Every day, millions of parents in recovery from substance use disorders show that healing is possible and that families can thrive. Recovery improves relationships, prevents child removal, reunites families, and strengthens communities. Yet too many families still face barriers to substance use disorder treatment and recovery support. Estimates from 2023 show that one in four U.S. children — almost 19 million children — live with at least one parent or primary caregiver who has a substance use disorder.¹

Children of parents with substance use disorders face higher risks of emotional, behavioral, and physical health problems, as well as family instability and poorer social and academic outcomes, due to disrupted relationships and reduced parental monitoring.² These risks increase the likelihood of child maltreatment and involvement with the child welfare system.³ In 2023, parental alcohol or drug use was cited as a condition associated with removal for about 39% of children entering out-of-home care.⁴

Traditional residential treatment programs for substance use disorders often focus only on the parent’s recovery and require separation from children. While this model can provide intensive counseling and clinical care, it also can weaken the parent–child bond and create barriers for families involved with the child welfare system that seek reunification. This is additionally problematic because primary motivators for parents to engage and succeed in treatment are reuniting with children and preserving their family. Residential substance use disorder treatment programs that recognize the importance of family and the parent-child connection are more likely to result in successful treatment, sustained recovery, and positive child welfare outcomes.

What family-based residential treatment looks like

Research on family-based residential treatment programs suggests that participating families are less likely to experience foster care placements and more likely to remain safely together.^5,6,7 Evaluations of pregnant and parenting women’s substance use disorder treatment found that comprehensive residential treatment:⁸

• Alleviated women’s substance abuse problems
• Improved birth outcomes
• Helped mothers increase parenting capacity
• Improved collaboration between child welfare agencies and family courts on reunification and custody planning

In family-based residential treatment, parents and children live together in a safe, structured, and supervised environment — or maintain frequent connections and family time when full co-residency is not feasible. Services often include:

• Comprehensive substance use disorder treatment, including individual and group therapy
• Parenting education and parent–child therapy
• Early education, developmentally appropriate services, and early intervention for children
• Integrated health care and mental health services
• Vocational training
• Childcare and respite services
• Safe and sober housing
• Onsite childcare
• Visits between parents and children fit around treatment schedules^9,10

This family-centered approach to substance use disorder treatment helps parents build recovery skills while providing children opportunities to grow emotionally, strengthen relationships with their parents, and receive the assessments and developmental and emotional therapeutic services they need.¹¹ Residential treatment programs for parents and their children that have been built around such a family-centered environment offer lessons on how substance use disorder treatment not only can help the parent recovering from the addictive disease, but also the entire family.

A family-centered approach to treatment recognizes that parents or primary caregivers are part of a family system. As all individuals are unique, so are the families within which they exist. Treatment plans are tailored to each individual and their family. Important considerations for family-based residential treatment are comprehensive assessments that provide essential information on the developmental status of children, parental capacity, and social support networks, thereby helping determine the course of family-centered care.

Centering safety and developmental needs

The safety of family members, especially children, is the foremost priority when determining treatment plans. Children have a range of age-related developmental needs that must be carefully considered in determining the extent of parent-child contact that is most appropriate. For example, infants have a critical need for secure bonding and attachment with a nurturing caregiver, while a school-age child may be better served in a stable, consistent environment with a kinship provider, with frequent visits with their parent in recovery, and continuity within school and their established peer group.

Understanding family-based residential treatment, how it operates, and the outcomes it produces can help child welfare workers guide families toward programs where parents actively build recovery skills, practice parenting, and maintain safe, consistent, and nurturing connections with their children. In 2019, The Annie E. Casey Foundation, Volunteers of America, and Wilder Research produced a national directory of family-based residential treatment programs.

Bridging the divide between treatment and child welfare

For too long, child protection agencies and substance use disorder treatment programs have operated in silos, with limited communication and collaboration. Although specialty substance use disorder treatment programs for pregnant and parenting women have operated since the late 1970s, availability remains scarce.

Barriers such as a lack of cross-system training, confidentiality rules, different success metrics, and mismatched timelines made coordination difficult. For example, recovery from substance use disorder is typically gradual and takes time. For some, recovery may detour with a brief return to substance use. Child welfare operates under the federal Adoption and Safe Families Act of 1997, with strict timelines and the initiation of termination of parental rights (TPR) if a child is in placement for 15 out of 22-months, with some exceptions. A parent actively engaging in treatment and reunification services may be an example of when TPR is not in a child’s best interests. Without communication, information sharing, cross-training, and coordinated service plans, these timeline differences may seem insurmountable — but they are not.

Collaborative and coordinated practice with child welfare systems and residential substance use disorder treatment contributes to successful family outcomes. Child welfare systems and providers should share treatment progress and case plan goals and timelines so that expectations of the parent are not in conflict. For example, a treatment provider knowing the visitation schedule for a parent with other children not placed with them is important for coordinating with treatment activities. Coordination will ensure visits can occur without missing required treatment activities. Having a structured communication protocol across agencies facilitates the exchange of information and reduces misunderstandings among staff.

Bridging the divides between substance use disorder treatment and child welfare is possible through family-centered treatment that recognizes a person’s role of parent as pivotal to the recovery and well-being of the whole family. Child welfare practice that is informed about substance use disorder treatment and recovery and prioritizes safe family preservation and timely reunification, increases the likelihood of positive outcomes for the children and their parents. Several multi-site evaluations of innovative programs serving families affected by SUDs and involved with child welfare have demonstrated consistent results over the past decade. The initiatives showed improvements across parental SUD recovery, children remaining at home, family reunification, reductions in repeat maltreatment and reductions in family re-entry into the foster care system.¹²

The Family First Prevention Services Act gives states, counties, and Tribes tools to support families affected by substance use disorders. Under Family First, federal foster care maintenance funds can cover the costs of children participating in licensed, evidence-based family-based residential treatment programs for up to 12 months. Though implementation across the states has been limited to date, Utah is using Title IV-E funds to cover these costs. This planning brief provides additional information on funding for residential substance use disorder treatment.

Making programs truly family-centered

Knowing the hallmarks of a family-centered approach to residential substance use disorder treatment can help child welfare systems assess treatment options for families. Some core elements are:

• A coordinated approach relies on relationships across systems and within the community. For example: holding joint substance use or co-occurring disorder treatment and child welfare service reviews; routinely monitoring and documenting progress toward respective goals and service objectives; and acknowledging and positively reinforcing a parent’s recovery wins, big or small.
• Resources and funding. Braided funding and partnerships can help pay for and provide essential services, such as on-site childcare or vouchers for transportation to a medical appointment.
• Data and continuous quality improvement. Use data to monitor progress in child and family safety and well-being, family reunification, recovery milestones, parenting skills, and long-term recovery and family stability. Engage in continuous quality improvement to strengthen services.
• Family definition. Honor the way each family defines itself, including its chosen kin such as grandparents, cousins, or close friends. Be open to a family’s desire to include chosen kin in therapy sessions or family time planning.
• Coordinated care. Coordinate all services to ensure seamless delivery, clear communication, and service and visitation schedules that reflect family priorities and address access issues.
• Family and child support. Connect families to services that meet children’s developmental, educational, and emotional needs, and provide family counseling that strengthens parent–child relationships and meets the needs of all family members.
• Quality treatment. Services are trauma-informed, evidence-based, and focused on long-term well-being, such as individual and parent–child therapy sessions that build coping skills, resiliency, and healthy parent–child interactions.
• Comprehensive services. Offer services that assist with parenting responsibilities (including childcare), housing, educational and recreational programs for children, and other basic needs. Connect parents or primary caregivers to peer mentors.

Promoting equity in access and outcomes

Native American children have the highest rate and fastest growth in foster care entries associated with parental drug use,¹³ and Black children are reported to child welfare at much higher rates than the child population as a whole, even after accounting for factors such as poverty.¹⁴ To support equitable access and engagement in treatment, questions should be considered when making a referral to a program:

• Does the program offer services in the family’s primary language and include practices that respect cultural traditions?
• Are treatment program staff trained to understand family histories and experiences that may influence trust and engagement?
• Does the program help families manage practical challenges related to racial disparities, such as inadequate access to childcare, housing, and transportation?

Family-based residential treatment matters for children

For child protection agencies and the broader child welfare system, family-based residential treatment programs can provide options that increase the likelihood of positive child and family well-being outcomes and reduce barriers in everyday casework challenges. Family-based residential treatment programs can:¹⁵

• Keep families together. Parents can live with their children or maintain regular, structured family time during treatment, reducing traumas related to family separation.¹⁶
• Strengthen recovery. Remaining connected to their children helps parents stay engaged in treatment, complete programs, and practice balanced and consistent caregiving.^17,18
• Reduce foster care entries and placement disruptions. Fewer children experience maltreatment and need to enter foster care, and those who are placed with their parent during treatment experience greater stability.¹⁹
• Increase timely reunification. When children are removed, families can reunify more quickly and build stronger, lasting relationships.²⁰
• Improve access to services. Children, parents, and extended family members are more likely to receive a comprehensive needs assessment and coordinated services that address their needs.²¹
• Strengthen long-term family stability. Children and parents maintain stronger bonds, improving the likelihood that families sustain reunification after treatment.²²
• Facilitate cross-system coordination. Working closely with child welfare and community providers helps to improve communication and service planning for families.²³
• Prioritize protective factors. Following protective protocols and closely monitoring families with 24-hour staffing while children are in residence helps minimize risk.²⁴