Chemical Dependency in Child Welfare Presented by: MeLinda Trujillo, DBHR Amy Martin , DBHR

1. Chemical Dependency in Child WelfarePresented by:MeLinda Trujillo, DBHRAmy Martin, DBHR

2. Introductions • Trainers • MeLinda Trujillo– Treatment Manager Division of Behavioral Health and Recovery • Amy Martin– Youth Treatment Manager • Division of Behavioral Health and Recovery • Training Ground Rules and Personal Reactions

3. Training Agenda • Introduction • The Basics of Alcohol and Other Drugs • Collaborative work with other Professionals & Families • Trauma in Substance Abusing Families • GAIN SS Screening Tool

4. Introduction to Alcohol and Other DrugsA Basic Understanding

5. Why Do People Use Alcohol and Other Drugs? • Biological • Psychological • Social • Cultural, and • Environmental factors • Research notes that men and women often experience different progressions from substance use to abuse and dependence.

6. Levels of Substance Use and Risk of Child Abuse and Neglect • General categorization of substance use is as follows: • Substance use • Abuse • Dependence. • Any level of substance use by a parent can place a child in imminent harm, create present danger or create impending danger of physical abuse and/or neglect. • It is important to determine if substance use is a factor in an unsafe situation for a child.HANDOUT

7. Impact of Drugs onthe Brain • Causes significant changes in brain chemistry • Disrupts normal communication between neurons. • Continued use can impact the ability to experience pleasure. • Engaging in a compulsive behavior, even in the face of negative consequences. • Inability to limit intake of the addictive substance • Long lasting or permanent changes to the brain

8. Brain Scan

9. Treatment Works • Periods of abstinence, or reduced substance use are a result of effective intervention and treatment • Treatment outcomes show a decrease in negative outcomes for addicts • Relapse is part of recovery. Increased and/or continued support and interventions assist in regaining abstinence.

10. Types of Treatment Continuum of Care in Washington State • Acute detox • Sub-acute detox • Intensive Inpatient • Recovery House • Long Term • Intensive Outpatient • Outpatient • Aftercare HANDOUT

11. Opiate Substitution Treatment • Client receives medication : • To assist in stabilizing brain chemistry • In conjunction with outpatient counseling. • Effective ONLY with opiate class drugs • Pregnant mothers generally are prescribed this modality as a way of remaining free from illegal substances and maintaining their pregnancy • Infant will likely need to detox after its birth as a result of this method of treatment • Of a number of treatment options methadone is the most commonly used modality.

12. Referral Issues/Options • Treatment access • Obtaining Funding • Knowing the Resources

13. Certified Chemical Dependency Provider Directory A directory that includes chemical dependency service providers certified by the Division of Behavioral Health and Recovery (DBHR).  Certified agencies are listed alphabetically within each county. http://www.dshs.wa.gov/dbhr/dadirectory.shtml

14. Tools for Working with Substance Abusing Individuals in the Child Welfare System • UAs are a tool to be used in monitoring levels of a substance (decreasing/increasing levels) in a person’s system • UA Best Practice will be discussed in more depth during 2 day training • Random, observed UA’s are the most accurate type of testing • UAs are a tool and can be augmented by the client. • UAs should not be the basis in deciding permanency – such as reunification • Other methods for collecting information on a person’s level of usage are hair follicle testing, oral swabs and blood tests – these tend to be less utilized due to increased cost of testing

15. Need for Collaboration • Expected family outcomes may differ based on perspective • CA looks at safely reunifying children with parents. • CDPs are working with the client to address addiction • CA concerns about the family need to be shared with the CDPs • It is critical the CDP and CA Social Worker understand the very different roles each have with the family. • CDP confidentiality guidelines are based on 42 CFR Part 2. CA Social Workers guidelines are based on Health Insurance Portability and Accountability Act of 1996 (HIPPA). • Redisclosure of information received from a chemical dependency program are subject to 42 CFR Part 2. HANDOUT

16. Keep in mind that… One person can’t collaborate.

17. Child Safety • CDPs are not trained to the policies & procedures of CA in great depth. • CDP risk factors mean something very different. They can provide information related to treatment progress that can help the social worker to better understand potential risks of abuse and/or neglect of children involved. • Parents diagnosed as chemically dependent may not be as responsive to skill development training (anger management classes, parenting classes, etc.) if their recovery program has not been established.

18. INDICATORS FOR PROGRESS IN THE SUBSTANCE ABUSE RECOVERY PROCESS: ZERO TO THREE MONTHS

19. Trauma in Substance Abusing Families

20. Working Definition of Trauma • Trauma is the unique individual experience of an event or enduring conditions in which- • The individual’s ability to integrate his or her emotional experience is overwhelmed; or • The individual experiences a threat to life, bodily integrity or sanity.

21. Exercise Questions • What originally brought you into the field? • Which clients do you most enjoy working with? What is it about them that you enjoy? • Which clients do you least enjoy working with? What is it about them that you do not enjoy? • What was your role in your family growing up? • Do you see any relationship between your role and the clients you enjoy or don’t enjoy?

22. Group Discussion • What did you notice your discussions? • How was this activity for you personally? • What if any emotions came up?

23. Some Consequences of Trauma • Alcohol, tobacco and other drug abuse to manage intense emotional states • Other self destructive behaviors • Either numb or over-reactive emotional states • Attention problems

24. Over/Under Responsibility • A reframe of co-dependency as a concept - is taking responsibility for myself legal? • Does each spouse take on responsibilities that make sense to the situation? • Do the children take on parenting roles? • Children placed in this role may have difficulty accepting and recognizing help and support. They may feel they have to be strong for parent or parents. • Focus on others to avoid focus on self. • Maintain known dysfunctional family dynamics better than unknown family dynamics.

25. Self Care forPractitioners Often secondary trauma is experienced while working with clients. As professionals, we are sometimes triggered on a very deep level by experiences that we had long thought were dealt with. It’s crucial to ensure that you have ways of caring for yourself and working through these experiences. Issues of transference and counter-transference arise with clients most often when we haven’t cared for ourselves.

26. Victimization and Connection to Substance Abuse • 90% of public behavioral health clients have been exposed to trauma (Muesser et al., 2004) • Most have multiple experiences of trauma • 34 to 53% report childhood sexual or physical abuse (Kessler et al., 1995) • 43 – 81% report some type of victimization

27. Resiliency Factors • Intelligence • Determination • Quality of relationships • Creativity • Caring for self • Accepting help from others

28. Introduction to Global Appraisal of Individual Needs – Short Screen (GAIN-SS)

29. Global Appraisal of Individual Needs – Short Screener (GAIN-SS) • A validated screening tool used with adults and youth (ages 13 years and older). • The GAIN-SS identifies a need for a chemical dependency, mental health or co-occurring assessment. The identified needed assessment would be referred to and completed by a community professional. • This tool does not identify service needs, only the need for further assessment. HANDOUT

30. When to administer the GAIN-SS screen: • During the first 45 days of an open CPS investigation • If a case is not going to be transferred and is a high standard referral, a GAIN-SS screen must be completed • FVS or CFWS social workers will complete a GAIN-SS screen if one has not yet been completed during the CPS investigation • CHET Screeners will administer the GAIN-SS to youth 13 years and older if one was not administered during the investigation

31. Results of Mental Health Component of GAIN-SS • If an adult or youth answers “YES” to the suicide question, regardless of any other answers, the social worker/CHET screener will: • Refer the client to the local crisis line, or • Notify a Designated Mental Health Professional (DMHP) to the positive suicide response on the screen

32. Mental Health and/or Substance Abuse Assessment - Referral Process • If the screen results produce two or more “YES” responses, the social worker will: • Make a referral to a community mental health provider or substance abuse professional for further assessment • If there are substance abuse indicators and mental health indicators, the social worker will make a referral to a community professional for a co-occurring disorder assessment • A referral can be made even if there are no questions with a “YES” answer on the screen • If a client is already involved in substance abuse or mental health services, a new referral is not needed.

33. Reflecting… • What, if anything, did you find out/discover about yourself and your work during this session? • What would you like to be sure to take with you and hold onto from this session? • What, if anything, would you like to get rid of or eliminate from your regarding your work with clients or in their behalf? • What, if anything, moved you during this session?

34. Thank You • Questions? • MeLinda Trujillo melinda.trujillo@dshs.wa.gov • Amy Martin amy.martin2@dshs.wa.gov