Health Care Competencies for Helping Children in Families Affected by Alcohol Abuse

Core Competencies for Involvement of Health Care Providers in the Care of Children and Adolescents in Families Affected by Substance Abuse*

These competencies are presented as a specific guide to the core knowledge, attitudes, and skills which are essential to meeting the needs of children and youth affected by substance abuse in families.

There are over 28 million children of alcoholics in America; almost 11 million are under the age of eighteen. Countless other children are affected by substance-abusing parents, siblings or other caregivers. There is an association between child physical, emotional and sexual abuse and neglect, domestic violence and substance abuse in the family. All children have a right to be emotionally and physically safe. No child of an alcoholic or other substance-abusing parent should have to grow up in isolation and without support. Recognizing that no one is unaffected in families with substance abuse, health professionals should play a vital role in helping to optimize the health, well-being and development of children and adolescents from these families and should recognize, as early as possible, associated health problems or concerns.

It is the hope of the National Association for Children of Alcoholics (NACoA) that organizations representing health care professionals will adopt these competencies or competencies modeled from them. Developed by a multi-disciplinary professional advisory group to NACoA, these competencies set forth three levels for professional involvement with children who grow up in homes where alcohol and other drugs are a problem. All health care providers should aspire to Level I. Resources and programs should be made available for the training of professionals who desire to achieve competency at Levels II and III.

For all health professionals with clinical responsibility for the care of children and adolescents:

1. Be aware of the medical, psychiatric and behavioral syndromes and symptoms with which children and adolescents in families with substance abuse present.
2. Be aware of the potential benefit to both the child and the family of timely and early intervention.
3. Be familiar with community resources available for children and adolescents in families with substance abuse.
4. As part of the general health assessment of children and adolescents, health professionals need to include appropriate screening for family history/current use of alcohol and other drugs.
5. Based on screening results, determine family resource needs and services currently being provided, so that an appropriate level of care and follow-up can be recommended.
6. Be able to communicate an appropriate level of concern, and offer information, support and follow-up.

In addition to Level I competencies, health care providers accepting responsibility for prevention, assessment, intervention, and coordination of care of children and adolescents in families with substance abuse should:

1. Apprise the child/family of the nature of alcohol and other drug abuse/dependence and its impact on all family members and strategies for achieving optimal health and recovery.
2. Recognize and treat, or refer, all associated health problems.
3. Evaluate resources—physical health, economic, interpersonal, and social—to the degree necessary to formulate an initial management plan.
4. Determine the need for involving family members & significant other persons in the initial management plan.

Develop a long-term management plan in consideration of the above standards and with the child or adolescent's participation.

Level III

In addition to Level I & II competencies, the health care provider with additional training, who accepts responsibility for long-term treatment of children and adolescents in families with substance abuse, should:

1. Acquire knowledge, by training and/or experience, in the medical and behavioral treatment of children in families affected by substance abuse.
2. Continually monitor the child/adolescent's health needs.
3. Be knowledgeable about the proper use of consultations.
4. Throughout the course of health care treatment, continually monitor and treat, or refer for care, any psychiatric or behavioral disturbances.
5. Be available to the child or adolescent and the family, as needed, for ongoing care and support.

* These core competencies were developed and reproduced with the permission of the National Association for Children of Alcoholics (11426 Rockville Pike, Suite 100, Rockville, MD 20852; phone: 1-888-554-2627).