Nancy K. Young, Ph.D. Director, NCSACW

1. Improving Outcomes for Families Affected by Substance Use Disorders: Policy and Practice Framework and Tools Nancy K. Young, Ph.D. Director, NCSACW Presented at Adolescents, Families, and Addiction: Family-Centered Approaches to Services April 20, 2006

2. A Program of the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment and the Administration on Children, Youth and Families Children’s Bureau Office on Child Abuse and Neglect

3. MISSION • To improve outcomes for families by promoting effective practice, organizational, and system changes at the local, state, and national levels by • Developing and implementing a comprehensive program of information gathering and dissemination • Providing technical assistance www.ncsacw.samhsa.gov

4. Consortium Approach • American Public Human Services Association (APHSA) • Child Welfare League of America (CWLA) • National Association of State Alcohol and Drug Abuse Directors (NASADAD) • National Council of Juvenile and Family Court Judges (NCJFCJ) • National Indian Child Welfare Association (NICWA)

5. Foundation of the Policy and Practice Framework and Tools

6. Where We’ve Been Beginnings – 30 + Years • 1960s and early 1970s • Recognition and naming of Fetal Alcohol Syndrome • Heroin epidemic • Hughes Act: Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970

7. Where We’ve Been Early and Mid 1980s – Forefront of Media Attention and Beginning of Research Efforts • Impact of crack cocaine in urban centers • Chasnoff’s group begin to publish research on prenatal effects of cocaine • Number of children in foster care escalates

8. 52% Increase over 6 Years Foster Care Population ASFA Number of Children in Foster Care on Last Day of Federal Fiscal Year

9. Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior Year

10. Where We’ve Been Mid to late 1990s – Practice Models • Many communities began program models • Paired Counselor and Child Welfare Worker • Counselor Out-stationed at Child Welfare Office • Multidisciplinary Teams for Joint Case Planning • Persons in Recovery act as Advocates for Parents • Training and Curricula Development • Family Treatment Courts

11. Where We’ve Been Late 1990s • Five National Reports over Two Years - 1998 • Responding to Alcohol and Other Drug Problems in Child Welfare: Weaving Together Practice and Policy • Young, Gardner & Dennis; Child Welfare League of America • Foster Care: Agencies Face Challenges Securing Stable Homes for Children of Substance Abusers • General Accounting Office • Healing the Whole Family: A Look at Family Care Programs • Children’s Defense Fund

12. Where We’ve Been Late 1990s • Five National Reports over Two Years - 1999 • No Safe Haven: Children of Substance-Abusing Parents • Center on Addiction and Substance Abuse Columbia University • Blending Perspectives and Building Common Ground: A Report to Congress on Substance Abuse and Child Protection • Department of Health and Human Services

13. Where We’ve Been Summary of the Five National Reports • Identified Barriers 1. Differences in values and perceptions of primary client 2. Timing differences in service systems 3. Knowledge gaps 4. Lack of tools for effective engagement in services 5. Intervention and prevention needs of children 6. Lack of effective communication 7. Data and information gaps 8. Categorical and rigid funding streams as well as treatment gaps

14. Where We’ve Been Summary of the Five National Reports • Identified Barriers 1. Differences in values and perceptions of primary client 2. Timing differences in service systems 3. Knowledge gaps 4. Lack of tools for effective engagement in services 5. Intervention and prevention needs of children 6. Lack of effective communication 7. Data and information gaps 8. Categorical and rigid funding streams as well as treatment gaps

15. Where We’ve Been Summary of the Five National Reports • Suggested Strategies 1. Develop principles for working together 2. Create on-going dialogues and efficient communication 3. Develop cross-training opportunities 4. Improve screening, assessment and monitoring practice and protocols 5. Develop funding strategies to improve timely treatment access 6. Expand prevention services to children 7. Develop improved cross-system data collection

16. Where We’ve Been Summary of the Five National Reports • Suggested Strategies 1. Develop principles for working together 2. Create on-going dialogues and efficient communication 3. Develop cross-training opportunities 4. Improve screening, assessment and monitoring practice and protocols 5. Develop funding strategies to improve timely treatment access 6. Expand prevention services to children 7. Develop improved cross-system data collection

17. Leadership of the Federal Government Blending Perspectives and Building Common Ground (Report to Congress in response to ASFA) • Five National Goals Established • Building Collaborative Relationships • Assuring Timely Access to Comprehensive Substance Abuse Treatment Services • Improving our Ability to Engage and Retain Clients in Care and to Support Ongoing Recovery • Enhancing Children’s Services • Filling Information Gaps

18. Leadership of the Federal Government • 1999 Stakeholders forum called for a central focal point for these efforts • 2000-2001 Regional forums of state teams • 2002 Funding of the National Center on Substance Abuse and Child Welfare

19. CFF and NCSACW Products Improvements and Revisions in CFF’s Comprehensive Framework and Policy Tools • 10 Element Framework

20. Connecting AOD, CWS, Court Systems: Elements of System Linkages* • Underlying Values • Screening and Assessment • Client Engagement and Retention in Care • AOD Services to Children • Information Sharing & Management • Training and Staff Development • Budgeting and Program Sustainability • Building Community Supports • Joint Accountability and Shared Outcomes • Working with Related Agencies and Support Systems From CSAT Technical Assistance Publication (TAP) 27: Navigating the Pathways *Revised March 2003

21. 1. Values and Common Principles Issues to Address • Who is the client -- Parent, Child, Family? • Can AOD users/abusers be effective parents? • What is the goal -- Recovery, child safety, family preservation, economic self-sufficiency?

22. 1. Values and Common Principles Common Strategies • Identify and resolve differences that exist across system • Ensure conversation happens at policy, supervisory and front-line levels • Develop common principles for working together NCSACW Product • Collaborative Values Inventory

23. 1. Values and Common Principles Massachusetts Family Recovery Collaborative Acccomplishments • State level Memorandum of Understanding between agency partners and tribe • Statement of Shared Values and Guiding Principles

24. 2. Daily Practice -- Client Intake, Screening and Assessment Issues to Address • Roles and responsibilities across systems • Communication paths across systems • Incentives for prioritization • Missing box problem • Welfare and child welfare agencies have far less information than they need on substance abuse among their clients • Alcohol and drug treatment agencies have far less information than they need about the children of their treatment clients

25. 2. Daily Practice -- Client Intake, Screening and Assessment Common Strategies • Clarify intake procedures and AOD/child safety screening protocols • Decide on team, tool, method, roles and responsibilities to • Provide AOD expertise to Child Welfare Workers in investigative/assessment phases • Ensure parents seeking treatment receive needed supports for child safety

26. 3. Daily Practice -- Client Engagement and Retention in Treatment Issues to Address • Outreach and engagement strategies • Addressing motivation to change • Cross-system agreement on approaches to relapse • Responding to clients’ progress in treatment

27. 3. Daily Practice -- Client Engagement and Retention in Treatment Common Strategies • Implement assessment and interventions based on readiness to change • Develop mechanism to re-engage clients in care • Ensure AOD treatment and CPS practice is responsive to clients’ individualized needs

28. Client Intake, Screening, Assessment, Engagement and Retention in Treatment NCSACW Product • Screening and Assessment for Family Engagement, Retention and Recovery (SAFERR): Guidance for States and Communities Serving Families with Substance Use Disorders in Child Welfare Services and Dependency Courts • Current practice and key factors and processes for child welfare, alcohol and drug services and dependency court systems • Guidance on developing collaborative efforts to improve outcomes for families.

29. Client Intake, Screening, Assessment, Engagement and Retention in Treatment Massachusetts Family Recovery Collaborative Accomplishments • Draft Protocol on Screening, Assessment, and Communication • Family Engagement Program Concept Paper and Proposal

30. 4. Daily Practice -- Services to Children Issues to Address • Prevention, early intervention, and treatment services for children in contact with CPS • Independent Living Programs’ content on substance abuse

31. 4. Daily Practice -- Services to Children Common Strategies • Develop partnerships to respond to potential neuro-developmental effects of prenatal substance exposure • Provide prevention and intervention services to children and adolescents • Provide youth with appropriate youth development intervention and activities • Ensure that ILP teens receive appropriate information related to risks of substance abuse NCSACW Product • Substance Exposed Infants Report • SAFERR Appendix on children of substance abusers

32. 5. Training and Staff Development NCSACW Products • The Child Welfare-Substance Abuse Connection: A Compendium of Training Curricula and Resources • Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers • On-line self-tutorials • Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals • Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Child Welfare Professionals • Substance Use Disorders, Mental Disorders and Co-Occurring Disorders Training Package

33. Other System Supportive Elements 6. Information Sharing and Data Systems7. Joint Accountability and Shared Outcomes￭ SAFERR￭ Consortium Workgroup Data Inventory 8. Budgeting, Funding and Program Sustainability ￭White Paper on Funding Comprehensive Services for Families with Substance Use Disorders in Child Welfare and Dependency Courts

34. Primary Health Care Domestic Violence Trauma Mental Health Dental Health Transportation Child Care Medicaid Housing Economic Security Education for Mother and Children 10. Working with Related Agencies 9. Developing Community Supports

35. NCSACW Products Development of a Comprehensive Framework and Policy Tools • 10 Element Framework • Collaborative Values Inventory • Collaborative Capacity Instrument • Matrix of Progress in Linking Services • Screening and Assessment for Family Engagement, Retention and Recovery -- SAFERR

36. NCSACW Products • Collaborative Capacity Instrument • A self-assessment by County (and/or State) alcohol and drug and child welfare service agencies • Designed to elicit discussion among and within agencies about their readiness for collaborative work • Scale Rating Disagree = 1 Somewhat Agree = 2 Agree = 3 Not Sure/Don’t know Not included in mean

37. CCI SUMMARY SCORES: Pre-IDTA

38. CCI SUMMARY SCORES: Post-IDTA

39. Massachusetts – pre/post CCI

40. Massachusetts Family Recovery Collaborative Accomplishments • State level Memorandum of Understanding between agency partners and tribe • Statement of Shared Values and Guiding Principles • Draft Protocol on Screening, Assessment, and Communication • Family Engagement Program Concept Paper and Proposal