Tuesday, January 1, 2013

Safety Intervention in Methamphetamine Using Families A Practice Guide for Safety Decision Making and Safety Management

Safety Intervention in Methamphetamine Using Families
A Practice Guide for Safety Decision Making and Safety Management
in Child Protective Services
October, 2005
Prepared by:
National Resource Center for Child Protective Services
A Service of the Children’s Bureau
Introduction and Purpose
The manufacture, sale and use of methamphetamine pose a serious threatto children’s
safety and challenge agencies and communities to develop appropriate protective and
treatment intervention strategies for these families
Methamphetamine is a highly addictive, syntheticcentral nervous systemstimulant that
appears to cause structural and long-termdamageto brain functioning resulting in
impaired thinking, aggression and psychiatric disturbances. According to reports in 2003,
methamphetamine is the fastest growing drug threat in the United States its use is
spreading fromwestern states into the Midwest toward the east coast. Originally a rural
and small town phenomenon, the impact of methamphetamines is now becoming more
common in midsize and large cities throughout the country.
The proliferation of methamphetamine laboratories has stimulated an organized response
fromlaw enforcement, health departments and child welfare departments.Extensive
protocols have been developed to guide law enforcement, health/medical personnel,
environmental and child protection personnel when children are found at the site of a
methamphetamine lab. These protocols ensure the physical safety of the CPS worker as
well as the children. They include specific procedures for managing any toxic hazards,
gathering evidence and determining the health status of children found at the site as well
as any other children who may have been exposed but are not present at the time of the
raid. These protocols, including sampleMemoranda of Agreements, have been
developed by various municipalities, counties and states participating in the Drug
Endangered Children’s network. (www.nationaldec.org/links/links.htm#decalliances;
As dangerous and difficult as the clandestine methamphetaminelaboratory situations are,
child protective service (CPS) workers are also having to respond to an increasing
number offamilies where one or more parent/caretakers are using methamphetamine but
are not involved in the production or distribution of the drug. These families cometo the
attention of child protective services fromschools, neighbors,family and other
community members. Reporters have varying levels ofinformation to assist the worker
to make decisions about accepting the case and the timeliness of the response. Presenting
concerns may include the condition of the household, co-occuring excessive drinking
and/or other drug use, unsupervised or neglected children, domestic violence or observed
physical or behavioral changes in children.
In response to this increasing number of methamphetamine using families entering the
child welfare systemand increasing agency caseloads, The National Resource Center for
Child Protective Servicesis developing a series ofarticles exploring the safety decision
making responsibilities with families using methamphetamine. Each safety decision
making point will beexplored regarding its relationship to what we know about
methamphetamine, its effects, how it plays out. Using the articles on safety decision
making posted monthly on the ACTION for Child Protection website asa starting point,
this series ofarticleswill attempt to explore if and/or how managing child safety when
methamphetamine is an issue is consistent with the concepts and practicalapplication of
safety decisions as described in the monthly articles.
Each article in this serieswill address an issue related to safety assessment and
intervention in methamphetamine using families. Building on the foundation of
established state-of-the-art safety intervention, these articles will examine and testthe
relevance ofstandard safety assessment and intervention practicesto CPS situations
involving methamphetamine use, addiction, trafficking and production. They will link
content-specific information about methamphetamine and procedural knowledge about
assessing, analyzing, planning and managing safety threats within a family. Each article
will include a case study and an exercise in critical thinking.
Addressing Safety Concerns
Key safety questions are: How does this parent’s use of methamphetamineaffect his/her
ability to keep their children safe, and whatbehaviors are resulting, or have resulted,
fromthe parent’s methamphetamineuse that creates danger?
Research suggests that methamphetamine users, even with low usage, are easily
susceptible to physical, cognitive, and emotional damage which have direct implications
for their capacity to protect their children. Behaviors of methamphetamineusers such as
confusion and paranoia make information gathering and engagement by the worker
difficult. The likelihood of criminal proceedingsalso inhibits the relationship between the
CPS worker and the family.
Someearly research suggests that users of even short duration are prone to have some
cognitive damage as well as damage to the parts of the brain that oversee judgment and
impulse control. The damage can be reversed with successful treatment, but the periodof
time required to recover greatly varieswith the extent and length of use. Judgment and
impulse control are criticalparenting capacities,and often these are precisely the
characteristics that CPS looks for to determine whether or not a child’s safety can be
sufficiently managed in the home. The impact of methamphetamine and the length of
time it may take to recover the use ofthese criticalparenting capacities present
challenges for CPS in terms ofdeveloping the protective capacities of the parent to
ultimately manage the safety oftheir own children. ASFA timelines for length ofstayin
out of homeplacement may not be consistent with the recovery period for some
methamphetamine using parents.
The reports that methamphetamine users are less likely than other substance abusers to
see themselves as addicted may have implicationsfor caregiver motivation to address
safety threats. Ifthe primary motivator is the CPS agency imposing control, this raises
questions about the parent’s willingness and ability to make and commit tothe changes
necessary toensure childsafety. Just as with other substance abuse disorders, discussion
with substance abuse treatment providers would be needed toplan for relapse episodes
which would impact on child safety.Criticalinformation is needed to determine how
dangerous any re-use of methamphetamine is to a child and if parents can protect their
children while using methamphetamine, or if CPS can step-up the intensity of an in-home
safety plan during such timeperiods. Fromthe CPS perspective it is importantto
differentiate between methamphetamine use itself and identifying specific problem
behaviors that affect child safety, which may arise fromthe use of methamphetamine.
The demographic profile about methamphetamineusers provides additional challenges to
child safety management. That they are young and have low educational levels, poor
employmenthistories and histories of other drug abuse means that community resources
are needed to re-establish a family economically and socially. If the parent has
permanent or long-termphysical, cognitive or emotional damage, employment and social
stability becomemore difficult. (www.recoveryres.org/html/meth_project.html)
Applying such knowledge into the framework ofkey safety concepts can help CPS
workers decrease uncertainty in decision making and increase the ability to judge the
validity ofcontent, given that methamphetamine is a relatively new drug with specific
and unique characteristics..
This series of articles will provide guidance in identifying, assessing and responding to
specific behaviors or conditions resulting fromparent/caregiver methamphetamine use
which threaten a child’s safety.
Intake and Initial Assessment
These articles will focuson Intake and Initial Assessment and include case examples to
clarify the application ofsafety principles with methamphetamine using families.
Safety decisions at Intakeand Initial Assessment include the need to assess safety threats,
to determine ifthere is a vulnerable child and to develop a safety responseto the assessed
These articles will applythe concepts ofpresent and foreseeable dangers to the safety
decisions of screening and response timeto referrals alleging methamphetamine using
parents. A list of what workers need toknow about the signs and symptomsof
methamphetamine use to elicit information fromreporters will be included.
(www.nida.nih.gov/NIDA_Notes/NNVol13N1/Comparing.html; www.stopdrugs.org/symptoms.html)
Knowledge of the signs and symptomsare also important atthe time ofthe first visit both
in situations where methamphetamine use was alleged in the referral and as part of the
situation and homeassessment during the first contact where any possible drug use is
Additionally, it is important to assess and understand the high associated with
methamphetamine use. Knowing the pattern ofuse – episodic, binge or chronic- and how
these manifest in threats ofdanger to children is criticalto determining danger thresholds
and crafting a response. Particularly with episodic users, individualized assessment of
protective capacities as well as deficits can lead to consideration ofless intrusive safety
plans. The articles will provide information on this to help CPS workers and supervisors
understand what this means for safety decision making.
Ongoing Safety Management and Reunification
Additional articles will address safety management beyond the investigative stage.
Content will include how to work with treatment providerstoevaluate safety threats and
protective capacity, ongoing safety issues, whathas to be in place for recovery and to
make reunification possible, dangers of relapse, underlying maltreatment dynamics.
Research showing an increased incidence of childhood physical and sexual abuse among
adult methamphetamineusers emphasizes the need for thorough assessment of each
family and situation. These underlying dynamics contribute to the particular
manifestation of maltreatment in families and need to be addressed in the case plan in
order to increase the likelihood of continuing safety and enhanced protective capacities.
Readiness tochange factors in methamphetamineusers including their perception of the
need to change, belief that change is possible, sense of self-efficacy to make changes and
their stated and credible intention to change will bediscussed in monitoringcase progress
and the ongoing evaluation of safetythroughout the life of the case.
Ideas for planning during ongoing case management to maintain child safety while
supporting parents to assumemore responsibility for protection during the recovery
process of transition, stabilization, early, middle stage and late recovery and maintenance
will be discussed.
The article will look at methamphetamine and its effect on motivation. Ideas will be
presented on how to engage parents as partners in working toward reunification or
What do CPS workers need to know about methamphetamineusers to know if and how
they can planfor relapseand for ensuring the safety ofthe child? A case example will
look at how family assessment information can be used to construct a case plan to cover
triggers ofrelapse.
Links in these articles will provide currentinformation on the long-termeffects of
methamphetamine on the level of brain chemicals and the timeframes for the brain to
normalize, becomeregulated and form new connections in previously damaged neurons
and the implications for parent protective capacities. There will also be links to the most
promising treatments. Therapeutic modelsbeing developed and evaluated include
cognitive behavioral approaches, motivational interviewing, contingency management
and the Matrix Mode. Information will be applied through the case example to support
the workers responsibility to make a decision about the feasibilityof reunification and
case closure.
Case Closure and Permanency Planning
This article will follow up on emerging research on the consequences for children
exposed to a methamphetamine environment and what this might mean forthe prospects
of reunification and other permanency solutions.
The key unanswered question is – Is there long term damage that creates continuing
safety issues and diminishes the potential to develop a parent’s protective capacity?
The initial studies on the length oftreatment needed to get parents to change may conflict
with the ASFA timelines. Financingthe level of intensity ofneeded care is also an issue
faced by social service departments.
Defining what is safety and acceptable risk in order to answer the questionof whether or
not a parent has made enough life style changes to support healing and to regain control
ofhis/her life will be included.
Links with Other Organizations
We all have a lot to learn about how to intervene with methamphetamineimpacted
families. Early identification and engagement ofparents in a change process that can
decrease safety concernsand lead to the caregivers providing for child safety on their
own are community challenges.
Training and organizational supports have been developed and are becoming more
available for child welfare workers who are calledin as partofpolice raids.Topics
include: information on the signs of possible methamphetaminelabs, how to manage the
potential chemical contamination of the children and themselves, how to conduct forensic
interviews and how to transfer care ofthe children to medical and family/foster care
providers. Additional trainings on the signs and effects ofmethamphetamine use have
and continue to be developed. (www.cwla.org/conferences/default.htm;
www.psattc.org/events/cates/index.html; www.colodec.org/decpapers/decpapers.htm#childabuseneglect:
Training and research information fromorganizations such as Substance Abuse and
Mental Health Services Administration (SAMHSA) are helping informworkers about the
effects of methamphetamines on parent behavior and health as well as the physical and
developmental impact on children exposed to the drug and living in a drug using
environment. (www.cffutures.org/MethamphetamineList.htm)Researchers are also studying the
most promising treatment strategies for users and medical interventions for
methamphetamine exposed children (http://matrixinstitute.org/Research.html;
For Child Protective Services, assessing and managing safety is the priority issue.
Linking with other organizations that provide expertise and incorporating that knowledge
into a proven safety framework can support CPS workers to effectively intervene and
manage cases involvingmethamphetamine using families.