The Family Wellness Court for Infants and Toddlers

1. The Family Wellness Court for Infants and Toddlers Judge Erica Yew Santa Clara County Superior Court In partnership with Cynthia Ambar, MPA, Project Director Santa Clara County Social Services Agency And First 5 of Santa Clara County

2. FWC Overview An expansion and enhancement of existing child welfare dependency drug court with a child focus Target population: Pregnant women and parents, with children 0 to 3, whose abuse of methamphetamine and other substances have placed their children in or at risk of out-of-home placement.

3. FWC Primary Partners Social Services Agency (SSA), SSA’s Department of Family and Children’s Services and SSA’s County Counsel Superior Court LACY (children’s attorneys) Dependency Advocacy Center (parent ‘s attorneys) Department of Drug and Alcohol Services County Mental Health FIRST 5 Santa Clara County

4. Primary FWC Goals (1) Early identification of and intervention for the needs of pregnant women and parents with substance use disorders. Rapid engagement and successful retention in treatment and care Reduction in subsequent positive tox births

5. Primary FWC Goals (2) Early identification and intervention for developmental delays, disabilities and concerns for children 0-3 whose parents come before the FWC Creation of a comprehensive System of Care across all systems serving children in or at risk of out-of-home placement as a result of parents’ methamphetamine and other substance abuse

6. FWC Eligibility Criteria The parent has given birth to an infant that has been exposed to methamphetamine or other substance abuse during the pregnancy; OR The parent has a child under the age of three that was either born drug exposed or has been raised in a substance abuse afflicted environment with documented abuse and/or neglect; AND The parent does not demonstrate intractable mental health issues as presented in the filed petition; AND The parent is not likely to face long term incarceration

7. Rationalefor Child Focus Substance exposed high risk for developmental and behavioral concerns Effectiveness of early intervention Improvements in overall family functioning and relationships CAPTA requirements for early intervention services, such as screening for substance abuse

8. FWC Customer Characteristics “Fast-track” cases History of child welfare system involvement as children Prior cases in CWS, many with prior termination of parental rights Extensive trauma history Extremely low income Homeless or living in substandard housing Methamphetamine primary drug of choice

9. FWC Services (1) Therapeutic court environment, with regular reviews Case management Legal representation Early drug and alcohol assessment and treatment Residential inpatient-treatment for women; and for women with their children Mentor Parent support Domestic violence advocacy and services Transportation assistance (bus tokens, bus passes for their children, bicycles, cab vouchers, gas money, out of county bus passes, car seats) Linkages to shelter and housing

10. FWC Services (2) Limited funding to assist with barriers to case plan completion Linkages to employment and benefits services, record clearance Coordination with Criminal Court partners Therapeutic services, dyadic and PCIT included Pregnancy prevention education Comprehensive developmental and behavioral screening, assessment and interventions for all children Child appointed special advocates (CASA’s) for many children

11. FWC Services (3) Linkage to health coverage and primary care physicians Access to a wide array of parenting workshops Home visitation and Public Health Nurses Early care and education services GED assistance Language assistance Oral health care for children and some limited dental services for adults Tattoo removal and MORE….

12. Children’s Services Overview Funded by FIRST 5 Santa Clara County Medi-Cal/EPSDT is leveraged MHSA (Prop 63), County General Fund and reimbursement via public children’s insurance programs are also utilized for Mental Health services System of Care: Tiered system based on level of need as determined by screening and assessments utilizing standardized tools and evidence-based practices

13. Assessing For and Addressing Developmental and Behavioral Concerns ASQ/ASQ-SE (Social Emotional)screening Level 1 assessment (based on concerns identified by ASQ/ASQ-SE) Level 2 assessment (based on concerns identified by ASQ/ASQ-SE) MDT (Multi-Disciplinary Team) meeting to discuss results, make recommendations Referrals for community interventions as indicated

14. Promoting Bonding and Attachment Parenting curriculums that include children and parent/child interactions Home visitation Supervised visitation Dr. T. Berry Brazelton’s Touchpoints Child Appointed Special Advocates in a new role

15. Addressing Mental Health Needs • Early Childhood Mental Health Specialist on FWC court team • Therapeutic services that include: • Parent-Child Interactive Therapy (PCIT) • Cognitive Behavioral Therapy (CBT) • Trauma-focused cognitive behavioral therapy (TF CBT) • Trauma-Focused Play Therapy • Dyadic (Child/Parent Psychotherapy) • The Incredible Years

16. Duration of Services Services initiated at dependency hearing Services continue until child welfare case closed Aftercare program in development, continued mentor involvement, recovery mentors, stepped down recovery support, alumni events, continuation of CASA services, continued mental health counseling for parent and child, in-home support services, parenting classes Customized aftercare packet upon dismissal ceremony with Solidarity bracelet, phone card, FWC Team and community resources, photo with team in engraved frame, motivational card

17. FWC Hearings (1) Hearings may occur daily, weekly, twice a month or once monthly depending on parent progress Staffings are held with the court team prior to the hearing to discuss case progress, concerns and develop joint recommendations Incentives or Sanctions may be given

18. FWC Hearings (2) Strength-based therapeutic court environment Parents are given positive feedback on progress and areas of non-compliance are addressed Providers problem solve with client to identify and address needs

19. FWC Hearings (3) “When I went to court, I always had a voice. I didn’t just sit and get talked about, I wasn’t just talked about from different views. I actually was given a choice, ‘Do you have any concerns? Anything that you need?’ I was given a chance, so I should to speak up and not be over looked and talked about among everybody.”

20. Family Team Meetings Purpose is to develop the child welfare case plan in a strength-based environment with input from family and friends, SW and FWC Team Scheduled between jurisdiction and disposition hearings Ultimate goals are to enable children to remain at home with extra support and to give the family an active role in developing their case plan

21. Engaging Fathers Equal focus on parents Court environment Men’s treatment counselors Mentor Father Male THU in which fathers and their children can remain together

22. Working with Trauma FWC values statement includes trauma-informed system Commitments by Partner Agencies Provider education Continual system assessment and modification Trauma specific services-DADS seeking safety, Mental Health trauma based cognitive behavioral therapy

23. FWC Funding (1) Awarded $3.7 million over five years $6.3 million total with First 5 match Grant funds Project Director, mentors, AOD assessor and counselor, mental health child specialist, court coordinator and training, onsite drug monitoring, short-term strategic planning and evaluation Evaluation >10% of project budget

24. FWC Funding (2) Enhanced model required an additional annual contribution of more than $500,000 for direct client services, many provided by one-time funding Additional positions include parent therapist, mentor father, part-time psychiatrist, men’s treatment counselors and eligibility worker

25. Implementation • March 14, 2008 • 105 Families, 141 parents (with 90 being actively engaged) and 179 children served as of August 2009. • 14 cases dismissed, 11 reunifications and three TPR (78%) successful. Two of the three TPR’s had open cases prior to FWC enrollment. (State 37%, County 44%, DDTC 76% with non-fast track cases) • Target population expanded to include fathers, regardless of maternal involvement • No subsequent pos-tox births (despite many births)

26. Sustainability (1) Inventory existing funding streams Identify gaps in funding or capacity issues in the service array Identifying opportunities for systems integration/coordination, maximization of current leverage funding streams, and identification of funding steams that could be easily accessed to maintain the existing program Implementation of governance structure that provides for top-down/bottom-up information exchange and decision-making

27. Sustainability (2) Identifying potential long term means to fund the program such as legislative initiatives, grant applications and seeking philanthropic support Ensuring families are linked to all benefits for which they qualify, in particular CalWORKS Cost analysis to demonstrate long-term cost savings

28. Sustainability (3) Making children in care a local funding priority Reprioritization of drug treatment slots Judicial advocacy for restoration of treatment services Sharing resources among County depts Convening and partnering with service providers with needed resources

29. Primary Keys to Success Commitment at highest agency administrative levels Shared values Passion and commitment of involved staff Comprehensive service model Service model that evolves as additional client needs are identified Incorporation of the parents’ voices (through mentors and the actual parents before the court) Promoting the parent-baby bond

30. Primary Challenges Sustainability of enhanced model in an environment of budget cuts Multiple and complex needs of clients, in particular housing and self-sufficiency, such as employment Information sharing and data collection without a centralized database Assessor funding years 3-5

31. Why Problem Solving Courts Work “What was beneficial for me was the encouragement that they [FWC] give you. They give you so much encouragement and acknowledge every good thing you do. I got teary eyed every time they would acknowledge me for all the good that I’ve done, you know, the hard work. I overcame the hard stuff in my life. Now it’s getting easier and easier. They acknowledge every single thing, too. And that’s what makes me want to go on more. It encouraged me to do good things, because I’m getting acknowledged by these people in the court.”

32. Why Problem Solving Courts Work • People want to do better, but don’t believe they can • The human spirit is strong • Genuine, constant positive regard penetrates pain and builds trust • Don’t discount “bribery” or the power of incentives • People love their children

33. QUESTIONS? • Please contact Melanie Daraio, Community Progam Manager, FIRST 5 of Santa Clara County • Email address: melanie@first5kids.org • Website: www.first5kids.org