A Strategic Plan for Texas Specialized Substance Abuse Services for Women and Their Families

1. A Strategic Plan for TexasSpecialized Substance Abuse Services for Women and Their Families

2. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas STEP 1 – A Review of Relevant Literature and Research What is Effective? STEP 2 – Defining : The Problem The Target Population Potential Partner Systems Desired Outcomes Possible Outcome Measures Guiding Principles The Service Continuum STEP 3 – Consistent Themes and Recommended Services

3. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas The Problem: • DUI Arrests for Women • Increased Drug Use Among Girls = Increased Maternal Drug Abuse • Increased Risk of Abuse and Neglect • Two Factors: Substance Abuse and Poverty • Increased Women in Prison • Impact on Children • Fetal Alcohol Spectrum Disorders (FASD), Other Learning Deficits • Birth Complications, Increased Hospital Costs • Poor Attachment, Other Developmental Delay • Child Welfare & Juvenile Justice Involvement

4. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas The Target Population: • Women with Children • Pregnant Women • Non-Pregnant Women of Childbearing Age • Older Women, Caregivers of Children • Teen Mothers • Substance-Exposed Children

5. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas Systems for Contact & Coordination: • Primary Health Care, Emergency Health Care • Schools, Alternative Schools, School-Age Parent Programs • Community Service Systems – WIC, Mental Health • Child Welfare • Family Courts • Criminal & Juvenile Justice • Substance Abuse Treatment

6. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas Desired Outcomes: • Reduced Use, Abstinence & Recovery • Participation in Appropriate Services • Increased Knowledge • Improved Mental Health • Reduction in Drug-Exposed Pregnancies • Improved Parenting and Family Function • Increased Wellness for Women and Children • Appropriate Child Development, Decreased Delay • Fewer Children Entering the Child Welfare System

7. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas Guiding Principles: • Family-Centered Services • Women Define the Family • Services Reflect Unique Needs & Resources • Services are Dynamic • Coordination Across Systems • Gender & Culturally Specific • Multidisciplinary Service Providers • Safety First • Address Barriers

8. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas The Continuum of Care: • Prevention • Intervention • Treatment

9. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas The Continuum of Care: • Prevention • Intervention • Treatment • Aftercare

10. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas The Continuum of Care: • Prevention • Intervention • Treatment • Aftercare Case Management

11. Prevention Consistent Themes and Recommended Services Screening in Primary Health Care Settings Screening in Other Appropriate Community Settings Further Assessment if Indicated Brief Interventions Education on Consequences of Substance Use Referral to Intervention, Treatment, Other Services ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas

12. Intervention Consistent Themes and Recommended Services Home-Based or Community-Based Motivational Interviewing – Individual & Group Screening & Assessment, if Indicated Parent Education and Skills Training Strengthening Mother-Child Bond Psychosocial Education ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas

13. Intervention Consistent Themes and Recommended Services Counseling, Mental Health Services Family Counseling Developmental Screening & Services for Children Substance Abuse Prevention Services for Children Mental Health Services for Children Referral to SA Treatment as Appropriate ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas

14. Case Management / Recovery Support Consistent Themes and Recommended Services Case Managers Assigned at Initial Point of Contact Employed by Independent Provider Serve Across the Continuum of Care Provide Support for the Entire Family System Responsible for Outcomes Co-Located with First-Point-of-Contact Systems Child Welfare/CPS, Court/Judicial, Primary Health Care, etc. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas

15. Treatment Consistent Themes and Recommended Services Home-Based or Community-Based Longer Lengths of Stay Use of Evidence-Based Models of Treatment Child Care Transportation Mental Health Services Prenatal, Family Planning & Other Health Care ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas

16. Treatment Consistent Themes and Recommended Services Health Education, Consequences of Drug Use Parent Education and Skills Training Psychosocial Education Developmental Screening & Services for Children Substance Abuse Prevention Services for Children Mental Health Services for Children ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas

17. Aftercare Consistent Themes and Recommended Services Transitional Housing Vocational & Educational Skills Training Social Support Ongoing Case Management and Recovery Support Linkages to Self-Help & 12-Step Groups Safe & Affordable Child Care ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas

18. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas Systemic Change and Cross System Case Management

19. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas Systemic Change is Needed • Systemic Change across multiple service systems is necessary in order to effectively address the problem

20. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas • The systems where women and families with drug and alcohol problems are most likely to come to someone’s attention are: • in the child welfare system, • primary and emergency health care system, • the substance abuse treatment service system, and the criminal justice system. • Many women have been/are involved in several of these systems.

21. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas • The National Center on Substance Abuse and Child Welfare (NCSACW) has created a model for cross systems collaboration and engaging families in recovery entitled SAFERR (Screening and Assessment for Family Engagement, Retention and Recovery). • SAMHSA/Administration for Children and Families (ACF) were involved in development of this document • Principle authors: Nancy Young, PhD., Mary Nakashian, M.A. and Shaila Yeh, M.S.W., and Sharon Amatetti, M.P.H.

22. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas • The SAFERR Model can be used as a guide for Texas to create a collaborative cross-system process to identify women and their families where substance abuse or dependence are creating the family risk factors that were outlined earlier

23. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas • The SAFERR Terms and Processes Grid describes how the Child Welfare System, the Alcohol and Drug Services System, and the Dependency Court System address the same questions and need similar information. • The primary health care system and the criminal justice systems are not included in this description however they, and any other systems could be added to this grid.

24. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas • The following slides that describe SAFERR were provided by Mary Nakashian, M.A. – the author of the final draft of SAFERR

25. Principles of SAFERR The problems . . . demand urgent attention and the highest possible standards of practice. . . Success is possible and feasible. Staff . . .want to and can change lives and create responsible public policies. Family members are active partners and participants in addressing these urgent problems. SAFERR pg. 3

26. Premises The team is the tool, and people, not tools, make decisions The family is the focus of concern Problems . . . are jumbled together Assessment is not a one-person responsibility SAFERR pp 3-5

27. Premises . . . there is no research-based answer There is no time to lose . . . collaboration is hard work SAFERR pp 3-5

28. Dropoff Points

29. Organization of SAFERR Building Cross-System Collaboration Creating the structure for change SAFERR pp 9-21

30. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas • In Texas we already have the Texas Partnership for Family Recovery (integrates three systems – the courts, child protective services and substance abuse) • Partners are DSHS, DFPS, The Office of Court Administration (OCA), The Texas Court Improvement Program (CIP) and the Texas Court Appointed Special Advocates (CASA). • NCSACW has provided technical assistance to this group

31. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas Texas Partnership for Family Recovery Mission Statement To reduce the number of children in out of home placements due to parental substance abuse and related mental health disorders, shorten time in care, and increase the number of children successfully reunited with families by building and sustaining integrated and coordinated substance abuse and mental health services, policies, protocols, and practices.

32. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas Texas Partnership for Family Recovery Mission Statement The Partnership realizes that no single agency has the resources and expertise to respond comprehensively to the needs of the parent/caregiver, the children, or the family as a whole. Therefore, the Partnership promotes working with other agencies. The Partnership promotes systems integration and implementation of evidence based practices that will result in improved outcomes for families who have substance use/abuse and related mental health disorders.

33. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas Texas Partnership for Family Recovery • Their work produced the excellent document: INTEGRATING CHILD WELFARE, SUBSTANCE ABUSE, JUDICIAL AND LEGAL SERVICES TO SUPPORT FAMILIES: A GUIDE http://www.supreme.courts.state.tx.us/children/pdf/TxPshipFamRecoveryISGuide-Nov07.pdf

34. Organization of SAFERR Collaborative Roles & Responsibilities What each system needs to know about itself and its partners SAFERR pp 23-38

35. Organization of SAFERR IIICollaboration in Action: Collaborative Practice at the Frontline Activities that create practice changes SAFERR pp 39-66

36. Assessment is a Process Assessment happens along a continuum to determine: Presence and Immediacy(41-48) Is there an issue? Is it immediate? Nature and Extent (48-56) What is the nature of the issue? What is the extent of the issue? Developing & Monitoring Change, Transitions & Outcomes of TX and Case Plans (57-64) What is the response? Are there changes? Is the family ready for transition? Did the Interventions Work?

37. Assessment is a Process Assessment proceeds along a continuum to determine: Presence and Immediacy(41-48) Is there an issue & is it immediate? Nature and Extent (48-56) What is its nature & extent? Changes, Transitions, Outcomes(57-64) What do we do and what happens then?

38. Terms and Processes(17-18 , 41 and A31-35) AOD Services CWS Services Court Services Is there an issue? What is the immediacy of the issue? What is the nature of the issue? What is the extent of the issue?

39. AOD Services CWS Services Court Services What is the Response? Is there demonstra-ble change? Is family ready for transition? What is to happen after discharge? Did the intervention work?

40. Clashes Between Child Welfare and Addictions Treatment ProgramsABA Child Law Practice, Vol. 19 No. 9, pp. 185-190, February 2001 “Working With Substance Abuse Practitioners on Behalf of Children and Families”, Elstein, Sharon G.

41. Clashes Between Child Welfare and Addictions Treatment Programs

42. Clashes Between Child Welfare and Addictions Treatment Programs

43. The SAFERR ModelDevelopment Establishes Individual and Cross System Roles and Responsibilities Builds Cross System Collaboration Identifies Front-Line Collaborative Practice Establishes and Monitors Individual and Cross-System Outcomes

44. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas The Continuum of Care: • Prevention • Intervention • Treatment • Aftercare Case Management

45. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas Cross System Case Management, Recovery Support and Collaboration Can Achieve: Increased identification of substance use disorders among families reported for child maltreatment and in other systems Increased identification of potential child maltreatment for people assessed/treated for SUDS Increased communication regarding screening and assessment for SUDS and child maltreatment

46. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas • Informed decision making by all involved systems • Reduced duplication and burden with regard to case plan requirements • Increased engagement and retention of women in treatment • Reduced risk of maltreatment of children • Increased family stability, reunification and well being

47. ASAP – Women & Children’s Services CommitteeA Strategic Plan for Texas Celebrate your successes