This paper explores the needs and related issues of substance abusing mothers in the child welfare system. Using a framework and through literature review, issues at the micro, mezzo, and macro levels are pinpointed. Six guidelines, incorporating these identified issues, are developed to help practitioners better engage and more effectively work with their clients: (1) treating mothers and children as one unit, (2) providing gender, mother role, and cultural sensitive practice, (3) offering life-skills training, (4) mobilizing old and facilitating new, nonusing support systems, (5) devising safety plans for children, and (6) organizing an interdisciplinary team and assuming the leadership.