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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Working together across sectors to strengthen families impacted by substance use means that it is critical that caseworkers and supervisors alike know how to read toxicology results, decipher symptoms related to substance use and know how substance use may or may not impact someone’s ability to parent children of all ages. This can be complicated and overwhelming. A Toxicology Resource Guide was developed to support Colorado child welfare professionals in understanding substances, possible effects and the utility and application of toxicology testing to enhance practice.

Accidental drug overdose is one of the leading causes of maternal death in Colorado [1], and a woman’s risk for overdose is highest at 7-12 months postpartum [2]. However, fear of losing custody of your child, stigma and lack of appropriate treatment options for parents are real challenges for families in Colorado. We need to work together to keep families together and support healthy kids.

Recent legislative changes have underscored the fact that substance use may or may not impact someone’s ability to care for a child, mandatory reporters in health care settings are still encouraged to refer a family to support from child protective services by reporting concerns to the Colorado Child Abuse and Neglect Hotline 844 -CO-4-Kids if they have a concern. These legislative changes to the Children’s Code in 2020 as a result of SB20-028 Substance Use Disorder Recovery included:

• • • de-emphasized the focus on a test,
    • removed the references to the federal schedule of substances,
    • elevated impacts to the child as the main consideration, and
    • advanced a two-generation approach to keep parents and their children together during treatment.

Only around 4% of referrals to county departments of human/social in 2019 contain allegations of a substance exposed newborn, according to the Colorado Department of Human Services. However, most referrals to the Colorado child welfare system related to substance use are for children under the age of one month old. [3] The experiences of children who have been involved in a fatal, near fatal and egregious incidents of child maltreatment also underscore the importance of working together to focus on supporting and engaging with families impacted by substance use. In 2019, 31 incidents were reviewed by the Colorado Department of Human Services Child Fatality Review Team (CFRT). Of the families involved in a fatal child maltreatment incident which met criteria for review by the CFRT, 63.6 percent of families had a history of substance abuse issues. It is important to note that some incidents do not have any of the stressors identified during the review process, while others will have more than one stressor identified, 45.4% percent of families were identified to have a history of domestic violence and history of mental health issues. [4]

When the referral reason is substance exposed newborn, the majority reported Marijuana (51%) as the substance used followed by methamphetamines (19%) and other opiates (8%).  These ratios remained largely the same for cases that were subsequently screened-in with methamphetamines rising to 22%.

WATCH VIDEO>>   Dr. Sam Wang, one of the authors of the Toxicology Guide, talks about using the tool and why each drug, each patient and each case is different. There are no universal rules with drug testing, underscoring why child welfare caseworkers and supervisors should bookmark COToxGuide.org or download the e-book today.

Sources

1. Metz et al. (2016). Maternal deaths from suicide and overdose in Colorado, 2004-2012. Obstetrics & Gynecology, 128(6), 1233-1240.
2. Schiff et al., (2018). Fatal and nonfatal overdose among pregnant and postpartum women in Massachusetts. Obstetrics & Gynecology, 132(2), 466-47
3. Oliveros, A., & Kaufman, J. (2011). Addressing substance abuse treatment needs of parents involved with the child welfare system. Child Welfare, 90(1), 25-41.
4. 2019 Colorado Department of Human Services (CDHS). Child Fatality Review Annual Report.

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When parents use substances, determining the safety of a child isn’t as simple as reading the results of a drug test because drug testing itself is rarely diagnostic when interpreted alone. The results of drug tests are best interpreted in conjunction with other strengths and risk factors. Caseworkers are no strangers to crucial conversations and the Toxicology Resource Guide may make those discussions more nuanced.

Anne Auld, the director of education for Illuminate Colorado, recently sat down with Becky Tolpa, the supervisor of child protection in Larimer County, to discuss the practical uses of the toxicology guide for supervisors as well as a caseworker in the field. Both Auld and Tolpa were able to offer some keen insights into the usefulness of this resource, having been instrumental in the creation of the guide in 2019.

View the video below to watch the full interview below.

Talking Toxicology 

To make this process easier, the online searchable Toxicology Resource Guide, along with eBook available for download at COtoxguide.org was created to support Colorado child welfare professionals in understanding substances, possible effects and the utility and application of toxicology testing to enhance practice. The resources were developed by Illuminate Colorado through a collaborative process with multiple contributors and by the Colorado Department of Human Services Office of Children, Youth, & Families Division of Child Welfare.

The Importance of Critical Thinking

In the field, issues are often complicated and a simple toxicology chart doesn’t always help as much as it should. The critical thinking components of the guide help to navigate the more complex situations that many caseworkers come across in their day to day job.

One of the best parts of the guide, Tolpa noted, is that it includes critical thinking sections that apply directly to a caseworker’s job. If a toddler is in the home, what considerations need to be had?  What about for a teenager?

The guide helps caseworkers think through these important areas, as well as next steps once test results come back.

“We want to empower people to come up with creative questions and think through every scenario when they’re out in the field and be able to think on their feet. And that’s a really difficult thing to do…when you have a guide like this, it gives you a jumping off point,” said Tolpa.

Engaging Families 

Planning is another important area where the guide can be helpful. Determining how to best help families is crucial, and it’s important to help families come up with a plan that keeps their kids safe. The guide can help in developing a plan for families in a way that works better for them.

The guide also helps to engage families better. Tolpa firmly believes that the more you know, the more you are able to help families. “[The guide] gives us the education to go out and have a great conversation with a family member and be transparent about our worries, and hear what they have to say in return.”

Visit COtoxguide.org to use the Toxicology Resource Guide in your work today.

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