Development of a Clinical Decision-Making Framework to Address Parental Substance Use and Child Safety

Objective: Clinicians caring for families impacted by substance use disorder often feel uncomfortable assessing for child protective concerns in the setting of non-prescribed parental substance use. This leads to a lack of standardization of care, where some clinicians choose to not ask any questions about the care of children for fear of receiving information that will leave them in an uncomfortable position as a mandated reporter, while others may reflexively report any identification of substance use to child protective services. The primary aim of this descriptive manuscript is to present a framework developed by a multidisciplinary team in a medical setting to address concerns about a recurrence of parental substance use. Design: We will highlight the development, implementation, and evolution of a clinical decision-making framework designed to help standardize clinicians' discussions around whether substance use could be affecting a parent's ability to safely care for their children. Discussion: Five main assessment areas will be discussed, including: 1). Safety of the child while substance use is occurring; 2). Safety of parental use patterns; 3). Parental treatment engagement; 4). Willingness to escalate treatment services; and 5). Stability of the home environment. We will present a clinical scenario to highlight how the framework is used as an aid to determine action planning with respect to immediate safety concerns, treatment escalation, and opportunities to maximize recovery supports. We discuss the challenges we've experienced and opportunities that arise in attempting to incorporate the principles of harm reduction within the context of assessments of child safety and well-being.