Assessment of Drug and Alcohol Use/Abuse
0070-521.10 | Revision Date: 7/27/2023

Overview

This policy provides CSWs with an overview on observing, gathering, and assessing for drug and/or alcohol use/abuse during an emergency response (ER) investigation and throughout the life of an open case.

Table of Contents

Version Summary

This policy guide was updated from the 07/29/15 version to provide additional guidance on assessing an individual's use/abuse of drugs and/or alcohol and add language related to Assembly Bill (AB) 2595 which states that, when investigating allegations of child abuse and neglect, a social worker must treat possession or use of marijuana by a parent or guardian in the same manner as possession or use of alcohol and legally prescribed medication.

POLICY

Parent/Caregiver Drug and Alcohol Assessment

Note: When reviewing this policy, the term "parent/caregiver" is defined as any parent, co-parent, legal guardian or other individual assuming a role as a caregiver.

Substance use/abuse is often an underlying cause or explanation for behaviors that result in various allegations, which place children at risk. Substance abuse/use may also result from trauma. CSWs should assess parents/caregivers for substance abuse regardless of whether or not it is an original allegation in an ER referral and continue to assess throughout the life of a case.

The mere fact that a parent/caregiver is using drugs or alcohol does not mean that a child should be removed from the home. An infant’s prenatal exposure is also not an automatic reason for removal of that infant from the parent(s).

  • However, when assessing a parent’s/caregiver’s use/abuse of drugs or alcohol, it is important to note that substance abuse/use may place a child at risk due to direct exposure or as a result of a parent’s impairment which may hinder their ability to care for a child, particularly the most vulnerable children (i.e., infants, toddlers, children with special needs and medically fragile children).
A thorough assessment of the family's protective actions/abilities must be completed to determine if a parent's/caregiver's  alcohol or drug use/abuse is impairing their judgment and ability to provide a safe level of care to the child. This assessment may include, but is not limited to the following:
  • An on-demand test or, for open cases, enrollment in DCFS' Testing Program.  When using testing as part of the assessment, it is important to review the results with the client.  See "Discussing Test Results with Clients" in this policy (below).
  • Self-reports, including but not limited to:
    • Information provided regarding past efforts at treatment and past progress
    • The family's story related to stressors/struggles that may be driving their substance abuse/use.
  • Observations of behavioral indicators by substance abuse treatment providers, CSWs or other professionals
  • Observations and reports from family members and social supports
  • A comprehensive substance abuse assessment, such nas those provided by Client Engagement and Navigation Services (CENS) staff or a Family Preservation Assessment.
  • Structured Decision Making (SDM) child safety and risk assessments
  • Analyzing criminal background checks (e.g., CLETS, ERIS) for substance use/abuse-related offenses

It is important to gather as much information from as many sources as possible in order to make an accurate assessment. 

  • It may be beneficial to also identify a Team [informal or via a Child and Family Teams (CFTs)] who can assist in strengthening and supporting the family.

Emergency Situations

There are emergent circumstances where children may be in imminent danger requiring immediate removal. Such emergency situations may prohibit an extensive, in-depth assessment at the point of detention. These situations may include the following:

  • Referrals from law enforcement, when a parent/caregiver has been arrested for criminal activity regarding the selling or the manufacturing of drugs or when a child is exposed to drug activity.
  • A reporting party alleges:
    • The parent/caregiver has been gone for multiple days, the parent’s/caregiver's whereabouts are unknown, and the child is without adult supervision in the residence, or
    • The parent/caregiver is in the home but unconscious or unable to function due to drug or alcohol use/abuse and the child is present.
  • School personnel refer a child who is too fearful to go home because of the parent's/caregiver's recent, current, or longstanding substance use/abuse and the parent cannot be located.
  • Hospital staff refers a newborn with a positive toxicology screen for drugs or alcohol, the mother has left the hospital, and their whereabouts are unknown.
  • Hospital staff or law enforcement refers a child whose parent/caregiver has overdosed, resulting in death or serious medical complications.
NOTE: CSWs should always seek guidance from County Counsel to determine if exigency is applicable or if a warrant is necessary.

Marijuana

The use of marijuana is to be treated in the same manner as alcohol and prescription medications when conducting an assessment of a parent's/caregiver's use and impact on child safety.  Additionally, the marijuana is to be locked and not accessible to children or nonminor dependents. It is inappropriate for a parent to be impaired by marijuana, rendering them unable to provide appropriate care and supervision for the child(ren) and nonminor dependents (NMDs).

  • Proper storage is to be physically verified and documented.
  • Attention should be given as to whether the use of marijuana impacts the parent’s ability to safely provide for the child’s needs and well-being. It is inappropriate for a parent/caregiver to be impaired, rendering them unable to provide appropriate care and supervision for the child(ren) or NMDs residing in the home.
When children/youth/NMDs are in out-of-home care (OHC), caregivers or others in that home:
  • May grow up to six (6) marijuana plants in their home, or on their property, if they are at least 21 years old (rules may vary by city).
  • Must not expose the child(ren) or NMD to marijuana smoke or fumes in the presence of the child(ren) or NMDs.
    • A parent's use of marijana and their failure to protect the child or NMD from second hand smoke may constitute evidence that the child is at risk of harm (Alexis E., 2009).

If a nexus (connection) is identified between the parent’s/caregiver’s marijuana use and harm, and/or there are identified safety issues, those safety issues must be addressed to determine what steps shall be taken to ensure child safety.  This may include removal.

Marijuana Use by a Dependent Child or Youth

For children/youth who use marijuana for medicinal purposes under the supervision of a medical professional* as part of a treatment plan (i.e., such as during the treatment of cancer), verification of its “prescribed”/recommended** use is to be verified.  This includes obtaining a written document from the treating medical professional* that includes the diagnosis, treatment and reason for the “prescribed”/recommended** use of marijuana.

  • *The “prescribed”/recommended use of marijuana must be from a treating medical professional and not from a marijuana clinic.
  • **California law allows for the use of recreational marijuana for adults. Prescriptions/authorizations are no longer required by law for such use.  For children/youth under the age of 18, marijuana use is not permitted; however, there may be circumstances in which a medical professional may “prescribe”/recommend its use.  This must be verified.
  • CSWs should consult with a Public Health Nurse (PHN) when reviewing the medical documentation and, to determine the appropriateness of facilitating a second opinion for alternative treatment options (an alternative to the use of marijuana).

If a child/youth is using marijuana for a purpose other than as part of a medically verified treatment plan,  the CSW should:

  • Assess the child/youth to determine if there are underlying substance use/abuse issues, and explore whether the marijuana use might be a cover for illicit drug use.
  • Treatment resources may be found on the Drug and Alcohol Testing Program’s website.

For additional guidance on substance use/abuse assessments for dependent youth, see the policy on “Foster Youth Substance Abuse Treatment Protocol and Program”.

Marijuana Use by a Nonminor Dependent (NMD)

California law allows for the use of recreational marijuana for adults at least 21 years of age, thus NMDs are not legally permitted to use recreational marijuana. The law requires medical authorization or a physician’s recommendation for use.

Upon the disclosure of the use of marijuana by an NMD, take the following steps:
  • Determine if the use of marijuana is related to a medical condition. If so,
    • Contact the NMD’s treating physician and obtain written documentation that includes the diagnosis, treatment and reason for the “prescribed/recommended** use of marijuana.
    • Consult with a PHN when reviewing the medical documentation and, to determine the appropriateness of facilitating a second opinion for alternative treatment options (an alternative to the use of marijuana).
  • If it is determined that the NMD’s marijuana use is not related to a medical condition,
    • Assess the NMD to determine if there are underlying substance use/abuse issues and explore whether the marijuana use might be a cover for illicit drug use.
  • Consider referring the NMD for a comprehensive substance abuse assessment.

Discussing Test Results with Clients

When used, testing is one tool that is an integral part of the investigation of a referral (e.g., to assist in determining whether or not to detain, etc.) and during the course of a case, it may be used to aid in case management activities, including but not limited to, case planning, determining child safety, and making decisions related to placement and visitation). Testing, in and of itself, shall not be the sole determining factor in decision-making for referrals and cases.

In order to ensure testing is practical and purposeful, test results must be reviewed and discussed with clients, regardless of the outcome of the test (e.g., no show/missed, positive, negative, drug level increase/decrease, etc.).

  • CSWs are to be mindful that test results may not be discussed with anyone other than the individual who tested without their consent to disclose this information. That includes the sharing of this information during Child and Family Team Meetings.
  • CSWs are to be mindful that Public Health Nurses (PHNs) cannot, by law, review or comment on any parent/legal guardian/RP drug and alcohol test results (or medical records).
  • When there is a pattern of missed drug tests (even if excused), in addition to discussing test results or lack thereof, CSWs shall consider putting safeguards in place, especially for those parents who are caring for vulnerable children, which includes infants, toddlers and children with special needs.

Discussions shall also include decisions about whether or not testing continues to be warranted, if the frequency of testing may be decreased (i.e., determine if weekly testing shall continue or if testing can be decreased) and/or if substance abuse/use treatment is recommended for clients not already participating.

  • Clients should be assessed/re-assessed on an ongoing basis for this purpose.
  • Enrollment and frequency of testing shall align with, and be reflected in, the current case plan.

DCFS no longer supports the philosophy that a missed test is a "dirty" test. Instead, the CSW shall use the referral or case factors in determining the circumstances surrounding the missed test to determine if the missed test is of concern. The explanation(s) for a missed test is to be assessed and, where possible, is to be verified and consideration for a make-up test is to be given.

It is important to look at a totality of the circumstances (and behavioral indicators) when assessing a parent/legal guardian's progress in drug and/or alcohol treatment.

As needed, CSWs shall consult with their SCSW about on how to communicate with their clients regarding test results and next steps. And, as applicable, CSW's shall consider holding a Child and Family Team Meetimg (CFTM).  Conversations/activities may include, but are not limited to, the following:

  • Engage with the parent around specific safety worries related to positive test results or missed drug tests.
  • Ask the parent to share their goal for their family.
  • For a parent enrolled in a substance abuse/use program, inquire about what they are learning from their program, including how they maintain their recovery/sobriety.
  • For CFTMs, consider bringing on additional CFT members to support the parent, including social connections and/or professional supports (i.e., Parent Partners, sponsor, etc.)
  • As applicable, during a CFTM, discuss how each team member may be able to support the parent’s recovery/sobriety. And, identify protective activities that the CFT members may be able to participate in to support the family.
PROCEDURE

Completing an Assessment of Drug/Alcohol Use/Abuse

CSW Responsibilities

  1. When observing the parent/caregiver, assess for indicators of substance use/abuse including:
    • Physical warning signs.
    • Bloodshot eyes, pupils larger or smaller than usual
    • Changes in appetite or sleep patterns
    • Sudden weight loss or weight gain
    • Deterioration of physical appearance, personal grooming habits
    • Unusual smells on breath, body, or clothing
    • Tremors, slurred speech, or impaired coordination
    • Behavioral signs
    • Drop in attendance and performance at work or school
    • Unexplained need for money or financial problems. They may borrow or steal to get it.
    • Engaging in secretive or suspicious behaviors
    • Sudden change in friends, favorite hangouts, and hobbies
    • Frequently getting into trouble (e.g., fights, accidents, illegal activities)
    • Psychological warning signs
    • Unexplained change in personality or attitude
    • Sudden mood swings, irritability, or angry outbursts
    • Periods of unusual hyperactivity, agitation, or giddiness
    • Lack of motivation; appears lethargic or “spaced out”
    • Appears fearful, anxious, or paranoid, with no reason
    • Indicators of methamphetamine, cocaine, heroin, and other illicit substances, if applicable
    • Indicators of marijuana and alcohol abuse, if applicable
    • Indicators of prescription medication abuse, including but not limited to, Xanax, Valium, Gamma-Hydroxybutrate (GHB), opiates, and synthetic variants, if applicable.
  2. When making an assessment of the family, inquire about the following:
    • Kind(s), frequency, and amount of substance(s) used
    • Accessibility of drugs, alcohol, and paraphernalia to children in the home
    • Willingness of the parent/caregiver to address their own substance use/abuse
    • Ability of the family to acknowledge the risks posed by substance use/abuse
    • Availability of family or extended family support to protect the children
    • Composition of the current family household, including whether there are any “significant others” residing in the house
    • Stability of income
    • Stability of housing
    • Whether the child has had frequent school changes
    • Whether the family has missed required medical or dental appointments
    • Whether the parent/caregiver has any recent arrests related to drug or alcohol use
    • History and duration of sbustance abuse/use.  When did the parent/caregiver start using and how were they introduced?
    • Whether there are underlying reasons for their substance abuse/use, such as an unaddressed trauma or mental health issues
  3. Assess for common signs of neglect of the child due to substance use/abuse. Signs may include:
    • Poor physical appearance (e.g. clothing, hygiene)
    • Gross thinness
    • Unusual affect (e.g. unexplained fear, excessively polite)
    • Lack of eye contact or excessive eye contact with the parent prior to responding to questions
    • Inappropriate attire for the weather
    • Frequent lack of supervision
    • Often requests food from neighbors
    • Demonstrates behavioral or academic problems in school
  4. Assess for signs of neglect of the home environment caused by substance use/abuse. Signs may include:
    • Little to no food, clothing, furniture, and/or appliances
    • Situations which are hazardous to health (e.g., broken windows, hanging electrical wires, extreme clutter, rotten food, etc.)
    • An abnormal number of bottles or cans of alcohol
    • An unusual number of people in the home or coming to the door, for which no reasonable explanation is given
    • No functioning utilities
    • Drug paraphernalia
  5. If a parent/caregiver appears and/or discloses that they are using/abusing drugs or alcohol:
    1. Request the parent(s)/caregiver(s) to drug test on demand.
      1. Consult with your SCSW if they decline to test or tamper with the test.
      2. Discussing test results with clients of the test with them.
    2. Evaluate prior attempts at sobriety, the duration of use, frequency, and type of substances used.
    3. Determine the parent's/caregiver’s ability and willingness to participate in treatment.
    4. Consult with your SCSW to determine if a Family Preservation Services Assessment (FPA), formerly known as an Up-Front Assessment (UFA), is appropriate.
  6. Upon disclsoure of the use of marijuana by a youth, take the following steps:
    1. Determine if the use of marijuana is related to a medical condition.  If so:
      1. Contact the youth's treating physician and obtain written documentation that includes the diagnosis, treatment and reason for the "prescribed"/recommended** use of marijuana.
      2. Consult with a PHN when reviewing the medical documentation and, to determine the appropriateness of facilitating a second opinion for alternative treatment options (an alternative to the use of marijuana).
    2. If it is determined that the youth's marijuana use is not related to a medical condition:
      1. Assess the youth to determine if there are underlying substance use/abuse issues, and explore whether the marijuana use might be a cover for illicit drug use.
      2. Consider referring the youth for a comprehensive substance abuse asessment.
  7. Upon disclosure of the marijuana by an NMD, assess them in the same manner as you would other adult clients.
  8. Determine whether the situation warrants detention or other interventions, or closure of the referral and linkage to Alternative Response Services or other Community-Based Resources.
    • Interventions may include holding a CFTM and/or consulting with your SCSW, ARA, County Counsel, etc.
  9. Complete  the appropriate SDM tools to determine whether removal is necessary.
    1. If not, consider the availability of all services that could adequately protect the child.
    2. If it is necessary to take a child into temporary custody, obtain one of the following: consent, exigent circumstances, or a court order.
    3. Consult with your SCSW, County Counsel, etc. regarding next steps.
    4. Ensure to make the appropriate referral to a medical hub upon removal.
  10. Submit the appropriate SDM tools to your SCSW for approval, as applicable.
  11. Document the entire assessment in the CWS/CMS Contact Notebook, including the parent's compliance and results of all drug tests.

SCSW Responsibilities

  1. Review and approve all applicable SDM toos and return to the CSW.
  2. Provide consultation to the CSW, as needed.

Assessing Infant Prenatal Exposure to Drugs or Alcohol

CSW Responsibilities

In the case of newborns, if there is an indication of maternal substance use/abuse; a thorough assessment must be completed for the child and the mother. [For additional guidance on these assessments, see Procedural Guide titled “Assessing Expectant Parents and Parenting Families of Newborns. In these cases:

  1. Obtain medical documentation and confirmation that the mother received prenatal care.
    1. Hospitals are to complete a newborn risk assessment prior to contacting the Child Protection Hotline to make a referral. The CSW is able to obtain this document, which may include toxicology screen results for the mother and/or newborn.
  2. Determine if the mother had any prior children who were prenatally exposed to drugs.
  3. Assess the mother’s drug/alcohol use or abuse as it affects their ability to appropriately parent, particularly regarding their accessing resources and providing ongoing care for the child (e.g., ability to supervise the child and be attuned to their needs).
    1. Drug/alcohol use or abuse and/or a positive toxicology screen of either the mother or the newborn is not, in and of itself, cause for removal. There must be a correlation (nexus) between the drug/alcohol use or abuse and child safety. Review SDM results and, as needed, consult with your SCSW and/or County Counsel.
  4. Determine the nature and extent of the newborn’s special needs, if any, by consulting with a medical professional.
  5. Consult with the PHN, as needed.
  6. Provide resources and referrals to a Regional Center.
    1. Complete and submit the automated DCFS 5004, Referral to Regional Center, to the Regional Center, if applicable, via the referral portal.  File a hard copy in the case (Psychological/Medical/ Dental/School report (purple) folder).
  7. Complete the CSW responsibilities items #10 through #12 under the section title "Completing an Assessment of Drug/Alcohol Use/Abuse".

SCSW Responbilities

  1. . Complete the SCSW Responsibilities items #1 through #2 under the section titled “Completing an Assessment of Drug/Alcohol Use/Abuse”.

APPROVALS

SCSW Approval

  • All SDM tools, as applicable
HELPFUL LINKS

Forms

CWS/CMS

DCFS 5004, Referral to Regional Center

FYIs

FYI 21-04, Substance use disorder – Trauma-informed Parent Support Program, including Use of Client Engagement and Navigation Services 
REFERENCED POLICY GUIDES

0070-516.10, Assessing a Child's Development & Referring to a Regional Center
0070-526.10, Assessment of Fetal Alcohol Spectrum Disorder (FASD)
0070-548.00, Community Response Services, Alternative Response Services and Up-Front Assessments
0070-548.01, Child and Family Teams
0070-548.07, Assessing Expectant Parents and Parenting Families of Newborns
0070-548.10, Disposition of Allegations and Closure of Emergency Response Referrals
0070-548.24, Structural Decision Making (SDM)
0070-548.25, Completing the Structured Decision Making (SDM) Safety Plan
0070-559.10, Clearances
0070-570.10, Obtaining Warrants and/or Removal Orders
0600-500.00, Medical Hubs
0600-508.00, Foster Youth Substance Abuse Treatment Protocol and Program
0600-518.31, Children Exposed to Drug Labs
1200-500.30, DCFS Countywide Alcohol and Drug Testing Program

STATUTES AND OTHER MANDATES

Americans with Disabilities Act of 1990 (Public Law 101-336) – Extend to people with disabilities civil rights similar to those now available on the basis of race, color, national origin, sex and religion through the Civil Rights Act of 1964.

AB 2595 - Added Section 328.2 to the Welfare and Institutions Code to include language stating that when investigating allegations of child abuse or neglect, a social worker must treat possession or use of marijuana by a parent or guardian in the same manner as possession or use of alcohol and legally prescribed medication.

171 Cal.App.4th 438 – States that a trial court may reasonably find a parent’s marijuana use as constituting a risk of harm to the child because the child parent fails to protect the child from second hand marijuana smoke.

Health and Safety (H&S) Code 11357 – Addresses the legal use of marijuana.

H&S Code 11358 – Addresses the legal growth of marijuana.

Penal Code 11165.13 – States “a positive toxicology screen at the time of the delivery of an infant is not in and of itself a sufficient basis for reporting child abuse or neglect. However, any indication of maternal substance abuse shall lead to an assessment of the needs of the mother and child.”