Critical thinking is always . . . well, critical.

Toxicology tests are the primary monitoring tool for departmental workers seeking to support the sobriety of their clients, and it is not uncommon for a child welfare department to require a substance use evaluation, and subsequently, cessation from all substances in a treatment plan.

The toxicology test results, however, are often viewed through a binary lens–either positive or negative. Unfortunately, this leads workers, and sometimes even the individuals being tested, to use terms such as “clean” or “dirty” to describe the results. Describing test results as “dirty” clearly carries a negative connotation, and using this kind of language is antithetical to the strengths-based practices that Colorado Department of Human Services is committed to.  

Instead, caseworkers can use the information contained in the Toxicology Resource Guide to better understand the data that they receive from testing agencies and move beyond the oversimplified and potentially harmful descriptors of “clean” and “dirty”. The guide contains information about types of toxicology tests, neonatal testing and testing children and adults. It breaks down the signs of substance use and misuse by substance–but it also acknowledges that toxicology test results don’t give us the whole picture.

Using substances in and of itself is not necessarily a child welfare concern. This is why it’s so important for caseworkers to put their critical thinking skills to the test! For example, The Colorado Family Safety Assessment tool enables caseworkers to perform a complete assessment to see what’s working and what’s not in each unique household.

Another Tool in the Toolbox

Just like a drug test is just one piece of the puzzle, the Toxicology Resource Guide is just one tool in a caseworker’s toolbox–but it’s an important tool for understanding the needs of families who may be using substances. A specialized tool like the Toxicology Resource Guide can empower Colorado child welfare caseworkers to interpret drug test results knowledgably and thoughtfully and, as a result, can positively affect the caregivers and children they serve. 

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Toxicology results can be complicated to understand. The results may or may not tell us whether the environment is safe for the children, who was exposed to a substance, or shed light on the strengths and protective capacities of caregivers and children. Even the decision to request a toxicology test is not be as straightforward as many may think–to say nothing of which test should be selected. Since research indicates that substance use is a factor in a majority of child welfare cases, caseworkers need to be prepared to work with parents, caregivers, pregnant people and youth as they navigate the complex issues surrounding substance use and child safety.

Trainings Featuring the Toxicology Resource Guide

Marijuana, Children and Families and Building Safety when Parents Use Substances are two highly-recommended course for all caseworkers, especially those who work in family drug courts or otherwise have a primary focus on substance use and child maltreatment. Training participants are encouraged to bookmark the guide and use it in future casework to guide them as they interpret the results of UA tests. They can also draw from the guide’s information when synthesizing court reports to accurately represent an individual’s progress toward their treatment plan objectives and toward case closure.

Impacts and Implications of Prenatal Substance Exposure is another full-day CWTS training where the Toxicology Resource Guide is provided as a resource for caseworkers. This training explores toxicology testing in pregnant people leading up to the time they give birth and immediately after birth, along with testing of newborn children. As the name suggests, learners explore the impacts of prenatal substance exposure, using the guide as a reference. Learners explore a broad range of implications, from personal trauma to systemic bias.

The Toxicology Resource Guide is just one of many online resources discussed in the course, such as the CHoSEN Collaborative and its initiative to promote equity in substance use screening procedures, and the Tough as a Mother Campaign to support pregnant people and mothers in recovery. Resources such as these help remind us that testing is only one part of the puzzle when it comes to child welfare casework.

Explore the Toxicology Resource Guide on your own, and when you’re ready for a deeper dive, review the CWTS course offerings and register for an upcoming training.

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Okay, so what are the impacts of substance use?

Substance use increases risk not only to the user, but also to any children in their care. Effects like inattentiveness and impaired decision making that impact the caregiver also affect child safety. As a result, the misuse of substances is directly linked to adverse childhood experiences, neglect and abuse. Children of substance users are more likely to use substances themselves, so youth substance use is itself a related problem.

That seems pretty straightforward. Why do we need a resource guide?

Drug testing is just one aspect of determining how concerned we need to be about a family’s substance use and is best done in conjunction with clinical examination and/or observation of behavior, environment, and evaluation of the entire situation. That said, drug testing is particularly complicated since each drug, patient and case is different. There are no universal rules with drug testing.

The complexity of drug testing makes a reference guide like the Toxicology Resource Guide beneficial for those who work directly with children and families that may be impacted by substance use. This guide is filled with accurate, evidence-based information about substances, toxidromes, testing and signs associated with the use and misuse of substances.

Don’t know what a toxidrome is? The Glossary of Terms is a strong foundation of useful information for caseworkers who are often tasked with interpreting clinical reports despite not being trained on the basic terminology contained within them.

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