자연주의적 탐구조사(Naturalistic Inquiry)

or challenge. These people, it is thought, are at points where growth or breakdo^11 may occur, and where short-term intervention is likely to have maximum impact. Th'j theory is central to the book, and has much to teach us, but offers such a convenieI1 framework for community planning that it could be accepted too uncritically. Of.. may doubt if these external crises are always the relevant ones, if the effect of cris'j intervention will not pass with the crisis, if we do not risk making some development3 stages more critical by anticipating difficulties. Although the author repudiates any idea of "government by psychiatrist", he sef

Principles of Preventive Psychiatry

There are relatively few empirically sound studies or nationally representative data on the number of children in Child Welfare Services (CWS) who are affected by their parents' substance abuse or dependence. The two systems that could systematically monitor this population, CWS and substance abuse treatment, are not required to capture the data elements that would identify families in both systems. The studies that are based on CWS populations or parents in treatment indicate that there is a substantial overlap in client populations. This review provides a summary of the available data; provides estimates of the overlap between populations, including the number of infants born each year with prenatal substance exposure; and suggests important opportunities to close the data gap between the systems. The findings underscore both the need for obtaining accurate data within the systems and the opportunities for states to improve their cross-system data efforts as part of their outcome monitoring.

Parental substance use disorders and child maltreatment: overlap, gaps, and opportunities.

In the past three decades, there has been increased recognition of the role of gender in influencing the course of substance use and treatment utilization. Concurrently, a substantial body of research on gender-related issues and substance abuse and its treatment has developed. This article reviews (1) policy initiatives that led to the growth of "specialized" treatment programs and services for women and recent policy changes that influence the provision of substance abuse treatment to women; (2) gender differences in the prevalence of substance use disorders and admissions to treatment; (3) gender differences in treatment needs,utilization, and outcomes, including long-term outcomes following treatment; (4) organizational characteristics of substance abuse treatment providers for women and the types of services provided in these programs; (5) treatment outcomes in gender-specific programs for women; and (6) the effectiveness of evidence-based treatment practices that have either been modified, or have the potential to be adapted, to address the treatment needs of women. This body of research is viewed within the context of a series of paradigm shifts from a generic treatment approach to a focus on gender differences and gender specificity and, most recently, to an emergent focus on gender responsiveness.

From generic to gender-responsive treatment: changes in social policies, treatment services, and outcomes of women in substance abuse treatment.

Does substance abuse treatment make a difference for child welfare case outcomes? A statewide longitudinal analysis

Meeting the needs of families involved with the child welfare system because of a substance abuse issue remains a challenge for child welfare practitioners. In order to improve services to these families, there has been an increasing focus on improving collaboration between child welfare, treatment providers, and the court systems. This paper presents the results from qualitative interviews with 104 representatives of these three systems that explore how the collaborative process works to benefit families, as well as the barriers and supports for building successful collaborations. Results indicate that collaboration has at least three major functions: building shared value systems, improving communication, and providing a "team" of support. Each of these leads to different kinds of benefits for families as well as providers and has different implications for building successful collaborative interventions. Despite these putative benefits, providers within each system, however, continue to struggle to build effective collaborations, and they face such issues as deeply ingrained mistrust and continued lack of understanding of other systems' values, goals, and perspectives. Challenges that remain for successful collaborations are discussed.

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The Role of Interagency Collaboration for Substance-Abusing Families Involved with Child Welfare.

The passage of the federal Adoption and Safe Families Act (ASFA), which calls for timely permanency planning for children placed into state foster care systems, has led to increased attention to the need for timely and appropriate treatment services to families with substance abuse issues who are involved with child welfare. Using statewide administrative data collected before and after the implementation of ASFA, the present study explores the influence of ASFA, as well as other family characteristics, on patterns of treatment service utilization by child-welfare involved clients. Findings suggest that in the period following the ASFA legislation, mothers entered substance abuse treatment significantly more quickly after the start of their child welfare cases, and remained in treatment longer, compared to pre-ASFA. No differences in rates of treatment completion were found. Results are interpreted in terms of the changing treatment service context, enhanced collaboration between child welfare and treatment systems, and the possible influence of the legislation on parents' motivation to enter treatment.

Understanding patterns of substance abuse treatment for women involved with child welfare: the influence of the Adoption and Safe Families Act (ASFA).

The complex issues associated with barriers to treatment entry for parents who are involved with child welfare has not been well explored. Accessing timely treatment is now critical for these parents since the introduction of the Adoption and Safe Families Act of 1997, limiting the time until a permanency decision is made. Using a longitudinal, qualitative approach, substance-abusing parents from 15 families, their relevant family members, and service providers were interviewed approximately every 3 months over an 18-month period. The experiences of these parents add to our knowledge of the unique barriers this population faces, and expands our understanding of the mechanisms by which certain barriers may delay treatment.

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Accessing substance abuse treatment: issues for parents involved with child welfare services.

The Adoption and Safe Families Act (ASFA) was designed to promote more timely permanent placements for children in the child welfare system. To date, however, available data have said little about whether ASFA is meeting its intended goals. This study looks at the impact of ASFA on parents struggling with substance abuse issues. The authors compared child welfare outcomes, pre- and post-ASFA, for children of more than 1,900 substance-abusing women with some treatment involvement. After the implementation of ASFA, children in this study spent less time in foster care, were placed in permanent settings more quickly, and were more likely to be adopted than remain in long-term foster care. The proportion of children who were reunified with their parent or parents stayed the same. These outcomes were apparent even controlling for case and family characteristics. Results are discussed in terms of the influence of ASFA on service delivery systems.

Anna Rockhill

Papers

Does substance abuse treatment make a difference for child welfare case outcomes? A statewide longitudinal analysis

The Role of Interagency Collaboration for Substance-Abusing Families Involved with Child Welfare.

Understanding patterns of substance abuse treatment for women involved with child welfare: the influence of the Adoption and Safe Families Act (ASFA).

Accessing substance abuse treatment: issues for parents involved with child welfare services.

Is the adoption and safe families act influencing child welfare outcomes for families with substance abuse issues