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AHCPR Archived reports, Put Prevention Into Practice and Minnesota Health Technology Advisory Committee SAMHSA/CSAT Treatment Improvement Protocols

36. TIP 36: Substance Abuse Treatment for Persons with Child Abuse and Neglect Issues

Title Page

Substance Abuse Treatment for Persons With Child Abuse and Neglect Issues

Treatment Improvement Protocol (TIP) Series 36

Judy Howard, M.D.

Consensus Panel Chair

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

Rockwall II, 5600 Fishers Lane

Rockville, MD 20857

DHHS Publication No. (SMA) 00-3357

Printed 2000

Link to the National Guideline Clearinghousetop link

Disclaimer

This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. All material appearing in this volume except that taken directly from copyrighted sources is in the public domain and may be reproduced or copied without permission from the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT) or the authors. Citation of the source is appreciated.

This publication was written under contract number 270-95-0013 with The CDM Group, Inc. (CDM). Sandra Clunies, M.S., I.C.A.D.C., served as the CSAT government project officer. Rose M. Urban, L.C.S.W., J.D., C.C.A.S., served as the CDM TIPs project director. Other CDM TIPs personnel included Raquel Ingraham, M.S., project manager; Jonathan Max Gilbert, M.A., managing editor; Cara Smith, production editor; Kurt S. Olsson, former editor/writer; Paul Seaman, former acting editor; Y-Lang Nguyen, former production editor; and MaryLou Leonard, former project manager. Special thanks go to consulting writers Tracy Simpson, Ph.D., and Christine Courtois, Ph.D., for their considerable contributions to this document.

The opinions expressed herein are the views of the Consensus Panel members and do not reflect the official position of CSAT, SAMHSA, or the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT, SAMHSA, or DHHS for these opinions or for particular instruments or software that may be described in this document is intended or should be inferred. The guidelines proffered in this document should not be considered as substitutes for individualized client care and treatment decisions.top link

What Is a TIP?

Treatment Improvement Protocols (TIPs) are best practice guidelines for the treatment of substance abuse, provided as a service of the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (CSAT). CSAT's Office of Evaluation, Scientific Analysis and Synthesis draws on the experience and knowledge of clinical, research, and administrative experts to produce the TIPs, which are distributed to a growing number of facilities and individuals across the country. The audience for the TIPs is expanding beyond public and private substance abuse treatment facilities as alcoholism and other substance abuse disorders are increasingly recognized as major problems.

The TIPs Editorial Advisory Board, a distinguished group of substance abuse experts and professionals in such related fields as primary care, mental health, and social services, works with the State Alcohol and Other Drug Abuse Directors to generate topics for the TIPs based on the field's current needs for information and guidance.

After selecting a topic, CSAT invites staff from pertinent Federal agencies and national organizations to a Resource Panel that recommends specific areas of focus as well as resources that should be considered in developing the content of the TIP. Then recommendations are communicated to a Consensus Panel composed of non-Federal experts on the topic who have been nominated by their peers. This Panel participates in a series of discussions; the information and recommendations on which they reach consensus form the foundation of the TIP. The members of each Consensus Panel represent substance abuse treatment programs, hospitals, community health centers, counseling programs, criminal justice and child welfare agencies, and private practitioners. A Panel Chair (or Co-Chairs) ensures that the guidelines mirror the results of the group's collaboration.

A large and diverse group of experts closely reviews the draft document. Once the changes recommended by these field reviewers have been incorporated, the TIP is prepared for publication, in print and online. The TIPs can be accessed via the Internet on the National Library of Medicine's home page at the URL: http://text.nlm.nih.gov. The move to electronic media also means that the TIPs can be updated more easily so they continue to provide the field with state-of-the-art information.

Although each TIP strives to include an evidence base for the practices it recommends, CSAT recognizes that the field of substance abuse treatment is evolving and that research frequently lags behind the innovations pioneered in the field. A major goal of each TIP is to convey "front line" information quickly but responsibly. For this reason, recommendations proffered in the TIP are attributed to either Panelists' clinical experience or the literature. If there is research to support a particular approach, citations are provided.

This TIP, Substance Abuse Treatment for Persons With Child Abuse and Neglect Issues, examines treatment issues for both adult survivors of child abuse or neglect and adults in treatment who may be abusing or neglecting their own children.

Chapters 1 through 3 focus primarily on adult survivors of child abuse and neglect. Chapter 1 defines child abuse and neglect, provides rates of child abuse and neglect both in the general population and among those in substance abuse treatment, and reviews the literature on links between childhood abuse and subsequent substance abuse. Chapter 2 describes screening and assessment tools that can be used to determine whether a client has a history of childhood abuse or neglect; Chapter 3 presents guidelines on treating clients with histories of child abuse or neglect and referring them to mental health care treatment when necessary. Chapter 4 discusses the personal issues counselors may encounter (e.g., countertransference) when working with clients with histories of abuse or neglect and offers suggestions for addressing them. In Chapters 5 and 6, the focus shifts to adults in treatment who may be abusing or neglecting their own children. Chapter 5 shows how alcohol and drug counselors can identify whether their clients are at risk of or are currently abusing or neglecting their children. It discusses what alcohol and drug counselors can do to break the cycle of child abuse and neglect, including how to work with child protective service agencies within the child welfare system. Chapter 6 is an overview of the legal issues that counselors should be aware of as mandated reporters. The TIP concludes with an overview in Chapter 7 of continuing and emerging trends, such as fast-track adoption and welfare reform, that counselors will need to follow in the coming years.

Other TIPs may be ordered by contacting SAMHSA's National Clearinghouse for Alcohol and Drug Information (NCADI), (800) 729-6686 or (301) 468-2600; TDD (for hearing impaired), (800) 487-4889.top link

Editorial Advisory Board


Karen Allen, Ph.D., R.N., C.A.R.N.
Professor and Chair
Department of Nursing
Andrews University
Berrien Springs, Michigan

Richard L. Brown, M.D., M.P.H.
Associate Professor
Department of Family Medicine
University of Wisconsin School of Medicine
Madison, Wisconsin

Dorynne Czechowicz, M.D.
Associate Director
Medical/Professional Affairs
Treatment Research Branch
Division of Clinical and Services Research
National Institute on Drug Abuse
Rockville, Maryland

Linda S. Foley, M.A.
Former Director
Project for Addiction Counselor Training
National Association of State Alcohol and Drug Abuse Directors
Washington, D.C.

Wayde A. Glover, M.I.S., N.C.A.C. II
Director
Commonwealth Addictions Consultants and Trainers
Richmond, Virginia

Pedro J. Greer, M.D.
Assistant Dean for Homeless Education
University of Miami School of Medicine
Miami, Florida

Thomas W. Hester, M.D.
Former State Director
Substance Abuse Services
Division of Mental Health, Mental Retardation and Substance Abuse
Georgia Department of Human Resources
Atlanta, Georgia

James G. (Gil) Hill, Ph.D.
Director
Office of Substance Abuse
American Psychological Association
Washington, D.C.

Douglas B. Kamerow, M.D., M.P.H.
Director
Office of the Forum for Quality and Effectiveness in Health Care
Agency for Health Care Policy and Research
Rockville, Maryland

Stephen W. Long
Director
Office of Policy Analysis
National Institute on Alcohol Abuse and Alcoholism
Rockville, Maryland

Richard A. Rawson, Ph.D.
Executive Director
Matrix Center and Matrix Institute on Addiction
Deputy Director, UCLA Addiction Medicine Services
Los Angeles, California

Ellen A. Renz, Ph.D.
Former Vice President of Clinical Systems
MEDCO Behavioral Care Corporation
Kamuela, Hawaii

Richard K. Ries, M.D.
Director and Associate Professor
Outpatient Mental Health Services and Dual Disorder Programs
Harborview Medical Center
Seattle, Washington

Sidney H. Schnoll, M.D., Ph.D.
Chairman
Division of Substance Abuse Medicine
Medical College of Virginia
Richmond, Virginia
Consensus Panel

Chair


Judy Howard, M.D.
Professor of Pediatrics
Developmental Studies Program
Department of Pediatrics
School of Medicine
University of California at Los Angeles
Los Angeles, California
Workgroup Leaders


Lynn Dorman, Ph.D., J.D.
Brattleboro, Vermont
David Duncan, Dr.P.H., C.A.S.
Associate Professor
Center for Alcohol and Addiction Studies
Brown University
Providence, Rhode Island
Jerry P. Flanzer, D.S.W., L.C.S.W., C.A.C.
Director
Recovery and Family Treatment, Inc.
Alexandria, Virginia
Marie Littlejohn, M.S.W., C.S.W.
Director of Social Work
Maternity Infant Care
Medical and Health Research Association
New York, New York
Joan E. Massaquoi, M.S.W., L.C.S.W., B.C.D.
Chicago, Illinois
Thomas J. McMahon, Ph.D.
Assistant Professor of Psychology
Substance Abuse Center
Yale School of Medicine
New Haven, Connecticut
Panelists


Sarah A. Addlesberger
Program Coordinator
Castle Medical Center
Ocean View, Hawaii
Christian A. Akiwowo, Ph.D.
President/Chief Executive Officer
Alajobi Rehabilitative Services
Olympia Fields, Illinois
Darlene Allen, M.S.
Director
Child Welfare Services
Children's Friend and Services
Providence, Rhode Island
Michael D. De Bellis, M.D.
Assistant Professor of Psychiatry
Developmental Traumatology Laboratory
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
Pamela L. Donaldson, A.R.N.P-C., C.A.R.N, Ph.D.
Post-Doctoral Fellow
New York State Psychiatric Institute
Columbia University
Hackensack, New Jersey
James Herrera, M.A., L.P.C.C.
Center on Alcoholism, Substance Abuse and Addictions
University of New Mexico
Albuquerque, New Mexico
Margo H. Juarez, L.A.D.A.C., R.I.M.H.C.
Albuquerque Metropolitan Central Intake
Albuquerque, New Mexico
Lewis Jay Lester, M.S.W., L.C.S.W.
Briceland, California
Herschel Swinger, Ph.D.
Children's Institute International
Los Angeles, California
Foreword

The Treatment Improvement Protocol (TIP) series fulfills SAMHSA/CSAT's mission to improve treatment of substance abuse by providing best practices guidance to clinicians, program administrators, and payors. TIPs are the result of careful consideration of all relevant clinical and health services research findings, demonstration experience, and implementation requirements. A panel of non-Federal clinical researchers, clinicians, program administrators, and client advocates debates and discusses their particular area of expertise until they reach a consensus on best practices. This panel's work is then reviewed and critiqued by field reviewers.

The talent, dedication, and hard work that TIPs panelists and reviewers bring to this highly participatory process have bridged the gap between the promise of research and the needs of practicing clinicians and administrators. We are grateful to all who have joined with us to contribute to advances in the substance abuse treatment field.


Nelba Chavez, Ph.D.
Administrator
Substance Abuse and Mental Health Services Administration
H. Westley Clark, M.D., J.D., M.P.H, CAS, FASAM
Director
Center for Substance Abuse Treatment
Substance Abuse and Mental Health Services Administration
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