Transcript 0506HSAdvisorsCWPanel (Slide 1)

Child Welfare and Substance Abuse:
Current Issues and In-Depth TA
The NGA Center for Best Practices
Institute on Child Welfare
Miami, Florida
June 16, 2005
4940 Irvine Boulevard, Suite 202
Irvine, CA 92620
714-505-3525
www.ncsacw.samhsa.gov
Presenters
 Joe Anna Sullivan, NCSACW
 Mary Chaliman, Michigan
 Karen Mooney, Colorado
A Program of the
Substance Abuse and Mental Health
Services Administration
Center for Substance Abuse Treatment
and the
Administration on Children, Youth and Families
Children’s Bureau
Office on Child Abuse and Neglect
MISSION
 To improve outcomes for families by promoting
effective practice, organizational, and system
changes at the local, state, and national levels
 Developing and implementing a comprehensive
program of information gathering and
dissemination
 Providing technical assistance
NCSACW Consortium
 American Public Human Services Association
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(APHSA)
Child Welfare League of America (CWLA)
National Association of State Alcohol and Drug Abuse
Directors (NASADAD)
National Council of Juvenile and Family Court Judges
(NCJFCJ)
National Indian Child Welfare Association (NICWA)
Children with Prenatal
Substance Exposure
Number of Children Prenatally
Exposed to Substances
Infants with prenatal substance
exposure
~410,000
Total child victims under 1 year old
~86,000
Total children under 1 year old
entering out-of-home-care
~41,000
Where did they all go?
Most Go Home
More than 80% are undetected and go
home without assessment and needed
services
 Many doctors and hospitals do not test, or may
have inconsistent implementation of state policies
 Tests detect only very recent use
 Inconsistent follow-up for woman identified as
AOD using or at-risk, but with no positive test at
birth
Potential Consequences for Children
 Prenatal substance exposure
 Fetal alcohol syndrome, fetal alcohol spectrum disorder,
neuro-developmental disorders
 Postnatal environment factors
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Violence or traumatic events
Drug and/or alcohol seeking behaviors
Illicit drug sales or manufacturing
Lack of adult interpersonal support systems
Community effects such as living in poverty
Lack of proper health care
Inconsistent caregivers
Areas of Child Development Affected by
Parental Substance Use Disorders
Research has shown that these effects can manifest
themselves in multiple areas, including:
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Physical health consequences
Lack of secure attachment
Language delays and communication disorders
Psychopathology
Behavioral problems
Poor social relations and skills
Deficits in motor skills
Cognition and learning disabilities
Children of Substance
Abusers who are also
Victims of Child Abuse
and/or Neglect
Children Living With One or More
Substance Abusing Parent
Used Illicit Drug in Past Year
10.6
Used Illicit Drug in Past Month
8.4
Dependent on Alcohol and/or Needs
Treatment for Illicit Drugs
8.3
Abused or Dependent on Alcohol or Illicit
Drug in Past Month
6.0
Dependent on AOD
7.5
Dependent on Alcohol
6.2
Dependent on Illicit Drugs
2.8
Need Treatment for Illicit Drug Abuse
In Millions
4.5
0
2
4
6
8
10
12
Documenting Substance Use
Disorders in Child Welfare
 Children and Family Service Reviews (CFSRs)
 Parental substance use disorders were a factor in
16% to 48% of cases
 CWW’s misclassify caregivers who are
substance dependent most of the time
 71% of caregivers who are alcohol dependent are
classified by the CWW as not having an alcohol
problem
 73% of caregivers who are drug dependent are
classified by the CWW as not having a drug problem
Children in the Child
Welfare System with
their own Substance
Use Disorder
Percentages of Past Year Substance Use
among 12 to 17 Year Olds by Foster Care Status
18
17.4
16
14
13.1
12
10
10.4
8
8.8
6
6.9
5.3
4
2
0
Need for Alcohol
Treatment
Need for Illicit Drug
Treatment
Ever Been in Foster Care
www.oas.samhsa.gov
Need for Alcohol or
Illicit Drug Treatment
Have Never Been in Foster Care
Children in the Child Welfare System
with their own SUD
 Children of substance abusers need in-depth
assessments and interventions that respond to their
developmental status and the special needs created
by substance use disorders in their family
 grief, loss, separation, attachment
 Adolescents who may have begun their own
substance use – Few Independent Living Programs
under Chafee Bill include prevention or intervention
for children of substance abusers aging out of foster
care
Challenges and
Opportunities
Crises/Opportunities
 Methamphetamine epidemic
 Continuing prenatal substance exposure
 CAPTA amendments and requirements to
report to CPS
 Need for better data systems to identify
children and parents
 Connecting to child abuse/neglect
prevention
 CFSR and new rounds of reviews
Challenges for Cross-system Collaboration
 Child safety – Treatment privacy & advocacy
 ASFA Timelines – Recovery takes a lifetime
 Accountability for parental actions – Client
Readiness
 Single System Funding
 Staff and Leadership Turn-over
 Special “Project-itis” and Sustainability
Opportunities
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TANF reauthorization
 Does your State define child welfare as
“Needy Families?”
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Title IV-E Access
 Waivers for treatment
 Case management funding
 Foster care providers
Policy Framework and Tools
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10 Element Framework
Collaborative Values Inventory
Collaborative Capacity Instrument
Matrix of Progress in Linkages
Screening and Assessment for Family
Engagement, Retention and Recovery
-- SAFERR
Connecting AOD, CWS, Court Systems:
Elements of System Linkages*
 Underlying Values
 Screening and
Assessment
 Client Engagement and
Retention in Care
 AOD Services to
Children
 Joint Accountability and
Shared Outcomes
 Information Sharing &
Management
 Training and Staff
Development
 Budgeting and Program
Sustainability
 Building Community
Supports
 Working with Related
Agencies and Support
Systems
From CSAT Technical Assistance Publication (TAP) 27: Navigating the Pathways *Revised March 2003
Four Components of System Reform
 Comprehensive cross-system joint training
 AOD basics for all staff – 4 days required
 AOD screening, brief intervention, motivational
enhancement and AOD treatment – 4 days required
of all case carrying workers
 Group intervention skills – 4 days required of all ADS
staff and voluntary for any CPS division staff
 Early Intervention Specialists
 Immediate access to intervention and assessment at
the court hearings
Four Components of System Reform
 Recovery Management Specialists
 Motivational enhancement
 Immediate access to recovery management and
treatment services
 Compliance monitoring
 Dependency Drug Court
 30, 60 and 90-day compliance hearings
 Structured incentives for compliance and sanctions
for non-compliance
 Voluntary participation in on-going services
PRODUCTS
 Free On-Line Training with CEUs
 Understanding Child Welfare and the
Dependency Court: A Guide for Substance Abuse
Treatment Professionals – Now Available
 Understanding Addiction and Recovery: A Guide
for Child Welfare Workers
 Understanding Families with Substance Use
Disorders: A Guide for Judges and Attorneys
working with Families in Family/Juvenile Court
PRODUCTS
 Materials
 Compendium of Training Curricula
 Understanding Substance Abuse: A Guide for
Child Welfare Practitioners
 Draft White Paper on Funding Substance Abuse
and Child Welfare Services
 Draft White Paper on Implementing the 2004
Substance Abuse Amendment in the Child Abuse
Prevention and Treatment Act (CAPTA)
PRODUCTS we’re working on…
 State Policies regarding Substance Exposed
Infants
 Guidance to States and Communities on:
 Screening and Assessment for Family
Engagement, Retention and Recovery (SAFERR)
 Methamphetamine and child risk and safety
assessments
 The use of drug testing in child welfare practice
 Medication assisted treatment for opiate
dependence and implications for child welfare
PRODUCTS
 Program of In-Depth Technical Assistance
 Round 1 – Summer 2003 to Fall 2004
 Colorado – Licensing/certification of providers who specialize
in child welfare population and protocol for improving services
 Florida – Regional contracts to ensure local-level system
linkages and preferred practice model
 Michigan – Revised SACWIS to prioritize SUDs
 Virginia – Comprehensive 5-year plan
 Round 2 – Winter 2005 to Spring 2006
 Arkansas, Massachusetts, Minnesota and Squaxin Island
Tribe at Puget Sound
MICHIGAN
Mary Chaliman
Michigan
Department of Human Services
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State run, county administered - 83
counties
19,020 children in foster care
system
65% of families with children in
foster care have substance abuse
needs
16 Substance Abuse Coordinating
Agencies
Family Drug Courts:
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2 operational
2 in planning stages
3 show level of interest
Michigan Challenges
 Budget deficits in each of the last 3 fiscal
years
 Changes in leadership and early retirements
 Sustaining and increasing provision of TA to
counties to facilitate the development of local
collaborations
 Competing collaborative efforts
Progress related to IDTA
 Endorsement from State Directors
 Pursuit of more Family Treatment Drug
Courts
 Work plan development for presentations
 Communications protocol for professionals
 Consolidation & Coordination
Benefits to Child Welfare
 Representation on the Methamphetamine
Task Force and Drug Endangered Children
Teams
 Representation on the FASD state team
 TA training for staff on family drug treatment
court and FASD
 Revision of Family Assessment of Needs and
Strengths to accurately score SA needs
Next Steps
 Re-engage leaders to champion efforts
 Evaluate effectiveness of community
treatment programs with new SACWIS
capabilities
 Spread best practices
 Provide educational and resource links in
worker manuals
COLORADO
Karen Mooney
Child Welfare
Juvenile and Family Court
Substance Abuse Treatment
Challenges to Collaboration
 Different priorities between systems
 Different levels of motivation for change
 Values were different
Impact of TA
 Motivation to get things done
 Added legitimacy to our process
 Gave us background and encouragement
Impact of TA (2)
 Required planning and execution of tasks
 Final product was Protocol
Outcomes
 Protocol was finalized
 New treatment population added to
substance abuse treatment regulations
 New requirement of women’s programs that
they screen for child safety issues at intake
and periodically thereafter
 New trainings incorporating Protocol
elements
Lessons:
 Local buy-in critical
 Stable leadership
needed at all
phases
 Identify and utilize
culture carriers
 Don’t give up
Lessons (2)
Photo used with
kind permission of
Robert Clark,
photographer
Availability of appropriate treatment (programs for women and
children) is insufficient to meet need