4.14 Substance testing of parents
Purpose
This procedure outlines the process for facilitating the substance testing of parents in cases where there are indicators that parents are engaging in serious and persistent substance misuse, and the substance misuse has contributed to a child being in need of protection.
Authority
- Child Protection Act 1999, section 5, 6, 7, 51A-51Y, 61(a), 73, 78, 82, 95, 159A-159H and 159M-159N
- Policy No. 372-2: Recordkeeping policy
- Policy No. 408-1: Information privacy policy
Responsibilities
Under this procedure the senior practitioner is responsible for a range of activities in relation to substance testing of parents. These responsibilities do not override the team leader's normal line management responsibility of a case or their decision-making and supervisory responsibilities.
When to consider the substance testing of parents
For the purpose of this procedure:
- substances incorporate alcohol, prescription drugs and illicit drugs; and
- any reference to Alcohol, Tobacco and other Drugs Services(ATODS) or an ATODS treatment plan will include any other related service and the treatment plan with that service.
The CSO will consider the substance testing of parents when there are indicators that a parent is engaging in serious and persistent substance misuse, contributing to a child being in need of protection. Serious and persistent substance misuse may be demonstrated by regular or heavy patterns of substance misuse, binge use or dependency.
Indicators may consist of one, or a combination, of the following:
- direct observations of a parent's behaviour and physical and emotional presentation during contact with the CSO;
- observations of parent-child behaviours and attachment;
- verbal advice provided by a child, family members or services and agencies currently or previously engaged with the child and the parent;
- a family history of addiction;
- in-home observations of paraphernalia (for example, syringes, pipes and storage);
- a parent's criminal history and/or domestic violence history;
- health conditions in the child or parent; and
- the presence of additional evidenced-based risk factors commonly associated with parental substance misuse (for example, domestic violence and mental health conditions in parents).
Information informing decisions about indicators of substance misuse may be accessed through the following websites:
- Department of Health and Ageing (Australia);
- DrugInfo Clearinghouse (Australia);
- NIDA - National Institute on Drug Abuse (United States Department of Health and Human Services); and
- Emory Department of Psychiatry and Behavioural Sciences (United States).
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Deciding whether to request a parent's participation in substance testing
Substance testing is one means of determining whether a parent is:
- misusing substances (for example, where a parent and the child deny substance misuse, however, indicators are present); or
- abstaining from substance misuse.
Substance testing may not be considered necessary by Alcohol, Tobacco and other Drugs Services (ATODS), if the parent's ATODS treatment goal is reduced or controlled use, rather than abstinence. However, substance testing may be considered a necessary and important part of the departmental case plan for the child, based on the parent's substance misuse history and the child's protection and care needs.
When there are indicators or suspected indicators of serious and persistent substance misuse, contributing to a child being in need of protection, and a parent is not currently engaged in ATODS, or related treatment:
- the CSO will consult with the senior practitioner and discuss:
- the extent and nature of indicators;
- the extent and nature of the substance misuse itself (for example, nature of substances, frequency and pattern of use and impacts for the child and parent);
- previous substance misuse treatment or intervention (including intervention outcomes) attended by the parent;
- the purpose of requesting the substance testing of a parent (monitoring substance use/abstinence or detecting recent intoxication); and
- the availability of accredited collection centres (refer to the section below entitled Compliance with the Australian/New Zealand Standard™);
- the senior practitioner will contact the Director of Forensic Medicine, Queensland Health
by telephone on (07) 3405 5742 and discuss:
- the proposed departmental decision to request that the parent participates in substance testing;
- the extent and nature of the parent's substance misuse, including all identified parental risk factors;
- harm and risk of harm to the child associated with the parent's substance misuse and/or other concurrent risk factors;
- whether the substance misuse appears indicative of regular/heavy use, binge use or dependency;
- associated benefits or outcomes of the substance testing, having regard to the individual circumstances of the parent and the protection and care needs of the child;
- the recommended substance testing schedule, should substance testing proceed; and
- whether the parent should be referred by the department to ATODS for screening and assessment (or another type of ATODS intervention program) instead of, or in addition to, any departmental request that a parent participates in substance testing; and
- the senior practitioner will consult with the team leader, to discuss and decide whether to proceed with a request that a parent participates in substance testing.
When a parent is engaged in ATODS and the treatment does not currently incorporate the substance testing of the parent, the CSO will consult with the senior practitioner and discuss:
- the matters outlined previously; and
- the extent and nature of the parent's current treatment program, including the goal of intervention (that is, reduced/controlled use or abstinence), whether the goal appears to be consistent with the child's protection and care needs, aspects of the intervention (for example, cognitive behavioural therapy, relapse planning) and the parent's progress to date.
Following this, the CSO will contact the parent/s ATODS worker, and discuss:
- the matters outlined previously; and
- whether the proposed substance testing of a parent is predominantly for child protection purposes, or whether, based on additional assessment information provided by the department to ATODS, the service decides that a parent should participate in substance testing for health/medical reasons; and
Following the above discussions, the senior practitioner will consult with the team leader, to discuss and decide whether to proceed with a request that a parent participates in substance testing.
When a parent is engaged in ATODS, and treatment already incorporates substance testing of the parent, the CSO will liaise with the ATODS worker as per relevant departmental procedures.
When a parent requests that they participate in substance testing, the CSO and senior practitioner will respond in accordance with the above-mentioned processes.
All discussions and/or meetings will be recorded in accordance with the departmental record keeping policy and procedures.
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The substance testing process
Substance testing is a process which incorporates two steps:
- the screening test, which provides a quick process for establishing whether a substance, or class of substance, is likely to be present in a given sample; and
- the confirmation test, a second test on the same sample in circumstances where the screening test indicates a positive result.
The purpose of the confirmation test is to eliminate any false positive results (when a substance is detected by a test when, in fact, that substance is not present in the sample) that may have originated from the initial screening test.
Responsibility for payment of substance testing
Where substance testing is requested of a parent, primarily for the purpose of assessing, responding to and monitoring the protection and care needs of a child, the department is able to meet the associated costs. The CSO will seek approval from the financial delegate for any anticipated expenditure involved in the implementation of substance testing, prior to requesting a parent's participation.
Where ATODS considers it necessary (based on the parent's substance misuse history and their individual health and treatment needs) that a parent participates in substance testing as part of the ATODS treatment plan, costs are dealt with in accordance with usual ATODS procedures.
Obtaining consent for parents to participate in substance testing
The substance testing of a parent can only be undertaken when a parent provides written consent. When approaching the parent about the issue of consent, the CSO will:
- advise of the departmental decision that the parent participates in substance testing as part of the case plan for the child;
- discuss:
- the rationale for the departmental decision, including relevant factors considered in discussions between departmental officers and/or the above-mentioned health or related service professionals;
- the processes involved in substance testing;
- the location of the nearest accredited collection centre;
- how negative test results cannot rule out substance misuse given that results may be affected by various factors (for example, metabolism, route of administration of the substance, the detection period);
- the subsequent need for:
- multiple tests to be undertaken over periods ranging between two to six months or more (depending on the level and nature of substance misuse, the child's protection and care needs and advice obtained during discussions with ATODS or related service/professional);
- concurrent ATODS intervention services; and
- concurrent departmental interventions and monitoring processes; and
- how the parent's participation in substance testing will assist the CSO with respect to assessment, planning, implementation and review;
- inform the parent that the department is able to meet the cost of screening and if a positive result is determined, the cost of confirmation testing;
- explain that while the parent is not obligated to provide consent, their participation in substance testing will assist the department in making future decisions about the parent's ability and willingness to meet the child's protection and care needs;
- record the parent's decision through the completion of the form, 'Consent form - Parent's participation in substance testing'
; - where the parent provides consent to substance testing, record this information in the case plan for the child; and
- file the original consent form on the child's paper file.
Where the parent participates, or is requested to participate, in substance testing by ATODS as a result of the parent's substance misuse and related health/treatment needs, the process of consent is negotiated in accordance with ATODS procedures, and incorporated in the parent's treatment plan.
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Substance testing following reunification
Where there has been serious and persistent substance misuse by parents, which has contributed to a child being in need of protection, the CSO will consider (in consultation with the senior practitioner) whether to request a parent's participation in substance testing for a specified period following the reunification of the child.
Method used to determine if substances are present in a sample
The substance testing of parents will occur by urinalysis (urine testing), unless another method of substance testing is already being undertaken as part of the parent's ATODS treatment plan, or otherwise recommended by ATODS.
The collection of a urine sample may be observed by a medical practitioner or paramedical staff under the direction of a medical practitioner, to reduce possibility of contamination and/or substitution.
Under no circumstances is a departmental officer to observe the provision of a urine sample.
The CSO is to determine whether the collection of each sample has been observed. Where this has not occurred, the CSO will consider the possibility that tampering may have occurred, thereby impacting on the test results.
Compliance with the Australian/New Zealand Standard™
Courts only accept and recognise results of tests where tests are conducted in accordance with the 'Australian/New Zealand Standard™, Procedures for the collection, detection and quantification of drugs of abuse in urine' (the standard).
Where possible, the parent is to attend Queensland Medical Laboratories (QML) Pathology or Sullivan Nicolaides (SN) Pathology collection centres, both of which are certified to conduct substance testing in accordance with the standard.
Where the parent does not have access to a QML or SN collection centre, the CSO is to consult with the senior practitioner. If necessary, the senior practitioner may contact the Commercial Accounts Liaison, QML by telephone on (07) 3121 4515 to discuss whether alternative accredited collection centres are available (for example, in rural and remote areas).
For information regarding the location of QML and SN Pathology collection centres, refer to the following relevant websites:
- the 'QML Pathology' website; and
- the 'Sullivan Nicolaides Pathology' website.
Queensland Health is unable to comply with the standard for the collection or analysis of samples.
Deciding the substance testing schedule
Taking into consideration the substance misuse history of the parent, their current ATODS treatment plan and the protection and care needs of the child, the senior practitioner is to determine the substance testing schedule (the frequency, duration and nature of substance testing), in consultation with:
- the Director of Forensic Medicine, Queensland Health (telephone (07) 3405 5742) where a parent is not currently engaged in ATODS treatment; or
- the ATODS worker, where a parent is currently engaged in treatment services.
In deciding the frequency, duration and nature of substance testing, the senior practitioner will consider the following factors:
- the appropriate frequency for obtaining samples is dependent on the testing method and specific purpose for testing;
- given the half-life (time taken for 50% of the substance to be removed from the body) of most illicit drugs, the detection period for most substances is approximately two to three days;
- for urinalysis testing to effectively detect substance misuse, testing would need to be carried out two to three times a week;
- to increase reliability, samples should be taken at a time unknown to the parent;
- substance testing may incorporate a combination of random and planned testing times;
- the duration of substance testing is dependent on the history of substance misuse, however, for less dependent parents, short-term testing of approximately two to six months may be adequate; and
- for a chronic, dependent parent, long-term substance testing would be appropriate, given the likelihood of relapse.
The CSO is to incorporate the substance testing schedule:
- into the case plan for the child; or
- as an attachment to the case plan, where the parent is participating in substance testing as part of their ATODS (or related service) treatment plan and the substance testing schedule is documented in the parent's treatment plan.
Facilitating the substance testing of a parent
Once a parent consents to substance testing, the CSO will:
- obtain the name and address of the parent's general practitioner or other medical officer;
- complete the referral letter, ' Letter to Medical Officer: request for the referral of a parent for substance testing'; and
- forward the referral letter to the parent's general practitioner or other medical officer, along with a copy of the signed 'Consent form - Parent's participation in substance testing';
- file a copy of the referral letter on the child's paper file; and
- request that the collection centre:
- note any prescription or over the counter medication the parent has taken or is taking (for each sample collected);
- inform the department whether or not the collection of the sample has been observed;
- provide the test results to the parent, with a copy to the CSO with case responsibility; and
- forward any invoice to the CSSC for payment, where the financial delegate has approved payment of costs associated with substance testing.
All positive test results will be subject to confirmation testing. To request confirmation testing:
- for QML:
- the CSO will consult the senior practitioner; and
- the senior practitioner will contact the Commercial Accounts Liaison, QML (telephone (07) 3121 4515), and request the confirmation test; or
- for SN, the CSO will contact the relevant collection centre and request the confirmation test.
Interpreting test results
Where a parent is currently receiving ATODS intervention, the CSO will:
- discuss the parent's test results with the ATODS workers, in order to:
- understand the outcomes of the test results; and
- clarify any questions or concerns about the results; and
- consult with the senior practitioner or team leader, in relation to:
- the outcome of the test results;
- possible immediate actions required; and
- implications for departmental intervention.
Where a parent is not currently engaged in ATODS intervention, the CSO is to advise the senior practitioner. The senior practitioner will contact the Director of Forensic Medicine, Queensland Health by telephone on (07) 3405 5742 to discuss the above factors.
The CSO or senior practitioner, in consultation with the above-mentioned persons, will also consider the parent's test results in the context of:
- the parent's ATODS treatment goal, that is, reduced or controlled use or abstinence;
- the departmental case plan for the child;
- the nature of substances detected, having regard to the parent's history of substance misuse;
- the parent's possible legal use of prescribed drugs and/or over the counter medications (as identified by parents), and whether this may have impacted on test results;
- parental symptoms and behaviours likely to be associated with the substances which have been detected;
- the possibility that the initial screening test result may correctly or incorrectly identify the presence of a substance, correctly identify the absence of a substance or fail to detect a substance when a substance is present in a sample;
- whether the collection of the sample was observed and if not, the possible impact on test results;
- other factors potentially impacting on the behaviour and/or parenting skills of the parent (for example, mental health, behaviour management and discipline techniques); and
- possible implications for the protection and care needs of the child, having regard to child, parent and environmental risk and protective factors.
Responding to positive test results
In all circumstances where a positive test result is received in relation to a parent, the CSO will:
- consult their senior practitioner in a timely manner, to determine whether the test results (and possibly additional risk factors present in the family) require:
- an urgent out-of-home care placement for a child;
- an urgent case plan review; and/or
- other immediate or ongoing actions by the CSO;
- refer the parent to ATODS for treatment, unless the parent is already engaged with a treatment service; and
- record the response of the parent and ATODS, to the referral for treatment.
The CSO must take immediate action (refer to exeption below) to review the child's protection and care needs where a positive test result is received for a parent, regardless of type of substance/s detected, where the parent's ATODS treatment goal is:
- abstinence; or
- reduced or controlled use of a substance and there is new information available to the
CSO indicating the presence of one or more of the following parental stressors:
- change in family composition (including the reunification of the child);
- death of a family member;
- major illness in the family;
- loss of employment;
- homelessness;
- relationship breakdown; and
- change in residence.
Any decision not to take immediate action to review the child's protection and care needs when a positive result is received, will be:
- discussed with, and decided by, the senior practitioner (having regard to all available assessment information); and
- recorded in case notes (including the rationale for not taking such action).
For example, in some circumstances, it may be considered necessary to undertake confirmation testing prior to any immediate action being taken (particularly the placement of a child).
However, where positive results from the initial screening test, whether in isolation from or in combination with the above-mentioned parental stressors, indicate significant risk to the child, the decision to take immediate action prior to confirmation testing will be considered in accordance with the Child Protection Act 1999, section 5(1).
Ongoing assessment, planning, implementation and review
The substance testing of a parent is one aspect of the case plan for a child, and is not generally considered an intervention in isolation from other substance treatment options. Having regard to the cycle of assessment, planning, implementation and review, the CSO will:
- request that the parent attends ATODS, for the purpose of:
- determining the level and nature of the substance misuse and associated health and intervention needs; and
- obtaining advice about the most effective and appropriate intervention/s available to the parent;
- utilise substance testing to encourage the parent to think about their own use, or as a first stage in motivating the parent towards changing their substance misuse and/or seeking treatment;
- ensure that the substance testing of a parent is a complementary method of establishing and/or monitoring substance misuse;
- incorporate substance testing of a parent and a range of alternative methods for establishing, monitoring and addressing substance misuse, into the case plan for the child;
- give appropriate consideration to the likelihood of relapse by the parent; and
- incorporate into the child's case plan, and/or ensure that the ATODS incorporates in the parent's treatment plan:
- practical strategies the parent can use to manage the stressors in their life; and
- relapse prevention planning.
When a parent requests ATODS assessment or treatment, regardless of whether substance testing is occurring and/or whether test results are positive, the CSO will always:
- refer the parent to an appropriate service; and
- record the referral outcome.
For information about residential/hospital withdrawal programs, treatment, rehabilitation and aftercare centres, counselling services, opioid pharmacotherapy, and needle and syringe programs, refer to the 'Alcohol, tobacco & other drug services in Queensland 2003 Inventory of specialist treatment agencies'.
Non-compliance by a parent
A parent may refuse to attend, or cease attending, substance testing or ATODS at any time. Where the child's case plan incorporates substance testing and/or other treatment options and the parent subsequently decides to cease attending, the CSO will consult their team leader or senior practitioner and determine whether:
- a case plan review is required and if so, the urgency of the review; and
- an out-of-home care placement is necessary to ensuring the child's protection while the case plan review is undertaken.
Collaboration and service delivery coordination
Where a parent is engaged in substance testing and/or ATODS intervention, the CSO will:
- negotiate the roles and responsibilities of each agency, in accordance with departmental procedures for case planning and ongoing intervention;
- proactively identify and implement a range of strategies to assist in achieving effective collaboration and coordination with ATODS workers;
- request the participation of ATODS workers in case planning processes;
- regularly and proactively seek updated assessment information from ATODS between case planning reviews;
- if necessary, consult the senior practitioner with respect to negotiating the necessary participation of, and/or provision of information by, ATODS;
- ensure ATODS are informed to the extent necessary of the child protection concerns, including:
- child, parent and environmental risk and protective factors associated with the parent's substance misuse; and
- the assessed impact or likely impact of the substance misuse on the child;
- ensure ATODS are consulted when responding to new child protection concerns, should they arise; and
- develop a thorough understanding of the ATODS intervention goal and corresponding treatment plan for the parent, and where necessary, negotiate plans and responsibilities for addressing any identified gaps.
When a parent refuses to consent to substance testing and/or will not attend ATODS treatment programs, and general, non-identifying advice is required to assist departmental officers in making assessments and decisions about the protection and care needs of a child, the CSO may:
- contact their local ATODS and obtain the necessary advice or information; or
- consult their senior practitioner, who may contact the Director of Forensic Medicine, Queensland Health by telephone on (07) 3405 5742.
Related discussions will occur in accordance with applicable privacy procedures and confidentiality requirements.
Drugs of Dependence Unit, ATODS
The Drugs of Dependence Unit (DDU), through ATODS, provides a monitoring, investigative, enquiry and research service in relation to controlled drugs and to a lesser extent, restricted drugs of dependency.
If during the course of departmental intervention, it becomes apparent that the DDU may hold information in relation to parents, under no circumstances will the CSO directly contact the DDU.
The CSO will in the first instance, contact their local ATODS to discuss the circumstances prompting the contact with ATODS, including possible information held by the DDU in relation to the parents. Following this discussion, the CSO will consult with the senior practitioner, who will decide whether to proceed with a request to ATODS for ATODS to contact the DDU.
- Last updated
- 18 September 2009
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