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This page contains links to external Web sites. Policy, Regulation and LegislationHere you'll find information on the latest major policies, regulations and legislation impacting women and children affected by substance use disorders. Substance Abuse Prevention and Treatment Block Grant (SAPT) and Women’s Set-AsideThe Substance Abuse Prevention and Treatment (SAPT) Block Grant is an annual formula grant awarded to States to support a national system of substance abuse treatment and prevention programs and services. Title 42 U.S.C. 300x-22 and 300x-24(b) require that States allocate a percentage of their block grant dollars for certain set-asides, including the provision of services to pregnant women and women with dependent children. These services include 1) the delivery or referral for primary medical care for women; 2) the delivery or referral for primary pediatric care for children; 3) the provision of gender specific substance abuse treatment; 4) therapeutic interventions for children; 5) child care; 6) case management; and 7) transportation. Beginning in fiscal year 1995, the women’s set-aside became a performance requirement that provides States with the flexibility to expend a combination of Federal and non-Federal funds to support treatment services for pregnant women and women with dependent children. States are not required to establish additional new programs or expand existing treatment capacity above the capacity developed in fiscal year 1994. In addition to the dollar set-aside, States must ensure that pregnant woman and women with dependent children who seek or are referred for and would benefit from treatment services are given admission preference to treatment facilities receiving SAPT Block Grant funds. Further, States and the programs that deliver services are required to publicize their availability of services and the fact that these women receive such preference. If a treatment facility does not have sufficient capacity to provide services to any pregnant woman who seeks them, the program must refer that woman to the State who, in turn, must refer the woman to a treatment facility that is able to treat her. If no treatment facility has the capacity to admit the woman, then the State must make interim services available to the woman no later than 48 hours after she has sought treatment. For more information on the SAPT Block Grant, please refer to statute 42 U.S.C. 300x-22(c)(1)(C) and the interim final rule 45 C.F.R. 96.122(e)(viii) and 96.124(c)(d)(e). SAPT 2008 Block Grant information is available at http://www.treatment.org/SAPT2008.html
Child Welfare PoliciesAdoption and Safe Families Act (ASFA)In 1997, ASFA was signed into law (P.L. 105-89), in part, to promote more timely permanent placements for children in the child welfare system. Among other changes, ASFA created adoption incentive bonuses to States; reauthorized the Family Preservation and Family Support program (renaming it the Promoting Safe and Stable Families [PSSF] program); and continued the child welfare demonstration waivers. ASFA includes several provisions that focus on ensuring the safety of children, stability and permanency of their home and their overall well-being. Two provisions that have particular significance for programs serving parents are ASFA requirements regarding decisions about a child’s permanent placement within 12 months after the child enters foster care, and requirements that states initiate proceedings to terminate parental rights if a child has been in foster care for 15 of the previous 22 months, unless there is a compelling reason not to initiate termination. This means families need to receive timely, appropriate, and individualized services, including substance abuse treatment. Section 405 of ASFA specifically addresses the coordination of substance abuse and child protection services and requires that the Secretary of Health and Human Services prepare a report to Congress that “describes the extent and scope of the problem of substance abuse in the child welfare population, the types of services provided to such population, and the outcomes resulting from the provision of such services to such population. The report shall include recommendations for any legislation that may be needed to improve coordination in providing such services to such population” (P.L. 105-89). This ASFA required report was published by the Department of Health and Human Services (DHHS) in 1999. It is:
Additional reports that may be of further interest and provide additional information specifically on ASFA include:
Promoting Safe and Stable Families The primary goals of Promoting Safe and Stable Families (PSSF) are to prevent the unnecessary separation of children from their families, improve the quality of care and services to children and their families, and ensure permanency for children by reuniting them with their parents, by adoption or by another permanent living arrangement. States are to spend most of the funding for services that address: family support, family preservation, time-limited family reunification and adoption promotion and support. The services are designed to help State child welfare agencies and eligible Indian tribes establish and operate integrated, preventive family preservation services and community-based family support services for families at risk or in crisis. Funds go directly to child welfare agencies and eligible Indian tribes to be used in accordance with their 5-year plans. Other grant funds are set aside for nationally funded evaluation, research, and training and technical assistance projects. In addition, funds are set-aside for court improvement programs. The Child and Family Services Improvement Act (P.L. 109-288) reauthorized the Promoting Safe and Stable Families through Fiscal Year 2011 and included $40 million in funds (with declining amounts over five years) for a competitive grant program to increase the well being of and improve permanency outcomes for children affected by methamphetamine or other substance abuse. For more information see: Child and Family Services Improvement Act www.acf.hhs.gov/programs/fysb/content/docs/06_ improvementact.pdf Compilation of Titles IV- B, IV- E and Related Sections of the Social Security Act - Draft - Social Security Act, as amended by The Tax Relief and Health Care Act of 2006 (P.L. 109-432), Effective June 20, 2007 http://www.acf.hhs.gov/programs/cb/laws_policies/cblaws/safe2007draft.htm Child Abuse Prevention and Treatment Act (CAPTA)The Child Abuse Prevention and Treatment Act (CAPTA) is a key piece of legislation that guides child protection. When CAPTA was amended and reauthorized in 2003 under The Keeping Children and Families Safe Act (P.L. 108-36), three important changes occurred. To maintain their CAPTA grant, States must assure that they have: 1) policies and procedures to address the needs of infants born and identified as affected by illegal substance abuse or withdrawal symptoms, including a requirement that health care providers involved in the delivery or care of such infants notify the child protective services system of the occurrence of such conditions in such infants; 2) a plan of safe care for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms; and 3) procedures for the immediate screening, risk and safety assessment, and prompt investigation of such reports. CAPTA also requires States to establish procedures to refer children under the age of three years who have substantiated cases of child abuse or neglect to early intervention services. While the CAPTA amendments regarding substance-exposed infants state that the identification of a substance-exposed infant shall not be construed as establishing child abuse or neglect in itself, these infants can be included in the group of children who can be referred for developmental assessments. The resource below provides a more detailed overview of CAPTA.
Child Welfare Policies – GeneralThe Child Welfare Policy Manual provides updated information on policies child welfare policies. It replaces the Children's Bureau's former policy issuance system and offers policy announcements and policy interpretation questions in an easy to use question and answer format. This manual, available at http://www.acf.hhs.gov/j2ee/programs/cb/laws_policies/laws/cwpm/index.jsp, is broken down into nine main policy areas (with detailed subsections):
Temporary Assistance for Needy Families (TANF)The TANF program replaced the Aid to Families with Dependent Children (AFDC) program in 1996, in accordance with the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). TANF is the primary source of funding for State welfare reform initiatives. It provides assistance to States to provide an array of support and services consistent with the program’s overall objectives (1) to assist needy families with children so that children can be cared for in their homes; (2) to reduce dependence by promoting job preparation, work, and marriage; (3) to reduce and prevent out-of-wedlock pregnancies; and (4) to encourage the formation and maintenance of two-parent families. On February 8, 2006, President George W. Bush signed into law the Deficit Reduction Act (DRA), which reauthorized TANF through 2010, but with important changes regarding substance abuse treatment and work participation requirements. The TANF Interim Final Rule (effective October 1, 2006) redefined what types of activities may be counted toward work participation rates. It indicates that while substance abuse treatment is considered an allowable work activity under the category of job readiness, it is no longer allowable under the community services or job skills training categories. Furthermore, treatment or therapy must be determined to be necessary by a qualified medical or mental health professional, and supervised by the TANF agency or other responsible party on an ongoing basis. States may only count the work portion hours of an individual’s participation in a treatment program—for example, an individual living in a halfway house may count those hours spent on assigned, supervised, documented work responsibilities for the benefit of all the residents (e.g., preparing meals, housecleaning).State expenditures on treatment can count toward meeting a State’s basic MOE expenditure. The statutory time limitations that apply to job search and job readiness assistance (no more than 6 weeks in any fiscal year and no more than 4 weeks consecutively) still apply. The implications of these changes remain to be seen.Although work participation requirements for States (in terms of percentages of families participating in activities and the minimum number of hours a family must work to be counted as participating) remain the same, DRA makes significant changes to how the caseload reduction credit is calculated. Among the changes, States will now receive c redit only for future caseload reductions, rather than for reductions that have occurred since FY 1995. As a result, States will have to obtain significant increases in their participation rates to meet the new standards. In addition, the new law requires that families receiving assistance under Separate State Programs (SSPs)—programs that receive no Federal TANF funding but only State funding that counts toward the State’s MOE—are now subject to the Federal work participation requirements. Before reauthorization, States had the flexibility of using SSPs to assist families who had significant barriers to employment, who were attending educational programs that lasted for more than 12 months, or for whom the Federal work requirements were otherwise unsuitable. Many States also provided assistance to two-parent families through SSPs to avoid fiscal penalties if they did not meet the applicable 90-percent participation rates. For more information, consult the resources below:
The Welfare Peer Technical Assistance Network, which provides peer-to-peer technical assistance to public agencies and private organizations operating the TANF program. Technical assistance is provided through a variety of mechanisms: peer-to-peer site visits, workshops, moderated teleconferences and interactive Q&A sessions. The Web site also highlights policy relevant research, innovative programs, related links and upcoming events. The objective of the Peer TA Network is to facilitate the sharing of information between and among states and to establish linkages between organizations serving the needs of welfare recipients. The site’s Research/Resources section includes information on those who are hard to employ and/or are experiencing barriers to self-sufficiency, such as substance abuse and mental health issues. http://peerta.acf.hhs.gov / Other Policy, Regulation or LegislationThe National Conference of State Legislatures (NCSL) tracks state legislation and policy that govern the safety and well-being of children through its State Child Welfare Legislation reports. Laws addressing substance abuse and women and their children and families that were enacted in 2005 ( http://www.ncsl.org/print/cyf/cwlegislation05.pdf) included:
Women’s Substance Abuse Treatment Standards – State Highlights and SummariesIn March 2007, CSAT sent a brief questionnaire to all State Women’s Services Coordinators (WSCs) to find out if States had substance abuse treatment standards or protocols for women and/or pregnant women (beyond the SAPT Block Grant requirements). The goal was to learn more about States’ standards and lay the groundwork for future collaborative efforts with the National Association of State Alcohol and Drug Abuse Directors (NASADAD) to develop guidance to States on creating women’s substance abuse treatment standards. A total of 28 States (55 percent) indicated they had some kind of standards for women and/or pregnant women beyond the SAPT Block Grant requirements; 20 States (39 percent) said they did not have standards; and 3 (6 percent) said they were developing standards. Children and Family Futures (CFF), contractor to CSAT, reviewed the standards from the 28 States. CFF’s review entailed a qualitative content analysis of the State standards, using the CSAT Comprehensive Substance Abuse Treatment Model for Women and Their Children as an organizing framework. The CSAT Comprehensive Model recommends that treatment providers provide a range of clinical treatment and support services to women and to children, as well as community support services to families, that cut across the continuum of care. In addition, CFF also looked at the standards for other more general administrative issues such as staffing, and outcomes and monitoring. The summary document presents the key themes regarding comprehensive services and select administrative issues, as well as a brief discussion of the issues WTCs said they would like NASADAD to address in developing guidance to the States. For a PDF version of this summary document, click here. For a listing of more general reports that address issues affecting women with substance use disorders and their children and families, please click on the TIE category, Recent Reports, Articles and Fact Sheets.
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