THE human face of what some public health officials say threatens to be a social time bomb can be adorable, if troubling.
There's the doe-eyed two-year-old who wanders among her peers, hands at her sides, uttering no sound.
There's the handsome 10-year-old who tests out in the mentally gifted range, but whose emotional problems - including those stemming from seeing his mother gunned down - keep him out of good schools.
There's the nine-year-old, his irresistable smile beaming beneath Coke-bottle lenses, whose years isolated in a closet cause him to cling to people, wrapping himself around them so insistently his friends run from him.
These children, exposed to drugs and alcohol, either physically before birth or environmentally in the home, are not uncommon in Anacostia, this city's most concentrated district of poverty and drugs.
A generation of these children - between 400,000 and 700,000 born per year nationally, experts estimate - coming of age with severe mental, physical, and social problems constitutes "a social time bomb...a predictable catastrophe," says Dr. Johanna Ferman, chief executive officer of the D.C. Institute for Mental Health.
Healing the whole family - not just the drug-addicted parent in isolation - is the key to preventing that catastrophe. Dr. Ferman's brainchild, the Center for Family Health, a national demonstration project run under the private, non-profit D.C. Institute, implements a new family-centered philosophy in drug treatment and prevention that has implications for the whole social services system.
"If you don't deal with the family, then all your ministerings to children end up being null and void... And the family shows a capacity for responsiveness that isn't often recognized if given adequate support and treatment," says Ferman.
The idea is to unite the family by keeping the parent off drugs, keeping the child in the parent's custody, and minimizing the frustration of poverty while the parent recovers from drugs. The earlier that help arrives in a child's life, says Ferman, the better the chance he or she will successfully finish school and become productive.
To cut red tape, the center offers one-stop shopping for a wide range of services. It supplies transportation, in-home services for coping with the notorious red tape of housing and welfare programs, and teaches such basic skills as budgeting and shopping.
The primary client is considered the child under five affected by drugs. Many exposed to drugs in the womb are said to face a number of medical problems. Likewise, exposure to drug abusers can range from physical and sexual abuse to severe neglect.
The center draws on extended families that can include parents, siblings, grandparents and other family members or foster parents responsible for the child. Center workers comb the court system, hospitals, and other agencies for eligible children, explains Christene McClelland, child services director, who receives an average of 60 requests a week to enter the program.
The center, based in a well-kept, cheerful space hardly the norm for institutional settings most D.C. drug users encounter, now serves 25 families - including more than 100 individuals.
Ms. McClelland points to the mission of the center - to save families - and the low caseload as one big difference between this and government programs she worked with in D.C. and Chicago. She says she didn't like the non-solution of removing children from homes where addicts could have been helped to deal with their families. Further, as a case worker, she would have as many or more clients to visit as the number shared among the Center's 30 staffers.
"It is terrifically expensive, but it is so clearly a case of prevention," says Lee Partridge, director of D.C. Medicaid, which will fund about $500,000 of the center's estimated $1.3 million annual budget for an eventual 30 families.
ERMAN estimates the annual cost to serve each family at about $20,000. In contrast, a drug-exposed infant abandoned in a hospital costs about $100,000 a year. One given up to a residential-care setting costs about $30,000. That, she says, is just the beginning. A child with developmental or emotional problems can cost untold amounts in the social welfare and criminal justice systems later in life.
In its first year of operation, the center has yet to release its first analysis of successes and failures. Staffers measure the children's progress in terms of manners learned and language improved. To be sure, clients have relapsed. But several like Donna (not her real name) remain drug-free and quite changed.
"They've helped me change things, teaching me to sit down and talk to [my kids] and understand them... I didn't know that's what family is till I met this program. I can't remember a time when my family sat down and talked to me," says Donna, a 27-year-old mother of eight, free of her crack cocaine habit for a year.
The father of the majority of her children was also a crack addict and now comes to the center for counseling, along with several of her children, she says. "The Center gives me hope for the future because I couldn't see no future before; I couldn't see this man turning around and going back to college [as he is]. Let's just call it a changed life for me."
"The holistic approach to family ultimately becomes a holistic approach to the community," explains Ferman. "The capacity to live productive lives and get along with other people grows from the family. If we can fix this even in a small way we can have an impact."