Child Welfare and Substance Abuse: Current Issues and In-Depth TA

1. Child Welfare and Substance Abuse:Current Issues and In-Depth TA The NGA Center for Best Practices Institute on Child WelfareMiami, Florida June 16, 2005 4940 Irvine Boulevard, Suite 202 714-505-3525 Irvine, CA 92620 www.ncsacw.samhsa.gov

2. Presenters • Joe Anna Sullivan, NCSACW • Mary Chaliman, Michigan • Karen Mooney, Colorado

3. 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

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

5. NCSACW Consortium • 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)

6. Children with Prenatal Substance Exposure

7. Number of Children Prenatally Exposed to Substances Infants with prenatal substance ~410,000 exposure Total child victims under 1 year old ~86,000 Total children under 1 year old ~41,000 entering out-of-home-care Where did they all go?

8. Most Go Home More than 80% are undetected and go home without assessment and needed services • Many doctors and hospitals do not test, or may have inconsistent implementation of state policies • Tests detect only very recent use • Inconsistent follow-up for woman identified as AOD using or at-risk, but with no positive test at birth

9. Potential Consequences for Children • Prenatal substance exposure • Fetal alcohol syndrome, fetal alcohol spectrum disorder, neuro-developmental disorders • Postnatal environment factors • Violence or traumatic events • Drug and/or alcohol seeking behaviors • Illicit drug sales or manufacturing • Lack of adult interpersonal support systems • Community effects such as living in poverty • Lack of proper health care • Inconsistent caregivers

10. Areas of Child Development Affected by Parental Substance Use Disorders Research has shown that these effects can manifest themselves in multiple areas, including: • Physical health consequences • Lack of secure attachment • Language delays and communication disorders • Psychopathology • Behavioral problems • Poor social relations and skills • Deficits in motor skills • Cognition and learning disabilities

11. Children of Substance Abusers who are also Victims of Child Abuse and/or Neglect

12. Children Living With One or More Substance Abusing Parent In Millions

13. Documenting Substance Use Disorders in Child Welfare • 71% of caregivers who are alcohol dependent are classified by the CWW as not having an alcohol problem • 73% of caregivers who are drug dependent are classified by the CWW as not having a drug problem • Children and Family Service Reviews (CFSRs) • Parental substance use disorders were a factor in 16% to 48% of cases • CWW’s misclassify caregivers who are substance dependent most of the time

14. Children in the Child Welfare System with their own Substance Use Disorder

15. Percentages of Past Year Substance Use among 12 to 17 Year Olds by Foster Care Status www.oas.samhsa.gov

16. Children in the Child Welfare System with their own SUD • Children of substance abusers need in-depth assessments and interventions that respond to their developmental status and the special needs created by substance use disorders in their family • grief, loss, separation, attachment • Adolescents who may have begun their own substance use – Few Independent Living Programs under Chafee Bill include prevention or intervention for children of substance abusers aging out of foster care

17. Challenges and Opportunities

18. Crises/Opportunities • Methamphetamine epidemic • Continuing prenatal substance exposure • CAPTA amendments and requirements to report to CPS • Need for better data systems to identify children and parents • Connecting to child abuse/neglect prevention • CFSR and new rounds of reviews

19. Challenges for Cross-system Collaboration • Child safety – Treatment privacy & advocacy • ASFA Timelines – Recovery takes a lifetime • Accountability for parental actions – Client Readiness • Single System Funding • Staff and Leadership Turn-over • Special “Project-itis” and Sustainability

20. Opportunities • TANF reauthorization • Does your State define child welfare as “Needy Families?” • Title IV-E Access • Waivers for treatment • Case management funding • Foster care providers

21. Policy Framework and Tools • 10 Element Framework • Collaborative Values Inventory • Collaborative Capacity Instrument • Matrix of Progress in Linkages • Screening and Assessment for Family Engagement, Retention and Recovery -- SAFERR

22. 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

23. Four Components of System Reform • Comprehensive cross-system joint training • AOD basics for all staff – 4 days required • AOD screening, brief intervention, motivational enhancement and AOD treatment – 4 days required of all case carrying workers • Group intervention skills – 4 days required of all ADS staff and voluntary for any CPS division staff • Early Intervention Specialists • Immediate access to intervention and assessment at the court hearings

24. Four Components of System Reform • Recovery Management Specialists • Motivational enhancement • Immediate access to recovery management and treatment services • Compliance monitoring • Dependency Drug Court • 30, 60 and 90-day compliance hearings • Structured incentives for compliance and sanctions for non-compliance • Voluntary participation in on-going services

25. PRODUCTS • Free On-Line Training with CEUs • Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals – Now Available • Understanding Addiction and Recovery: A Guide for Child Welfare Workers • Understanding Families with Substance Use Disorders: A Guide for Judges and Attorneys working with Families in Family/Juvenile Court

26. PRODUCTS • Materials • Compendium of Training Curricula • Understanding Substance Abuse: A Guide for Child Welfare Practitioners • Draft White Paper on Funding Substance Abuse and Child Welfare Services • Draft White Paper on Implementing the 2004 Substance Abuse Amendment in the Child Abuse Prevention and Treatment Act (CAPTA)

27. PRODUCTS we’re working on… • State Policies regarding Substance Exposed Infants • Guidance to States and Communities on: • Screening and Assessment for Family Engagement, Retention and Recovery (SAFERR) • Methamphetamine and child risk and safety assessments • The use of drug testing in child welfare practice • Medication assisted treatment for opiate dependence and implications for child welfare

28. PRODUCTS • Program of In-Depth Technical Assistance • Round 1 – Summer 2003 to Fall 2004 • Colorado – Licensing/certification of providers who specialize in child welfare population and protocol for improving services • Florida – Regional contracts to ensure local-level system linkages and preferred practice model • Michigan – Revised SACWIS to prioritize SUDs • Virginia – Comprehensive 5-year plan • Round 2 – Winter 2005 to Spring 2006 • Arkansas, Massachusetts, Minnesota and Squaxin Island Tribe at Puget Sound

29. MICHIGAN Mary Chaliman

30. Michigan Department of Human Services • State run, county administered - 83 counties • 19,020 children in foster care system • 65% of families with children in foster care have substance abuse needs • 16 Substance Abuse Coordinating Agencies • Family Drug Courts: • 2 operational • 2 in planning stages • 3 show level of interest

31. Michigan Challenges • Budget deficits in each of the last 3 fiscal years • Changes in leadership and early retirements • Sustaining and increasing provision of TA to counties to facilitate the development of local collaborations • Competing collaborative efforts

32. Progress related to IDTA • Endorsement from State Directors • Pursuit of more Family Treatment Drug Courts • Work plan development for presentations • Communications protocol for professionals • Consolidation & Coordination

33. Benefits to Child Welfare • Representation on the Methamphetamine Task Force and Drug Endangered Children Teams • Representation on the FASD state team • TA training for staff on family drug treatment court and FASD • Revision of Family Assessment of Needs and Strengths to accurately score SA needs

34. Next Steps • Re-engage leaders to champion efforts • Evaluate effectiveness of community treatment programs with new SACWIS capabilities • Spread best practices • Provide educational and resource links in worker manuals

35. COLORADO Karen Mooney

36. Child Welfare Juvenile and Family Court Substance Abuse Treatment

37. Challenges to Collaboration • Different priorities between systems • Different levels of motivation for change • Values were different

38. Impact of TA • Motivation to get things done • Added legitimacy to our process • Gave us background and encouragement

39. Impact of TA (2) • Required planning and execution of tasks • Final product was Protocol

40. Outcomes • Protocol was finalized • New treatment population added to substance abuse treatment regulations • New requirement of women’s programs that they screen for child safety issues at intake and periodically thereafter • New trainings incorporating Protocol elements

41. Lessons: • Local buy-in critical • Stable leadership needed at all phases • Identify and utilize culture carriers • Don’t give up

42. Lessons (2) Availability of appropriate treatment (programs for women and children) is insufficient to meet need Photo used with kind permission of Robert Clark, photographer