Keeping Families Front and Center Each Step of the Way How ... · recovery and well-being occurs in the context of families. Focusing Only on Parent’s Recovery Without Addressing

Advancing the FDC Movement 2017

Honorable Phillip Britt | Julie Spielman| Alexis Balkey

July 9, 2017 | NADCP

Keeping Families Front and Center Each Step of the Way –

How Family Drug Courts are Supporting Recovery and

Reunification Using a Milestones Approach

Acknowledgement

Improving

Family

Outcomes

Strengthening

Partnerships

This presentation is supported by:

The Office of Juvenile Justice and Delinquency Prevention Office of Justice

Programs(2016-DC-BX-K003)

Points of view or opinions expressed in this presentation are those of the presenter(s) and do not necessarily represent the official position or

policies of OJJDP or the U.S. Department of Justice.


• Understand the impact of parental substance

use on the parent-child relationship and the

essential service components needed to address

these issues

• Understand family readiness as a collaborative

practice issue and why “team” is just as

important as any “tool” for assessing readiness

• Learn key elements of Milestones Approach

and various case management strategies,

including implementation of quality visitation

and contact, evidence-based services,

coordinated case plans and effective

communication protocols across child welfare,

treatment and court systems

Learning Objectives

Strengthening

Partnerships

Improving

Family

Outcomes


FDC Practice Improvements

Approaches to child well-being in FDCs have changed

Child-focused

assessments

and services

In the

context of

parent’s

recovery

Family-

centered

Treatment(includes

parent-child

dyad)

Sacramento County, CAM Project, Children in Focus (CIF)

Parent-child

parenting

intervention

FDC

CIF

Connections

to community

supports

Improved

outcomes

Across all FDC programs, Sacramento is getting ready to admit its 5,000th parent!

• Dependency Drug

Court (DDC) - Post-File

• Early Intervention

Family Drug Court

(EIFDC) - Pre-File


49.2

64.3

44

53.7

0

10

20

30

40

50

60

70

80

90

100

Treatment Completion Rates

DDC EIFDCCIF CIF


41.8

64.4

34

50.3

0

10

20

30

40

50

60

70

80

90

100

Rate of Positive Court Discharge/Graduate

DDC EIFDCCIF CIF


89.9

95.1

84

86

88

90

92

94

96

98

100

Remained at Home

EIFDCCIF


87.8

97

85.1

94.9

53.1

0

10

20

30

40

50

60

70

80

90

100

Reunification Rates

COUNTY

SAC

DDC CIF EIFDC CIF

SacramentoCounty, CAM Project, Children in Focus (CIF)

90.2

97.9

95.7 95.6

88.7

82

84

86

88

90

92

94

96

98

100

No Recurrence of Maltreatment at 12 Months

COUNTY

SAC

DDC CIF EIFDC CIF


89.6

91.8

100 100

87.7

80

82

84

86

88

90

92

94

96

98

100

No Re-Entry at 12 Months

COUNTY

SAC

DDC CIF EIFDC CIF

North Carolina Family Assessment Scale (NCFAS) Intake Results

67.3%

45.4%

40.5%

27.1%

23.2%

32.7%

54.6%

59.5%

72.9%

76.8%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Readiness for Reunification (n=156)

Parental Capabilities (n=163)

Family Interactions (n=173)

Caregiver/Child Ambivalence* (n=155)

Child Well-Being (n=168)

Adequate/Strength Mild-Moderate-Serious Problem

*This domain is for reunification cases only and addresses both the child’s and

caregiver’s desire to reunite and the nature of their relationship with one another.

Percentage of families by rating category (overall domain item)

New Ways of

Serving Children in

Family Drug Courts

Lessons Learned and

Case Studies from the

Children Affected by

Methamphetamines

Grant Program

Address the Needs of Parents#6

Key Component 2: Using a non-adversarial approach

Key Component 4: Access to a continuum of services

Key Component 5: Drug testing

FDC partner agencies encourage parents to complete the recovery process

and help parents meet treatment goals and child welfare and court

requirements. Judges respond to parents in a way that supports continued

engagement in recovery. By working toward permanency and using active

client engagement, accountability and behavior change strategies, the entire

FDC team makes sure that each parent that the FDC serves has access

to a broad scope of services.

Address the Needs of Children#7

Key Component 2: Using a non-adversarial approach

Key Component 4: Access to a continuum of services

FDCs must address the physical, developmental, social, emotional

and cognitive needs of the children they serve through prevention,

intervention and treatment programs. FDCs must implement a

holistic and trauma‐informed perspective to ensure that children

receive effective, coordinated and appropriate services.

The Impact of

Recovery Support

On Successful

Reunification

We know more about

• Recovery Support

Specialists

• Family-Centered Services

• Evidence Based Treatment

• Evidence Based Parenting

• Parenting Time

• Reunification Groups

• Ongoing Support

“Here’s a referral, let me know when you get into treatment.”

“They’ll get into treatment if they really want it.”

“Don’t work harder than the client.”

“Call me Tuesday.”

Missed opportunities

Rethinking Treatment

Readiness

Addiction as an elevator

Re-thinking “rock bottom”

“Raising the bottom”

ASAM Definition of Addiction

Adopted by the ASAM Board of Directors 4/12/2011

• Addiction is characterized by inability to consistently

abstain, impairment in behavioral control, craving,

diminished recognition of significant problems with

one’s behaviors and interpersonal relationships, and a

dysfunctional emotional response

• Like other chronic diseases, addiction often involves

cycles of relapse and remission

• Without treatment or engagement in recovery

activities, addiction is progressive and can result in

disability or premature death

A Chronic, Relapsing Brain Disease

• Brain imaging studies show physical changes in areas of the brain that are critical to

• Judgment

• Decision making

• Learning and memory

• Behavior control

• These changes alter the way the brain works, and help explain the compulsion and continued use despite negative consequences

Substance Use

Disorders are similar to

other diseases, such as

heart disease.

Both diseases disrupt

the normal, healthy

functioning of the

underlying organ, have

serious harmful

consequences, are

preventable, treatable,

and if left untreated,

can result in premature

death.

• Think of a pleasant experience (a romantic evening, a relaxing vacation, playing w/ a child). Pleasure is caused by dopamine, a major brain chemical, that is secreted into the amygdala region of the brain causing that pleasure part of the brain to fire. Addictive drugs do the same, only more intense.

• When drug use is frequent and causes a surge of dopamine on a regular basis, the brain realizes the dopamine is being provided artificially, and it essentially loses its natural ability for pleasure (at least for a period of time).

Effects of Drug Use on Dopamine Production

Effects of Drug Use on Dopamine Production

• Think about the implications for a child welfare parent who has just stopped using drugs and is trying to resume normal interactions with their child/ren.

• If you are tasked with observing this visitation, what conclusions might you draw?

• If cues are misread, how might this affect a parent’s ability to keep or obtain custody of their child/ren?

• How do we balance compassion, understanding and patience with a parent’s temporarily compromised brain condition while maintaining parent accountability and child safety?

A Treatable Disease

• Substance use disorders are preventable and are treatable diseases

• Discoveries in the science of addiction have led to advances in drug

abuse treatment that help people stop abusing drugs and resume

their productive lives

• Similar to other chronic diseases, addiction can be managed

successfully

• Treatment enables people to counteract addiction's powerful

disruptive effects on brain and behavior and regain areas of life

function

These images of the dopamine transporter show the brain’s

remarkable potential to recover, at least partially, after a long

abstinence from drugs - in this case, methamphetamine.9

Addiction and Other Chronic Conditions

JAMA, 284:1689-1695, 2000

Family–Centered Approach

Recognizes that addiction is a family disease and that

recovery and well-being occurs in the context of families

Focusing Only on Parent’s Recovery

Without Addressing

Needs of ChildrenCan threaten parent’s ability to achieve and

sustain recovery and establish a healthy

relationship with their children, thus risking:

• Recurrence of maltreatment

• Re-entry into out-of-home care

• Relapse and sustained sobriety

• Additional substance-exposed infants

• Additional exposure to trauma for child/family

• Prolonged and recurring impact on child well-being

Challenges for the Parents

• The parent lacks understanding of and the ability to cope with the child’s medical, developmental, behavioral, and emotional needs

• The child’s physical, developmental needs were not assessed, or the child did not receive appropriate interventions/treatment services for the identified needs

• The parent and child did not receive services that addressed trauma (for both of them) and relationship issues

Effective

Substance Abuse

Treatment

We know more about• Readily available

• Attends to multiple needs of the individual (vs. just the drug abuse)

• Engagement strategies to keep clients in treatment

• Counseling, behavioral therapies (in combination with medications if necessary)

• Co-occurring conditions

• Continuous monitoring

(National Institute on Drug Abuse, 2012)

TREATMENT RETENTION AND COMPLETION

1. Women who participated in programs that included a “high” level

of family and children’s services and employment/education

services were twice as likely to reunify with their children as those

who participated in programs with a “low” level of these services. (Grella,

Hser & Yang, 2006)

2. Retention and completion of treatment have been found to be

the strongest predictors of reunification with children for substance-

abusing parents. (Green, Rockhill, & Furrer, 2007; Marsh, Smith, & Bruni, 2010)

3. Substance abuse treatment services that include children in

treatment can lead to improved outcomes for the parent, which can

also improve outcomes for the child.

Family Engagement and Ongoing Support

Ensure family treatment and recovery success by:

• Understanding, changing and measuring the cross-system processes

for referrals, engagement and retention in treatment

• Recruiting and training staff who specialize in outreach and

motivational (i.e. Motivational Interviewing) approaches and who

monitor processes of recovery and aftercare

• Jointly monitoring family progress through a combination of case

management, coordinated case planning, information sharing, timely

and ongoing communication

• Aftercare, Community and Family Supports and Alumni Groups

• Review publicly available information

• Need to have a structure for comparing programs

• Pairing the curriculum to your FDC needs and realities

• Understand the outcomes you’d like to see, and be able to articulate

them and link them to the program of choice

Selection of an

Evidence-Based Parenting Program

Considerations When Selecting a Parenting Program

• Understand the needs of Court consumers - What do these families look

like? Are there unique struggles?

• Have realistic expectations of their ability to participate - especially in early

recovery

• Parenting program should include parent-child interactive time, but this

should not be considered visitation

• Child development information needs to be shared with the parent and the

parenting facilitator in advance

✓ True in adult, family, juvenile

Drug Courts That Offer Parenting Classes

Had 68% Greater Reductions in

Recidivism and 52% Greater Cost Savings

PROGRAM PROVIDES PARENTING

CLASSES

N=44

PROGRAM DOES NOT PROVIDE

PARENTING CLASSES

N=17

38%

23%

% R

educt

ion in R

eci

div

ism

Children Need to Spend Time with Their Parents

• Involve parents in the child’s

appointments with doctors and therapists

• Expect foster parents to participate in

visits

• Help parents plan visits ahead of time

• Enlist natural community settings as

visitation locations (e.g. family resource

centers)

• Limit the child’s exposure to adults with

whom they have a comfortable

relationship

Elements of Successful Visitation Plans

Parenting time should occur:

• Frequently

• For an appropriate period of time

• In a comfortable and safe setting

• With therapeutic supervision

• Children and youth who have regular, frequent

contact with their families are more likely to reunify

and less likely to reenter foster care after

reunification (Mallon, 2011)

• Visits provide an important opportunity to gather

information about a parent’s capacity to

appropriately address and provide for their child’s

needs, as well as the family’s overall readiness for

reunification

• Parent-Child Contact (Visitation): Research shows

frequent visitation increases the likelihood of

reunification, reduces time in out-of-home care

(Hess, 2003), and promotes healthy attachment

and reduces negative effects of separation

(Dougherty, 2004)

Impact of Parenting time on Reunification Outcomes

Support Strategy — Reunification Group

• Begin during unsupervised/overnight visitations through 3

months post reunification

• Staffed by an outside treatment provider and recovery

support specialist (or other mentor role)

• Focus on supporting parents through reunification

process

• Group process provides guidance and encouragement;

opportunity to express concerns about parenting without

repercussion

Aftercare and Ongoing Support• Ensure aftercare and recovery success beyond FDC and CWS

participation:

‒ Personal Recovery Plan – relapse prevention, relapse

‒ Peer-to-peer – alumni groups, recovery groups

‒ Other relationships – family, friends, caregivers, significant others

‒ Community-based support and services – basic needs (childcare,

housing, transportation), mental health, physical health and medical

care, spiritual support

‒ Self-sufficiency – employment, educational and training opportunities

Rethinking Readiness

How will we know?

Effective FDCs focus on

behavioral benchmarks

Essential Elements of Responses to Behavior

• Addiction is a brain disorder

• Length of time in treatment is the key; the longer we keep someone in treatment, the greater probability of a successful outcome

• Purpose of sanctions and incentives is to keep participants engaged and motivated in treatment

Safe vs. Perfect

Addiction

Stigma & Perceptions

• Once an addict, always an addict

• They don’t really want to change

• They lie

• They must love their drug more than

their child

• They need to get to rock bottom,

before…

Collaborative Value Inventory (CVI)

• Anonymous web-based survey to be

completed by cross-disciplinary

teams of professionals

• Increase the understanding of the

values that guide different disciplines

and systems

• To assist community members and

professional staff in developing

common principles for their work together

What Do We Believe About Alcohol and Other Drugs, Services to

Children and Families, and Dependency Courts?

0

10

20

30

40

50

60

70

80

90

Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree

84.4

15.6

0.0 0.0

Perc

ent

PEOPLE WHO ARE CHEMICALLY DEPENDENT HAVE A

DISEASE FOR WHICH THEY NEED TREATMENT

n = 90

0

10

20

30

40

50

Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree

15.6

41.1

32.2

11.1

Perc

ent

IN ASSESSING THE EFFECTS OF THE USE OF ALCOHOL

AND OTHER DRUGS, THE STANDARD WE SHOULD USE

FOR DECIDING WHEN TO REMOVE OR REUNIFY

CHILDREN WITH THEIR PARENTS IS WHETHER THE

PARENTS ARE FULLY ABSTAINING FROM THE USE OF

ALCOHOL OR OTHER DRUGS

n = 90

Reasonable Efforts to Preserve and Reunify Families

• Were services to the

family accessible,

available, and

appropriate?

• Were the services

specifically relevant to

the family's problems

and needs?

• Were the appropriate

services available to

the family on a timely

basis?

Critical Questions

• When the parents complete all of

the steps on the case plan, will you

be comfortable allowing the children

to go home?

• Is there any step in the case plan

that, if not completed, will keep you

from allowing the child to go home?

35th

Circuit Treatment Courts,

Dunklin County Family

Treatment Court

Treatment Courts In Missouri

92 Adult Drug Courts7 Juvenile Drug Courts

12 Family Treatment Courts20 Stand-Alone DWI Courts10 Veterans Treatment Courts

_________________________141 Treatment Court Programs

Dunklin County Family Treatment Court

▪ Dunklin County Drug Court began in 1998▪ Decision was made to explore Family Treatment Court▪ Family Treatment Court Planning Initiative 2004▪ Family Treatment Courts were initially modeled after Criminal Drug Courts

▪ Three active phases and one aftercare phase▪ Each phase had specific time requirements that must be met to advance▪ Phase requirements were the same for each participant▪ Progress was reported to the Juvenile Court Judge at their scheduled

hearings▪ Changes in visitation were determined by the Juvenile Court Judge, not the

Family Treatment Court▪ Rewards for positive behavior and Sanctions for negative behavior

What we observed

▪ Phase structure of Family Treatment Court was meaningless to our parents▪ Parents did not care what number phase they were in, they cared about how

often they could see their children and when their children would be back home with them

▪ Parents, therefore, lacked motivation to complete the phases which were part of the program

▪ Readiness for reunification was based on sobriety, safe housing, and whether the issues resulting in removal were remedied, not on phase 1, 2, 3 or 4

▪ Not everyone on the team agreed on readiness for reunification when it was time to report to the Juvenile Court Judge

▪ Many parents were ready for reunification, but had not completed the time allotted for the treatment program phases

▪ No real sanctions with any impact were available

Results this was producing

▪ Families who were maintaining sobriety and had fewer issues to resolve were being reunified early in the process, but still had minimum phase times and standard phase requirements left to complete.

▪ Once reunified, participants knew that failing to attend treatment would not result in removal as long as they were testing clean and maintaining a safe home environment.

▪ Eventually participants stopped coming to treatment prior to completion of the program. This resulted in unsuccessful discharges from Family Treatment Court even though the goal of reunification had been met.

Lessons learned from these results

▪ We needed to find a better way to motivate participants to move through the phases and program, without threatening sanctions.

▪ We needed a better way to keep participants engaged at the end of the program.

▪ We needed better collaboration with the Juvenile Court.

▪ We needed to have the whole treatment court team on the same page before Juvenile Court hearings.

Our approach to the problem

▪ Sought input from the entire system to resolve the problems we were observing.

▪ Invited the Juvenile Court Judge, the Juvenile Office, the Children’s Division, Treatment, and all of the attorneys involved to a meeting.

▪ Asked each part of the system what they thought were the strengths and weaknesses of the Family Treatment Court and how we could make it a more cohesive process with successful results.

What we learned

▪ Not everyone had an accurate understanding of Family Treatment Court.

▪ Everyone wanted to make the system as cohesive as possible for the families involved.

▪ We needed to make the Family Treatment court timeframes match the Family Court timeframes so that it made sense to the families and to the practitioners.

▪ We needed better communication between the Family Treatment Court and the Juvenile Court.

The Changes we made

▪ No more Phase 1, 2, 3, & 4

▪ Eliminated any discussion of Sanctions from our vocabulary

▪ Family Treatment Court progress is now based on visitation status

▪ Supervised visits

▪ Unsupervised visits ( broken into daytime and overnight visits)

▪ Trial Home visit

The Process

▪ Removal with Substance Abuse results in a referral for assessment.

▪ Referral is made at the Protective Custody Hearing.

▪ Assessment by treatment provider, a report is made to the Juvenile Court regarding appropriateness of the parents for Family Treatment Court.

▪ Report is reviewed at Hearing on Petition, Parent is ordered into Family Treatment Court if deemed appropriate. Treatment Court is given discretion for setting visits.

▪ Upon entering Family Treatment Court, each participant meets with Service Coordinator, Children’s Division caseworker, Juvenile Officer and Treatment.

The Process, Continued

Goal sheets for each benchmark are developed.

Benchmarks• Unsupervised Visits• Overnight Visits• Trial Home Visit• Case Closed

The goals are determined with input from all agencies and the parent.All agency representatives sign off on the goals as well as the Treatment Court Judge and it is made part of the TC file.

The results

▪ No more one size fits all program. Participants are engaged in designing their own treatment court program. Each goal sheet is unique to the needs of the individual family.

▪ Pairing progress with visitation increases motivation to accomplish the goals in a timely manner.

▪ Coordinating completion of the Family Treatment Court with closing of the Juvenile Court case eliminated the problem of participants who failed to complete Family Treatment Court due to their underlying case being closed prior to graduation.

▪ Meeting to develop the goal sheets increased collaboration and ensured that all agencies and the participant were in agreement before attending the Juvenile Court hearings.

Missouri FTC Guidelines

1. Create Shared Mission and Vision FTC partners must have a shared mission and vision to define their work together.

2. Develop Interagency Partnerships

3. Create Effective Communication Protocols for Sharing Information

4. Interdisciplinary Knowledge

5. Develop a Process for Early Identification and Assessment

Missouri FTC Guidelines, continued

6. Address the Needs of Parents

7. Address the Needs of Children

8. Garner Community Support

9. Implement Funding and Sustainability Strategies

10. Evaluate for Shared Outcomes and Accountability

National Peer Learning Court

• January 2015, Family Treatment Court in Dunklin County named National Peer Learning Court by OJJDP.

• We have the opportunity to mentor other courts and share our innovations with them.

• One of two rural peer learning courts (Ottumwa, IA)• One of two peer learning courts in Missouri (Jackson County)• Visits from ___________Circuits in ______2015, and a visit via Polycom with

the ______________Circuit in _______ 2016.• We would welcome visits.

We can no longer say

“We don’t know what to do.”

Q&A and Discussion

Building on

our Success

Resources

http://www.ncsacw.samhsa.gov/files/SAFERR.pdf

Resource: Screening and Assessment for

Family Engagement, Retention, and

Recovery (SAFERR)

To download a copy, please visit:

FDC Guidelines

http://www.cffutures.org/files/publications/FDC-Guidelines.pdf

To download a copy today visit our website:

• Webinar Recordings

• FDC Podcasts

• FDC Resources

• FDC Video features

• Webinar registration information

FDC Learning Academy Blog

www.familydrugcourts.blogspot.com

FAMILY DRUG COURTPEER LEARNING COURT PROGRAM

King County, WA

Baltimore City, MDJackson County, MO

Chatham County, GAPima County, AZ

Wapello County, IA

Miami-Dade, FL

Jefferson County, AL

Dunklin County, MO

CONTACT US FOR MORE INFORMATION: [email protected]

mailto:[email protected]

FDC Discipline Specific Orientation Materials

Child Welfare | AOD Treatment | Judges | Attorneys

Please visit: www.cffutures.org/fdc/

Resources

1. Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers

2. Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals

3. Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Legal Professionals

Please visit: http://www.ncsacw.samhsa.gov/

NCSACW Online Tutorials

Resources

Contact InformationHon. Phillip BrittCommissionerDunklin County Family Treatment [email protected]

Julie SpielmanAdministratorDunklin County Family Treatment [email protected]

Alexis Balkey, MPA, RASFamily Drug Court Program ManagerChildren and Family [email protected]

Strengthening

Partnerships

Improving

Family

Outcomes





Documents

Keeping Families Front and Center Each Step of the Way How ... · recovery and well-being occurs in the context of families. Focusing Only on Parent’s Recovery Without Addressing