Improving Outcomes for Improving Outcomes for Families Affected by Families Affected by

Substance Use DisordersSubstance Use Disorders

Presented at 9Presented at 9thth Annual Conference of the Annual Conference of the Association of Alcoholism and Substance Abuse Association of Alcoholism and Substance Abuse

Providers of New York StateProviders of New York State

STRENGTHENING FAMILIES AND STRENGTHENING FAMILIES AND EMPOWERING COMMUNITIESEMPOWERING COMMUNITIES

January 31 2006January 31 2006

NNational ational CCenter on enter on SSubstance ubstance AAbusebuse

and and CChild hild WWelfareelfare

wwwncsacwsamhsagov

Power Point atwwwcffuturesorg

Children and Family Futures

NNational ational CCenter on enter on SSubstance ubstance AAbusebuse

and and CChild hild WWelfareelfare

wwwncsacwsamhsagov

Power Point atwwwcffuturesorg

Children and Family Futures

A Program of theA Program of the Substance Abuse and Mental Health Substance Abuse and Mental Health

Services AdministrationServices AdministrationCenter for Substance Abuse TreatmentCenter for Substance Abuse Treatment

and theand the

Administration on Children Youth and FamiliesAdministration on Children Youth and FamiliesChildrenrsquos BureauChildrenrsquos Bureau

Office on Child Abuse and NeglectOffice on Child Abuse and Neglect

To improve outcomes for families by promoting To improve outcomes for families by promoting effective practice and organizational and effective practice and organizational and system changes at the local state and national system changes at the local state and national levelslevels

Developing and implementing a Developing and implementing a comprehensive program of information comprehensive program of information gathering and disseminationgathering and dissemination

Providing technical assistanceProviding technical assistance

MissionMission

Recent ProductsRecent Products Understanding Substance Abuse and Facilitating Understanding Substance Abuse and Facilitating

Recovery A Guide for Child Welfare WorkersRecovery A Guide for Child Welfare Workers(A short monograph for front-line workers)(A short monograph for front-line workers)

On-Line Training ndash On-Line Training ndash Now AvailableNow Available Understanding Child Welfare and the Dependency Understanding Child Welfare and the Dependency

Court A Guide for Substance Abuse Treatment Court A Guide for Substance Abuse Treatment ProfessionalsProfessionals

Understanding Substance Use Disorders Treatment Understanding Substance Use Disorders Treatment and Family Recovery A Guide for Child Welfare and Family Recovery A Guide for Child Welfare ProfessionalsProfessionals

VisitVisit

wwwncsacwsamhsagovwwwncsacwsamhsagov

Program of In-Depth Technical AssistanceProgram of In-Depth Technical Assistance Fifteen months of in-depth work with a State Fifteen months of in-depth work with a State

Team to develop practice protocols and Team to develop practice protocols and policies that improve outcomes for familiespolicies that improve outcomes for families

Round 1 ndash 20032004Round 1 ndash 20032004Colorado Florida Michigan VirginiaColorado Florida Michigan Virginia

Round 2 ndash 20042006Round 2 ndash 20042006Arkansas Massachusetts MinnesotaArkansas Massachusetts Minnesota

Squaxin Island TribeSquaxin Island Tribe

Round 3 ndash 20062007Round 3 ndash 20062007New YorkNew York TexasTexas

Four Sites with a less intensive level of supportFour Sites with a less intensive level of support

Program of In-Depth Technical AssistanceProgram of In-Depth Technical Assistance Fifteen months of in-depth work with a State Fifteen months of in-depth work with a State

Team to develop practice protocols and Team to develop practice protocols and policies that improve outcomes for familiespolicies that improve outcomes for families

Round 1 ndash 20032004Round 1 ndash 20032004Colorado Florida Michigan VirginiaColorado Florida Michigan Virginia

Round 2 ndash 20042006Round 2 ndash 20042006Arkansas Massachusetts MinnesotaArkansas Massachusetts Minnesota

Squaxin Island TribeSquaxin Island Tribe

Round 3 ndash 20062007Round 3 ndash 20062007New YorkNew York TexasTexas

Four Sites with a less intensive level of supportFour Sites with a less intensive level of support

Putting the Pieces Together for Children and Families Putting the Pieces Together for Children and Families Second National Conference on Substance Abuse Child Welfare Second National Conference on Substance Abuse Child Welfare and the Courtsand the Courts

January 30 2007January 30 2007 Pre-conference symposium on substance-exposed infants Pre-conference symposium on substance-exposed infants with Dr Ira Chasnoffwith Dr Ira Chasnoff

January 31 to February 2 2007January 31 to February 2 2007 National ConferenceNational Conference

Disneyland Hotel Anaheim CaliforniaDisneyland Hotel Anaheim California Sign up for information at Sign up for information at

contactuscffuturesorgcontactuscffuturesorg

ANNOUNCINGANNOUNCING

Children of Parents with Substance Use Disorders

So how many are there

Living with parent

Mother used while pregnant

Parent entered treatment

Children Living with One or More Children Living with One or More Substance-Abusing ParentSubstance-Abusing Parent

45

28

62

75

83

84

106

0 2 4 6 8 10 12

Need Treatment for Illicit Drug Abuse

Dependent on Illicit Drugs

Dependent on Alcohol

Dependent on AOD

Dependent on Alcohol andor NeedsTreatment for Illicit Drugs

Used Illicit Drug in Past Month

Used Illicit Drug in Past Year

Numbers indicate millions

500000 NY Children Living with Parent

About 33000 in Out-of-Home Care for Child AbuseNeglect in 2003

COSAs and Child AbuseNeglect VictimsCOSAs and Child AbuseNeglect Victims

02

05

18

30

83

Placed in Out ofHome Care

SubstantiatedVictims

Investigations

Abuse NeglectReports

Living withAlcoholic Addict

Parent

In Millions 0 2 4 6 8 10

Parent Entered TreatmentParent Entered Treatment

New York and US Gender SplitNew York and US Gender Split

7570

2530

0

10

20

30

40

50

60

70

80

Male Female

New York United States

Parents Entering Publicly-Funded Parents Entering Publicly-Funded Substance Abuse TreatmentSubstance Abuse Treatment

Had a Child under age 18Had a Child under age 18 59 59

Had a Child Removed by CPSHad a Child Removed by CPS 22 22

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights 10 10

Based on CSAT TOPPS-II Project

Estimated New York Parents Entering Estimated New York Parents Entering Publicly-Funded Treatment ndash 286000Publicly-Funded Treatment ndash 286000

Had a Child under age 18Had a Child under age 18168700168700

Had a Child Removed by CPSHad a Child Removed by CPS 4049040490

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights ~ ~ 45004500

Based on CSAT TOPPS-II Project

New York Data on ChildrenNew York Data on Children Family History Variable

Marital Status 1048713 Married 1048713 Never Married 1048713 Living as Married 1048713 Separated 1048713 Divorced 1048713 Widowed

Child of AlcoholicSubstance Abuser 1048713 No 1048713 Both 1048713 Child of Alcoholic(s) 1048713 Child of Substance Abuser(s)

No of children ___ No of children living with Client ___ No of Children living in Foster Care ___ Case with Child Protective Services 1048713 Yes 1048713 No

45 of Persons Admitted

Mother Used While PregnantMother Used While Pregnant

Last Statewide StudyLast Statewide Study1992 in California1992 in California

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

State prevalence studies report 10-12 of infants or State prevalence studies report 10-12 of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

To improve outcomes for families by promoting To improve outcomes for families by promoting effective practice and organizational and effective practice and organizational and system changes at the local state and national system changes at the local state and national levelslevels

Developing and implementing a Developing and implementing a comprehensive program of information comprehensive program of information gathering and disseminationgathering and dissemination

Providing technical assistanceProviding technical assistance

MissionMission

Recent ProductsRecent Products Understanding Substance Abuse and Facilitating Understanding Substance Abuse and Facilitating

Recovery A Guide for Child Welfare WorkersRecovery A Guide for Child Welfare Workers(A short monograph for front-line workers)(A short monograph for front-line workers)

On-Line Training ndash On-Line Training ndash Now AvailableNow Available Understanding Child Welfare and the Dependency Understanding Child Welfare and the Dependency

Court A Guide for Substance Abuse Treatment Court A Guide for Substance Abuse Treatment ProfessionalsProfessionals

Understanding Substance Use Disorders Treatment Understanding Substance Use Disorders Treatment and Family Recovery A Guide for Child Welfare and Family Recovery A Guide for Child Welfare ProfessionalsProfessionals

VisitVisit

wwwncsacwsamhsagovwwwncsacwsamhsagov

Program of In-Depth Technical AssistanceProgram of In-Depth Technical Assistance Fifteen months of in-depth work with a State Fifteen months of in-depth work with a State

Team to develop practice protocols and Team to develop practice protocols and policies that improve outcomes for familiespolicies that improve outcomes for families

Round 1 ndash 20032004Round 1 ndash 20032004Colorado Florida Michigan VirginiaColorado Florida Michigan Virginia

Round 2 ndash 20042006Round 2 ndash 20042006Arkansas Massachusetts MinnesotaArkansas Massachusetts Minnesota

Squaxin Island TribeSquaxin Island Tribe

Round 3 ndash 20062007Round 3 ndash 20062007New YorkNew York TexasTexas

Four Sites with a less intensive level of supportFour Sites with a less intensive level of support

Program of In-Depth Technical AssistanceProgram of In-Depth Technical Assistance Fifteen months of in-depth work with a State Fifteen months of in-depth work with a State

Team to develop practice protocols and Team to develop practice protocols and policies that improve outcomes for familiespolicies that improve outcomes for families

Round 1 ndash 20032004Round 1 ndash 20032004Colorado Florida Michigan VirginiaColorado Florida Michigan Virginia

Round 2 ndash 20042006Round 2 ndash 20042006Arkansas Massachusetts MinnesotaArkansas Massachusetts Minnesota

Squaxin Island TribeSquaxin Island Tribe

Round 3 ndash 20062007Round 3 ndash 20062007New YorkNew York TexasTexas

Four Sites with a less intensive level of supportFour Sites with a less intensive level of support

Putting the Pieces Together for Children and Families Putting the Pieces Together for Children and Families Second National Conference on Substance Abuse Child Welfare Second National Conference on Substance Abuse Child Welfare and the Courtsand the Courts

January 30 2007January 30 2007 Pre-conference symposium on substance-exposed infants Pre-conference symposium on substance-exposed infants with Dr Ira Chasnoffwith Dr Ira Chasnoff

January 31 to February 2 2007January 31 to February 2 2007 National ConferenceNational Conference

Disneyland Hotel Anaheim CaliforniaDisneyland Hotel Anaheim California Sign up for information at Sign up for information at

contactuscffuturesorgcontactuscffuturesorg

ANNOUNCINGANNOUNCING

Children of Parents with Substance Use Disorders

So how many are there

Living with parent

Mother used while pregnant

Parent entered treatment

Children Living with One or More Children Living with One or More Substance-Abusing ParentSubstance-Abusing Parent

45

28

62

75

83

84

106

0 2 4 6 8 10 12

Need Treatment for Illicit Drug Abuse

Dependent on Illicit Drugs

Dependent on Alcohol

Dependent on AOD

Dependent on Alcohol andor NeedsTreatment for Illicit Drugs

Used Illicit Drug in Past Month

Used Illicit Drug in Past Year

Numbers indicate millions

500000 NY Children Living with Parent

About 33000 in Out-of-Home Care for Child AbuseNeglect in 2003

COSAs and Child AbuseNeglect VictimsCOSAs and Child AbuseNeglect Victims

02

05

18

30

83

Placed in Out ofHome Care

SubstantiatedVictims

Investigations

Abuse NeglectReports

Living withAlcoholic Addict

Parent

In Millions 0 2 4 6 8 10

Parent Entered TreatmentParent Entered Treatment

New York and US Gender SplitNew York and US Gender Split

7570

2530

0

10

20

30

40

50

60

70

80

Male Female

New York United States

Parents Entering Publicly-Funded Parents Entering Publicly-Funded Substance Abuse TreatmentSubstance Abuse Treatment

Had a Child under age 18Had a Child under age 18 59 59

Had a Child Removed by CPSHad a Child Removed by CPS 22 22

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights 10 10

Based on CSAT TOPPS-II Project

Estimated New York Parents Entering Estimated New York Parents Entering Publicly-Funded Treatment ndash 286000Publicly-Funded Treatment ndash 286000

Had a Child under age 18Had a Child under age 18168700168700

Had a Child Removed by CPSHad a Child Removed by CPS 4049040490

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights ~ ~ 45004500

Based on CSAT TOPPS-II Project

New York Data on ChildrenNew York Data on Children Family History Variable

Marital Status 1048713 Married 1048713 Never Married 1048713 Living as Married 1048713 Separated 1048713 Divorced 1048713 Widowed

Child of AlcoholicSubstance Abuser 1048713 No 1048713 Both 1048713 Child of Alcoholic(s) 1048713 Child of Substance Abuser(s)

No of children ___ No of children living with Client ___ No of Children living in Foster Care ___ Case with Child Protective Services 1048713 Yes 1048713 No

45 of Persons Admitted

Mother Used While PregnantMother Used While Pregnant

Last Statewide StudyLast Statewide Study1992 in California1992 in California

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

State prevalence studies report 10-12 of infants or State prevalence studies report 10-12 of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Recent ProductsRecent Products Understanding Substance Abuse and Facilitating Understanding Substance Abuse and Facilitating

Recovery A Guide for Child Welfare WorkersRecovery A Guide for Child Welfare Workers(A short monograph for front-line workers)(A short monograph for front-line workers)

On-Line Training ndash On-Line Training ndash Now AvailableNow Available Understanding Child Welfare and the Dependency Understanding Child Welfare and the Dependency

Court A Guide for Substance Abuse Treatment Court A Guide for Substance Abuse Treatment ProfessionalsProfessionals

Understanding Substance Use Disorders Treatment Understanding Substance Use Disorders Treatment and Family Recovery A Guide for Child Welfare and Family Recovery A Guide for Child Welfare ProfessionalsProfessionals

VisitVisit

wwwncsacwsamhsagovwwwncsacwsamhsagov

Program of In-Depth Technical AssistanceProgram of In-Depth Technical Assistance Fifteen months of in-depth work with a State Fifteen months of in-depth work with a State

Team to develop practice protocols and Team to develop practice protocols and policies that improve outcomes for familiespolicies that improve outcomes for families

Round 1 ndash 20032004Round 1 ndash 20032004Colorado Florida Michigan VirginiaColorado Florida Michigan Virginia

Round 2 ndash 20042006Round 2 ndash 20042006Arkansas Massachusetts MinnesotaArkansas Massachusetts Minnesota

Squaxin Island TribeSquaxin Island Tribe

Round 3 ndash 20062007Round 3 ndash 20062007New YorkNew York TexasTexas

Four Sites with a less intensive level of supportFour Sites with a less intensive level of support

Program of In-Depth Technical AssistanceProgram of In-Depth Technical Assistance Fifteen months of in-depth work with a State Fifteen months of in-depth work with a State

Team to develop practice protocols and Team to develop practice protocols and policies that improve outcomes for familiespolicies that improve outcomes for families

Round 1 ndash 20032004Round 1 ndash 20032004Colorado Florida Michigan VirginiaColorado Florida Michigan Virginia

Round 2 ndash 20042006Round 2 ndash 20042006Arkansas Massachusetts MinnesotaArkansas Massachusetts Minnesota

Squaxin Island TribeSquaxin Island Tribe

Round 3 ndash 20062007Round 3 ndash 20062007New YorkNew York TexasTexas

Four Sites with a less intensive level of supportFour Sites with a less intensive level of support

Putting the Pieces Together for Children and Families Putting the Pieces Together for Children and Families Second National Conference on Substance Abuse Child Welfare Second National Conference on Substance Abuse Child Welfare and the Courtsand the Courts

January 30 2007January 30 2007 Pre-conference symposium on substance-exposed infants Pre-conference symposium on substance-exposed infants with Dr Ira Chasnoffwith Dr Ira Chasnoff

January 31 to February 2 2007January 31 to February 2 2007 National ConferenceNational Conference

Disneyland Hotel Anaheim CaliforniaDisneyland Hotel Anaheim California Sign up for information at Sign up for information at

contactuscffuturesorgcontactuscffuturesorg

ANNOUNCINGANNOUNCING

Children of Parents with Substance Use Disorders

So how many are there

Living with parent

Mother used while pregnant

Parent entered treatment

Children Living with One or More Children Living with One or More Substance-Abusing ParentSubstance-Abusing Parent

45

28

62

75

83

84

106

0 2 4 6 8 10 12

Need Treatment for Illicit Drug Abuse

Dependent on Illicit Drugs

Dependent on Alcohol

Dependent on AOD

Dependent on Alcohol andor NeedsTreatment for Illicit Drugs

Used Illicit Drug in Past Month

Used Illicit Drug in Past Year

Numbers indicate millions

500000 NY Children Living with Parent

About 33000 in Out-of-Home Care for Child AbuseNeglect in 2003

COSAs and Child AbuseNeglect VictimsCOSAs and Child AbuseNeglect Victims

02

05

18

30

83

Placed in Out ofHome Care

SubstantiatedVictims

Investigations

Abuse NeglectReports

Living withAlcoholic Addict

Parent

In Millions 0 2 4 6 8 10

Parent Entered TreatmentParent Entered Treatment

New York and US Gender SplitNew York and US Gender Split

7570

2530

0

10

20

30

40

50

60

70

80

Male Female

New York United States

Parents Entering Publicly-Funded Parents Entering Publicly-Funded Substance Abuse TreatmentSubstance Abuse Treatment

Had a Child under age 18Had a Child under age 18 59 59

Had a Child Removed by CPSHad a Child Removed by CPS 22 22

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights 10 10

Based on CSAT TOPPS-II Project

Estimated New York Parents Entering Estimated New York Parents Entering Publicly-Funded Treatment ndash 286000Publicly-Funded Treatment ndash 286000

Had a Child under age 18Had a Child under age 18168700168700

Had a Child Removed by CPSHad a Child Removed by CPS 4049040490

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights ~ ~ 45004500

Based on CSAT TOPPS-II Project

New York Data on ChildrenNew York Data on Children Family History Variable

Marital Status 1048713 Married 1048713 Never Married 1048713 Living as Married 1048713 Separated 1048713 Divorced 1048713 Widowed

Child of AlcoholicSubstance Abuser 1048713 No 1048713 Both 1048713 Child of Alcoholic(s) 1048713 Child of Substance Abuser(s)

No of children ___ No of children living with Client ___ No of Children living in Foster Care ___ Case with Child Protective Services 1048713 Yes 1048713 No

45 of Persons Admitted

Mother Used While PregnantMother Used While Pregnant

Last Statewide StudyLast Statewide Study1992 in California1992 in California

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

State prevalence studies report 10-12 of infants or State prevalence studies report 10-12 of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Program of In-Depth Technical AssistanceProgram of In-Depth Technical Assistance Fifteen months of in-depth work with a State Fifteen months of in-depth work with a State

Team to develop practice protocols and Team to develop practice protocols and policies that improve outcomes for familiespolicies that improve outcomes for families

Round 1 ndash 20032004Round 1 ndash 20032004Colorado Florida Michigan VirginiaColorado Florida Michigan Virginia

Round 2 ndash 20042006Round 2 ndash 20042006Arkansas Massachusetts MinnesotaArkansas Massachusetts Minnesota

Squaxin Island TribeSquaxin Island Tribe

Round 3 ndash 20062007Round 3 ndash 20062007New YorkNew York TexasTexas

Four Sites with a less intensive level of supportFour Sites with a less intensive level of support

Program of In-Depth Technical AssistanceProgram of In-Depth Technical Assistance Fifteen months of in-depth work with a State Fifteen months of in-depth work with a State

Team to develop practice protocols and Team to develop practice protocols and policies that improve outcomes for familiespolicies that improve outcomes for families

Round 1 ndash 20032004Round 1 ndash 20032004Colorado Florida Michigan VirginiaColorado Florida Michigan Virginia

Round 2 ndash 20042006Round 2 ndash 20042006Arkansas Massachusetts MinnesotaArkansas Massachusetts Minnesota

Squaxin Island TribeSquaxin Island Tribe

Round 3 ndash 20062007Round 3 ndash 20062007New YorkNew York TexasTexas

Four Sites with a less intensive level of supportFour Sites with a less intensive level of support

Putting the Pieces Together for Children and Families Putting the Pieces Together for Children and Families Second National Conference on Substance Abuse Child Welfare Second National Conference on Substance Abuse Child Welfare and the Courtsand the Courts

January 30 2007January 30 2007 Pre-conference symposium on substance-exposed infants Pre-conference symposium on substance-exposed infants with Dr Ira Chasnoffwith Dr Ira Chasnoff

January 31 to February 2 2007January 31 to February 2 2007 National ConferenceNational Conference

Disneyland Hotel Anaheim CaliforniaDisneyland Hotel Anaheim California Sign up for information at Sign up for information at

contactuscffuturesorgcontactuscffuturesorg

ANNOUNCINGANNOUNCING

Children of Parents with Substance Use Disorders

So how many are there

Living with parent

Mother used while pregnant

Parent entered treatment

Children Living with One or More Children Living with One or More Substance-Abusing ParentSubstance-Abusing Parent

45

28

62

75

83

84

106

0 2 4 6 8 10 12

Need Treatment for Illicit Drug Abuse

Dependent on Illicit Drugs

Dependent on Alcohol

Dependent on AOD

Dependent on Alcohol andor NeedsTreatment for Illicit Drugs

Used Illicit Drug in Past Month

Used Illicit Drug in Past Year

Numbers indicate millions

500000 NY Children Living with Parent

About 33000 in Out-of-Home Care for Child AbuseNeglect in 2003

COSAs and Child AbuseNeglect VictimsCOSAs and Child AbuseNeglect Victims

02

05

18

30

83

Placed in Out ofHome Care

SubstantiatedVictims

Investigations

Abuse NeglectReports

Living withAlcoholic Addict

Parent

In Millions 0 2 4 6 8 10

Parent Entered TreatmentParent Entered Treatment

New York and US Gender SplitNew York and US Gender Split

7570

2530

0

10

20

30

40

50

60

70

80

Male Female

New York United States

Parents Entering Publicly-Funded Parents Entering Publicly-Funded Substance Abuse TreatmentSubstance Abuse Treatment

Had a Child under age 18Had a Child under age 18 59 59

Had a Child Removed by CPSHad a Child Removed by CPS 22 22

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights 10 10

Based on CSAT TOPPS-II Project

Estimated New York Parents Entering Estimated New York Parents Entering Publicly-Funded Treatment ndash 286000Publicly-Funded Treatment ndash 286000

Had a Child under age 18Had a Child under age 18168700168700

Had a Child Removed by CPSHad a Child Removed by CPS 4049040490

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights ~ ~ 45004500

Based on CSAT TOPPS-II Project

New York Data on ChildrenNew York Data on Children Family History Variable

Marital Status 1048713 Married 1048713 Never Married 1048713 Living as Married 1048713 Separated 1048713 Divorced 1048713 Widowed

Child of AlcoholicSubstance Abuser 1048713 No 1048713 Both 1048713 Child of Alcoholic(s) 1048713 Child of Substance Abuser(s)

No of children ___ No of children living with Client ___ No of Children living in Foster Care ___ Case with Child Protective Services 1048713 Yes 1048713 No

45 of Persons Admitted

Mother Used While PregnantMother Used While Pregnant

Last Statewide StudyLast Statewide Study1992 in California1992 in California

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

State prevalence studies report 10-12 of infants or State prevalence studies report 10-12 of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Program of In-Depth Technical AssistanceProgram of In-Depth Technical Assistance Fifteen months of in-depth work with a State Fifteen months of in-depth work with a State

Team to develop practice protocols and Team to develop practice protocols and policies that improve outcomes for familiespolicies that improve outcomes for families

Round 1 ndash 20032004Round 1 ndash 20032004Colorado Florida Michigan VirginiaColorado Florida Michigan Virginia

Round 2 ndash 20042006Round 2 ndash 20042006Arkansas Massachusetts MinnesotaArkansas Massachusetts Minnesota

Squaxin Island TribeSquaxin Island Tribe

Round 3 ndash 20062007Round 3 ndash 20062007New YorkNew York TexasTexas

Four Sites with a less intensive level of supportFour Sites with a less intensive level of support

Putting the Pieces Together for Children and Families Putting the Pieces Together for Children and Families Second National Conference on Substance Abuse Child Welfare Second National Conference on Substance Abuse Child Welfare and the Courtsand the Courts

January 30 2007January 30 2007 Pre-conference symposium on substance-exposed infants Pre-conference symposium on substance-exposed infants with Dr Ira Chasnoffwith Dr Ira Chasnoff

January 31 to February 2 2007January 31 to February 2 2007 National ConferenceNational Conference

Disneyland Hotel Anaheim CaliforniaDisneyland Hotel Anaheim California Sign up for information at Sign up for information at

contactuscffuturesorgcontactuscffuturesorg

ANNOUNCINGANNOUNCING

Children of Parents with Substance Use Disorders

So how many are there

Living with parent

Mother used while pregnant

Parent entered treatment

Children Living with One or More Children Living with One or More Substance-Abusing ParentSubstance-Abusing Parent

45

28

62

75

83

84

106

0 2 4 6 8 10 12

Need Treatment for Illicit Drug Abuse

Dependent on Illicit Drugs

Dependent on Alcohol

Dependent on AOD

Dependent on Alcohol andor NeedsTreatment for Illicit Drugs

Used Illicit Drug in Past Month

Used Illicit Drug in Past Year

Numbers indicate millions

500000 NY Children Living with Parent

About 33000 in Out-of-Home Care for Child AbuseNeglect in 2003

COSAs and Child AbuseNeglect VictimsCOSAs and Child AbuseNeglect Victims

02

05

18

30

83

Placed in Out ofHome Care

SubstantiatedVictims

Investigations

Abuse NeglectReports

Living withAlcoholic Addict

Parent

In Millions 0 2 4 6 8 10

Parent Entered TreatmentParent Entered Treatment

New York and US Gender SplitNew York and US Gender Split

7570

2530

0

10

20

30

40

50

60

70

80

Male Female

New York United States

Parents Entering Publicly-Funded Parents Entering Publicly-Funded Substance Abuse TreatmentSubstance Abuse Treatment

Had a Child under age 18Had a Child under age 18 59 59

Had a Child Removed by CPSHad a Child Removed by CPS 22 22

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights 10 10

Based on CSAT TOPPS-II Project

Estimated New York Parents Entering Estimated New York Parents Entering Publicly-Funded Treatment ndash 286000Publicly-Funded Treatment ndash 286000

Had a Child under age 18Had a Child under age 18168700168700

Had a Child Removed by CPSHad a Child Removed by CPS 4049040490

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights ~ ~ 45004500

Based on CSAT TOPPS-II Project

New York Data on ChildrenNew York Data on Children Family History Variable

Marital Status 1048713 Married 1048713 Never Married 1048713 Living as Married 1048713 Separated 1048713 Divorced 1048713 Widowed

Child of AlcoholicSubstance Abuser 1048713 No 1048713 Both 1048713 Child of Alcoholic(s) 1048713 Child of Substance Abuser(s)

No of children ___ No of children living with Client ___ No of Children living in Foster Care ___ Case with Child Protective Services 1048713 Yes 1048713 No

45 of Persons Admitted

Mother Used While PregnantMother Used While Pregnant

Last Statewide StudyLast Statewide Study1992 in California1992 in California

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

State prevalence studies report 10-12 of infants or State prevalence studies report 10-12 of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Putting the Pieces Together for Children and Families Putting the Pieces Together for Children and Families Second National Conference on Substance Abuse Child Welfare Second National Conference on Substance Abuse Child Welfare and the Courtsand the Courts

January 30 2007January 30 2007 Pre-conference symposium on substance-exposed infants Pre-conference symposium on substance-exposed infants with Dr Ira Chasnoffwith Dr Ira Chasnoff

January 31 to February 2 2007January 31 to February 2 2007 National ConferenceNational Conference

Disneyland Hotel Anaheim CaliforniaDisneyland Hotel Anaheim California Sign up for information at Sign up for information at

contactuscffuturesorgcontactuscffuturesorg

ANNOUNCINGANNOUNCING

Children of Parents with Substance Use Disorders

So how many are there

Living with parent

Mother used while pregnant

Parent entered treatment

Children Living with One or More Children Living with One or More Substance-Abusing ParentSubstance-Abusing Parent

45

28

62

75

83

84

106

0 2 4 6 8 10 12

Need Treatment for Illicit Drug Abuse

Dependent on Illicit Drugs

Dependent on Alcohol

Dependent on AOD

Dependent on Alcohol andor NeedsTreatment for Illicit Drugs

Used Illicit Drug in Past Month

Used Illicit Drug in Past Year

Numbers indicate millions

500000 NY Children Living with Parent

About 33000 in Out-of-Home Care for Child AbuseNeglect in 2003

COSAs and Child AbuseNeglect VictimsCOSAs and Child AbuseNeglect Victims

02

05

18

30

83

Placed in Out ofHome Care

SubstantiatedVictims

Investigations

Abuse NeglectReports

Living withAlcoholic Addict

Parent

In Millions 0 2 4 6 8 10

Parent Entered TreatmentParent Entered Treatment

New York and US Gender SplitNew York and US Gender Split

7570

2530

0

10

20

30

40

50

60

70

80

Male Female

New York United States

Parents Entering Publicly-Funded Parents Entering Publicly-Funded Substance Abuse TreatmentSubstance Abuse Treatment

Had a Child under age 18Had a Child under age 18 59 59

Had a Child Removed by CPSHad a Child Removed by CPS 22 22

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights 10 10

Based on CSAT TOPPS-II Project

Estimated New York Parents Entering Estimated New York Parents Entering Publicly-Funded Treatment ndash 286000Publicly-Funded Treatment ndash 286000

Had a Child under age 18Had a Child under age 18168700168700

Had a Child Removed by CPSHad a Child Removed by CPS 4049040490

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights ~ ~ 45004500

Based on CSAT TOPPS-II Project

New York Data on ChildrenNew York Data on Children Family History Variable

Marital Status 1048713 Married 1048713 Never Married 1048713 Living as Married 1048713 Separated 1048713 Divorced 1048713 Widowed

Child of AlcoholicSubstance Abuser 1048713 No 1048713 Both 1048713 Child of Alcoholic(s) 1048713 Child of Substance Abuser(s)

No of children ___ No of children living with Client ___ No of Children living in Foster Care ___ Case with Child Protective Services 1048713 Yes 1048713 No

45 of Persons Admitted

Mother Used While PregnantMother Used While Pregnant

Last Statewide StudyLast Statewide Study1992 in California1992 in California

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

State prevalence studies report 10-12 of infants or State prevalence studies report 10-12 of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Children of Parents with Substance Use Disorders

So how many are there

Living with parent

Mother used while pregnant

Parent entered treatment

Children Living with One or More Children Living with One or More Substance-Abusing ParentSubstance-Abusing Parent

45

28

62

75

83

84

106

0 2 4 6 8 10 12

Need Treatment for Illicit Drug Abuse

Dependent on Illicit Drugs

Dependent on Alcohol

Dependent on AOD

Dependent on Alcohol andor NeedsTreatment for Illicit Drugs

Used Illicit Drug in Past Month

Used Illicit Drug in Past Year

Numbers indicate millions

500000 NY Children Living with Parent

About 33000 in Out-of-Home Care for Child AbuseNeglect in 2003

COSAs and Child AbuseNeglect VictimsCOSAs and Child AbuseNeglect Victims

02

05

18

30

83

Placed in Out ofHome Care

SubstantiatedVictims

Investigations

Abuse NeglectReports

Living withAlcoholic Addict

Parent

In Millions 0 2 4 6 8 10

Parent Entered TreatmentParent Entered Treatment

New York and US Gender SplitNew York and US Gender Split

7570

2530

0

10

20

30

40

50

60

70

80

Male Female

New York United States

Parents Entering Publicly-Funded Parents Entering Publicly-Funded Substance Abuse TreatmentSubstance Abuse Treatment

Had a Child under age 18Had a Child under age 18 59 59

Had a Child Removed by CPSHad a Child Removed by CPS 22 22

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights 10 10

Based on CSAT TOPPS-II Project

Estimated New York Parents Entering Estimated New York Parents Entering Publicly-Funded Treatment ndash 286000Publicly-Funded Treatment ndash 286000

Had a Child under age 18Had a Child under age 18168700168700

Had a Child Removed by CPSHad a Child Removed by CPS 4049040490

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights ~ ~ 45004500

Based on CSAT TOPPS-II Project

New York Data on ChildrenNew York Data on Children Family History Variable

Marital Status 1048713 Married 1048713 Never Married 1048713 Living as Married 1048713 Separated 1048713 Divorced 1048713 Widowed

Child of AlcoholicSubstance Abuser 1048713 No 1048713 Both 1048713 Child of Alcoholic(s) 1048713 Child of Substance Abuser(s)

No of children ___ No of children living with Client ___ No of Children living in Foster Care ___ Case with Child Protective Services 1048713 Yes 1048713 No

45 of Persons Admitted

Mother Used While PregnantMother Used While Pregnant

Last Statewide StudyLast Statewide Study1992 in California1992 in California

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

State prevalence studies report 10-12 of infants or State prevalence studies report 10-12 of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Children Living with One or More Children Living with One or More Substance-Abusing ParentSubstance-Abusing Parent

45

28

62

75

83

84

106

0 2 4 6 8 10 12

Need Treatment for Illicit Drug Abuse

Dependent on Illicit Drugs

Dependent on Alcohol

Dependent on AOD

Dependent on Alcohol andor NeedsTreatment for Illicit Drugs

Used Illicit Drug in Past Month

Used Illicit Drug in Past Year

Numbers indicate millions

500000 NY Children Living with Parent

About 33000 in Out-of-Home Care for Child AbuseNeglect in 2003

COSAs and Child AbuseNeglect VictimsCOSAs and Child AbuseNeglect Victims

02

05

18

30

83

Placed in Out ofHome Care

SubstantiatedVictims

Investigations

Abuse NeglectReports

Living withAlcoholic Addict

Parent

In Millions 0 2 4 6 8 10

Parent Entered TreatmentParent Entered Treatment

New York and US Gender SplitNew York and US Gender Split

7570

2530

0

10

20

30

40

50

60

70

80

Male Female

New York United States

Parents Entering Publicly-Funded Parents Entering Publicly-Funded Substance Abuse TreatmentSubstance Abuse Treatment

Had a Child under age 18Had a Child under age 18 59 59

Had a Child Removed by CPSHad a Child Removed by CPS 22 22

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights 10 10

Based on CSAT TOPPS-II Project

Estimated New York Parents Entering Estimated New York Parents Entering Publicly-Funded Treatment ndash 286000Publicly-Funded Treatment ndash 286000

Had a Child under age 18Had a Child under age 18168700168700

Had a Child Removed by CPSHad a Child Removed by CPS 4049040490

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights ~ ~ 45004500

Based on CSAT TOPPS-II Project

New York Data on ChildrenNew York Data on Children Family History Variable

Marital Status 1048713 Married 1048713 Never Married 1048713 Living as Married 1048713 Separated 1048713 Divorced 1048713 Widowed

Child of AlcoholicSubstance Abuser 1048713 No 1048713 Both 1048713 Child of Alcoholic(s) 1048713 Child of Substance Abuser(s)

No of children ___ No of children living with Client ___ No of Children living in Foster Care ___ Case with Child Protective Services 1048713 Yes 1048713 No

45 of Persons Admitted

Mother Used While PregnantMother Used While Pregnant

Last Statewide StudyLast Statewide Study1992 in California1992 in California

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

State prevalence studies report 10-12 of infants or State prevalence studies report 10-12 of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

COSAs and Child AbuseNeglect VictimsCOSAs and Child AbuseNeglect Victims

02

05

18

30

83

Placed in Out ofHome Care

SubstantiatedVictims

Investigations

Abuse NeglectReports

Living withAlcoholic Addict

Parent

In Millions 0 2 4 6 8 10

Parent Entered TreatmentParent Entered Treatment

New York and US Gender SplitNew York and US Gender Split

7570

2530

0

10

20

30

40

50

60

70

80

Male Female

New York United States

Parents Entering Publicly-Funded Parents Entering Publicly-Funded Substance Abuse TreatmentSubstance Abuse Treatment

Had a Child under age 18Had a Child under age 18 59 59

Had a Child Removed by CPSHad a Child Removed by CPS 22 22

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights 10 10

Based on CSAT TOPPS-II Project

Estimated New York Parents Entering Estimated New York Parents Entering Publicly-Funded Treatment ndash 286000Publicly-Funded Treatment ndash 286000

Had a Child under age 18Had a Child under age 18168700168700

Had a Child Removed by CPSHad a Child Removed by CPS 4049040490

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights ~ ~ 45004500

Based on CSAT TOPPS-II Project

New York Data on ChildrenNew York Data on Children Family History Variable

Marital Status 1048713 Married 1048713 Never Married 1048713 Living as Married 1048713 Separated 1048713 Divorced 1048713 Widowed

Child of AlcoholicSubstance Abuser 1048713 No 1048713 Both 1048713 Child of Alcoholic(s) 1048713 Child of Substance Abuser(s)

No of children ___ No of children living with Client ___ No of Children living in Foster Care ___ Case with Child Protective Services 1048713 Yes 1048713 No

45 of Persons Admitted

Mother Used While PregnantMother Used While Pregnant

Last Statewide StudyLast Statewide Study1992 in California1992 in California

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

State prevalence studies report 10-12 of infants or State prevalence studies report 10-12 of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Parent Entered TreatmentParent Entered Treatment

New York and US Gender SplitNew York and US Gender Split

7570

2530

0

10

20

30

40

50

60

70

80

Male Female

New York United States

Parents Entering Publicly-Funded Parents Entering Publicly-Funded Substance Abuse TreatmentSubstance Abuse Treatment

Had a Child under age 18Had a Child under age 18 59 59

Had a Child Removed by CPSHad a Child Removed by CPS 22 22

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights 10 10

Based on CSAT TOPPS-II Project

Estimated New York Parents Entering Estimated New York Parents Entering Publicly-Funded Treatment ndash 286000Publicly-Funded Treatment ndash 286000

Had a Child under age 18Had a Child under age 18168700168700

Had a Child Removed by CPSHad a Child Removed by CPS 4049040490

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights ~ ~ 45004500

Based on CSAT TOPPS-II Project

New York Data on ChildrenNew York Data on Children Family History Variable

Marital Status 1048713 Married 1048713 Never Married 1048713 Living as Married 1048713 Separated 1048713 Divorced 1048713 Widowed

Child of AlcoholicSubstance Abuser 1048713 No 1048713 Both 1048713 Child of Alcoholic(s) 1048713 Child of Substance Abuser(s)

No of children ___ No of children living with Client ___ No of Children living in Foster Care ___ Case with Child Protective Services 1048713 Yes 1048713 No

45 of Persons Admitted

Mother Used While PregnantMother Used While Pregnant

Last Statewide StudyLast Statewide Study1992 in California1992 in California

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

State prevalence studies report 10-12 of infants or State prevalence studies report 10-12 of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

New York and US Gender SplitNew York and US Gender Split

7570

2530

0

10

20

30

40

50

60

70

80

Male Female

New York United States

Parents Entering Publicly-Funded Parents Entering Publicly-Funded Substance Abuse TreatmentSubstance Abuse Treatment

Had a Child under age 18Had a Child under age 18 59 59

Had a Child Removed by CPSHad a Child Removed by CPS 22 22

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights 10 10

Based on CSAT TOPPS-II Project

Estimated New York Parents Entering Estimated New York Parents Entering Publicly-Funded Treatment ndash 286000Publicly-Funded Treatment ndash 286000

Had a Child under age 18Had a Child under age 18168700168700

Had a Child Removed by CPSHad a Child Removed by CPS 4049040490

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights ~ ~ 45004500

Based on CSAT TOPPS-II Project

New York Data on ChildrenNew York Data on Children Family History Variable

Marital Status 1048713 Married 1048713 Never Married 1048713 Living as Married 1048713 Separated 1048713 Divorced 1048713 Widowed

Child of AlcoholicSubstance Abuser 1048713 No 1048713 Both 1048713 Child of Alcoholic(s) 1048713 Child of Substance Abuser(s)

No of children ___ No of children living with Client ___ No of Children living in Foster Care ___ Case with Child Protective Services 1048713 Yes 1048713 No

45 of Persons Admitted

Mother Used While PregnantMother Used While Pregnant

Last Statewide StudyLast Statewide Study1992 in California1992 in California

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

State prevalence studies report 10-12 of infants or State prevalence studies report 10-12 of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Parents Entering Publicly-Funded Parents Entering Publicly-Funded Substance Abuse TreatmentSubstance Abuse Treatment

Had a Child under age 18Had a Child under age 18 59 59

Had a Child Removed by CPSHad a Child Removed by CPS 22 22

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights 10 10

Based on CSAT TOPPS-II Project

Estimated New York Parents Entering Estimated New York Parents Entering Publicly-Funded Treatment ndash 286000Publicly-Funded Treatment ndash 286000

Had a Child under age 18Had a Child under age 18168700168700

Had a Child Removed by CPSHad a Child Removed by CPS 4049040490

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights ~ ~ 45004500

Based on CSAT TOPPS-II Project

New York Data on ChildrenNew York Data on Children Family History Variable

Marital Status 1048713 Married 1048713 Never Married 1048713 Living as Married 1048713 Separated 1048713 Divorced 1048713 Widowed

Child of AlcoholicSubstance Abuser 1048713 No 1048713 Both 1048713 Child of Alcoholic(s) 1048713 Child of Substance Abuser(s)

No of children ___ No of children living with Client ___ No of Children living in Foster Care ___ Case with Child Protective Services 1048713 Yes 1048713 No

45 of Persons Admitted

Mother Used While PregnantMother Used While Pregnant

Last Statewide StudyLast Statewide Study1992 in California1992 in California

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

State prevalence studies report 10-12 of infants or State prevalence studies report 10-12 of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Estimated New York Parents Entering Estimated New York Parents Entering Publicly-Funded Treatment ndash 286000Publicly-Funded Treatment ndash 286000

Had a Child under age 18Had a Child under age 18168700168700

Had a Child Removed by CPSHad a Child Removed by CPS 4049040490

If a Child was Removed Lost If a Child was Removed Lost

Parental RightsParental Rights ~ ~ 45004500

Based on CSAT TOPPS-II Project

New York Data on ChildrenNew York Data on Children Family History Variable

Marital Status 1048713 Married 1048713 Never Married 1048713 Living as Married 1048713 Separated 1048713 Divorced 1048713 Widowed

Child of AlcoholicSubstance Abuser 1048713 No 1048713 Both 1048713 Child of Alcoholic(s) 1048713 Child of Substance Abuser(s)

No of children ___ No of children living with Client ___ No of Children living in Foster Care ___ Case with Child Protective Services 1048713 Yes 1048713 No

45 of Persons Admitted

Mother Used While PregnantMother Used While Pregnant

Last Statewide StudyLast Statewide Study1992 in California1992 in California

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

State prevalence studies report 10-12 of infants or State prevalence studies report 10-12 of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

New York Data on ChildrenNew York Data on Children Family History Variable

Marital Status 1048713 Married 1048713 Never Married 1048713 Living as Married 1048713 Separated 1048713 Divorced 1048713 Widowed

Child of AlcoholicSubstance Abuser 1048713 No 1048713 Both 1048713 Child of Alcoholic(s) 1048713 Child of Substance Abuser(s)

No of children ___ No of children living with Client ___ No of Children living in Foster Care ___ Case with Child Protective Services 1048713 Yes 1048713 No

45 of Persons Admitted

Mother Used While PregnantMother Used While Pregnant

Last Statewide StudyLast Statewide Study1992 in California1992 in California

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

State prevalence studies report 10-12 of infants or State prevalence studies report 10-12 of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Mother Used While PregnantMother Used While Pregnant

Last Statewide StudyLast Statewide Study1992 in California1992 in California

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

State prevalence studies report 10-12 of infants or State prevalence studies report 10-12 of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

State prevalence studies report 10-12 of infants or State prevalence studies report 10-12 of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

State prevalence studies report 10-12 of infants or State prevalence studies report 10-12 of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

State prevalence studies report 10-12 of infants or State prevalence studies report 10-12 of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Use During PregnancyUse During Pregnancy

Substance Used Substance Used (Past Month)(Past Month)

1st1st TrimesterTrimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester

Any Illicit DrugAny Illicit Drug

Alcohol UseAlcohol Use

Binge Alcohol Binge Alcohol UseUse

SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2002 and 2003 applied to New York 2003 birth data

23 women5800 infants

47 women11900 infants

07 women1800 infants

77 women 19481 infants

196 women 49588 infants

109 women27577 infants

32 women8100 infants

61 women15400 infants

14 women3500 infants

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Parent is alcohol dependent or need treatmentParent is alcohol dependent or need treatment

About 25000 New York infants affected per year

Mother uses while pregnant

About 500000 New York children affected

New York Children AffectedNew York Children Affected

Parents in Treatment

About 168000 New York Treatment AdmissionsWere parents of minor children

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot really have the numbershellipWe donrsquot really have the numbershellip

Letrsquos look at the overall foster care population over timehellip

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Foster Care PopulationFoster Care PopulationEnd of Each Federal Fiscal YearEnd of Each Federal Fiscal Year

0

100000

200000

300000

400000

500000

600000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Children in Foster Care

ASFA

50 Increase over 6 Years

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack in Prior YearUsed Crack in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Foster Care Population and Persons Who First Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior YearUsed Crack or Methamphetamine in Prior Year

0

100000

200000

300000

400000

500000

600000

1985198619871988198919901991199219931994199519961997199819992000200120022003

0

100000

200000

300000

400000

500000

600000

Children in Foster Care New Crack Users New Methamphetamine Users

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

New York State Foster CareNew York State Foster CareIn Care Admissions and DischargesIn Care Admissions and Discharges

05000

100001500020000

25000300003500040000

4500050000

1999 2000 2001 2002 2003

In Care Admissions

Source New York State Monitoring and Analysis Profiles (2003)

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

New York Child Victims by Age Group 2003New York Child Victims by Age Group 2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Age 0-3 Age 4-7 Age 8-11 Age 12-15 Age 16-17

Source Child Maltreatment 2003

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Children in Foster Care by Age Group 2003Children in Foster Care by Age Group 2003

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Age lt2 Age 2-5 Age 6-9 Age 10-13 Age 14-17 Age 18+

New York State New York City

Source New York MAPS (2003)

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17

378336 344

217

0

5

10

15

20

25

30

35

40

Alcohol Illicit Drug

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

Compared to African-American Youth Caucasians were more likely to use alcohol (414 versus 298) and illicit drugs (362 versus 267)

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Percent of Youth Ages 12 to 17 Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment Needing Substance Abuse Treatment

by Foster Care Statusby Foster Care Status

104

59

131

53

174

88

0

2

4

6

8

10

12

14

16

18

Need for AlcoholTreatment

Need for IllicitDrug Treatment

Need for Alcoholor Illicit Drug

Treatment

Ever in Foster Care Not in Foster Care

Office of Applied Studies SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

How Big a Problem are SubstanceHow Big a Problem are SubstanceUse Disorders in CWS CaseloadsUse Disorders in CWS Caseloads

We donrsquot have good datahellipWe donrsquot have good datahellip

The ldquomissing boxrdquo problem means data is The ldquomissing boxrdquo problem means data is not readily available in most states and not readily available in most states and communitiescommunities

Most practitioners agree and federal Most practitioners agree and federal government reported that at least 13 of government reported that at least 13 of referrals and 23 of removals involve referrals and 23 of removals involve families with a substance use disorderfamilies with a substance use disorder

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Estimates of AOD ProblemsEstimates of AOD ProblemsAmong Parents in Child WelfareAmong Parents in Child Welfare

Research studies vary based onResearch studies vary based on

Definition of substance abuseDefinition of substance abuse

Population (rural versus urban)Population (rural versus urban)

Sample (in-home versus out of home)Sample (in-home versus out of home)

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Risks for ChildrenRisks for Children

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Parent uses or abuses drugs andor alcoholParent uses or abuses drugs andor alcohol

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Special circumstances involving Special circumstances involving methamphetamine and manufacturingmethamphetamine and manufacturing Parent ldquocooksrdquo small quantities of methParent ldquocooksrdquo small quantities of meth Parent involved in super labParent involved in super lab

Parent involved in traffickingParent involved in trafficking

Mother uses while pregnantMother uses while pregnant

Parent is dependent on drugs andor alcoholParent is dependent on drugs andor alcohol

Mother uses while pregnantMother uses while pregnant

Risks for ChildrenRisks for ChildrenHow does Child Welfare Assess for the Differences

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Substance Exposed InfantsSubstance Exposed Infants

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Total births 253000

10 of total births 25300

Total child victims under age 1 year 6300

Total age 0-2 years in OOHC = 2400

Where did they all go

2003 Estimated Number of Children Prenatally 2003 Estimated Number of Children Prenatally Exposed to Substances in New YorkExposed to Substances in New York

25

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

MOST GO HOMEMOST GO HOMEMOST GO HOMEMOST GO HOME

80-95 are undetected and go home without assessment and needed services

Many doctors and hospitals do not test or may have Many doctors and hospitals do not test or may have inconsistent implementation of state policiesinconsistent implementation of state policies

Tests detect only very recent useTests detect only very recent use

Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk but with no positive test at birthor at-risk but with no positive test at birth

CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Child Abuse Prevention and Treatment Act Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments(CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments2003 Keeping Families Safe Act Amendments Policies and procedures (including appropriate referrals to child Policies and procedures (including appropriate referrals to child

protection service systems and for other appropriate services) to address protection service systems and for other appropriate services) to address the needs of the needs of infants born and identified as affected by illegal infants born and identified as affected by illegal substance abusesubstance abuse or or withdrawal symptoms resulting from prenatal withdrawal symptoms resulting from prenatal drug exposuredrug exposure including a requirement that health care providers including a requirement that health care providers involved in the delivery or care of such infants involved in the delivery or care of such infants notify the child notify the child protective services system of the occurrence of such condition in protective services system of the occurrence of such condition in such infantssuch infants except that such notification shall not be construed to (I) except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse establish a definition under Federal law of what constitutes child abuse or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii)) or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii))

The development of The development of a plan of safe carea plan of safe care for the infant born and identified for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))(section 106(b)(2)(A)(iii))

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

There is no absolute profile of developmental There is no absolute profile of developmental outcomes based on a childrsquos exposure to his or her outcomes based on a childrsquos exposure to his or her parentsrsquo substance use abuse or dependence parentsrsquo substance use abuse or dependence

Other problems arising in parental behavior Other problems arising in parental behavior competence and disorders interact with substance competence and disorders interact with substance use abuse and dependence to cause multiple co-use abuse and dependence to cause multiple co-occurring problems in the lives of these children occurring problems in the lives of these children

The complexity of screening and assessment for these The complexity of screening and assessment for these children is compounded by at least two realitieschildren is compounded by at least two realities

Screening and Assessment of Screening and Assessment of Consequences for ChildrenConsequences for Children

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

5 Identify and respond to the needs of

Infant Preschooler Child Adolescent

ParentChild

Five Points of Intervention for Policy and Practicewith Substance Exposed Infants

Identify and respond to familyrsquos needs

Initiate enhanced prenatal services

3 Identification at Birth

4 Ensure infantrsquos safety and respond to infantrsquos needs

2 Prenatal screening and assessment

1 Pre-pregnancy awareness of substance use effects

System Linkages

Respond to familyrsquos needs

System Linkages

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Key Barriers Between Substance Key Barriers Between Substance Abuse Child Welfare and the CourtsAbuse Child Welfare and the Courts

Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Many communities began program models in 1990sMany communities began program models in 1990s

Models of Improved ServicesModels of Improved Services

Family Treatment CourtsFamily Treatment Courts

Training and Curricula DevelopmentTraining and Curricula Development

Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents

Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning

Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office

Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

More Advanced Models of Team EffortsMore Advanced Models of Team Efforts Workers out-stationed in collaborative settings at Workers out-stationed in collaborative settings at

courts at CWS agencies at treatment agenciescourts at CWS agencies at treatment agencies

Increased recovery management and monitoring Increased recovery management and monitoring of recovery progressof recovery progress

New methods and protocols on sharing New methods and protocols on sharing informationinformation

Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts

New priorities for treatment access for child New priorities for treatment access for child welfare-involved familieswelfare-involved families

New responses to childrenrsquos needsNew responses to childrenrsquos needs

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Roles and ResponsibilitiesRoles and Responsibilities

11 Referral and BrokeringReferral and Brokering

22 Clinical Consultation and Clinical Consultation and InterpretationInterpretation

33 Engaging Clients in TreatmentEngaging Clients in Treatment

44 Cross-trainingCross-training

55 Creating AwarenessCreating Awareness

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Lessons and Challenges of Lessons and Challenges of Out-stationed Substance Abuse CounselorsOut-stationed Substance Abuse Counselors

Environment and ContextEnvironment and Context Who Is the CustomerWho Is the Customer Specific QualificationsSpecific Qualifications Clear Policies Protocols and LocationClear Policies Protocols and Location Clear Supervisory RelationshipsClear Supervisory Relationships Clear Functions for the Substance Clear Functions for the Substance

Abuse and Child Welfare Agencies Abuse and Child Welfare Agencies andor the Overall Countyandor the Overall County

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Integrated Integrated (eg Santa Clara Reno Suffolk)(eg Santa Clara Reno Suffolk)bull Both dependency matters and recovery management Both dependency matters and recovery management

conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer

bull Dual Track Dual Track (eg San Diego)(eg San Diego)bull Dependency matters and recovery management Dependency matters and recovery management

conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase

bull If parent is noncompliant with court orders parent may If parent is noncompliant with court orders parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Family Drug Treatment Court Models Family Drug Treatment Court Models

bull Parallel Parallel (eg Sacramento)(eg Sacramento)bull Dependency matters are heard on a regular family Dependency matters are heard on a regular family

court docket court docket bull Specialized court services offered before Specialized court services offered before

noncompliance occursnoncompliance occursbull Compliance reviews and recovery management heard Compliance reviews and recovery management heard

by a specialized court officerby a specialized court officer

bull Cross-Court Team Cross-Court Team (eg Orange County CA)(eg Orange County CA)bull Dependency and recovery matters are heard by same Dependency and recovery matters are heard by same

courtcourtbull Recovery management child welfare services legal Recovery management child welfare services legal

representation assigned to a teamrepresentation assigned to a teambull Team works in six courts with separate Team works in six courts with separate

judgescommissionersjudgescommissioners

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Emergence of Family Based TreatmenthellipEmergence of Family Based Treatmenthellip

Models are not Not Yet Reformed SystemsModels are not Not Yet Reformed Systems

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Womenrsquos programming 1970s - 80sWomenrsquos programming 1970s - 80s Strategies still largely based on male modelsStrategies still largely based on male models

Women and children 1990sWomen and children 1990s Increased recognition of specific needs for Increased recognition of specific needs for

women ndash Trauma and Co-occurring disorderswomen ndash Trauma and Co-occurring disorders Childrenrsquos intervention needs ndash Early 2000sChildrenrsquos intervention needs ndash Early 2000s

Significant therapeutic needs of childrenSignificant therapeutic needs of children Poor parenting skills and minimal attachment Poor parenting skills and minimal attachment

abilityability

Emergence of Family Based TreatmentEmergence of Family Based Treatment

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Moving Toward Family Based TreatmentMoving Toward Family Based Treatment

ChallengesChallenges Defining who is the family memberDefining who is the family member How many and ages of children in programsHow many and ages of children in programs

bull Logistics milieu and clinical reasonsLogistics milieu and clinical reasons Incorporating fathers in treatment milieuIncorporating fathers in treatment milieu

bull Preventing further trauma of family divisions and Preventing further trauma of family divisions and separationsseparations

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level One

Serve women

bullFamily relationships framework is built into service delivery

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Level Two

Serve women and children

bullChild care ndash often through co-op babysitting

bullTreatment plan includes parenting and family relationships

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Level Three

Serve women and children

bullTherapeutic needs of children are recognized

bullParenting and family relationships are part of treatment plan

bullFor families in child welfare services dual role of supporting recovery and ensuring health and safety of children

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Level Four

Serve women and children

bullTherapeutic needs of children are recognized and they have own treatmenttherapeutic goals

bullFathers andor significant others receive services in support of the womanrsquos recovery

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Level Five

Serve women children and family members they define as their family

bullAll members of family unit have individualize treatment plans

bullFocus is on family members and the family system as a whole

bullCommunity supports including domestic violence employment and re-entry services are addressed

Continuum of Family Based TreatmentContinuum of Family Based Treatment

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Safety comes firstSafety comes first For each family memberFor each family member

ComprehensiveComprehensive Clinical treatment clinical supports and community Clinical treatment clinical supports and community

supportssupports Family members are defined by the participantFamily members are defined by the participant Based on unique needs and resources of Based on unique needs and resources of

individual familiesindividual families Treatment is dynamicTreatment is dynamic

Not everyone comes together for pre-determined Not everyone comes together for pre-determined length of treatment episodelength of treatment episode

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Conflict is inevitable but resolvableConflict is inevitable but resolvable Substance use disorders are viewed as Substance use disorders are viewed as

chronic but treatablechronic but treatable Treatment content acknowledges and Treatment content acknowledges and

focuses on the importance of attachment focuses on the importance of attachment and relationships to others while helping and relationships to others while helping family to function as a wholefamily to function as a whole

Services are gender responsive and Services are gender responsive and specificspecific

Services are culturally competentServices are culturally competent

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Comprehensive Family Based ServicesComprehensive Family Based ServicesCharacteristics and PrinciplesCharacteristics and Principles

Requires an array of staff professionals in Requires an array of staff professionals in an environment of mutual respect and an environment of mutual respect and shared trainingshared training

Treatment supports creation of healthy Treatment supports creation of healthy family systems with appropriate roles and family systems with appropriate roles and good communicationgood communication

REQUIRES CROSS-SYSTEM REQUIRES CROSS-SYSTEM COLLABORATIVE RELATIONSHIPSCOLLABORATIVE RELATIONSHIPS

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Navigating the PathwaysNavigating the Pathways TAP 27 published by CSATTAP 27 published by CSAT

EstablishedEstablished

A framework for defining elements of A framework for defining elements of collaboration collaboration

Methods to assess effectiveness of Methods to assess effectiveness of collaborative workcollaborative work

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

To define linkage points across systems

To describe the components of the initiative

To assess the progress in implementation

To assist sites in measuring their implementation

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

10 Element Framework10 Element Framework

Collaborative Values InventoryCollaborative Values Inventory

Collaborative Capacity InstrumentCollaborative Capacity Instrument

Matrix of Progress in LinkagesMatrix of Progress in Linkages

Screening and Assessment for Family Screening and Assessment for Family Engagement Retention and Recovery -- Engagement Retention and Recovery -- SAFERR SAFERR

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Framework and Policy Tools for Framework and Policy Tools for Systems ChangeSystems Change

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

Underlying valuesUnderlying values Joint accountability Joint accountability and shared outcomeand shared outcome

Information systemsInformation systems Training and staff Training and staff

developmentdevelopment Budgeting and program Budgeting and program

sustainabilitysustainability

Elements of System Linkages

Daily practice screening and assessment

Daily practice client engagement and retention in care

Daily practice AOD services to children

Working with related agencies

Building community supports

Visit wwwncsacwsamhsagov for Examples from States to Implement these Elements

The Voice of a ChildThe Voice of a Child

Nothing But SilenceBy Ashley G

Age 12January 2005

People all around mePeople all around meCalling out my nameCalling out my name

But no I cannot hear themBut no I cannot hear themFor my heart is filled with shameFor my heart is filled with shame

Nothing but silenceNothing but silence

But only till the break of dawnBut only till the break of dawnWill I be feeling sadWill I be feeling sad

For wandering out on the streetsFor wandering out on the streetsAre my birth mom and dadAre my birth mom and dad

Whyrsquod she do this to her and meWhyrsquod she do this to her and meWith this wersquoll have to copeWith this wersquoll have to cope

But while shersquos clean you never knowBut while shersquos clean you never knowThere still could be hopeThere still could be hope

But in the perfect world I knowBut in the perfect world I knowTherersquos no harmful stuffTherersquos no harmful stuffNow Irsquove come to realizeNow Irsquove come to realizeItrsquos just a bunch of bluffItrsquos just a bunch of bluff

Nothing but silenceNothing but silence

Sitting by the widow sillSitting by the widow sillA tear rolls down my cheekA tear rolls down my cheek

Although it hurts I canrsquot expressAlthough it hurts I canrsquot expressMy heart is just too weakMy heart is just too weak

Nothing but acheNothing but ache

Itrsquos funny what one pill can doItrsquos funny what one pill can doTo a mother or a kidTo a mother or a kid

And now I know that for a factAnd now I know that for a factI wonrsquot do what she didI wonrsquot do what she did

Nothing but acheNothing but ache

Now I live a better lifeNow I live a better lifeAnd drugshellipI wouldnrsquot dareAnd drugshellipI wouldnrsquot dare

Away from all the harmful thingsAway from all the harmful thingsWith a family who caresWith a family who cares

Nothing but loveNothing but love

I know it hurts it sure hurt meI know it hurts it sure hurt meThatrsquos why Irsquoll remain drug freeThatrsquos why Irsquoll remain drug free

Nothinghellip but hopeNothinghellip but hope

Nothing But Silence

People all around mePeople all around meCalling out my nameCalling out my name

But no I cannot hear themBut no I cannot hear themFor my heart is filled with shameFor my heart is filled with shame

Nothing but silenceNothing but silence

But only till the break of dawnBut only till the break of dawnWill I be feeling sadWill I be feeling sad

For wandering out on the streetsFor wandering out on the streetsAre my birth mom and dadAre my birth mom and dad

Whyrsquod she do this to her and meWhyrsquod she do this to her and meWith this wersquoll have to copeWith this wersquoll have to cope

But while shersquos clean you never knowBut while shersquos clean you never knowThere still could be hopeThere still could be hope

But in the perfect world I knowBut in the perfect world I knowTherersquos no harmful stuffTherersquos no harmful stuffNow Irsquove come to realizeNow Irsquove come to realizeItrsquos just a bunch of bluffItrsquos just a bunch of bluff

Nothing but silenceNothing but silence

Sitting by the widow sillSitting by the widow sillA tear rolls down my cheekA tear rolls down my cheek

Although it hurts I canrsquot expressAlthough it hurts I canrsquot expressMy heart is just too weakMy heart is just too weak

Nothing but acheNothing but ache

Itrsquos funny what one pill can doItrsquos funny what one pill can doTo a mother or a kidTo a mother or a kid

And now I know that for a factAnd now I know that for a factI wonrsquot do what she didI wonrsquot do what she did

Nothing but acheNothing but ache

Now I live a better lifeNow I live a better lifeAnd drugshellipI wouldnrsquot dareAnd drugshellipI wouldnrsquot dare

Away from all the harmful thingsAway from all the harmful thingsWith a family who caresWith a family who cares

Nothing but loveNothing but love

I know it hurts it sure hurt meI know it hurts it sure hurt meThatrsquos why Irsquoll remain drug freeThatrsquos why Irsquoll remain drug free

Nothinghellip but hopeNothinghellip but hope

Nothing But Silence