Transcript Timelines - Children and Family Futures

Responding to Families:
Timelines, Clocks and the Future
Nancy K. Young, Ph.D., Director
July 14, 2004
Baltimore, MD
Responding to Families:
Timelines, Clocks and the Future
Two Opposing Ideas:
 A Sense of Satisfaction
We have much to feel good about in our efforts to
combine forces to help children and families affected
by substance use disorders and child abuse or neglect
 A Sense of Urgency
At the same time, we need a much greater sense of
urgency in building on these victories to enter into the
next phase of getting serious and getting to scale
Timelines
1968
1973
1980s
1990s
2004
Looking Back
Timelines
Beginnings
 1968 – Report of alcoholic mothers with babies
with a distinctive, unusual appearance in
France
 1973 – Fetal Alcohol Syndrome named by a
team of researchers in Seattle
 Mid 1970s
 Estimate of the number of children of heroin addicts
and children of alcoholics
 Fanshel reports substance abuse is common
among families in child welfare
Timelines
Early and Mid 1980s
 Impact of crack cocaine in urban centers
 Chasnoff’s group begin to publish research on
prenatal effects of cocaine
 1983 National Institute on Drug Abuse (NIDA)
College on Problems of Drug Dependence
conference – First Poster Session on Children
Prenatally-Exposed to Cocaine
Timelines
Mid to Late 1980s
 Number of children in foster care escalates
Foster Care Population
600,000
8
7
500,000
6
400,000
5
300,000
4
3
200,000
2
100,000
1
0
0
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Total Children
Number of Children in Foster Care on Last Day of Federal Fiscal Year
Children per 1,000
Foster Care Population and Persons
who First Used Crack or Meth in Past Year
600000
600,000
500000
500,000
400000
400,000
300000
300,000
200000
200,000
100000
100,000
0
0
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Children in Foster Care
*All persons age 12 and over
New Crack Users*
New Methamphetamine Users*
Timelines
Mid to Late 1980s
 Child welfare agencies began responding to
an epidemic of kids coming into care and
cocaine
 Schools began their efforts to understand
prenatally-exposed children
 1987 Los Angeles Unified School District
develops pilot program to understand
educational impact of prenatal cocaine
exposure
Timelines
1990s
 Federal Grant Support Began
 National Center on Child Abuse and Neglect
 94 programs, including Illinois, Connecticut, New Jersey
 Piloted out-stationing substance abuse counselors in child
welfare offices
 NIDA research efforts
 SAMHSA Specialized women’s treatment programs
 Between 1997 and 1999
 Five National Reports on Substance Abuse and
Child Welfare
Timelines
1990s
 Five National Reports on Substance Abuse and
Child Welfare
 Responding to Alcohol and Other Drug Problems in Child
Welfare: Weaving Together Practice and Policy (1998)
 Foster Care: Agencies Face Challenges Securing Stable
Homes for Children of Substance Aubsers (1998)
 Healing the Whole Family: A Look at Family Care Programs
(1998)
 No Safe Haven: Children of Substance-Abusing Parents (1999)
 Blending Perspectives and Building Common Ground: A Report
to Congress on Substance Abuse and Child Protection (1999)
Timelines
1990s
 Many communities began program models
 Paired Counselor and Child Welfare Worker
 Counselor Out-stationed at Child Welfare Office
 Multidisciplinary Teams for Joint Case Planning
 Persons in Recovery act as Advocates for Parents
 Training and Curricula Development
 Family Treatment Courts
Timelines
1990s
 Efforts by members of Congress and advocacy
groups to ensure that substance abuse issues
were addressed in the Adoption and Safe
Families Act (ASFA)
Timelines
2004
1980s
1990s
Looking at our Achievements
Timelines
Our Biggest Achievements
1. Active working relationships and multiple
models of connection


Courts, Child Welfare Agencies and Treatment
Providers
Leadership provided by NCSACW consortium
member organizations:





American Public Human Services Association - 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
Timelines
Our Biggest Achievements
2. Leadership of the Federal Government




1999 Blending Perspectives report, in
response to ASFA
1999 Stakeholders forum called for a
central focal point for these efforts
2000-2001 Regional forums held around
the nation
2002 Funding of the National Center on
Substance Abuse and Child Welfare
Timelines
Our Biggest Achievements
3. Progress in the Dependency Courts
 Judge McGee in Reno and Judge Parham in
Pensacola Florida apply principles and strategies of
adult drug courts to dependency proceedings.
 Judge Milliken in San Diego initiated the first countywide approach to parental substance use disorders
 Courts increasingly document their effectiveness
 The NCJFCJ and NADCP have provided strong
foundations for expansion of model courts and
development of family treatment courts
Timelines
Our Biggest Achievements
4. Advances in the accountability agenda

Children’s Bureau’s Child and Family Service
Review (CFSR) process

SAMHSA’s Plan to Transition the Substance
Abuse Prevention and Treatment Block Grant
(SAPTBG) to a Performance Environment

Missing boxes versus data protocols
Timelines
Our Biggest Achievements
5. Development of a Comprehensive
Framework and Policy Tools

10 Element Framework
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
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
Timelines
Our Biggest Achievements
5. Development of a Comprehensive
Framework and Policy Tools




10 Element Framework
Collaborative Values Inventory
Collaborative Capacity Instrument
Screening and Assessment for Family
Engagement, Retention and Recovery -SAFERR
Biggest Challenges:
Clocks still running
The Four Clocks
The First Clock
ASFA Timetable
 Timeliness of intervention versus “Call me Tuesday”
 CFSR’s have documented
 Case reviews found parental substance use disorders
were a factor in 16% to 48% of cases
 Need for child welfare training in addictions
 Gaps in services
 Inadequate assessment and follow up on the
underlying needs of families, including substance
abuse
 Substance use disorders in families with repeat cases
National Study on Child and Adolescent
Well-Being: Child Welfare Workers’ (CWW)
Identification of Substance Abuse
 Of the caregivers who are alcohol dependent
 71% are classified by the CWW as not having an alcohol
problem
 Of the caregivers who are drug dependent
 73% are classified by the CWW as not having a drug
problem
 CWW’s misclassify caregivers who are
substance dependent most of the time
The First Clock
ASFA Challenges
 Timeliness of Interventions
 Taking CFSR findings seriously and
including remediation strategies in Program
Improvement Plans
The Second Clock
TANF Timetable
 Poverty and low-income work affect neglect,
which is the majority of all reports
 Neglect is often associated with both
substance abuse and poverty
 TANF resources have been used in innovative
models for this population
 Treatment aftercare focus on jobs and housing
 TANF reauthorization proposes treatment be
counted as a work activity
The Third Clock
Recovery Timetable
 “A day at a time for the rest of your life”
Recovery is a lifelong process with a disease
management approach not emergency care
 Low-dosage, 4-hour a week outpatient
programs do not build on what we know about
effective treatment for this population
The Third Clock
Recovery Challenges
 Comprehensive services and longer-term supports
are critical
 Clinical treatment, clinical support and community
supports
 Recognizing the needs of children of parents in
treatment
Findings from TOPPS II
on Status of Children
 61% of women coming into treatment live with a
child less than 18 years old
 Among women with children, 31% had a child
removed from home due to a child protection
court order
 Among women who had children removed from
home, 41% had parental rights terminated to 1 or
more child
 8 out of every 100 women had their parental rights
terminated
The Fourth Clock
Child Development Timetable
 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
The Fourth Clock
Child Development Timetable
 Every 70 seconds a baby is born in this country
who was prenatally exposed to alcohol or illicit
drugs
Putting the Four Clocks in Sync
Communication, Linkages and Priorities
 Communication – a critical factor in all four of
the systems represented by the four clocks,
and in several others that affect these children
and families
 Frontline workers
 Program managers
 Policy officials
Putting the Four Clocks in Sync
Communication, Linkages and Priorities
 Communication: Who needs to know what when
 Communication strategies, protocols, supports and
policy that clarifies communication pathways
 Confidentiality is usually not about legal barriers, but
often more about trust
 Encouraging the flow of information
 Linkage points across systems
 10 elements of system linkages
Putting the Four Clocks in Sync
Communication, Linkages and Priorities
 Collaboration takes time
 Real reform is more than a collaboration meeting
every month
 Getting clocks connected to each other requires
genuine collaboration… which takes time
 Priority – Community-wide agreement that
these families receive the services they need
Future Trends
1968
1973
1980s
1990s
2004
Four Trends: Pushing the
Timeline into the Future
Future Trends
1. Substance-Exposed Births

We are learning more about the enormous costs of
letting most of these babies go home without help

We are learning how powerful early intervention
can be in improving the life chances of these
children

We are learning more about how to prevent
substance-exposed births

CAPTA Amendments

We need a national debate on both “upstream”
prenatal screening and universal screening at birth
Future Trends
2. Growth of Family Drug Treatment Courts
 Courts and their communities will need to decide
how large-scale their interventions need to be
 How timely their intervention
 How to adapt family treatment court strategies to
prevent child removal among families receiving child
welfare services
Future Trends
3. The Pressures for Accountability
 Only child welfare agencies and treatment providers
that develop their capacity to measure their impact
will survive the continuing hard fiscal climate
 When resources are scarce, allocating them to
ineffective programs has moral implications and real
consequences for those children and families
 Redefining “reasonable efforts” based on CFSR
findings that substance abuse services are not
available for reunification efforts in many states may
heighten the focus on the array of available services
Future Trends
4. Family-Centered Policy and Practice
 Intervening with families before children need to be
removed is good economics and good practice
 Pew Commission’s recommendations for changing the
financing of the child welfare system to remove incentives
for foster care underscore the need for front-end reforms
 As child welfare links to reforms in home visiting,
family support programs, and school-based
interventions, these need to be measured against
what they have done for the children living with
parents with substance use disorders
The Fifth Clock
Urgency
 The fifth clock is the one that is ticking on
us…it measures how fast we get it…how
rapidly we respond to human needs that grow
larger by the day
 We have to measure what we do against
what needs doing, not against what we did
last year
The Fifth Clock
Urgency
 Every 70 seconds a baby is born in this country
who was prenatally exposed to alcohol or illicit
drugs
 Every minute and a half, one of those babies goes
home without screening or any effort to begin early
intervention
 A baby and a family we already know are highly at risk
Responding to Families:
Timelines, Clocks and the Future
Listening to the voice of a child
“I Have a Dream”
This is the Fifth Clock