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.

Contents

• What Is a TIP?
• Editorial Advisory Board
• Consensus Panel
• Foreword
• Executive Summary and Recommendations
• Chapter 1—Working With Child Abuse and Neglect Issues
  • Substance Abuse and Child Abuse and Neglect
  • Implications for Treatment of Clients With Child Abuse Histories
  • Incidence of Child Abuse and Neglect
  • Incidence of Child Abuse and Neglect Histories Among Adults
  • Defining Abuse and Neglect
• Chapter 2—Screening and Assessing Adults For Childhood Abuse and Neglect
  • Challenges to Accurate Screening and Assessment
  • Screening for a History of Child Abuse or Neglect
  • Formal Assessment for a History of Child Abuse Or Neglect
  • Special Considerations and Recommendations
• Chapter 3—Comprehensive Treatment for Adult Survivors of Child Abuse and Neglect
  • Treatment Issues
  • Treatment Techniques
• Chapter 4—Therapeutic Issues for Counselors
  • Transference, Countertransference, and Secondary Traumatization
  • Establishing the Treatment Frame and Special Issues
  • Responsibility of the Agency To Support the Counselor
• Chapter 5—Breaking the Cycle: The Substance-Dependent Client as Parent/Caregiver
  • Who Abuses and Why
  • Role of the Counselor
  • Clues That the Client May Be Endangering Children
  • Incorporating Treatment Strategies for Child Abusers
  • Organizational Roles and The Need for Collaboration
• Chapter 6—Legal Responsibilities and Recourse
  • Mandated Reporting
  • State Laws Regarding Child Abuse and Neglect
  • CPS Agency Investigation and Potential Outcomes
• Chapter 7—Emerging and Continuing Issues
  • The Impact of New Legislation on Parents in Treatment
  • Emerging Issues
  • Continuing Trends
• Appendix A --Bibliography
• Appendix B --Protecting Clients' Privacy
• Appendix C --Implications of Recent Federal Legislation for Clients in Treatment
• Appendix D—Obtaining Screening and Assessment Tools
• Appendix E --Resources Related to Childhood Trauma Among Adults
• Appendix F --Resource Panelists
• Appendix G—Field Reviewers

This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. This publication was written under contract number 270-95-0013 with The CDM Group, Inc. (CDM). Sandra Clunies, MS, ICADC, served as the CSAT government project officer. Rose M Urban, LCSW, JD, CCAS, served as the CDM TIPs project director. Other CDM TIPs personnel included Raquel Ingraham, MS, project manager; Jonathan Max Gilbert, MA, 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, PhD, and Christine Courtois, PhD, 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.