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Substance

Exposed

Newborn

Safe

Environment

Families with substance exposed newborns agree to participate in the SENSE program offered by DCS after a report was made.

SENSE is a multidisciplinary approach to ensuring children’s safety and needs are met while making behavioral changes with parents.

A coordinated service delivery in which there are up to 5 visits in the home weekly made by service providers and DCS.

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Who is Eligible for SENSE? • Any newborn exposed to substances

prenatally.

• The SEN was reported to DCS as a report, with or without dependency.

• The baby is going home with parents and parents agree to services, can be safe or unsafe w/safety plan.

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Mandated reporters including OB/GYN staff, hospitals, midwives and relatives with concerns report prenatal substance abuse

Once the newborn and/or parent test positive, the parent reports drug use or a positive drug test during prenatal visits results in a report generated at the DCS hotline.

A.R.S.13-3620e the requirement that health care professionals report substance exposure in infants to DCS.

A.R.S.13-3401 lists 150+ possible substances.

SFY 2015 the Child Abuse Hotline received 3,594 reports with a tracking characteristic of substance exposed newborn and SFY 2016 reports were up to 4,059 received w/SEN tracking characteristic

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Impaired fetal growth

Prematurity

Neurobehavioral impairment

Regulatory impairment

Behavioral changes

Developmental delays

SIDS

Child abuse

For use with parents who have addictions to Opiods

Medications to reduce problem addiction behavior and cravings

Medications include methadone, suboxone, vivitrol

Can use MAT as long as needed to assist the person to reframe from abuse of drugs

Breast feeding should be encouraged with mom’s that are not using any other drugs

Has the parent signed an ROI for coordination

Is parent participating in drug testing and counseling?

Is parent missing doses?

Are there any questionable behaviors of the parent your or someone observed?

Is the parent showing any other substances on the PDMD?

Can you please send a monthly progress report for the parent’s participation in MAT?

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Parent should be engaged and/or completed formal substance abuse treatment

Ask MAT provider what is the level of treatment provided to parent

Parents actively engaged in MAT are 70% more likely to be reunited w/children

Good Clinics can be found by going to Arizona Opiate Treatment Coalition (AOTC)

HOSPITAL

HOTLINE

DCS INVESTIGATIONS

Global Assessment

of present and

impending danger

and risk

Child Safety and

Risk Assessment

(CSRA)

C-CSRA and Case

Plan

1. Extent of maltreatment2. Circumstances surrounding maltreatment and prior history3. Parents functioning4. Children’s functioning5. Parenting Practices6. Disciplinary Practices

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Is the child/ren safe? The first priority is to ensure safety and keep families together whenever possible.

Substantiate/unsubstantiate allegation

Based on assessments, what services are needed and could the family benefit from?

What type of intervention is warranted?

Is court oversight needed?

Voluntary

PlacementHome with Parents

OR

With Safety

Monitor.

Without

Safety

Monitor.OR

Out of home

90 days.

Out of Home

Dependency

Not a SENSE case

OR

OR

In

Home

Intervention

In

Home

Dependency

OR SENSE SERVICE

ONLY

JFCS SWHD HRT/PSP

DCS SENSE PROGRAM MARICOPA COUNTY

Families FIRST& Drug testing

Intensive In Home Service

ProviderHV Nurse

Healthy Families or Parents as

Teachers where available

DCS In-homeSpecialist

Recovery Coaches

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Complete a substance abuse assessment to determine the level of treatment

Notify client of Families First treatment recommendations and set appointments

Notify team members of the assessment results and treatment recommendations

Communicate with team client’s progress or relapses.

Vision Statement and Guiding Principles

The vision of the Substance Abuse Treatment Fund is to build a family centered service delivery system, which promotes family independence, stability, self-sufficiency, and recovery from substance abuse, assures child safety and supports permanency for children.

TERROS Substance Abuse Treatment Philosophy

Uses the strengths-based, best practice Recovery Model

Number of sessions are not counted

Based on treatment/recovery/case plans/behavioral changes

Stages of change model

Motivational interviewing

Involvement in community supports

SENSE cases will utilize all providers to engage client into treatment services

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Substance Abuse Treatment

ASSESSMENT

The AFF assessment is a comprehensive substance abuse assessment that is also provided by the RBHA and is designed to determine the level of care that is most beneficial to the client.

The referred client will need to meet the DSM-5 diagnostic criteria for a recommendation of substance abuse treatment services

Levels of Care

Substance Abuse Awareness: contemplative stage

Standard Outpatient: least restrictive outpatient treatment, minimum 3 hours of group therapy a week

Intensive Outpatient: most intensive outpatient treatment, minimum 8 hours group therapy a week

Residential: 24 hour care treatment

Recovery Maintenance: aftercare services and community resource involvement

(Treatment is a combination of individual, group, and family components)

Drug Testing

AFF uses a best practice model for Drug Testing frequency:

– 2X per week for the first 60 days

– 2X per month from 61-120 days

– 1X per month after 120 days

Testing results from other entities are included in the above requirements to ensure services are not duplicated

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Supportive Services

Case Management Services: to eliminate any barriers to treatment including child care, transportation, utilities, housing assistance, etc.

Concreate Support Services: financial assistance

Recovery Coaches• Engage clients into treatment

• Encourage clients to remain in treatment

• Help clients navigate the child welfare system

• Guide clients through the process of recovery

• Recovery Coaches are assigned to all SENSE clients

• May attend the 10, 45, 90 day SENSE staff meetings

Make contact with client within 12 hours

Assist in coordinated case plan development with family and all team members.

Ensures infant is assessed by pediatric nurse within 30 days of case assignment

Make the referral to Healthy Families/PAT/Home visitor program

Set up email for all team members. Set up10, 45 and 90 day staffings with family and all providers

Infant Physical

Weight, length, head circumference

Allergies, medications

Nutrition, feedings

Respiratory/cardiovascular

Immunizations, car seats

Vision, hearing

Elimination, sleep patterns

ER—Urgent care visits

PCP well child visits

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Infant Developmental

Denver II Developmental screen

Ages and Stages Questionnaire (ASQ) developmental screen

Maternal Health

Postpartum visit and inter-conception information

Edinburgh Postnatal Depression Scale (EPDS)

Smoking

Brief Medical HX

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Families voluntarily participate in the program from pregnancy up to the child turning 5 years old

Families must enroll prior to baby turning 90 days old

Visits are weekly w/SENSE families

Developmental screenings, parenting skills and family self sufficiency are goals of the program.

All families are eligible for PAT regardless of income, needs and includes ALL family members

Participation is voluntary and families can enter the program with chn any age under 5

Families can enter the program prenatally and can participate in the program until kindergarten

Visits weekly w/SENSE families and does a baseline developmental screening

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With SENSE cases

communication is the Key.

The parents sign a Release of Information to ALL involved providers so all providers can communicate with each other and the family.

TASC/ PSI

FAMILY

Families FIRST

Completes intake

and reports results

Healthy Families for

Infant assessment &

Long Term Services

where available or PAT

Family Preservation

Team engages family

in behavioral changes

In-Home case

manager

conducts

weekly home

visit .

Court

The earlier in a case we communicate, the better the outcome for the family...and the infant.

Communication starts with attending training, the 10, 45 and 90 day meetings and weekly emails.

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In Home Unit case managers see family within 2 days.

If Release of Information was not signed at TDM, CM has family sign, giving permission for all parties to communicate with one another.

In Home CM makes referral to AZ Families FIRST if this was not done at TDM

Refers for Family Preservation/Intensive In Home Team

Ensures drug testing has been requested and who will be monitoring weekly results

Set up 10, 45 and 90 day staffing with family and all providers

Once teams are identified by agencies:

In Home CM creates and adds to email list of all team members

In Home CM arranges team meeting with family within 10 days

At this time the family’s case plan is developed.

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Mid-point meeting will be held with family in their home and all team providers in 6-8 weeks to discuss behavioral changes made, barriers to goals and progress of the family

Comprehensive case plan will be reviewed by all parties along with Infant Care Plan

Closure staffing will be held with family and all team members.

Development or review of after-care plan with family.

Family Preservation services conclude at this time.

Healthy Families/PAT/Home Visitor Program and Families First should be encouraged with the family to continue services.

DCS In Home case manager will continue contact with AFF and Healthy Families/PAT as long as the DCS case is open.

DCS will monitor the family until the DCS case is closed and review infant care plan

It is a goal of SENSE the home visitor program such as HF or PAT services and AFF continue after DCS case closure.

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When all members of the SENSE team communicate with one another, it looks like this:

Safe Children, Healthy Families

Without coordination and communication we can not support parents and children effectively.

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We can make a difference…

…that’s what makes SENSE.

SFY 2014 and 2015 SFY 2014 and 2015

Signed into law August 2016 to address SEN’s

Plans for safe care for infants identified as being affected by substance abuse or withdrawal symptoms

States report number of infants affected, number of infants with safe care plans and number of infants for whom service referrals were made including services to parents and caregivers.

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DCS Specialists must Create an Infant Care Plan for ALL newborns prenatally exposed to alcohol or other substances

ALL SEN cases remaining open or closing at investigations

Create plan with parents, caretakers, providers

Have plan signed by parents or out of home caregivers

Plan should address substance abuse treatment for parents, medical care for infant, safe sleep, knowledge of parenting and infant development, living arrangements, child care and social connections.

Plan should be reviewed and reassessed during staffings, CFT and other meetings

Develop Aftercare plan prior to case closure

QUESTIONS?

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Thank you

for your time

and your

commitment

to Arizona’ s

Children.