Summary

This brief was developed in partnership with Children and Family Futures. It summarizes core principles, benefits, and implementation considerations of family-centered approaches to support families affected by substance use disorders.

The need for family-centered approaches

Parental substance use disorders (SUDs) affect nearly 19 million children nationwide.¹ These disorders are strongly linked to adverse outcomes for youth, including educational difficulties, anxiety, trauma, emotional or physical abuse, and heightened vulnerability to developing their own substance use disorder.^2,3 For children involved with child welfare, parental substance use disorders are of critical concern. In 2025, parental alcohol or drug abuse was cited as a circumstance in 38% of removals to foster care — a figure widely considered a significant undercount due to state-level reporting variations.⁴

Children removed from home due to parental substance use face distinct hurdles, including longer stays in foster care, higher re-entry rates, and lower rates of permanent reunification compared to their peers in foster care for other reasons.⁵ At the same time, parents struggling with substance use disorder while navigating the child welfare system often contend with deep-seated trauma, cyclical addiction patterns, and environmental triggers that complicate their path to wellness.⁶ These complex challenges require shifting from reacting to crises to providing proactive care to ensure child safety and stability. Substance use disorders are complex and progressive, yet a treatable brain disease. As a result, early screening and comprehensive assessment are essential to identify the needs of families before child welfare system involvement escalates. Child welfare, working with other family-serving systems, can employ a prevention-focused, family-centered model where families receive timely, clinically appropriate assessment, treatment, and services. This approach can help prevent unnecessary child removals, assist in parental recovery, and support safe, timely reunification when family separation has occurred.

Family-centered approaches accept and respect each person’s unique definition of “family,” which often evolves over time based on personal values, beliefs, and supportive bonds. A family unit may extend beyond blood or marriage across multiple generations and households to include any key individual — relatives or non-relatives — who plays a meaningful role in the family’s well-being. By recognizing every individual in this supportive network, child protection agencies and family-serving programs can collaborate to overcome traditional service barriers and deliver comprehensive care that strengthens overall family functioning and improve child safety and family well-being.

Core tenants of a family-centered approach

A family-centered framework supports children by focusing on their core needs of safety, permanency, and healthy development. This model recognizes that children’s well-being is deeply tied to the strength and stability of their family.

Safety

Child safety is the foundation of every family-centered intervention. Child welfare workers continuously assess risk to ensure a child’s immediate protection is the top priority. Once safety is secured, professionals can meaningfully integrate the parent’s treatment and recovery needs into case planning to create long-term stability.

Permanency

Permanency planning promotes child stability by preserving their connections to family and community, which are vital. A family-centered model should prioritize family reunification and make kinship care the first option for temporary out-of-home placement whenever possible. Adoption also can be an option when a child’s safety and developmental needs cannot be met with their birth family. All decisions involving a child’s future should include and involve the youth and the family.

Healthy development

Supporting a child’s developmental growth requires looking at the circumstances of the whole family rather than treating the child in isolation. In a family-centered approach, child welfare professionals partner with the family to design service plans that include age-appropriate interventions to enhance both child development and overall family functioning.

For more information on the family-centered framework, see: Implementing a Family-Centered Approach Series.

Evidence-based benefits and outcomes

A growing body of research demonstrates that a family-centered approach is effective in improving child, parent, and family outcomes for families affected by substance use disorders. Positive outcomes include:⁷

• Decreased risk of child abuse.
• Increased rates of reunification and successful permanency.
• Increased treatment retention rates and reduced substance use rates.
• Reduced rates of infants with prenatal substance exposure.
• Improved psychosocial and family functioning for children, parents, and family members.
• Improved parent mental health, physical health, and employment.
• Reductions in depression and parental stress.
• Improved parenting attitudes.
• Increased parenting skills and capacity.
• Enhanced parental bonding with children.
• Improved child development and behavior.

For some families, out-of-home placement for the child may be necessary, while others may need support to ensure a stable home environment to keep the child safe at home. Centering on the family requires collaboration with substance use disorder and mental health treatment providers, dependency courts, and other child and family service sectors outside of child welfare to ensure child safety and family well-being are being holistically addressed and achieved.

Systemic foundations for implementation

A family-centered model sustains itself through diversified funding and interagency collaboration that extend beyond traditional child welfare, substance use disorder and mental health treatment systems. A family-centered model includes all agencies and individuals that interact with and serve children, parents, and families. While services will vary based on local resources, the overarching goal remains constant: Enhance overall family functioning and concentrate on the needs of every family member, rather than focusing exclusively on treating an individual parent or child.

Sustainability and diverse funding

Siloed, single-agency funding often presents a significant operational hurdle for service providers, as restrictions on what services are allowed can limit the ability to provide the child and family the holistic care they need to achieve safety and stability. Although grant funding and demonstration projects offer vital seed capital to launch family-centered initiatives, long-term sustainability requires strategic, diversified funding strategies. Engaging government funders early in the planning process is critical to long-term viability. Aligning local project objectives with broader state, regional, and federal initiatives strengthens institutional partnerships and helps build stable financial support. Jurisdictions can overcome the challenges of siloed funding by braiding multiple funding streams.

A primary vehicle to achieve a diversified funding approach is the Family First Prevention Services Act, which provides federal funding to strengthen families and promote child safety, permanency, and well-being — and some practices approved for funding under the act cover substance use disorder prevention or treatment.

Under Family First, states develop prevention plans that define target populations and outline specific, evidence-based services approved by the Title IV-E Prevention Services Clearinghouse. State plans vary in scope, however, so child protection agencies need to review their own state’s plan to identify eligible populations and interventions.

Examples of evidence-based interventions eligible for Family First funding include:

• Family-Based Recovery
• Medications for opioid use disorder including Methadone, Naltrexone, and Buprenorphine
• Motivational Interviewing
• Multidimensional Family Therapy
• Qualified Residential Treatment Programs
• Sobriety Treatment and Recovery Teams
• Solution-Focused Brief Therapy
• Strengthening Families Program
• Wellness Recovery Action Plan

For more information on Family First, see Casey Family Programs resources on this topic.

Timely, high-quality substance use disorder treatment

A parent completing substance use disorder treatment remains the single strongest predictor of safe reunification. Mothers who complete at least 90 days of treatment are nearly twice as likely to reunify with their children, and prompt access to treatment significantly reduces a child’s time in foster care.^8,9 Other research shows that parents who were involved with child welfare and received treatment in tandem with additional support services were more likely to reunify with their children.¹⁰

Achieving timely reunification, however, can become a systemic challenge when treatment waitlists, caseworker shortages, and limited access to family-centered services delay a parent’s entry into — and completion of — treatment. The federal Adoption and Safe Families Act requires states to file for termination of parental rights after a child spends 15 of the previous 22 months in foster care. Therefore, ensuring access to timely treatment for parents with substance use disorder promotes permanency as it allows treatment to be completed within that federal timeframe.

Child protection agencies can do their part to help achieve timely treatment for parents by implementing early screening, conducting comprehensive assessment, and connecting parents to providers within communities. Children and families receiving those three key services have been shown to have reduced rates of substantiated repeat maltreatment and decreased rates of out-of-home placement when compared to similar populations receiving only standard child welfare services.^11,12

Recovery coaches also play a vital role in bridging systemic gaps and achieving the goal of safe family reunification.¹³ By guiding parents through barriers to treatment, offering continuous encouragement, and facilitating cross-agency communication, recovery coaches help parents enter, remain in, and complete treatment.

Promoting positive family outcomes requires high-quality, trauma-informed substance use disorder treatment. For residential treatment settings, this means keeping families safely together whenever possible. It also means following up intensive treatment with aftercare support. Program options include:

• Family-based and mother-infant residential treatment programs.
• Outpatient programs with on-site childcare or parent-infant programming.
• Treatment that is tailored specifically to either women or men.

For more information, see: Peer Support Specialist Programs for Families Affected by Substance Use and Involved with Child Welfare Services: A Four-Module Implementation Toolkit, and Understanding Substance Use Disorder Treatment: A Resource Guide for Professionals Referring to Treatment.

Comprehensive family assessment

Comprehensive family assessments are at the core of a family-centered approach and are necessary to establish a treatment plan and case plan for families affected by substance use disorder. With appropriate consent, assessment results can be shared with family-serving providers to ensure interventions meet the needs of all family members. A thorough family assessment process identifies and evaluates:

• Parental needs — mental health, physical health, and substance use disorder treatment.
• Child needs — development and mental health.
• Family dynamics — parenting skills and parent-child bonding.

Interagency collaboration

No single agency can meet the needs of all family members, which is why cross-agency partnership is a vital component of an effective family-centered model. Formal multi-agency coalitions promote long-term operational alignment and information sharing, which may help resolve service gaps and barriers.

Joint efforts between child protection agencies, dependency courts, and substance use disorder treatment providers, however, often are hindered by misaligned priorities and obstacles to information sharing.¹⁴ These challenges are further compounded when working across state lines.

Children and Family Futures’ Comprehensive Framework to Improve Outcomes for Families Affected by Substance Use Disorders and Child Welfare Involvement helps guide systems alignment by outlining 10 policy- and practice-level strategies designed to improve family outcomes.

The five policy efforts that help build and sustain multi-agency collaboration are:

• A commitment to shared mission, vision, and goals. Establish joint operating procedures, develop a common language, and regularly identify opportunities for system improvement.
• Efficient cross-system communication. Implement formal information-sharing protocols and establish streamlined communication channels.
• Ongoing cross-training and staff development. Provide joint, multi-level training for leadership, management, and frontline staff across child welfare, dependency courts, healthcare, and substance use disorder treatment providers.
• Institutionalizing practices to achieve sustainability. Embed innovative practices directly into agency infrastructure from the outset, leverage multi-system funding streams, and continuously demonstrate outcome-driven results.
• Measuring and monitoring outcomes. Agree on a set of comprehensive performance measures that track family outcomes, including child safety, permanency, well-being, and parental treatment completion.

The five practice strategies are:

• Early identification. Implement standardized screening to identify families requiring treatment at the earliest possible point of child welfare contact.
• Timely access to supports. Establish rapid, equitable pathways to comprehensive clinical assessments and evidence-based treatment services.
• Peer recovery supports. Integrate peer recovery specialists and recovery coaches throughout child welfare and dependency courts.
• Family-centered treatment services. Embed holistic treatment models that address the needs of the parent and child simultaneously.
• Frequent joint monitoring. Maintain accountability and track compliance among — and across — child welfare, dependency courts, and treatment providers.

Family-centered approaches in action

Family treatment courts

Family treatment courts (FTCs) offer a family-centered approach built around cross-sector collaboration, as they involve child protection agencies, substance use disorder treatment providers, the mental health system, and dependency courts. FTCs have been shown to prevent family separation, reduce the amount of time children spend in foster care, and accelerate permanency.^15,16,17,18 

Practices used in FTCs — including early identification and treatment, peer recovery coaches, and intensive case management and case coordination — help inform other efforts to assist families with substance use disorders and catalyze systems change. They also offer a timely and motivational approach to providing feedback and support to parents during their treatment and recovery.

Tompkins County, N.Y., (county seat: Ithaca) has operated an FTC since 2001 and has experienced dramatically improved family outcomes. Program graduation rates for adults engaged in treatment have grown from 20% to 45%, voluntary relinquishments of parental rights dropped from 45% to 16%, and kinship-based custody rose from 10% to 41%. Improvements to the FTC over time have been family-focused, including the adding of a parent-child services coordinator and two evidence-based programs that promote healthy parent-child relationships.

The Tompkins County FTC supports families moving toward reunification by offering home visits from public health nurses, using the SafeCare model. In addition, the Strengthening Families Program is offered to all families involved with the FTC, which offers parents extra time with their children on top of required visits — a strategy that has incentivized parental engagement.

Sobriety Treatment and Recovery Teams

Sobriety Treatment and Recovery Teams (START) is a child welfare service model that has been shown, when implemented with fidelity, to improve outcomes for families with young children affected by parental substance use disorder. The model promotes collaboration and systems-level change within and between child protection agencies, substance use disorder and mental health treatment providers, dependency courts, and other family-serving entities. Program elements include shared decision-making meetings, peer support, intensive case management, rapid access to recovery services, and services for all family members, including older children and non-custodial parents.

START focuses on safely keeping children with their parents but also provides services to separated families until safe permanency is achieved. START has undergone rigorous evaluation, described in at least a dozen peer-reviewed publications, with positive outcomes including decreased foster care placements and decreased parental substance use.

Several states have implemented START. Iowa, Kentucky, Maryland, North Carolina, and Ohio are conducting studies of its implementation and effectiveness. Maryland, Ohio, Oswego County (N.Y.), and Washoe County (Nev.) also are participating in a study of START. Iowa, which began serving families in two sites in 2026, already reports the START model has helped keep children safely with their parents who would likely otherwise have been removed.¹⁹