Transcript ASAP – Women & Children’s Services Committee A Strategic

A Strategic Plan for Texas
Specialized Substance Abuse Services
for Women and Their Families
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
STEP 1 – A Review of Relevant Literature and Research
What is Effective?
STEP 2 – Defining :
The Problem
The Target Population
Potential Partner Systems
Desired Outcomes
Possible Outcome Measures
Guiding Principles
The Service Continuum
STEP 3 – Consistent Themes and Recommended Services
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
The Problem:
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DUI Arrests for Women
Increased Drug Use Among Girls = Increased Maternal Drug
Abuse
Increased Risk of Abuse and Neglect
Two Factors: Substance Abuse and Poverty
Increased Women in Prison
Impact on Children
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Fetal Alcohol Spectrum Disorders (FASD), Other Learning Deficits
Birth Complications, Increased Hospital Costs
Poor Attachment, Other Developmental Delay
Child Welfare & Juvenile Justice Involvement
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
The Target Population:
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Women with Children
Pregnant Women
Non-Pregnant Women of Childbearing Age
Older Women, Caregivers of Children
Teen Mothers
Substance-Exposed Children
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
Systems for Contact & Coordination:
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Primary Health Care, Emergency Health Care
Schools, Alternative Schools, School-Age Parent Programs
Community Service Systems – WIC, Mental Health
Child Welfare
Family Courts
Criminal & Juvenile Justice
Substance Abuse Treatment
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
Desired Outcomes:
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Reduced Use, Abstinence & Recovery
Participation in Appropriate Services
Increased Knowledge
Improved Mental Health
Reduction in Drug-Exposed Pregnancies
Improved Parenting and Family Function
Increased Wellness for Women and Children
Appropriate Child Development, Decreased Delay
Fewer Children Entering the Child Welfare System
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
Guiding Principles:
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Family-Centered Services
Women Define the Family
Services Reflect Unique Needs & Resources
Services are Dynamic
Coordination Across Systems
Gender & Culturally Specific
Multidisciplinary Service Providers
Safety First
Address Barriers
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
The Continuum of Care:
 Prevention
 Intervention
 Treatment
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
The Continuum of Care:
 Prevention
 Intervention
 Treatment
 Aftercare
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
The Continuum of Care:
 Prevention
 Intervention
 Treatment
 Aftercare
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
Prevention
Consistent Themes and Recommended Services
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Screening in Primary Health Care Settings
Screening in Other Appropriate Community Settings
Further Assessment if Indicated
Brief Interventions
Education on Consequences of Substance Use
Referral to Intervention, Treatment, Other Services
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
Intervention
Consistent Themes and Recommended Services
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Home-Based or Community-Based
Motivational Interviewing – Individual & Group
Screening & Assessment, if Indicated
Parent Education and Skills Training
Strengthening Mother-Child Bond
Psychosocial Education
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
Intervention
Consistent Themes and Recommended Services
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Counseling, Mental Health Services
Family Counseling
Developmental Screening & Services for Children
Substance Abuse Prevention Services for Children
Mental Health Services for Children
Referral to SA Treatment as Appropriate
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
Case Management / Recovery Support
Consistent Themes and Recommended Services
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Case Managers Assigned at Initial Point of Contact
Employed by Independent Provider
Serve Across the Continuum of Care
Provide Support for the Entire Family System
Responsible for Outcomes
Co-Located with First-Point-of-Contact Systems
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Child Welfare/CPS, Court/Judicial, Primary Health Care, etc.
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
Treatment
Consistent Themes and Recommended Services
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Home-Based or Community-Based
Longer Lengths of Stay
Use of Evidence-Based Models of Treatment
Child Care
Transportation
Mental Health Services
Prenatal, Family Planning & Other Health Care
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
Treatment
Consistent Themes and Recommended Services
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Health Education, Consequences of Drug Use
Parent Education and Skills Training
Psychosocial Education
Developmental Screening & Services for Children
Substance Abuse Prevention Services for Children
Mental Health Services for Children
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
Aftercare
Consistent Themes and Recommended Services
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Transitional Housing
Vocational & Educational Skills Training
Social Support
Ongoing Case Management and Recovery Support
Linkages to Self-Help & 12-Step Groups
Safe & Affordable Child Care
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
Systemic Change and Cross
System Case Management
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
Systemic Change is Needed
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Systemic Change across multiple
service systems is necessary in order to
effectively address the problem
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
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The systems where women and families with
drug and alcohol problems are most likely to
come to someone’s attention are:
in the child welfare system,
 primary and emergency health care system,
 the substance abuse treatment service system, and
the criminal justice system.
 Many women have been/are involved in several of
these systems.
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ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
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The National Center on Substance Abuse and
Child Welfare (NCSACW) has created a model
for cross systems collaboration and engaging
families in recovery entitled SAFERR (Screening
and Assessment for Family Engagement,
Retention and Recovery).
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SAMHSA/Administration for Children and Families (ACF) were
involved in development of this document
Principle authors: Nancy Young, PhD., Mary Nakashian, M.A.
and Shaila Yeh, M.S.W., and Sharon Amatetti, M.P.H.
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ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
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The SAFERR Model can be used as a
guide for Texas to create a collaborative
cross-system process to identify women
and their families where substance abuse or
dependence are creating the family risk
factors that were outlined earlier
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
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The SAFERR Terms and Processes Grid
describes how the Child Welfare System, the
Alcohol and Drug Services System, and the
Dependency Court System address the same
questions and need similar information.
The primary health care system and the criminal
justice systems are not included in this
description however they, and any other systems
could be added to this grid.
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
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The following slides that describe SAFERR
were provided by Mary Nakashian, M.A. – the
author of the final draft of SAFERR
Principles of SAFERR
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The problems . . . demand urgent attention and
the highest possible standards of practice. . .
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Success is possible and feasible. Staff . . .want to
and can change lives and create responsible
public policies.
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Family members are active partners and
participants in addressing these urgent problems.
SAFERR pg. 3
Premises
1. The team is the tool, and people, not tools, make
decisions
2. The family is the focus of concern
3. Problems . . . are jumbled together
4. Assessment is not a one-person responsibility
SAFERR pp 3-5
Premises
5. . . . there is no research-based answer
6. There is no time to lose
7. . . . collaboration is hard work
SAFERR pp 3-5
Dropoff Points
1,000 Children – 750 Parents
60% of Parents Need Assessment
450
50% Go for Assessment
225
80% Need Treatment
180
50% Go to First Session
90
30% Complete
90 Days - 30
50%
Reunify - 15
Organization of SAFERR
I. Building Cross-System Collaboration
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Creating the structure for change
SAFERR pp 9-21
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
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In Texas we already have the Texas Partnership for
Family Recovery (integrates three systems – the
courts, child protective services and substance
abuse)
Partners are DSHS, DFPS, The Office of Court
Administration (OCA), The Texas Court
Improvement Program (CIP) and the Texas Court
Appointed Special Advocates (CASA).
NCSACW has provided technical assistance to this
group
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
Texas Partnership for Family Recovery Mission
Statement
To reduce the number of children in out of home
placements due to parental substance abuse and related
mental health disorders, shorten time in care, and
increase the number of children successfully reunited
with families by building and sustaining integrated and
coordinated substance abuse and mental health
services, policies, protocols, and practices.
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
Texas Partnership for Family Recovery
Mission Statement
The Partnership realizes that no single agency has the
resources and expertise to respond comprehensively to
the needs of the parent/caregiver, the children, or the
family as a whole. Therefore, the Partnership promotes
working with other agencies. The Partnership promotes
systems integration and implementation of evidence
based practices that will result in improved outcomes
for families who have substance use/abuse and related
mental health disorders.
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
Texas Partnership for Family Recovery
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Their work produced the excellent document:
INTEGRATING CHILD WELFARE,
SUBSTANCE ABUSE, JUDICIAL AND LEGAL
SERVICES TO SUPPORT FAMILIES: A GUIDE
http://www.supreme.courts.state.tx.us/children/pdf/TxPshipF
amRecoveryISGuide-Nov07.pdf
Organization of SAFERR
II. Collaborative Roles &
Responsibilities
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What each system needs to know
about itself and its partners
SAFERR pp 23-38
Organization of SAFERR
IIICollaboration in Action: Collaborative
Practice at the Frontline
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Activities that create practice
changes
SAFERR pp 39-66
Assessment is a Process
Assessment happens along a continuum to determine:
 Presence and Immediacy
(41-48)
 Is there an issue?
 Is it immediate?
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Nature and Extent
 What is the nature of the issue?
 What is the extent of the issue?
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Developing & Monitoring Change, Transitions
& Outcomes of TX and Case Plans
(57-64)
 What is the response?
 Are there changes?
 Is the family ready for transition?
 Did the Interventions Work?
(48-56)
Assessment is a Process
Assessment proceeds along a continuum to determine:
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Presence and Immediacy
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Is there an issue & is it immediate?
Nature and Extent
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(48-56)
What is its nature & extent?
Changes, Transitions, Outcomes
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(41-48)
What do we do and what happens then?
(57-64)
Terms and Processes
(17-18 , 41 and A31-35)
AOD Services
CWS Services
Is there an
issue?
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Screen
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What is the
immediacy
of the
issue?
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Immediate
Need Triage
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What is the
nature of
the issue?
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Diagnosis
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MultiDimensional
Assessment
What is the
extent of
the issue?
Child Abuse
Report
In-Person
Safety
Assessment
 In-Person
Response/ Risk
Assessment
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Court Services
Family
assessment
Preliminary
Protective
Hearing
 Court Findings
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Petition Filed;
Preliminary
Protective
Hearing
AOD Services
CWS Services
Court Services
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Treatment Plan
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Case Plan
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Adjudication/D
ispositional
Hearing; Courtordered Case
Plan
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Treatment
Monitoring
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Case Plan
Monitoring
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Court Review
Hearings
Is family
ready for
transition?
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Transition
Planning
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Permanency
Determination
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Permanency
Hearing
What is to
happen after
discharge?
Did the
intervention
work?
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Recovery
Management
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Family Well
Being
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Case Closed
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Outcome
Monitoring
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Outcome
Monitoring
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Outcome
Monitoring
What is the
Response?
Is there
demonstrable change?
Clashes Between Child Welfare and Addictions
Treatment Programs
ABA Child Law Practice, Vol. 19 No. 9, pp. 185-190, February 2001 “Working With Substance
Abuse Practitioners on Behalf of Children and Families”, Elstein, Sharon G
Factor
Child Welfare
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Addiction Treatment
Programs
How Clients
Enter System
Involuntarily
Voluntarily, in
most programs
Who is the
Client?
Child/Family
Addicted parent
Location of
Services
Home and community.
Services focus on home
visits, keeping families
together.
Rarely provide inhome services.
Clashes Between Child Welfare and
Addictions Treatment Programs
Timeframes
Guided by legislation and
court scheduling. Focus is
getting families out of
the system quickly. ASFA
makes timeframes a
bigger issue.
(Adoption and Safe
Treatment takes as long
as it takes to get your life
back together. Addiction
recovery itself is a life-
long pursuit
Families Act, 1997)
Risk Factors
Have to do with risk
factors for child abuse
(of which parental
substance abuse is one).
People, places and things
that will cause a relapse
(e.g., going into a bar
with friends who are
drinking).
Level of Use,
Abuse and Safety
There are “acceptable”
levels of substance abuse.
There is no “acceptable”
level of use. Abstinence
is the only option.
Clashes Between Child Welfare and
Addictions Treatment Programs
Recovery and
Relapse
Relapse viewed as
negative requires
an immediate
response
Recovery is a life-long
process and requires
changes in thought,
attitude, emotional and
spiritual outlook. Relapse
is a normal part of
recovery.
Defining
Success
A minimal standard of
care is provided to the
child. Parents are not
mistreating the child, and
the child’s basic needs are
being met.
Being clean and sober for
three to five years and
taking responsibility in
one’s life (e.g., being
employed, caring for
family).
The SAFERR Model
Development
Builds Cross
System
Collaboration
Establishes
Individual
and
Cross System
Roles and
Responsibilities
Identifies
Front-Line
Collaborative
Practice
Establishes and Monitors Individual
and Cross-System Outcomes
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
The Continuum of Care:
 Prevention
 Intervention
 Treatment
 Aftercare
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
Cross System Case Management, Recovery
Support and Collaboration Can Achieve:
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Increased identification of substance use disorders
among families reported for child maltreatment
and in other systems
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Increased identification of potential child
maltreatment for people assessed/treated for SUDS
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Increased communication regarding screening and
assessment for SUDS and child maltreatment
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
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Informed decision making by all involved systems
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Reduced duplication and burden with regard to case
plan requirements
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Increased engagement and retention of women in
treatment
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Reduced risk of maltreatment of children
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Increased family stability, reunification and well being
ASAP – Women & Children’s Services Committee
A Strategic Plan for Texas
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