Implementing a

Family-Centered
Approach
For Families Affected by Substance Use Disorders
and Involved With Child Welfare Services

MODULE
Overview of a Family-Centered 1
Approach and Its Effectiveness

Substance Abuse and Mental Health

Services Administration
This Technical Assistance Tool was developed by the National Center on Substance Abuse and Child Welfare (NCSACW). NCSACW is
a technical assistance resource center jointly funded by the Substance Abuse and Mental Health Services Administration (SAMHSA)
and the Children’s Bureau (CB), Administration on Children, Youth and Families (ACYF), U.S. Department of Health and Human
Services. Points of view or opinions expressed in this guide are those of the authors and do not necessarily represent the official
position or policies of SAMHSA or ACYF.

National Center on Substance Abuse and Child Welfare

MODULE 1

Overview of a Family-Centered Approach

and Its Effectiveness

Substance use disorders (SUDs) affect the entire family—they

About This Module
can interfere with a parent’s ability to take care of and bond
Module 1 provides an overview of family-centered
with a child and can disrupt family health and well-being.
treatment and how it differs from traditional SUD
Traditional SUD treatment focuses on the individual, despite
treatment. It highlights the benefits and effectiveness
evidence that parents and children are most effectively
of a family-centered treatment approach and provides
served through a family-centered treatment approach. A
a series of steps that communities can take to
family-centered approach to SUD treatment provides a
implement this approach.
comprehensive array of clinical treatment and related support
services that meet the needs of each member in the family,
not only the individual requesting care. The Family First
NCSACW recognizes that a family-centered approach
Prevention Services Act (FFPSA) offers a historic opportunity
extends well beyond the SUD treatment system, the child
for child welfare agencies and their SUD treatment partners
welfare system, the courts, and mental health services, and
to expand and enhance family-centered interventions.
includes all other agencies and individuals that interact with
To help communities move toward family-centered care, and serve families. The work of all partners must reflect an
the National Center on Substance Abuse and Child Welfare understanding and responsiveness to the fact that parents
(NCSACW) prepared a series of companion modules on and children live within the context of a larger family system
implementing a family-centered approach. This series is and that families exist within the context of their community
designed for state, county, and agency-level collaborative and culture. The cultural influences of race, ethnicity, religion,
partners that are working together to improve systems, geography, and customs are considerations that must be
services, and outcomes for children and families affected by prioritized when implementing a family-centered approach.
SUDs. The modules include:
NCSACW strives to improve family recovery, safety, and
§ Module 1: Overview of a Family-Centered Approach stability by advancing best practices and collaboration among
and Its Effectiveness agencies, organizations, and courts working with families
affected by substance use and co-occurring mental health
§ Module 2: On the Ground—Family-Centered Practice disorders and child abuse or neglect. For more information
about this module or assistance with implementing
§ Module 3: Collaboration To Support Family-Centered a family-centered approach, visit the NCSACW webpage
Practices at the County and State Level or email us at [email protected].

1 Module 1
 Legislative Supports for a Family-Centered Approach
Family-based services grew out of residential treatment a webpage featuring a host of resources and materials on
programs for pregnant and parenting women that were addressing the CAPTA requirements and implementing a
developed in the early 1990s. The Substance Abuse comprehensive approach to Plans of Safe Care. NCSACW also
and Mental Health Services Administration (SAMHSA) provides a summary of states’ strategies for Plans of Safe
funded the development of model programs to provide Care.
services for women and their children. Since then, family-
centered approaches have continued to grow nationwide Family First Prevention Services Act (FFPSA)
as communities have increasingly seen a need for these Signed into law in 2018, FFPSA allows states to provide
programs. Two recent pieces of federal legislation further enhanced supports to children and families, notably
supported states to integrate family-centered treatment: substance use and mental health prevention and treatment
services, to prevent foster care placements. FFPSA provides
Child Abuse Prevention and Treatment Act (CAPTA) an opportunity for child welfare and SUD treatment providers
In 2016, Congress amended CAPTA to require states to to build the infrastructure to support family-centered
develop a statewide program to provide Plans of Safe Care treatment models and implement strategies to support the
for infants born with and identified as being affected by recovery and well-being of children and their family members.
substance abuse, withdrawal symptoms, or a Fetal Alcohol Children and Family Futures provided a webinar and online
Spectrum Disorder (FASD) to ensure the safety and well- toolkit on implementing the SUD provisions of FFPSA.
being of infants and their families. The Plans of Safe Care also
address the health and SUD treatment needs of the infants Both pieces of legislation underscore the importance of
and their affected family or caregiver. NCSACW provides a family-centered approach to effectively treat SUDs and
promote sustained recovery and family well-being.

National Center on Substance Abuse and Child Welfare 2

 How Family-Centered Treatment Approaches
Differ From Traditional Treatment
Family-centered treatment is designed to meet the needs and relationships. Family-centered treatment ensures
of each member in the family as well as support the family’s development of treatment plans not only for the identified
functioning, not only the person diagnosed with the SUD. client, but also for other individuals in the family and for the
While the length of the services, type of setting (e.g., family as a whole. A family-centered approach goes beyond
residential, outpatient), and size of the programs may vary, a parent’s SUD to address relationship dynamics and seeks
the common objectives across all family-centered treatment to prevent intergenerational transmission of SUDs. Parenting
approaches are that parents are fully supported in their classes serve as a valuable tool to help parents, improve
parenting roles and children receive the necessary services family functioning, and promote family well-being. Relapse
and supports to remain with their parent(s) during the prevention plans include strategies to address parenting
treatment and recovery process. Family-centered treatment stressors. Treatment plans also address the needs of children
focuses on parental recovery and addresses the children through screenings for developmental delays, trauma, and
and other identified family members’ trauma and social, social and emotional challenges, and incorporate child and
emotional, and developmental challenges (Children and family therapies.
Family Futures et al., 2020).
SAMHSA (2012) defines recovery as “a process of change
Both traditional treatment and family-centered treatment through which individuals improve their health and wellness,
address SUDs and co-occurring mental health concerns live a self-directed life, and strive to reach their full potential.”
teach coping mechanisms to achieve sobriety, and support For parents, the recovery process occurs within the context
the client to develop continuing care plans. However, of family relationships. The parenting role itself cannot be
family-centered treatment carries out these fundamental separated from the recovery process. Likewise, the effects of
practices for the individual within the context of the family SUDs on children need to be addressed within the treatment

Continuum of Family-Based Services

Parent’s Treatment Parent’s Treatment Parent’s

Family Family-Centered
with Family with Children and Children’s
Services Treatment
Involvement Present Services

Services for Children accompany Children accompany Children accompany

parent(s) with parent(s) to parent(s) to parent(s) to Each family
substance treatment. Children treatment. Parent(s) treatment; parent(s) member has a
use disorders. participate in child and attending and children have treatment plan
Treatment plan care but receive no children have treatment plans. and receives
includes family therapeutic services. treatment plans and Some services individual and
issues, family Only parent(s) have receive appropriate provided to other family services.
involvement. treatment plans. services. family members.

Goals: improved Goals: improved Goals: improved

Goal: improved Goal: improved
outcomes for outcomes for outcomes for
outcomes for outcomes for
parent(s) and parent(s) and parent(s), children,
parent(s) parent(s)
children, better children, better and other family
parenting parenting members; better
parenting and
Werner, D., Young, N.K., Dennis, K, & Amatetti, S.. Family-Centered family functioning
Treatment for Women with Substance Use Disorders – History, Key
Elements and Challenges. Department of Health and Human Services,
Substance Abuse and Mental Health Services Administration, 2007.

3 Module 1
and recovery process. By using a family-centered treatment allow children to accompany their mother, not all programs
approach, services address the needs of the parent, child, allow children of all ages to live on campus, or provide a
and other family members to build lasting recovery, health, comprehensive family-centered treatment approach.
and well-being.
While family-centered treatment is predominantly evident
Family-Centered Treatment Continuum in residential settings, this intensive level of treatment
Family-centered treatment emerged from SUD treatment represents only a small portion of the SUD treatment
models focused on the individual, and programs have available along a continuum of care. Availability of these
increasingly integrated the needs of family members over programs is limited, particularly in rural areas. In 2019,
time. The SAMHSA monograph (Werner et al., 2007), an estimated 363 residential SUD treatment programs
Family-Centered Treatment for Women With Substance Use representing 299 organizations across 48 states, Puerto Rico,
Disorders: History, Key Elements and Challenges, outlines and the District of Columbia had program models for parents
a continuum of family-centered treatment on which SUD and children in the same treatment facility (Wilder Research
treatment programs can exist. & Volunteers of America, 2019). Even those residential
treatment programs that do allow children to accompany
The process of integrating family-centered treatment their parent may be difficult to access due to restrictions on
approaches into traditional SUD treatment takes time, and the age and number of children allowed (SAMHSA, 2015). The
thus SUD treatment providers can be at different points along 2017 National Survey of Substance Abuse Treatment Services
this continuum during this process. reports that between 2007 and 2017, clients in outpatient
treatment made up 89 to 91 percent of all clients each year,
Family-Centered Residential Treatment whereas clients in residential (non-hospital) and hospital
Family-centered treatment approaches are most commonly inpatient treatment represented a much smaller percentage
highlighted in residential treatment settings, which offer (7 to 9 percent and 1 to 2 percent, respectively; SAMHSA,
a range of services in a structured, 24-hour living support 2018). Family-centered programs for fathers are even more
setting with available trained personnel (American Society limited, with very few states offering any residential options
of Addiction Medicine, 2015; Casey Family Programs, 2019; for fathers and their children.
SAMHSA, 2020; Wilder Research & Volunteers of America,
2019). Residential treatment programs for mothers with their The limited availability of residential treatment underscores
children have achieved positive parent and child outcomes the need to implement family-centered treatment within each
such as enhanced parent-child bonding, improved interactive of the SUD treatment levels of care, including in outpatient
and reciprocal communication, and maternal sensitivity to and medication-assisted treatment (MAT) programs, to meet
the child’s needs (Clark, 2001; Conners et al., 2001; Grella the comprehensive needs of more families affected by SUDs.
et al., 2000; Jackson, 2004; Metsch et al., 2001; Milligan et The NCSACW resource, Understanding Substance Use
al., 2011a; Moore & Finkelstein, 2001; Porowski et al., 2004; Disorder Treatment: A Resource Guide for Professionals
Wong, 2009). The design of these programs also enables Referring to Treatment, offers more information on the
treatment staff to assess parenting skills and parent-child SUD treatment and recovery process. This guide also offers
attachment and to provide intensive parenting interventions, discussion questions that child welfare and court staff can
developmentally appropriate services for children, and family pose to their community SUD treatment providers to ensure
therapy (National Abandoned Infants Assistance Resource that they refer to high-quality SUD treatment that addresses
Center, 2012; Wong, 2009). While many residential programs the needs of children and families.

National Center on Substance Abuse and Child Welfare 4

 Positive Outcomes of Family-Centered
Treatment Approaches

There is a growing body of research that demonstrates the

Family-Centered Treatment Encourages Retention in
effectiveness of family-centered treatment in improving child,
Treatment – Studies of residential treatment programs for
parent, and family outcomes. Positive outcomes include:¹
parenting women with SUDs found that women living with
§ Increased treatment retention rates and reduced substance their infants had the highest level of treatment completion
use rates rates and longer stays in treatment compared to women
who did not have their children with them (Clark, 2001).
§ Decreased risk of child abuse
§ Increased rates of reunification and positive Family-Centered Approaches Increase Parenting Skills
permanency outcomes and Capacity – Women who participated in programs that
included a high level of family and children’s services and
§ Reduced rates of infants with prenatal substance exposure
employment/education services were twice as likely to
§ Improved psychosocial and family functioning for children, reunify with their children than those who participated in
parents, and family members programs with a low level of these services
§ Improved parent mental health, physical health, (Grella et al., 2006).
and employment
Family-Centered Approaches Enhance Child Well-Being
§ Reductions in depression and parental stress – Family-centered approaches address the needs of all
§ Improved parenting attitudes family members individually and as a unit which leads to
improvements in parenting attitudes and psychosocial
§ Enhanced parental bonding with children functioning for the family (McComish et al., 2003).
§ Improved child developmental and behavioral outcomes

1(Calhoun et al., 2015; Child Welfare Information Gateway, 2014; Claus et al., 2007; Dakof et al., 2010; Grella et al., 2009; Hanson et al., 2015; McComish et al., 2003;
Milligan et al., 2011b; National Academies of Sciences, Engineering, and Medicine, 2016; Niccols et al., 2012; Rodi et al., 2015; Sword et al., 2009).

5 Module 1
 Defining “Family”
There is no specific definition of “family” within a Additionally, family-centered approaches provide culturally
family-centered treatment approach. Individual clients are appropriate services to the families that they serve. Ideally
free to identify their family members. Families are diverse services can be rooted in the culture and values of the clients
and can be made up of nuclear family members, extended that are being served. When this is not possible, it is essential
family members, or non-blood relatives. Cultural identity that providers ensure their clients are referred to or
affects family membership and makeup. Clinicians take a engaged with services that connect their clients to their
person-centered approach to supporting their clients to cultural community.
identify the members of their family and how to involve
them in treatment.

Essential Ingredients of a Family-Centered Approach

Essential Ingredients of a Family-Centered Approach 1. Collaborative Partnerships
Collaborative partnerships are the foundation of a family-
centered approach. A single SUD treatment provider is
unlikely to be able to provide all the services a family needs
due to the costs, staffing, clinical expertise, and the physical
space required. SUD treatment providers can establish
collaborative partnerships with community service providers,
county and state administrators, and funders that can
support the development of a comprehensive community-
based, family-centered approach. Ideally, these partnerships
will become an established collaborative initiative that
will continue to address barriers, support interagency
partnerships, and promote information sharing to
benefit families.

2. Adequate and Flexible Funding

There is not currently a universally accepted definition of a Implementation of innovative services requires new
family-centered approach or a specific model. Thus, each and flexible funding. SUD treatment providers and their
treatment agency may operationalize a family-centered collaborative partners can work with state and county leaders
approach differently. Differences in practice may reflect to identify funds that could support family-centered services,
regional variations, the needs of different populations, or particularly newly available funds through FFPSA and CAPTA
availability of services. state grants.
Despite differences, there is a set of common essential
3. Performance Monitoring
ingredients to a family-centered approach that is used across
the continuum of SUD treatment providers. The essential Effective programs develop a process for regular performance
ingredients are introduced below and will be described in monitoring and ongoing quality improvement. As SUD
detail with practice examples in Module 2. treatment providers and their collaborative partners work
together to implement and sustain comprehensive family-
centered treatment, they can identify shared performance
measures and build data dashboards to monitor
families’ success.

National Center on Substance Abuse and Child Welfare 6

4. Intensive and Coordinated Case Management depending on the target population and geographic location.
Coordinated case management for families ensures that Family-centered support services often include:
the SUD treatment provider and its collaborative partners
§ Family-centered service planning
are coordinating services, addressing barriers to access and
engagement in services, and sharing information on families’ § Family strengthening services and programs, evidence-
progress against baseline data. based parent-child programs, and parenting education
§ Culturally responsive and gender-specific services
5. High-Quality Substance Use Disorder Treatment
§ Individual and family therapy to address mental health
At the heart of a family-centered approach is a high-quality
and trauma
SUD program that uses evidence-based and trauma-informed
models to deliver therapeutic services and aftercare support. § Children’s services to address identified developmental,
healthcare, trauma and mental health, early childhood
6. Comprehensive Service Array education, and other needs
Families require access to services that address the needs § Recovery or peer support services are provided and include
of children and adults and that support and strengthen the staffing considerations for gender, age, and culture
family across the continuum of outpatient to residential care.
§ Links to family health clinics
Any service begins with a comprehensive assessment of
strengths and needs. Each family-centered treatment program § Wraparound support and services, such as childcare,
will identify which services are required to meet the needs vocational support, education, housing, legal aid,
of its clients, and the services each offers may look different and transportation

7 Module 1
 Steps To Implement a Family-Centered Approach
SUD treatment providers and their community partners 2. Assess Resources
seeking to infuse family-centered treatment into their practice The next step is to survey state and local funding streams that
can complete the following steps to support implementation: could support new programming.
1. Assess Needs Action Steps
SUD treatment providers and their collaborative partners § Review current funding opportunities for children,
survey the community to understand the needs of the SUD parents, and families. Can funds be redirected from
treatment population, including both parents and children. other sources?

§ Engage state and county leadership to identify

funding opportunities.
Key Questions in Assessing Existing Services
1. How are the needs of family members included in
3. Build Partnerships
service plans? Is there a multi-generational
approach used? SUD treatment providers then identify community partners
working with children, parents, and families that can support
2. Are services integrated and coordinated? the initiative. Support from state, county, and local leadership
3. Are children’s services distinct from parenting services? can also solidify the initiative and ensure its sustainability.
Module 3 provides more information on building a
4. Are partnerships and collaborations in place to provide
services to meet family needs? collaborative partnership.

5. What evidence-based services are used, and do they Action Steps

support family-centered treatment? § Build and initiate a governance team consisting of
6. How is the family’s point of view prioritized in treatment community agencies that serve parents, children, and
goals? How is information shared? Are there data family members. Include local and county leadership
sharing agreements in place? as applicable. Recruit partners that offer diverse
perspectives.
7. Do the services include diverse family structures?
8. Do the services include trauma-responsive services § Use the governance team to develop a data dashboard to
provided by staff who understand historical trauma? identify priorities and measure progress.

9. Do the staff represent diverse backgrounds?

4. Implement New Services
Together with partners, SUD treatment providers can review
Action Steps survey results and data dashboards to determine the services
§ Determine what services are missing or needed, what to prioritize and implement. As services are implemented, the
services are available, and which available services are team can continue to monitor progress and further needs to
evidence-based. determine next steps.

Determine if there are services that cater specifically to Action Steps

§
communities of color and diversity among families. Are § Work with partners to determine where new services
current service providers trusted by these communities? can be housed.

§ Continue to work with funders to ensure services

can be sustained.

National Center on Substance Abuse and Child Welfare 8

 Take Action—Next Steps

§ Research local, state, and federal

opportunities for funding
family-centered approaches.

§ Understand the essential elements of a

family-centered approach and its benefits.

§ Assess the need for a family-centered

approach in the community.

9 Module 1
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RECDEF

11 Module 1