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Advancing the FDC Movement 2017
July 10, 2017
Planning for Safe Care: What Your Family Drug Court
Needs to Know about Serving Pregnant Women with Opioid Use Disorders
and Their Infants
Nancy K. Young, PhD, MSWDirector
Strengthening Partnerships
Improving Family Outcomes
An Initiative Funded by the
Substance Abuse and Mental Health Services Administration (SAMHSA)
and the
Administration for Children, Youth and Families (ACYF),
Children’s Bureau
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.
Advancing the FDC Movement 2017
Understand best practices in the treatment of Opioid use disorders for parenting and
pregnant women Infants prenatally exposed to opioids
Learn how the Child Abuse and Prevention Treatment Act (CAPTA) provisions on prenatally substance exposure can improve outcomes for families
Learning Objectives
I. Some Data: Scope of the IssueII. Windows of Opportunity
Child Abuse and Prevention Treatment Act (CAPTA), Substance-Exposed Infants Provisions
III. Family Drug Court: Stage for Transformation Adult Drug Court Family-Centered Approach Case
Studies Expanding the FDC Partnership
IV. ResourcesV. Discussion
Agenda
Drugs of the Decades
Age-Adjusted Rates of Death Related to Prescription Opioids and Heroin Drug Poisoning in the United States, 2000–2014*
*Data from Centers for Disease Control and Prevention 2015
Highest risk after a period
of abstinence,
inpatient treatment or incarceration
Number of Children in Out of Home Care2000-2015
Source: AFCARS Reports, 2000-2015. Retrieved from http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/afcars
Parental Alcohol or Other Drug Use as a Contributing Factor for Reason for Removal in the United States,
2000 to 2015
Note: Estimates based on all children in out of home care at some point during Fiscal Year
Source: AFCARS Data, 2000-2015
Parental Alcohol or Drug Use as a Contributing Factor for Reason for Removal by State, 2015
National Average: 34.4%
Note: Estimates based on all children in out of home care at some point during Fiscal Year
Source: AFCARS Data, 2015
Age of Children who Entered Out of Home Care by Age, 2015
Num
ber o
f Chi
ldre
n
Note: Estimates based on all children who entered out of home care during Fiscal Year
Source: AFCARS Data, 2015
*Approximately 4 million (3,932,181) live births in 2013; National Vital Statistics Report, Vol. 64, No. 1 http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_01.pdfEstimates based on: National Survey on Drug Use and Health, 2013; http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdfPatrick, et al., (2015). Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. Journal ofPerinatology, 35 (8), 667 May, P.A., and Gossage, J.P.(2001).Estimating the prevalence of fetal alcohol syndrome: A summary. Alcohol Research & Health 25(3):159-167. Retrieved October 21, 2012 from http://pubs.niaaa.nih.gov/publications/arh25-3/159-167.htm
Estimated Number of Infants* Affected by Prenatal Exposure, by Type of Substance and Infant Disorder
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
Tobacco Alcohol Illicit Drugs Binge Drinking Heavy Drinking NAS FASD
600,00015%
360,0009%
80,0002% 16,000
0.4%
28,000(.2-7 per
1,000 births)
24,000(6 per 1,000
births)
Potentially Affected by Prenatal Exposure
200,0005%
FASD
Withdrawal Syndrome
From Medicaid data, the
mean length of stay for
infants with NAS was 16.4
days at an average cost of $53,000 1.2 1.4
1.8
3.4
5.86.0
0
1
2
3
4
5
6
7
2000 2003 2006 2009 2012 2013Rate
of N
AS p
er 1
,000
Hos
pita
l Bi
rths
Year
*
*2013 Data in 28 States from the Center for Disease Control publicly available data in Health Care and in 28 states
Source: Patrick, S. W., et al. (2012). Neonatal abstinence syndrome and associated healthcare expenditures – United States, 2000-2009. JAMA, 307(18), 1934-40Patrick, S. W., et al. (2015). Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009-2019. J Perinatol, 35(8), 650-655Ko, M. Y., Patrick, S. W., Tong, V. T., Patel, R., Lind, J. N., & Barfield, W. D. (2016). Incidence of Neonatal Abstinence Syndrome – 28 States, 1999-2013. MMWR Morb Mortal Wkly Rep 2016; 65:799-802
Rate of Neonatal Abstinence Syndrome Over Time
New England - 13.7
East South Central – 16.2
Patrick, S. W., Davis, M. M., Lehmann, C. U., & Cooper, W. O. (2015). Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. Journal of Perinatology, 35(8), 650-655.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520760/
NAS National Hospital Rates 2009-2012
Source: AFCARS Data, 2013
Children Under Age 1 Entering Foster Care, 2013
The American College of Obstetricians and Gynecologists. (2012) Committee Opinion No. 524: Opioid Abuse, Dependence, and Addiction in Pregnancy. Obstetrics & Gynecology, 119(5), 1070-1076; U.S. National Library of Medicine, National Institutes of Health. Neonatal Abstinence Syndrome. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/007313.htm on July 24, 2014Hudak, M.L., Tan, R.C. The Committee on Drugs and the Committee on Fetus and Newborn. Neonatal Drug Withdrawal. Pediatrics. 2012, 129(2): e540; Jansson, L.M., Velez, M., Harrow, C. The Opioid Exposed Newborn: Assessment and Pharmacological Management. Journal of Opioid Management. 2009; 5(1):47-55
NAS occurs with notable variability,
with 55-94% of
exposed infants exhibiting symptoms
Medication is required in
approximately
50% of cases
Neonatal Abstinence SyndromeAn expected and treatable condition that follows prenatal exposure to opioids
Symptoms begin within 1-3 days after birth, or may take 5-10 days to appear and include:
• Blotchy skin; difficulty with sleeping and eating; trembling, irritability and difficult to soothe; diarrhea; slow weight gain; sweating; hyperactive reflexes; increased muscle tone
Timing of onset is related to characteristics of drug used by mother and time of last dose
Most opioid exposed babies are exposed to multiple substances
Neonatal Abstinence Syndrome: Treatment
American Academy of Pediatrics, Committee on Drugs (1998). Neonatal Drug Withdrawal. Pediatrics, 101(6), 1079-1088; Hudak, M.L., Tan, R.C. The Committee on Drugs and the Committee on Fetus and Newborn. Neonatal Drug Withdrawal. Pediatrics. 2012, 129(2): e540; Jansson, L.M., Velez, M., Harrow, C. The Opioid Exposed Newborn: Assessment and Pharmacological Management. Journal of Opioid Management. 2009; 5(1):47-55; Jones, H., Kaltenbach, K., Heil, S., Stine, S., Coyle, M., Arria, A., O’Grady, K., Selby, P., Martin, P., Fischer, G. (2010). Neonatal Abstinence Syndrome After Methadone or Buprenorphine Exposure. New England Journal of Medicine, 363(24):2320-2331
The concurrent goal of treatment is to soothe the newborn’s discomfort and
promote mother-infant bonding.
Pharmacological TreatmentIndividualized based on severity of symptomsStandardized scoring tool to measure severity of symptomsAssessment of risks and benefits
Non-Pharmacological Treatment SwaddlingBreastfeedingCalm, low-stimulus environmentRooming with mother
Nicotine Alcohol Marijuana Opiates Cocaine Methamphetamine
Fetal Growth
Anomalies
Withdrawal
Neurobehavior
Growth
Behavior
Cognition
Language
Achievement
Effect No Effect
Strong Effect
No Consensus
? Not Enough Data
Short-Term Effects of Prenatal Exposure by Substance
Long-Term Effects of Prenatal Exposure by Substance
Adapted from: Behnke, M., & Smith, V. C. (2013). Prenatal Substance Abuse: Long and short term effects on the exposed fetus. Pediatrics
Complex Interplay of Factors
Interaction of various prenatal and environmental factors:
• Family characteristics• Prenatal care• Exposure to multiple substances: alcohol
and tobacco• Early childhood experiences in bonding
with parent(s) and caregiver(s) • Other health and psychosocial factors
have a significant impact
The American College of Obstetricians and Gyneocolgoists. (2012) Committee Opinion No. 524: Opioid Abuse, Dependence, and Addiction in Pregnancy. Obstetrics & Gynecology, 119(5), 1070-1076; Emmalee, S. B. et al. (2010) Prenatal Drug Exposure: Infant and Toddler Outcomes. Journal of Addictive Diseases, 29(2), 245-258; Baldacchino, A., et al. (2014). Neurobehavioral consequences of chronic intrauterine opioid exposure in infants and preschool children: a systematic review and meta-analysis. BMC Psychiatry, 14(104); Nygaard, E., Slinning, K., Moe, V., & Walhoyd, K.B. (2015). Cognitive function of youths born to mothers with opioid and poly-substance abuse problems during pregnancy. Child Nueropsychology, 23(2), 15-187.
“…across a number of models with and without covariates,
accounted for more variance in developmental trajectories than did prenatal exposure.”
Environmentalrisk
Windows ofOpportunity
Substance-Exposed Infants: Primary Changes in Child Abuse Prevention and Treatment Act (CAPTA)
“Except that such notification shall not be construed to—
Establish a definition under Federal law of what constitutes child abuse or neglect; orrequire prosecution for any illegal action.”
• Federal funding to support prevention, assessment, investigation, prosecution, and treatment activities related to child abuse and neglect
• Current funding provides several grant programs:
• State Grants: a formula grant to improve CPS
• Discretionary grants: competitively awarded funds to support research, technical assistance, and demonstration projects
• Community-based Grants (CBCAP): funding to all states for support of community-based activities to prevent child abuse and neglect
• Children’s Justice Act Grants: to States and territories to improve the assessment, investigation, and/or prosecution of child abuse and neglect cases with particular focus on sexual abuse and exploitation of children, child fatalities, and children who are disabled or with serious health disorders
1974Child Abuse Prevention and Treatment Act (CAPTA)
2003The Keeping Children and Families Safe Act of 2003
• Amends CAPTA and creates new conditions for States to receive their State grant
• Congressional report states: “To identify infants at risk of child abuse and neglect so appropriate services can be delivered to the infant and mother to provide for the safety of the child” and...
• “the development of a safe plan of care...to protect a child who may be at increased risk of maltreatment, regardless of whether the State had determined that the child had been abused or neglected as a result of prenatal exposure”
• To receive State grant, Governor must assure they have policies and procedures for:
• Appropriate referrals to address needs of infants “born with and identified as being affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure”
• Health care providers to notify CPS; notification not to be construed to establish a definition of what constitutes abuse or neglect or require prosecution for any illegal action
• A Plan of Safe Care for infant and immediate screening, risk and safety assessment, and prompt investigation
2010The CAPTA Reauthorization Act of 2010
• Conditions for receipt of State grant were updated to clarify definition of substance exposed infant and added Fetal Alcohol Spectrum Disorder: • “Born with and identified as being affected by illegal substance
abuse or withdrawal symptoms resulting from prenatal drug exposure or a Fetal Alcohol Spectrum Disorder
• Added reporting requirements to Annual State Data Reports to include • Number of children referred to child welfare services identified as
prenatally drug exposed or FASD
• Number of children involved in a substantiated case of abuse or neglect determined to be eligible for referral to Part C of the Individuals with Disabilities Education Act (children under age 3)
• Number of children referred to agencies providing early intervention services under Part C
2016Comprehensive Addiction and Recovery Act of 2016 (CARA)
• Further clarified population requiring a Plan of Safe Care:
• “Born with and identified as being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure, or a Fetal Alcohol Spectrum Disorder,” specifically removing “illegal”
• Required the Plan of Safe Care to include needs of both the infant and family/caregiver
• Specified data reported by States, to the extent practical, through National Child Abuse and Neglect Data System (NCANDS)
• The number of infants identified as being affected by substance abuse, withdrawal symptoms resulting from prenatal drug exposure, or Fetal Alcohol Spectrum Disorder
• The number of infants for whom a Plan of Safe Care was developed• The number of infants for whom referrals were made for appropriate services—
including services for the affected family or caregiver
• Specified increased monitoring and oversight • Children’s Bureau through the annual CAPTA report in the State plan • States to ensure that Plans of Safe Care are implemented and that families have
referrals to and delivery of appropriate services
2016 Primary Changes in CAPTA• Further clarified population to infants “born with
and affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure, or a Fetal Alcohol Spectrum Disorder,” specifically removing “illegal”
• Required Plan of Safe Care to include needs of both infant and family or caregiver
• Specified data to be reported by States• Specified increased monitoring and oversight for
States to ensure that Plans of Safe Care are implemented and that families have access to appropriate services
CAPTA: State Policy Implications
Development of a state-level collaborative body to enforce or develop and oversee related laws and policies (e.g. child abuse/neglect statutes on prenatal substance exposure)
Defining the population of infants: affected by substance abuse, withdrawal symptoms or fetal alcohol spectrum disorder
Determining populations of families and the appropriate organization to implement and oversee the Plan of Safe Care
Strengthening of state data systems to meet the reporting requirements
CAPTA Practice Consideration Plan of Safe Care Principles
• Inter-disciplinary• Family-centered, including a preference that infants
and mothers remain together when possible• Ideally developed prior to the birth of the infant
Plan of Safe Care Principles
Brings together:• Child Welfare Risk, Safety and Strengths Assessment
(e.g. investigation)• Hospital Discharge Plan• Infant Care Plan• Substance Use Treatment Case Plan• Prenatal Care Plan
Plan of Safe Care Principles
• Facilitates identification of the family’s overall needs and engagement into the appropriate services including
• Specifies to whom the infant will be discharged• Identifies a lead agency for development and
ongoing monitoring based on a determined frequency to ensure child and family well-being
Although the Safety Plan may address some of the components in a Plan of Safe Care, they have different purposes and may not:
• Include parents’ or infants’ treatment needs• Include other identified needs that are not determined to
be immediate safety concerns• Involve systems outside of child welfare• Continue beyond the child welfare assessment if the
case is not promoted for ongoing services
“…a safety plan is designed to control safety threats and have an immediate effect…[it] stay[s] in effect as long as the threats to child safety exist and the family remains unable to provide for the child’s safety…”
- Child and Family Services Review (CFSR) E-Training Platform https://training.cfsrportal.org/section-2-understanding-child-welfare-system/3016
CAPTA Practice Consideration Plan of Safe Care & Safety Plan
CAPTA Practice Consideration Plan of Safe Components
Supports for MotherDomain Types of Needed Services and
SupportsPrimary and OB/GYN Health
Pregnancy and post-partum obstetrical, gynecological and family planning
Pain management Breastfeeding coaching Co-occurring mental health,
particularly maternal depression
Supports for Mother and FatherDomain Types of Needed Services and Supports
Substance Use and Mental Health Disorders Prevention, Intervention and Treatment
Access to and retention in substance use treatment services and ongoing recovery support
Mental health services Treatment provider that is knowledgeable about
the child welfare systems and offers gender-specific, family-centered and trauma-informed services
Parenting/Family Support
Coordinated care management for parents and children
Domestic partner and family violence intervention Infant care, parent-infant bonding, nurturing
parenting coaching, safe-sleep Child care Income support and safety net
Supports for InfantDomain Types of Needed Services and Supports
Health Linkage to a medical home, pediatrician or primary care provider
High-risk infant follow-up care as needed Referral to specialty health care as needed
Child Development
Coordination of early care, developmentaland education programming
Services provided by staff knowledgeable in child development and in working with infants with prenatal substance exposure
Developmental screening and assessment Referral to developmental pediatrician as
needed
Family Drug Courts : Stage for Transformation
“If OTPs and other MAT providers cannot establish a foothold in drug courts, they are unlikely to do so elsewhere in the criminal justice system.”
- Marlowe, Wakeman, Rich, & Baston (2016). Increasing Access to Medication-Assisted Treatment for Opioid Addiction in Drug Courts and Correctional Facilities and Working Effectively with Family Courts and Child Protective Services
(98%) surveyed drug courts reported participants with an opioid use disorder
(56%) reported offering medication assisted treatment
Matusow, H. et al., Medication Assisted Treatment in US Drug Courts: Results from a Nationwide Survey of Availability, Barriers and Attitudes. Journal of Substance Abuse Treatment, 2013. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602216/
Almost All
Approximately Half
Medication Assisted Treatment in Drug Courts, 2013
(20-25%) reported blanket prohibitions against medication assisted treatmentApproximately a Quarter
SAMHSA Grants to Expand Substance Abuse Treatment Capacity in Adult and Family Drug Courts (April 10, 2015)http://www.samhsa.gov/sites/default/files/grants/pdf/ti-15-002-modified-due.pdf
Statement of Assurance: …the treatment drug court(s) for which funds are sought will not deny any eligible client for the treatment drug court access to the program because of their use of FDA-approved medications for the treatment of substance use disorders (e.g., methadone, buprenorphine products including buprenorphine/naloxone combination formulations and buprenorphine monoproduct formulations, naltrexone products including extended-release and oral formulations, disulfiram, and acamprosatecalcium). [2015]
9 Components of Successful MAT ProgramsIn Drug Court Settings
Medication Assisted Treatment in Drug Courts, Recommended Strategies (2016). Legal Action Center, Center for Court Innovation, New York State Unified Court System’s Office of Policy and Planninghttp://lac.org/wp-content/uploads/2016/04/MATinDrugCourts.pdf
• Counseling and other services, plus medication, are essential.
• Courts are selective about treatment programs and private prescribing physicians.
• Courts develop strong relationships with treatment programs and require regular communication regarding participant progress.
• Screening and assessment must consider all clinically appropriate forms of treatment.
• Judges rely heavily on the clinical judgement of treatment providers as well as the court’s own clinical staff.
26% surveyed drug courts reported availability of medication assisted treatment for pregnant participants (2013)
A quarter
Matusow, H. et al., Medication Assisted Treatment in US Drug Courts: Results from a Nationwide Survey of Availability, Barriers and Attitudes. Journal of Substance Abuse Treatment, 2013. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602216/
Misusingprescription drugs, or is using legal or illegal drugs, meets criteria for a substance use disorder, not actively engaged in a treatment program
3Using legal or illegal drugs, on an opioid medication for chronic pain or on medication (e.g., benzodiazepines) that can result in a withdrawal syndrome and does not have a substance use disorder
1
Receiving medication assisted treatment for an opioid use disorder (Buprenorphine or Methadone) or is actively engaged in treatment for a substance use disorder
2
Differentiating Different Populations of Pregnant Women
Supporting Pregnant Women with Opioid Use Disorders
• Screeningduring pregnancy
• Treatment during pregnancy
• Support at birth and beyond
Routinely Screened Conditions*
Prevalence
Cystic Fibrosis (Caucasians)
1/2500 = 0.0004%
HIV 1/500 = 0.002%
Birth Defects 2%
Anemia 2-4%
Pre-eclampsia 2-8%
Gestational diabetes 2-10%
Post partum depression 10-15%
Substance Use** PrevalenceAlcohol 9.4%Cigarettes 15.4%Illicit drugs 5.4%
Prenatal Care Screening
*American College of Obstetrics and Gynecology (ACOG): http://www.acog.org/-/media/List-of-Titles/PBListOfTitles.pdf
**National Survey on Drug Use and Health, 2013; http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf
Patient• Fear of discrimination or
judgment• Previous bad experience
with health care provider• Fear of Child Protective
Services• They don’t consider their
use problematic
Provider• “My patients don’t use
drugs”• “I don’t have time”• “I won’t get paid”• “I don’t know what to do if
they screen positive”
Barriers to Screening
• Early identification is key• Allows for early intervention and treatment that
minimizes potential harms to the mother and her pregnancy
• Maximizes motivation for change during pregnancy• Universal screening is recommended
• Alcohol (ACOG 2011)• Prescription opioids (ACOG 2012)
• Selective screening based on “risk factors” perpetuates discrimination and misses most women with problematic use
Assessment during Pregnancy
Opioids during Pregnancy
Stability for pregnant woman and fetus, prevent relapse
Standard of care: Medication Assisted Treatment plus counseling
• Methadone or Buprenorphine
Benefits• Stable intrauterine environment (no cyclic withdrawal)• Increased maternal weight gain • Increased newborn birth weight and gestational age• Increase PNC adherence• Decrease in illicit drug use - reduction of HIV/HCV acquisition• Decrease risk of overdose• Other supportive services
Treatment for Opioid Use Disorders in Pregnancy
(2008). Mental Health Services Administration, SAMHSA. Medication-assisted treatment for opioid addiction in Opioid Treatment Programs. Treatment Improvement Protocol (TIP) 43. DHHS Publication No. 05-4048. 2005 Rockville Maryland(2012). Dependence, and Addiction in Pregnancy. Committee Opinion No. 524. American College of Obstetricians and Gynecologists. Obstet Gynecol, 119, 1070-6.American Society of Addiction Medicine, National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use (2015)http://www.asam.org/quality-practice/guidelines-and-consensus-documents/npg
American College of Obstetricians and Gynecologists and American Society of Addiction Medicine, Committee Opinion on Opioid Abuse, Dependence, and Addiction in Pregnancyhttp://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Opioid-Abuse-Dependence-and-Addiction-in-Pregnancy
“Medically supervised tapered doses of opioids during pregnancy often result in relapse to former use. Abrupt discontinuation of opioids in an opioid-dependent pregnant woman can result in preterm labor, fetal distress, or fetal demise.”
Critical Period• Newborn care, breastfeeding, maternal/infant bonding• Mood changes, sleep disturbances, physiologic changes• Cultural norms, “the ideal mother” in conflict with what it is actually
like to have a newborn
Neglected Period• Care shifts away from frequent contact with Prenatal care provider
– to pediatrician• Care less “medical” (for mom) and shifts to other agencies (WIC)• Insurance and income support realignment• SUD treatment provider(s) – care may be on-going
Gaps in care – addressed through public health interventions – e.g., home visiting
Postpartum
Adult Drug Court (ADC) Case Study
Purpose: Obtain in-depth knowledge of policies and practices of ADCs in broadening services beyond the individual client to the family
Three ADCs: 11th Judicial Circuit; Miami-Dade, FL 13th Judicial District Drug Court; Billings,
MT Van Buren County Circuit Court; Paw
Paw, MI Qualitative Methods
Semi-structured interview guide based on Guidance to States: Recommendations for Developing Family Drug Court Guidelines
Review of policy and procedural manuals
https://www.ndci.org/wp-content/uploads/2016/05/Transitioning-to-a-Family-Centered-Approach.pdf
• Encourages retention in treatment
• Increases parenting skills and capacity
• Enhances child well-being
• Is cost-effective
Werner, D., Young, N. K., Dennis, K., & Amatetti, S. (2007). Family-centered treatment for women with substance use disorders: History, key elements and challenges. Substance Abuse and Mental Health Services Administration Department of Health and Human Services.
Treatment that Supports Families
Parent RecoveryParenting skills and
competenciesFamily connections
and resourcesParental mental health
Medication management
Parental substance use
Domestic violenceFamily Recovery and Well-beingBasic necessities
EmploymentHousing
Child careTransportation
Family counselingSpecialized Parenting
Child Well-beingWell-being/behavior
Developmental/healthSchool readiness
TraumaMental health
Adolescent substance abuse
At-risk youth prevention
Family Centered Treatment for Women with Substance Use Disorders: History, Key Elements and Challenges » http://www.samhsa.gov/sites/default/files/family_treatment_paper508v.pdf
Family Centered Treatment is not Residential Treatment Family Recovery is not Treatment Completion&
Continuum of
Family-Based
Services
Werner, D., Young, N. K., Dennis, K., & Amatetti, S. (2007). Family-centered treatment for women with substance use disorders: History, key elements and challenges. Substance Abuse and Mental Health Services Administration Department of Health and Human Services.
Adult Drug Court Case Study: Strategies for implementing a
family-focused approach
• Strong judicial and coordinator leadership to guide change
• Cross-system partnerships• Strengthen partnerships to expand array of evidence-
based services• Effective cross-system communication and information
sharing• Cross-system training• Early identification of family’s needs• Evidence-based services to children and parents• Responses to behavior that are sensitive to the needs of
children and parents• Sustainability planning• Outcomes monitoring
Expanding the FDC Partnership to Address the Needs of Pregnant Women and their Infants
• MAT and substance use treatment providers who are knowledgeable and experienced in working with pregnant women
• Mother’s medical providers – OB/GYN and others
• Infant’s medical providers – Pediatrician, Neonatologists and others
• Early Childhood • Home Visiting Programs
& Discussion
Resources
Resources on Medication Assisted Treatment for Drug Courts
Marlowe, Wakeman, Rich, & Baston (2016). Increasing Access to Medication-Assisted Treatment for Opioid Addiction in Drug Courts and Correctional Facilities and Working Effectively with Family Courts and Child Protective Services• Includes recommendations to OTPs to improve access to MAT within the
criminal justice system
Legal Action Center• MAT in Drug Courts, Recommended Strategies• MAT Advocacy Toolkit• MAT in Drug Courts: Recommended Strategies• Attorney’s Guide: Addiction Medication and your Client• Legality of Denying MAT in the Criminal Justice Systemhttps://lac.org/resources/substance-use-resources/medication-assisted-treatment-resources/
• Guide for Collaborative Planning
• 7 guides to identify collaborative strengths and challenges
• Facilitator’s Guide• Case Study
NCSACW Resources on Opioids
Web-Based Resource Directory
• Substance Exposed Infants In Depth Technical Assistance: 8 states
• Policy Academy: 10 states
Case Study: CHARM Collaborative
What Makes it Work Shared Understanding Among Partners Regular Meetings Information Sharing
Early Identification and Intervention MAT and substance use treatment services Prenatal Care Child Welfare 30-day pre-birth-assessment
Intense Level of Support Pregnancy Birth Post-Partum
• Publications• Webinars• Online Tutorials• Toolkits• Video
http://www.ncsacw.samhsa.gov/
Additional 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
Contact InformationNancy K Young, PhD, MSWDirectorNational Center on Substance Abuse and Child WelfareNational Family Drug Court Training and Technical Assistance Program(714) [email protected]
