Building community and client-level relationships to support families with infants or young children affected by substan

1. Building community and client-level relationships to support families with infants or young children affected by substance abuse Lessons Learned from Abandoned Infants Assistance Projects

2. Amy Price, MPA National AIA Resource Center University of California at Berkeley 510-643-8383 amyprice@berkeley.edu Oneta Templeton McMann, LCSW Children's Mercy Hospitals & Clinics Social Work & Community Services Department Kansas City, MO 816-234-3113 omcmann@cmh.edu

3. AIA Legislation • In 1988 Congress passed the Abandoned Infants Assistance Act to address needs of infants or young children who are abandoned or at-risk of abandonment due to HIV and/or substance abuse • Act reauthorized in 1991 and 1996. • In 2003, AIA Act reauthorized through FY 2008 as part of the Keeping Children and Families Safe Act

4. National AIA Resource Center • Funded by Children’s Bureau since 1991 • Part of UC Berkeley’s Center for Child & Youth Policy • Mission: to enhance the quality of social and health services delivered to children who are abandoned or at-risk of abandonment due to the presence of drugs and/or HIV in the family. The Resource Center provides training, information, support, and resources to service providers who assist these children and their families.

5. Brief Description of AIA Projects • Projects funded by Children’s Bureau in 4-year cycles since 1991 • Currently 26 AIA projects in 18 states and DC • 20 comprehensive services, 4 kinship caregiver projects, and 2 recreation projects • Flexible funding • Comprehensive, home-based services

6. General Goal of AIA Projects • Prevent abandonment and promote permanency, well-being, and safety for children affected by substance abuse and/or HIV/AIDS

7. Cross-Site Evaluation • AIARC contracts with University of Missouri-Kansas City, Institute for Human Development to conduct annual client-level, cross-site evaluation—client characteristics, services, completion rates, basic outcomes

8. Description of Clients Served • Referred from health care providers, child welfare agencies or treatment providers • Single women with infants/young children • Multiple Risk Factors: • Poor and uneducated with limited resources • Almost one-quarter with no prenatal care • Drug use during pregnancy

9. Client Risk Factors continued… • Domestic Violence reported for more than 50% • More than one-third have history of abuse, psychiatric illness, criminal conviction, and/or history of child removed from custody • 29% of children low or very low birth weight • Majority involved in CPS at intake

10. Primary Service Needs • Primary medical care • Parenting support • Mental health services • Drug treatment/recovery support • Transportation • Financial support/food/clothing • Housing • Child development services • Case management/service coordination

11. Example: The TIES ProgramTeam for Infants Endangered by Substance Abuse • Funded as demonstration under federal AIA and local COMBAT tax • Governed by multi-agency consortium with single identified grantee agency • Intensive, home-based, community focused intervention with families affected by substance abuse or HIV • Professional staff provide direct services and care coordination of myriad agency services

12. To enhance continuing community collaboration To identify/address needs of all children in enrolled families To develop an individualized, comprehensive, culturally appropriate plan with each family To promote permanency for each child in enrolled families TIES ProgramObjectives

13. TIESProgramComponents Professional social work staff provides: • In-home counseling • Transportation • Parenting education • Linkage to community services • Drug treatment support • Women’s Support Group

14. Key Issue: Relationship Building With community partners Formal and informal To address community needs To address individual families’ needs With families With gatekeeper With extended family as possible With family service providers Involves rapport building and service provision

15. Parallel Process • Parallel processes in work with community partners and individual families • Build rapport/address trust issues • Establish goals • Identify strengths and challenges • Acknowledge long term or chronic barriers • Build positive supports • Internal and External • Re-assess

16. Identifying Community Partners • What do your clients need that you can’t provide? • Does someone in the community provide it? • Why should they collaborate with you? • Don’t forget independent landlords and employers; religious and fraternal organizations

17. Establishing Partnerships • Develop shared mission • Clarify roles and expectations • Establish process for information sharing and regular communication • Conduct cross-training/education • Form multi-agency advisory boards or task forces

18. Fostering Collaborative Relationships • Hold regular meetings • Provide training, education, outreach • Participate in local task forces or “transagency” collaboratives • Be responsive and respectful

19. Lessons Learned In Building Collaboration • Involve action oriented decision makers from key organizations • Build trust, but not at the  expense of compromising professional values • Affirm professional differences, welcome dialogue that engenders more thoughtful decisions and plans of action • Recognize that health care, child welfare, and AOD treatment philosophies have different premises • Create an environment where problem solving is the norm and group is action oriented • Create or fine tune existing data collection system to meet the needs of the planning and implementation process

20. More Lessons Learned • Record your goals, philosophy and action plans • Meet regularly and track all action plans to resolution or revise the plan • Be prepared to handle conflict, embrace it -- it is your friend! • Heighten recognition of windows of opportunity for collaboration and seize them when they occur • Pay attention to the regulatory details, and advocate for legislation when needed • Recognize accomplishments and celebrate victories

21. Strategies for Building Relationships with Families • Peer workers & mentors • Small caseloads • Couple new participants with more seasoned program participants • Provide concrete services to address immediate needs • Motivational interviewing and solution focused therapy

22. Core Issues in Relationships • Do not judge • Respect families • Ask families and listen to what they say • Allow families to set their own goals • Work with families, not for them • Recognize strengths and expertise of families • Provide clear, honest information

23. Interpersonal or Counseling Strategies • Identify current interpersonal strengths • Build a relationship of positive regard without accepting destructive behavior by: • Being consistent & persistent • Balancing confrontation with support • Communicating honestly about difficult issues • Encouraging behavior related to family goals • Support alcohol and other drug treatment • Provide parenting training and coaching • Encourage discussion of relinquishment of children, when appropriate

24. Build Positive External Support • Identify existing support network • Connect family’s efforts with positive consequences • Role model problem-solving & social skills • Work with significant other & extended family members • Promote adult and child health care • Promote family planning • Encourage other healthy social supports • Provide opportunities for family to “give back”

25. IT’S ALL ABOUT THE RELATIONSHIP