The following authors contributed to the content of this manual: Vickie Kropenske, Editor Cheryl Breitenbach, M.D., Assistant Professor Susan B. Edeistein, M.S.W., Social Worker Judy Howard, M.D., Professor of Pediatrics Katherine K. McTaggart, M.A., Consultant, Substance Abuse Prevention Specialist Annette Moore, M.A., Consultant Mary Beth Sorenson, M.S.W., Social Worker Rachelle Tyler, M.D., Clinical Instructor UCLA School of Medicine, Department of Pediatrics, Los Angeles, California and Virginia Weisz, J.D., Directing Attorney Children's Rights Project, Public Counsel, Los Angeles, formerly of UCLA's Department of Psychology, Los Angeles, California

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TABLE OF CONTENTS
HEAD START SUBSTANCE ABUSE CIRCLE OF CAPACITIES

PREFACE

I. INTRODUCTION: SUBSTANCE ABUSE AMONG FAMILIES 
    ALCOHOL AND OTHER DRUG ABUSE: A BASIC OVERVIEW OF THE PROBLEM
        The Prevalence of Substance Abuse in Families
        The Impact of Substances of Abuse on Mental Status
    IDENTIFYING ALCOHOL AND/OR OTHER DRUG USE.
        Observations of Parents: Physical and Behavioral Indicators of Adult Substance Abuse
        Observations of Children: Physical and Behavioral Signs That May Indicate Parental Substance Abuse
    SPECIAL SERVICES THAT HELP ADDRESS PARENTAL SUBSTANCE ABUSE
        Pre-Treatment/Early Intervention
        Treatment and Relapse
        After-Care
    SUMMARY: THE ROLE OF HEAD START STAFF

II. SUBSTANCE-ABUSING PARENTS:
CHARACTERISTICS OF PARENTS INVOLVED WITH ADDICTION
    THE NATURE OF ADDICTION
    THE SUBSTANCE-ABUSING PARENT.
        Childhood Deprivation
        Survival Needs
        Mental Health Issues
        Denial
    THE TASKS OF PARENTING AND SUBSTANCE ABUSE
    IMPLICATIONS FOR INTERVENTION

III. CHILDREN OF SUBSTANCE-ABUSING PARENTS: SPECIAL RISKS
    NEWBORN AND INFANT COMPLICATIONS
        Newborn Behaviors
        Prematurity
        Infectious Diseases
        Fetal Alcohol Syndrome (FAS)
        Sudden Infant Death Syndrome (SIDS)
        Failure to Thrive (FTT)
    DEVELOPMENTAL ISSUES
    CONCLUSION

IV. COMPREHENSIVE FAMILY ASSESSMENT
    GATHERING INFORMATION
        Interactions with Parents and Other Family Members
        Visits to the Family Home
        Observations of the Child
        Contacts with Other Service Providers
        Areas of Strength

V. AREAS OF ASSESSMENT
        Determining One's Own Attitudes and Feelings
        Assessment of the Infant and Child
            Infant Assessment
            Child Assessment
        Assessment of Parents
            Substance Abuse History
            Drug and Alcohol Treatment History
            Health and Health Care
            Mental Health
            Awareness of the Impact of Drug Use on the Child
            Parenting Skills and Responsiveness to Child
            Work History and Education
        Assessment of the Home Environment
            Environmental Conditions of the Home
            Partners or Parent Substitutes within the Home
            Family Support Systems within the Community
        Relative Caregivers
            Parenting Skills
            Alcohol and/or Other Drug Use
            Quality of the Relative's Relationship with the Parent
            Access to Services
        Foster Parents
            Attitudes Towards Birth Parents
            Caregiving and Family Supports

VI. WORKING WITH CHILDREN IN A PRESCHOOL SETTING
    CLASSROOM ORGANIZATION
    THE ROLE OF HEAD START STAFF
        Careful Observation
        Effective Communication
        Enhancing Learning Experiences for All Children
        Strategies for Children with Special Needs
            Distractibility
            Impulsivity or Hyperactivity
            Speech and Language Delays
            Difficulty with Task Organization and Sporadic Mastery of Tasks
            Problems with Attachment and Separation
            Difficulty with Developing Appropriate Social Skills
            Delays in Motor Development
    CONCLUSION
    CONFIDENTIALITY

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HEAD START SUBSTANCE ABUSE CIRCLE OF CAPACITIES

    In order to help families who are involved with the abuse of alcohol, tobacco and other drugs, as well as those who are at risk of involvement, Head Start programs need to develop a continuum of services, as illustrated in the Head Start Substance Abuse Circle of Capacities. This continuum should address four major areas: (1) Staff Preparation and Support; (2) Prevention and Family Wellness; (3) Early Intervention, Referral and Support; and (4) Community Collaboration and Partnerships.

1. Staff Preparation and Support

Fundamental to any Head Start program is the preparation and support of staff in order to enhance their ability to meet the needs of Head Start families and children. Roles and responsibilities included are:

• making staff aware of the problem of substance abuse;
• providing education regarding the nature of chemical dependency and its causes, as well as training in methods of working with families to support their needs;
• offering opportunities for staff healing and wellness; and
• strengthening line staff supervision to ensure that they have the support and direc tion necessary to meet the needs of families.

2. Prevention and Family Wellness

Head Start programs can enhance family weliness and the capacity to prevent the abuse of alcohol, tobacco and other drugs through the support of family resiliency. Roles and responsibilities included are:

• providing a wide range of activities to support a healthy lifestyle among Head Start families;
• providing family education in health and wellness;
• supporting the development of effective parenting and adult life skills; and
• increasing family awareness of the problem of substance abuse.

3. Early Intervention, Referral and Support

Providing early intervention requires developing the capacity to help families identify substance abuse issues, to refer them for treatment and other services, and to support them as they recover. Roles and responsibilities include:

• enhancing the family needs assessment to address concerns of substance abuse;
• helping families to identify their problems and referring them to treatment;
• teaming within Head Start and with outside agencies to help families access well managed services which are responsive to their multiple needs;
• supporting children affected by substance abuse who experience stress, abuse, violence, and a lack of nurturing; and
• supporting families in substance abuse treatment and recovery.

4. Community Collaboration and Partnerships

Programs promote community collaboration strategies by strengthening the capacities to develop partnerships with family support networks and treatment resources. Roles and responsibilities included are:

• promoting and strengthening both formal and informal linkages with family support groups and programs;
• advocating for improved community services to help families involved with sub stance abuse, as well as for development of a stronger community response in preventing the abuse of alcohol and other drugs;
• developing and strengthening collaborative partnerships with other community resources, so that Head Start becomes an integral part of a community-wide ap proach to helping families; and
• seeking out and supporting effective community-based treatment resources, espe cially those for women with families.

Each of these capacities is part of a continuum or circle of roles and responsibilities which Head Start grantees need to develop and sustain as part of their ongoing programs. A Head Start grantee can enter the circle at any point that seems appropriate and that matches its current interests and needs. Once a grantee enters the circle, it is helpful to assess needs and capacities around the circle in order to carry out those program roles and responsibilities which currently may be missing from the program.

This manual addresses the following roles and responsibilities, which appear shaded in the Head Start Substance Abuse Circle of Capacities:

• Early Intervention, Referral and Support (all roles and responsibilities);
• Staff Preparation and Support (awareness, training and education, and supervision and support);
• Prevention and Family Wellness (awareness, training and education, and supervision and support).

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PREFACE
    Most staff of programs that serve families with young children can expect to encounter parental abuse of alcohol and other drugs. The purpose of this manual is to help the Head Start Management Team and other staff become more knowledgeable about substance abuse and its impact on children and parents. One of the fundamental components of Head Start programs is to help families identify specific needs and seek appropriate services to meet those needs. This manual is specifically written to provide a framework of information and strategies appropriate to Head Start which addresses issues of substance abuse. By understanding the nature of addiction and its impact on parents and children, Head Start staff can become more sensitive to the issues with which many substance-abusing families struggle and better assist families in obtaining the range of services that they may require.

This manual will provide:

• An overview of the problem of substance abuse;
• A review of the characteristics of substance-abusing parents and children growing up in households where alcohol and/or other drugs are abused;
• A description of approaches to assessment of families who are or may be involved with abuse of substances;
• Strategies for working with children in a preschool setting.

    By reviewing the information presented in this manual, Head Start Management Teams will have a better understanding of substance abuse and families. This will enable the management teams to assess their programs, including staff qualifications, responsibilities and training, and to develop an approach to the problem of substance abuse as experienced by Head Start families, children, and communities. "

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