assess child care and

parenting activities that are acted out in the best interest of the parent - a narcissistic approach to parenting.

Forum on Public Policy

8

withdrawal, and dependence, presents its own risks vis a vis addictions-compromised personal

and social functioning—including parenting.

The distinction between use, misuse and abuse, or addiction to substances, most often

becomes moot when considering risks, impacts and children’s needs for care, parenting and

protection. Applying causal theories, such as parental disinhibition due to substance use and

abuse, or an expectation effect associated with drug effects (Walsh, MacMillan and Jamieson,

2003; Fromme, D’Amico and Katz, 1999), may help refine assessments, but do not mediate risks

and harm to the child. Without attending to risks posed by parents’ friends and acquaintances, a

parent might be on a relapse prevention program that supports what is defined as safe controlled

use, or may be on a harm reduction program that supports what is defined as use with some

known impacts, but with predictably less harm to the parent. The child-centered assessment issue

is that even low to moderate levels of substance use may contribute to child risks, harm, unmet

needs and developmental damage. For example, even two standard drinks of beverage alcohol

(King and Byars, 2004), let alone the single use of a drug like ecstacy, (Jansen and Theron,

2006) may disinhibit parental sexual behavior in the presence of a child; a predictable, imminent

and serious risk is premature sexualization and eroticization 12

A parent may put a child at risk

irrespective of the parent not consuming drugs while parenting; for example the child may

consume prescription or street drugs left within reach, or the child may be given a drug (often

non-prescribed prescription drugs) in the interest of the parents’ needs to control the child or to

induce somnolence, or the child may be exposed to other adults or youth who pose risks

associated with use and abuse of substances or related life-style issues. As well, a parent’s

behavior and cognitive functioning are most likely impacted by drug tolerance, emotional

dependence, “hangover” and/or withdrawal; chronic exposure to drug mediated parenting is

associated with risks, harm and developmental problems for the child. For the child, parental use,

moderate use, misuse, excessive use, dependence and addictions all present avoidable risks in

addictions-compromised parents.

The analysis below addresses issues associated with children’s protection cases, or cases

where children’s protection should have been notified, where there was a high level of parental

abuse of street drugs, prescription medications and/or alcohol, and associated lifestyle—with

some cases meeting criteria for dual, concurrent, or otherwise labeled as co-occurring mental

health and addiction problems - considered to be a high risk and difficult to treat with sustained

success (Centre for Addiction and Mental Health, 2001). Many parents meet criteria for being

alcohol or drug dependent (American Psychiatric Association (2000) and fit the patterns

associated with a general addictions paradigm (Doweiko, 2008); others fit concurrent or dual

disorder criteria (Kimberley and Osmond, 2003; Centre for Addiction and Mental Health, 2003).

12

The author distinguishes between premature adult range sexualized behaviour and actions, which may be

expressed by the child without having sexual feelings, sensations, or motives (e.g. when a child is forced to fondle

her brother for a porn movie), and premature eroticization, which involves the child having sexual feelings and

sensations, sometimes without ostensibly related sexual actions (e.g. observed in children who have observed adult

sex movies or live sex acts, at a young age). At another extreme, the author has observed expressions of deviant

sexual acts by children such as bestiality, possibly associated with exposure to adult videos, or the fusion of sex acts

and physical aggression, by children who have been directly exposed to sexual assault. Such cases have involved

addicted or co-morbid parents and/or surrogate care givers.

Forum on Public Policy

9

Either are likely to be high risk clinically, are not likely to sustain personal and child centered

change needed to ensure child safety, well being and normative range development.

Notwithstanding the above, from a child-centered perspective, high risk parent’s who are

now abstinent, parents who are using substances at low levels, parents who abuse, parents who

are addicted, or parents who live an addicted lifestyle, may all pose considerable risk and harm

for the child. Assuming that parental progress in control of substance use and abuse significantly

reduces risk and harm to the child, and/or results in parenting and care that is in the best interest

of the child, is a dangerous assumption. Current parental abstinence or low levels of use are not a

sufficient rational for returning children to parental care.

The likelihood is increasing that more children will need to be placed in continuous care,

with little hope of family preservation, is becoming a reality. Beyond the social costs, levels of

risk and personal and family difficulty are making costs of support, protection and care of great

concern. As well, the changing face of families involved with children’s protection, it appears,

include more persons with (or having had) adequate to significant education and resources—

often presenting children’s protection with new layers of legal and political complexity. 13

Assessing risks, needs and harm to children in an addictions context

Within the context of significant and repeated parental abuse of substances, the analysis below is

based on selected research and practice related literature and a review of a limited clinical

sample of cases in one service which has provided case consultation to children’s services and

expert opinion to the courts. Parenting capacity, correlated parenting assessment concerns and

exemplars of child-risk need issues are integrated into each child assessment dimension, thus

supporting a child centered and child relevant parenting assessment and plan. 14

The need to belong

The need to belong to someone or with someone who is a care giver typically does not appear on

a list of common human needs [although it is referred to in the United Nations Convention on the

Rights of the Child, including the right to a name.]. At times the need to belong is enmeshed

conceptually with cultural, ethnic, racial, familial and social identity, and personal identity. The

author is making the case that even when children have a sense of cultural, ethnic, familial and

social identity, they may lack a sense of where they belong and to whom they belong. Children

of high risk parents who have a high level of involvement with drugs and the substance abuse

lifestyle may be left with various extended family members, friends and neighbors, and have a

13

Even those parents who meet the minimal criteria for good enough parenting, but who repeatedly return to

repeated high risk, are not likely to sustain their motivation, attention and actions expected with good enough

parenting. Some children have reported that their parents “fooled the judge and the counsellors” for a few days, then

returned to drug parties within hours of “winning me back” in court. When a newborn half-brother was returned to a

drug involved mother, in the interest of mother-infant-mother bonding, the pre-teen, concerned for her new half-

brother said: “she couldn’t take care of us, what makes them think she can take care of him.” 14

The position taken in this analysis is that parent centered parenting capacity assessment criteria often

disadvantage the child(ren). For example, as part of a court order, an addicted parent may be assessed as needing a

parenting course; in many cases such courses teach knowledge and skills, often already possessed by the addicted

parent. The case plan for, or parental compliance in, completing a parent training program, would result in no

verifiable reduction or control in child risk or harm associated with addictions-compromised parenting.

Forum on Public Policy

10

sense that they belong to no one (e.g. A child was left with a neighbor who was a stranger and

the parent never returned to claim the child—a form of abandonment; other children have been

“forgotten” in shopping malls.).

Even when apprehended and placed, the child’s level of biopsychosocial difficulty may

be such that he/she must placed in 24/7 “alternate living arrangements” that do not model a

family care environment. In extreme cases children may be “sold”, sometimes before birth

(sometimes to pay for drugs) or given to others in informal “adoption” arrangements. The sense

of not belonging with, or to, a parent or care giver is associated with high insecurity, distrust of

adults and threats to attachment and bond and a stable and integrated identity. With high risk

addictions-compromised parents, children who do not have a sense of belonging may never have

this need met; their coping strategies may result in them being relatively independent, adultified,

and the “resilience poster child”, but efforts at family preservation, in these cases, may actually

exacerbate the risks and long term developmental damage. Repeated failures to protect may

contribute to premature school leaving and the child “running”.

In addition to the above, in addictions-compromised parent assessments, direct observations

have included parents:

 missing planned and agreed upon access with their child(ren);

 arranging to attend to adults and adult matters during access visits;

 expressing emotional and intended commitment and then not following through;

 playing in parallel activity with a child, when the child is trying to be interactive;

 competing with a child for success in play and/or social tasks;

 competing with the child for the attention of the parent supervisor-coach;

 showing up to access while being under the influence of substances and/or impaired, or

evidencing significant withdrawal symptoms;

 falling asleep during access with the child, often associated with addictions and life style

choices;

 evidencing very little bond with the child and avoiding the child’s attempts to bond.

Issues of physical, emotional or sexual abuse, maltreatment or exploitation, would compound

problems associated with the need to belong. A stable placement with adequate supports (e.g. an

in vivo therapeutic environment) may give the child a sense of belonging and a sense of

continuity as well as more secure structure in her/his life. 15

The need for security and safety

Independent of more general concerns with maltreatment, abuse, exploitation and neglect, while

it is not uncommon that children in need of protection experience insecurity and threats to safety,

the children of high risk substance abusers may experience a range of risks and harm that are

linked to the substance use-abuse and the substance abusing life-style (Covey, 2007; Peleg-Oren

and Teichman, 2006). One major problem is children who have been exposed to hazardous

15

As part of differential assessment, the social worker must consider the logical possibility that a parent’s

demonstrated efforts to give the child a sense of belonging may be associated with the child being a source of social

assistance income and/or exploitation income, that may be used to support parental addiction.

Forum on Public Policy

11

substances (chemicals of abuse) in the womb and at birth (Schmittroth, 1994)—with special risks

for those children experiencing drug effects at birth. Lack of parental attention, care and

supervision (Barnard, 2007; Hogan, 2007) can take on new meaning when parents are so

impaired that they do not know the whereabouts of their three year old, for four days. Physical

environmental threats such as “needles”, broken bottles, and drugs within reach, present clear

and imminent dangers. The child’s physical environments may pose a HAZMAT risk for

children and safety professionals (e.g. a “crystal meth” lab, see Swetlow, 2003). Additionally,

some drugs may compound the risk of physical violence against a child (e.g. “meth”; “coke”;

“Oxy’s”) (see for example Covey, 2007: 150) or risks of sexual maltreatment of a child (e.g.

ecstacy). Parents’ drug abusing peers may pose many child protection risks. The drug abusing

lifestyle may be associated with substances and relationships that expose the children to the

immediate threat of being in the presence of violence—let alone the know developmental harm

related to such exposure (Potter-Efron , Potter-Efron, and Carruth, B.,1990). With high risk

abusers, it is difficult to arrive at a level of confidence in parenting-care change that is child

relevant, that would be sustained and control risk.

An additional risk, by default, is that if a child improves in care, the courts may judge that

the improved stability and well being of the child is sufficient to give the parent “another

chance”. Improvements in a child’s mood or actions in care, or even in the home with 24/7

parent coaching, often have no association with related improvements in the parent with respect

to care, parenting, risk reduction or harm amelioration. Besides giving parents multiple “last”

chances, children may cue the social workers that the parent has not changed and that risks are

still present. 16

Cases and addictions-compromised parenting assessments reviewed, and the literature

suggest giving attention to:

 parental impairment, child centered attention and child supervision by the parent, even

under conditions where the parent-child contact is being supervised by another adult;

 parental agitation, irritability, threat and/or verbal or physical aggression towards a child,

even while being observed;

 parents giving the child an excess of negative attention or punishment based on parental

needs, paradoxically at times to impress the parent coach or access supervisor;

 parental sexualization or eroticization of some aspect of activities with the child(ren),

sometimes related to active drug use and impairment, independent of other valid concerns

about sexual abuse or sexual exploitation;

 parents “accidentally” giving unsafe persons access to the child during the child’s access

visit with the parent -even an adult who may have access prohibited;

 parents significantly misjudging the safety of the environment or the level of hazard to

which the child is exposed, even while being observed;

 parents exposing the child to physical or verbal violence in adult to adult exchanges,

during access or parental supervision;

16

In one case a thirteen year old child, doing well in foster care, requested to be present at the decision

conference to “prove” that her parent had not “really changed”; the parent failed the child’s test and the child got her

wish of having her and her sister remain in care.

Forum on Public Policy

12

 parents not complying with children’s protection directions (in case plans or in real time

directives) regarding physical, emotional and developmental safety, security and well

being, even when the parent has supervised custody. 17

One failure in judicial decision rules for a child protection service plan, that is not in the

child’s best interest, is using the child’s progress as a basis to, by default, risk his or her

regression in the interest of meeting the parents’ needs for access, under conditions where the

parent has not demonstrated adequate child-centered and safety-security relevant progress.

The need for stability and continuity

Children with high risk parents often experience unstable life experiences and significant

breaches of continuity associated with substance abuse. One source of rapid and dramatic

destabilization is when the child’s parent(s) are sent to prison (e.g. on drug related offenses).

(See for example, Srikanthan, 2005) More common instability is associated with long periods in

extended and repeated temporary care while a parent is “on a binge”, in withdrawal, or in

“rehab”. Terms of parental access may cause further instability and discontinuity when there is a

conflict associated with contact and access, or where the parent defaults on a promised “visit.”

One of the decision rules in many protection jurisdictions is to place a child with an

approved extended family member or known family friend, as opposed to in a stranger foster

home. Relative foster care may reinforce some of the risk dynamics such as permitting a risky

parent to have unauthorized and unsupervised access. By the time some children are offered

stranger foster care, their biopsychosocial problems are so pervasive (e.g. FASD compounded

with PTSD) that risks of foster care failure are increased and risks of adoptive placement failure

are increased. There is some evidence that a therapeutic foster care plan, or a therapeutically

supported adoption, may enable more amelioration of impact, but such practices may not be

supported, broadly and on a sufficiently continuous basis, in policies and programs, as they

imply additional costs for a system that is largely reactive.

Related addictions-compromised parenting assessments observed suggest giving attention

to:

 parent functional capacity to sustain stable actions and patterns associated with optimal

child care and child centered parenting; 18

 parent functional capacity for good judgement and actions to create child-centered

stability and continuity that is in the child’s best interest, as opposed to a narcissistic

agenda by the parent;

 parent risks in explicitly or surreptitiously misbehaving or destabilizing out of home

placements, or the daycare or school environment;

17

One differential assessment dynamic that is important to consider is a parent making parentified demands of

an age-stage inappropriate child, such as sending the nine year old to get the baby some milk at 1 a.m., based on

parental reasoning that the parentified child has proved able in the past. The link between parentification and

addiction and mental health-compromised parenting is strong. 18

One differential assessment consideration is in situations where the parent is creating stability and security

because the parent needs the child in her his life for social support and/or economic gain.

Forum on Public Policy

13

 not succumbing to parent agendas in breaking continuity for the child when out of home

placements are so child centered that they do not permit the birth parent much

opportunity for manipulation and control masquerading as “inclusive care.”

One case on which the author consulted was particularly dramatic. The child had stabilized

and progressed and in foster care, benefitting from continuous care from the ages six to eight at

the time of observation. The foster mother had the task of monitoring telephone contact between

the child and either birth parent. The telephone contact was encouraged, even when the child was

“not in the mood”, theoretically in the interest of attachment and bond, identity formation and

family inclusion. After one such telephone contact the child became very unstable—emotionally

and behaviourally. The foster mother was confused because she had heard nothing in the

telephone exchange that would make her suspicious. What was discovered in assessment was

that the parent had strategically targeted the foster home for disruption, likely hoping to get the

child to declare that she wished to return to her birth home. It appeared that the birth parent

strategically “caused” the destabilization by telling the child that he was petting a family pet—

the named pet had died years earlier. The foster parent was guided in taking ameliorative and

supportive action that would reinforce treatment effect for the child (a modified treatment foster

care model).

In short, in the face of repeated addictions-compromised parenting, the child’s need for

stability and continuity in a child-centered manner must take presidence over the parent’s need to

continue as parent.

The need for attachment and bond

The assumption made by most children’s protection, justice, addictions and mental health

professionals is that one of the foundations of healthy and normative biopsychosocial

development is an adequate attachment and bond to serve the mental health and developmental

needs of the child (Davies, 2004). There is considerable indication that parents with addiction

and mental health problems have deficits in enabling an infant or young child to attach and bond

sufficiently to meet the developmental needs of the child (Flores, 2004). When parents are

heavily into substance use and abuse and/or an addictions lifestyle, there is likely very little

energy put into enabling and retaining healthy attachment and bond that is child centered. At

later stages of the parents’ development of dependence and addictions, often interacting with the

parentification of the child, there may be an unhealthy trauma bond that is developed between

the parent and the child. The children need to have a healthy social bond supported, hopefully

one that has sufficient continuity to enable more normative development.

In considering parent capacity, assessments should examine the following. Some children

report a double bind message from the parent that is reflected in the following depiction:

“Mom/Dad wants to be closer to you; go away and stop bothering me”. In observing access, care

and parenting it is important to look for indications that the parent has problems with attachment

and with enabling the child to attach and sustain attachment. In assessments it is important to

distinguish those times when a parent is enabling attachment because a child needs a social bond,

care, security, versus the narcissistic counterpoint (Forrest, 1994) that the parent needs the

Forum on Public Policy

14

feeling of bond with her/his child and expects the child to be there for him or her. The risk of

significant developmental problems, including reactive attachment disorder, for the children of

high risk parents, is evident in some of the patterns of attachment, detachment or failure to attach

that are observed and reported. There is some evidence that attachment problems may be

overcome through enabling the child to attach to an alternate effective caregiver such as a foster

parent (Howes, 1999). The position of this author is that therapeutically integrated foster care or

supported adoption increases the chance of the child achieving and sustaining more optimal

growth and development, including attachment - with due consideration to the child’s potential. 19

Need for positive and instructive attention and affection

There are indications that children respond to parental direction when balanced with affection

and positive attention (Suchman, Rounsaville, DeCoste and Luthar, 2007). Children brought into

care often experience much negative attention and directives (coaching); parenting may not be

associated with child-centered affection. It is not uncommon for the addicted parent, as observed

in assessments, to express or look for affection when it is the parent needs such expression.

Associated with the issues of the quality of attention and affection, the high risk parent

often has pervasive problems with respect to self-control and then complains that they can’t

parent, as expected by children’s protection, because their child is “out of control”, “never

cooperates” and “was always that way”. The parent then feels vindicated (often supported by

default in court decisions) when his/her child is placed in a youth corrections facility or is

referred to a children’s mental health center 20

. Addicted parents, often, have much first-hand

experience with social exchange based relationships and may barter affection and positive

attention needed by their child, on a conditional basis. Foster parents, adoptive parents and

therapists, who are trying to successful integrate the child into a more promising social unit,

often must address issues such as: instructive attention being defined as negative attention and

the child wishing to “escape” structure and control; the child not knowing how to received

positive attention and affection and to process their meanings in a healthy fashion; the child

interpreting being spoken to by an adult as an indication that the child has failed in some fashion.

In short, it is important to understand care and parenting based on the child’s experience

in life as lived, not life as reported by the parent. With younger children, direct observation of

them and interacting with the child in play may be a source of hypotheses regarding the quality

19

In differential assessment, aside from the issues of trauma bond, it is important to the assessor to be sensitive

to illusions of healthy attachment based on a parent’s actions to get the child to meet the parent’s need for bond. One

marker that the author has found useful in assessment, is when the parent becomes angry with the child because

mom/dad “needs a hug/kiss/cuddle”, and the child has not responded or complied; yet when the child is trying to

attach, based on child-centered initiative, the parent may be unattentive, unaware or rejecting - sometimes

compounded by substance induced impairment. Another dimension that is important to differentiate is parental use

of what this author has labeled “strategic empathy” for parent centered purposes, with a child who needs positive

attention. 20

This author has seen cases where a parent has insisted that her/his child see one mental health professional

after another until a diagnosis is discovered and confirmed, not within the sense of Munchausen’s Syndrome, but in

the sense that if the child has a now “proven” mental disorder, then a thesis of parental deficits may be replace with

the cognitive script that: “I knew this all along; I am a good parent with an impossible child”.

Forum on Public Policy

15

of parental attention the child has experienced. Within this context, the child’s interpretation of

the quality and quantity of parental attention must be factored into the assessments.

Need for freedom from preventable maltreatment and trauma

While the author has focussed on impacts of parental addictions independent of other forms of

child maltreatment, abuse, exploitation and related trauma, the literature and research has many

examples of findings that parental use and abuse of substances, addictions and related life styles

are associated with a child’s increased risk of death, sex abuse, physical abuse, neglect and

various levels of exploitation from parentification to sexual exploitation. Children may be faced

with a double disadvantage and sets of risks in that they experience the direct effects of parental

addictions as well as associated risks of other forms of maltreatment (see for example Wolock

and Magura, 1996). While family preservation theory was built largely on the assumption that

neglected children would have less harm if they did not go into continuous care and thus

benefitted from family preservation plans, children who are repeatedly abused and/or put at

repeated risk for maltreatment, may be sacrificed on the alter of family preservation.

Need to not be increasingly resilient in the interest of parents

Application of resilience theory is often paradoxical in that children and youth, who have

suffered maltreatment and developmental damage associated with a life with addictions-

compromised parenting, often demonstrate much ability to adjust, adapt and cope (Ungar, 2005).

Their strengths are often framed being associated with resilience. Yet, in their silent awareness,

or shared thoughts in confidence with counselors, many do not define themselves as resilient;

they define themselves as fragile. The metaphor used by some is that of the tough outer shell but

with anxiety provoking cracks. The paradox is that the children’s apparent strength may be used

by “the system” to justify giving their parents yet another chance. When the child’s resilience

finally fails and the child ends up in mental health services, addictions services or youth

detention, accounts seldom point to the system’s responsibility or to parental responsibility but to

the child (now a youth) taking responsibility for his/her actions, attitudes and feelings. As one

child queried, “How come I am responsible for what I did but mom and dad were never

responsible for what they did to me, it was always blamed on the booze or the drugs”. When

another youth (aged 14) was complimented by professionals on her strength and resilience, the

wise teen retorted, “My resilience runs thin”. In assessments it is important to explore the child’s

paradoxical perspective on strengths and resilience as the voice of the child often expresses

nuances of anxiety and fragility that imply risk, need and harm that requires amelioration. In

short, the great strength of resilience may be experienced as a troubling weakness and be self-

defined, by the child, as a fraudulent presentation of self.

Conclusion

As parental use, abuse, addictions and substance abuse lifestyles become more intractable, and

have more repeated and lasting damage on children and youth, society must come to define

parental addictions that are chronic and/or repeated as a form of child maltreatment. As parenting

capacity is increasingly compromised by parental addictions and/or related life-style, and as

Forum on Public Policy

16

developmental risks increase, addictions and children’s services, as well as the justice, education

and mental health systems, are faced with the growing reality of parents defaulting on care and

parenting responsibilities. Child centered risk-need and parenting assessments, which include

significant in vivo observations, must address how the effects of the chemicals themselves,

addictions-compromised parenting and and/ or 21

addictions lifestyle, independent of any other

child maltreatment and developmental issues, should be addressed in policy, program and

practices in the best interest of children 22

.

Variations of in vivo therapeutic foster care, even

within 24/7 alternate care or adoptions, present one avenue for amelioration of harm, control of

risk, and support for more normative child-youth development. As one male child in an

alternative living arrangement offered: “I tried it again back there. I’m doing better with my four

mothers; they all take care of me” . But, his statement is not as poignant as the plea of a six year

old in a letter to the judge:

“Dear Judge, please don’t send me and my sister back to mommy and daddy.

They can fool you. They don’t change.”

References

American Psychiatric Association (2000). The diagnostic and statistical manual of mental disorders - text

revised (4 th

Ed.). Washington, D.C.: Author.

Archer, C. and Hughes, D.A. (2003). Trauma, attachment and family permanence. London, U.K.: Jessica

Kingsley Publishers.

Aubertin, C. and Berlinguet, M. (1971). L’alcoholisme, la famille et intervention clinique en service

social. Quebec, Canada: Publie sur les auspices de la federation des services sociaux a la famille

due Quebec.

Barnard, M. (2007). Drug addiction and families. London, U.K.: Jessica Kingsley Publishers.

Basford, D. L., Thorpe, K., and Williams, R. (2005). State of the evidence: fetal alcohol spectrum

disorder (FASD) prevention, final report. Lethbridge, Alberta, Canada: University of Lethbridge,

Alberta Centre for Child, Family and Community Research.

Bepko, C. (2002). The responsibility trap: a blueprint for treating the alcoholic family. Second

Edition. New York: Simon & Schuster.

Briere, J. N. (1992). Child abuse trauma: theory and treatment of lasting effects. Newbury Park,

California: Sage Publications.

21

The reason “and/or” is used in relation to life-style assessment is that even if a parent is in a “sober” period,

life as lived on a daily basis still may exhibit parental lifestyle patterns, some associated with “the drug scene”, that

pose continued and unacceptable risks for children and youth. 22

One significant developmental issue is how addiction compromised parenting impacts the child’s

participation in and performance in day care, school and, later, part-time employment. One need category that could

be further developed is the child’s need for support for optimal growth and development within the context of

optimizing her/ his potential. This frame for assessment would remove the challenge of having unreasonable parent

capacity expectations of addiction-compromised parents, yet attend to the developmental needs of the child. See for

example Suchman et al. 2007. For a summary of issues associated with parental problems and disorders, parenting

capacity and children’s needs see Cleaver, Unell and Aldgate, 1999)

Forum on Public Policy

17

Brown, J. A. and Hohman, M. (2006). The impact of methamphetamine use on parenting. In

Ashenberg Straussner, S. L. and Huff Fewell, C. Impact of substance abuse on children

and families: research and practice implications. New York: The Haworth Press, 63-88.

Centre for Addiction and Mental Health (2001). Best practices: Concurrent mental health and

substance use disorders. Ottawa, Canada: Health Canada.

Chapman, K., Tarter, R.E., Kirisci, L. and Cornelius, M.D. (2007). Childhood neurobehaviour

disinhibition amplifies the risk of substance use disorder: interaction of parental history

and prenatal alcohol exposure. Journal of Developmental & Behavioural Pediatrics, 28

(3), 219-224.

Cipani, E. (1999). Helping parents help their kids: a clinical guide. Philadeplphia, PA:

Brunner/Mazel.

Cleaver, H., Unell, I. and Aldgate, J. (1999). Children’s needs - parenting capacity: The impact

of parental mental illness, problem alcohol and drug use, and domestic violence on

children’s development. London, U.K.: Her Majesty’s Stationary Office.

Cork, R. M. (1969). The forgotten children. Toronto, Ontario: Alcoholism & Drug Addiction

Research Foundation.

Covey, H. C. (2007). Child welfare and methamphetamine. In H. C. Covey, The

methamphetamine crisis. Westport, CT: Praeger Publishers, 137-159.

Crosson-Tower, C. (2008). Understanding child abuse and neglect, seventh edition. Boston:

Allyn and Bacon.

Daniel, B., Wassell, S. and Gilligan, R. (1999). Child development for child care and protection

workers. London, U.K.: Jessica Kingsley Publishers.

Davies, D. (2004). Child development: a practitioner’s guide, second edition. New York: The

Guilford Press.

Doweiko, H.E. (2008). Concepts of chemical dependency, sixth edition. Florence, Kentucky:

Cengage Learning Inc. (Wadsworth Publishing).

Dozier, M. and Rutter, M. (2008). Challenges to development of attachment relationships faced

by young children in foster and adoptive care. In J. Cassidy and

P. R. Shaver, Handbook of attachment: theory, research and clinical applications, second edition.

New York: The Guilford Press.

Famularo, R., Kinscherff, R. and Fenton, T. (1992). Parental substance abuse and the nature of

child maltreatment. Child Abuse & Neglect, 16, (4), 475-483.

Flores, P. J. (2004). Addiction as an attachment disorder. New York: Jason Aronson Publishers.

Forrest, G. G. (1994). Alcoholism, narcissism and psychopathology. New York: Jason Aronson

Publishers.

Fromme, K., D’Amico, E. J. and Katz, E.C. (1999). Intoxicated sexual risk taking: an expectancy

or cognitive impairment explanation? Journal of Studies on Alcohol, 60 (1), 54-63.

Hogan, D. M. (2007). The impact of opiate dependence on parenting processes: contextual,

physiological and psychological factors. Addictions Research and Theory, 15 (6), 617-

635.

Hohman, M. M., Shillington, A. M., and Baxter, H.G. (2003). A comparison of pregnant women

presenting for alcohol and other drug treatment by CPS status. Child Abuse & Neglect,

27 (3), 303-317.

Howes, C. (1999). Attachment relationships in the context of multiple caregivers. In J. Cassidy

and P. R. Shaver, Handbook of attachment: theory, research and clinical applications.

New York: The Guilford Press, 671-687.

Forum on Public Policy

18

Jansen, K. L. and Theron, L. (2006). Ecstasy (MDMA), methamphetamine, and date rape (drug-

facilitated sexual assault): a consideration of the issues. Journal of Psychoactive Drugs,

38 (1), 1-12.

Kimberley, M. D. and Osmond, M. L. (2003). Concurrent disorders and social work intervention.

In Csiernik, R. and Rowe, W.S. (Eds.). Responding to the oppression of

addiction:Canadian social work perspectives. Toronto, Canada: Canadian Scholars’ Press

Inc., 227-248.

King, A. C. and Byars, J.A. (2004). Alcohol-induced performance impairment in heavy episodic

and light social drinkers. Journal of Studies on Alcohol, 65 (1), 27-36.

Kroll, B. and Taylor, A. (2003). Parental substance misuse and child welfare. London, U.K.:

Jessica Kingsley Publishers.

McKim, W. (2007). Drugs and behaviour: an introduction to behavioural pharmacology, sixth

edition. Upper Saddle River, New Jersey: Prentice Hall.

Peleg-Oren, N. and Teichman, Meir (2006). Young children of parents with substance use

disorders: a review of the literature and implications for social work practice. In

Ashenberg Straussner, S. L. and Huff Fewell, C., (eds.) (2006).

Impact of substance abuse on children and families: research and practice implications. New

York: Haworth Press, 49-61.

Pidcock, B. W. and Fischer, J. L. (1998). Parental recovery as a moderating variable of adult

offspring problematic behaviours. Alcoholism Treatment Quarterly, 16 (4), 45-57.

Potter-Efron, R.T., Potter-Efron, P.S. and Carruth, B. (1990). Aggression, family violence and

chemical dependency. Florence, Kentuky: Taylor Francis Group.

Richmond, M. E. (1917/1944). Social diagnosis. New York: The Russell Sage Foundation.

Schmittroth, L. (Ed.) (1994). Statistical record of children. Detroit: Gale Research.

Srikanthan, T. (August 22, 2005). Orphaned by pot. From [email protected].

Steinhauer, P. D. (1991). The least detrimental alternative: a systematic guide to case planning

and decision making for children in care. Toronto, Canada: The University of Toronto

Press.

Suchman, N. E., Rounsaville, B., DeCoste, C. and Luthar, S. (2007). Parental control, parental

warmth, and psychosocial adjustment in a sample of substance-abusing mothers and their

school-aged and adolescent children. Journal of Substance Abuse Treatment, 32 (1), 1-

10.

Swetlow, K. (2003). Children at clandestine methamphetamine labs: helping meth’s youngest

victims. Office for Victims of Crime, Bulletin. June, 2003.

www.ojp.usdoj.gov/ovc/publications/bulletin///children/197590.pdf [accessed 08-02-01]

Ungar, M. (2005). Pathways to resilience among children in Child Welfare, Corrections, Mental

Health and Educational Settings: Navigation and negotiation. Child and Youth Care

Forum, 34, 6, 423-444.

United Nations (1989). Convention on the rights of the child. New York: The Office of the High

Commissioner on Human Rights. www. Unhchr.ch/html/ menu3/b/k2/crc.htm [accessed

08-02-01]

Walsh, C., MacMillan, H. L. and Jamieson, E. (2003). The relationship between parental

substance abuse and child maltreatment: findings from the Ontario Health Supplement.

Child Abuse & Neglect, 27, 1409-1425.

Woititz, J. G. (1990). Adult children of alcoholics: expanded edition. Deerfield Beach, Florida:

Health Communications.

Wolock, I. and Magura, S. (1996). Parental substance abuse as a predictor of child maltreatment,

child abuse and neglect re-reports. Child Abuse & Neglect, 20, 1183-1193.

Forum on Public Policy

19

The author wishes to acknowledge the contributions of Louise Osmond, M.S.W., RSW and Meghan Hillier, R.A. in

the preparation of this paper.

Published by the Forum on Public Policy

Copyright © The Forum on Public Policy. All Rights Reserved. 2009.