Dependency Drug Court: A Collaborative Approach for Mothers and Newborns

1. Dependency Drug Court: A Collaborative Approach for Mothers and Newborns A Multidisciplinary Treatment Model That Exemplifies The Linkages Philosophy Presented by Susan Feldman M.S. Carol Hughes M.S.W., LCSW and Susana Jehle B.A.

2. A Historical Perspective of Dependency Drug Court in Ventura County In 2000 Ventura County introduced Dependency Drug Court (DDC) to the Dependency Court System. Initially Drug Court was designed to serve Family Maintenance Cases specifically for mothers and their newborn children. The Drug Court Program has since expanded to include children up to 3 years of age, some siblings and their mothers. Typically a family is offered 12 months of intensive services through the Drug Court Program. The Drug Court team has always been a collaborative approach, but has expanded over the years. We now have a multidisciplinary team and we are part of the Linkages Project in Ventura County.

3. Who are the team members? • Children and Family Services (CFS)/ Child Welfare Social Worker • Public Health Nurse (PHN) • CalWORKs Employment Specialist • Behavioral Health Clinician • Residential and Outpatient treatment providers • Dependency Court Judge and Court Coordinator

4. What are their roles?Children and Family Services • When a family enters the Dependency Court System, and Substance Abuse has been determined to be the primary issue resulting in abuse or neglect, the case is staffed for Drug Court Services. • When a family is determined to be eligible, Drug Court services are offered, and overseen by the Children and Family Services Social Worker. • The Children and Family Services DDC Social Worker presents families to the Drug Court Team for recommendations and assistance in accessing services.

5. What are their roles?Children and Family Services • A Coordinated Case Plan is created by the DDC Social Worker, with input from team members. • The DDC Social Worker monitors participation in services, and facilitates discussion regarding the client’s participation and progress. • Input from the entire team is presented to the Dependency Court Judge at weekly review sessions for all Drug Court cases.

6. What are their roles?Public Health Nurses * A Public Health Nurse works closely with the mother and child, providing assessment, screening, education, and referrals for medical and community resources. * Having weekly contact with the mother and child promotes maternal and infant bonding and healthy medical follow up for both mother and child. * A Public Health Nurse also provides instruction to parents in the areas of child development, parenting, and infant massage

7. What are their roles?CalWORKs • A CalWORKs Employment Specialist works closely with all families that are eligible for services including cash aid, MediCal, and Food Stamps. • In addition, CalWORKs can also provide assistance with supportive services such as child care assistance, some educational expenses, drivers training courses, transportation, and many other services. • The Employment Specialist is able to coordinate needed screening and Learning Disability Assessments for Drug Court clients. • CalWORKs and Children and Family Services work together to provide a collaborative case plan that satisfies the mandates of the CalWORKs program, as well as the Dependency case requirements.

8. What are their roles?Behavioral Health • Clinician provides a comprehensive psycho-social assessment to each client, including trauma history, present/previous post partum depression, co-occurring disorders, and domestic/family violence history. These are taken into careful consideration due to the impact they will have when treating substance abuse disorders in women. • Clinician works closely with the public health nurse to identify post partum depression and ensure immediate treatment needs are met. • Recommendations for treatment needs are made to the DDC team including referral to psychiatric services for medication evaluation and management due to the high prevalence of co-occurring disorders with DDC participants. Residential treatment provides on site psychiatric services to participants. Outpatient programs utilize Ventura County Behavioral Health services for psychiatric services. • Clinician monitors appropriate level of treatment for DDC participants and consults with residential and outpatient providers to ensure coordination of care.

9. What are their roles?Substance Abuse Treatment Providers • Ventura County utilizes three local AOD (Alcohol and Other Drugs) treatment providers in the DDC program. Prototypes Women’s center provides family-centered residential treatment. A New Start for Moms and Miracles for Moms provides intensive outpatient AOD treatment. • Gender-responsive AOD treatment is provided to all DDC participants to address women’s specific physiological, emotional, family (including child rearing) and social needs as well as trauma effects. Treatment is individualized to meet the needs of each participant in the DDC program and is always strength-based and relational.

10. What are their roles?Substance Abuse Treatment Providers • Parenting: AOD treatment providers put a strong emphasis on parenting skills, including reinforcement of the parent-infant bond, teaching practical methods to improve parents responsiveness to their infant’s needs. CFS has contracted with a local community-based agency, Aspira, to provide in home parent aides to women participating in DDC. • Domestic/family violence: Adjunctive services are provided to address domestic/family violence issues which are highly prevalent with DDC participants. Residential treatment provides groups on site. Outpatient treatment providers utilize community based domestic violence programs to provide support and advocacy. • Trauma Treatment: Trauma issues are addressed both individually and in group settings. “Safe Coping” groups in residential treatment help women learn effective coping skills to address ongoing trauma related issues. Grief issues, boundary setting and communication skills building is addressed in a relational context. Contracted services also provides individual and family therapy services for DDC clients.

11. What are their roles?Dependency Drug Court Judge • The DDC Judge will handle each court case from acceptance into the program through completion. • The Judge provides the leverage that enables the team to work effectively with families in the DDC program. • Frequent and consistent interaction, along with providing feedback, homework, and incentives, are crucial components of a successful drug court. • In the courtroom, the Judge leads the team. The Judge’s concern for the family, fairness, and insistence on compliance are significant elements that impact the clients ability to successfully complete their Dependency case.

12. What are their roles?Drug Court Coordinator • The Court Coordinator will provide project oversight. • The coordinator will serve as the key contact for all grants management functions including providing required program data. • This person, with the assistance of the DDC social worker and other team members, will collect, maintain and organize program records, participant data, and program statistics. • This person is also responsible for administering the incentive program for Dependency Drug Court.

13. The Benefit of Coming Together • The entire team meets on a weekly basis to review all clients who are scheduled to appear in Drug Court that day, as well as any “add on” clients who have been asked to appear. • In collaborating, the team is able to provide updated and accurate information to the Judge, as well as recommendations and solutions for obstacles that the client is experiencing. • Coming together allows everyone to bring their own expertise to the table, and ensure everyone is on the same page to better benefit the client.

14. A Case Study, “Sandy” “Sandy” is a 25 year old Hispanic female. Sandy’s son, David, was born at 35 weeks gestation (5 weeks premature). David tested positive for Methamphetamine. Sandy has one other child, (Julia 8yrs old) who is in the custody of the maternal grandmother. David is experiencing withdrawal symptoms, including fussiness, poor feeding, and jitteriness. After 3 weeks of being hospitalized in the NICU, David will be placed with Sandy. Sandy entered intensive women’s residential treatment after the birth of David, per the recommendation of Children and Family Services.

15. Sandy’s History • Sandy has a 8 year history of drug and alcohol use, her primary drug of choice being Methamphetamine. • Sandy has been in a relationship with David’s father for 1 year. David’s father also has a history of Methamphetamine use. • Sandy reports a history of physically and emotionally abusive relationships. • Sandy has never participated in any type of substance abuse treatment before. • Sandy has limited work history, and dropped out of High School in the 11th grade. • Sandy had limited pre-natal care during her pregnancy, and acknowledges using Methamphetamine, Marijuana, and Alcohol throughout her pregnancy.

16. How does Sandy Access Drug Court? • Because David was born testing positive for Methamphetamine, a referral was made to Children and Family Services (CFS). • Sandy was interviewed by a CFS Emergency Response Social Worker shortly after David’s birth, and was willing to enter into a residential treatment program immediately. • Because of mother’s willingness to enter treatment, her case was staffed to see if she is eligible for Dependency Drug Court services. • At the Detention Hearing, CFS was given discretion by the Court to place David with his mother, contingent upon her going into residential treatment. This is a huge motivation for Sandy to participate.

17. Providers Come Together • After Sandy enters Residential Treatment, she begins attending Drug Court. • Once Sandy begins to attend Drug Court, the multidisciplinary team is able to collaborate and make recommendations to help Sandy meet her Court ordered Case Plan and treatment goals. This allows Sandy quicker access and less duplication of services.

18. Goals For Sandy • Successfully participate in a substance abuse treatment program. (to be monitored by inpatient/ outpatient treatment providers) • Secure benefits such as MediCal, cash aid, and Food Stamps for herself and her son. (to be monitored by CalWORKs Specialist) • Complete a behavioral health assessment, and ensure appropriate access to services. (to be completed by Behavioral Health Partner) • Understand and meet child’s medical and developmental needs, as well as her own health needs. (to be monitored by Public Health Nurse) • Comply with court ordered case plan, and all other recommended treatment services (to be monitored by Children and Family Services Social Worker)

19. Reporting Back • Sandy will attend Drug Court on a weekly basis/ or bi-weekly basis. • This allows the team members to review Sandy’s progress in treatment and report this information to the Judge. • Our Dependency Judge plays a very important role. She will provide encouragement, discuss concerns, and give Sandy “homework” for her to complete before she returns for her next Drug Court appearance. • Sandy will continue to come back to Drug Court for the next 12 months to get support and encouragement as she completes residential treatment and transitions back into the community.

20. A Case Study, “Monica” “Monica” is a 38 year old Caucasian female. Monica’s daughter, Sarah was born at 32 weeks gestation, testing positive for Methadone and benzodiazepine. Monica received no prenatal care during her pregnancy, and reported that she did not realize she was pregnant until she delivered her child. This is Monica’s only child. Monica reports that she has been on Methadone for 2 years. Monica reports that she was injured in a car accident 5 years ago. For 3 years Monica took Vicodin for her pain. She went on Methadone to manage her Vicodin dependency. Monica has a history of “ER Hopping” and “Doctor Shopping”. Monica has no current prescription for benzodiazepine. Monica is initially very resistant to going into a substance abuse treatment program, as she maintains she does not have a drug problem, rather was on medication to manage her chronic pain.

21. A Case Study, Monica Monica’s daughter, “Sarah” was born very premature, with a low birth weight, and is experiencing severe withdrawal and medical complications. Sarah will be hospitalized for 6 weeks in the NICU. During this hospitalization she will need to gain an appropriate amount of weight, demonstrate that she can feed through a nipple, completely withdraw off all medications, and demonstrate that she is medically stable.

22. Monica’s History • Monica denies any illegal drug use, but acknowledges use of prescription narcotics for the last 5 years. Monica has used Vicodin, Methadone, and benzodiazepines such as Klonopin. • Monica reports a long history of what she reports to be “Bi-Polar” disorder. Monica has never received any consistent treatment for this condition, although reports she has tried different antidepressants and mood stabilizers. • Monica is a high school graduate with some college education. • Monica has worked the last 10 years at an insurance company. • Monica reports she does not know the identity of Sarah’s father.

23. Our Challenges with Monica’s Case • The health concerns of Sarah, who will need to stabilize medically and withdraw off of opiate medication. • Monica’s unwillingness to participate in residential treatment, feeling she does not really have a drug problem. • Trying to differentiate Monica’s mental health issues from substance abuse issues. • Monica’s own health issues, including withdrawing off of Methadone, within residential treatment. • Feelings of isolation, Monica does not see herself like the other women in her treatment program.

24. Unique Goals for Monica • Safely detoxing off of Methadone, and finding non-narcotic ways to manage her chronic pain. • Psychiatric care, finding the right balance of psychotropic medication, and regularly taking her medication. • Seeing the need for treatment, and breaking the cycle of narcotic dependency.

25. Our Outcomes(Dec. 2000 – Jun. 2007) • 70% of Drug Court clients are between the ages of 18-30. • The majority of our clients report their length of drug use to be 2-5 years. • 55% of Drug Court clients report that Methamphetamine is their Drug of Choice. • Since Drug Court began in Ventura County, (Dec. 2000), 66% of our clients have successfully completed the program. • 69% of our graduates avoided re-arrest or entering back into the Criminal Justice System.

26. Some Challenges We Face • Engaging fathers to participate in treatment, and actively engage in the Drug Court Program. • Ensuring that undocumented clients have access to the services they need. • Fitting a client’s treatment needs into a 12-month time frame. • Different philosophies and theoretical perspectives. • The need for Transitional Housing and after care services.

27. Resources • California Women Children and Families Technical Assistance Project www.cffutures.org/calwcf • National Center for Trauma-Informed Care http://mentalhealth.samhsa.gov/nctic/ • National Center on Substance Abuse and Child Welfare www.ncsacw.samhsa.gov • PROTOTYPES, Inc. www.prototypes.org • Aspira Foster and Family Services www.AspiraNet.org • NCAST (Nursing Child Assessment) University of Washington www.ncast.org • Infant Massagewww.lovingtouch.com • University of Oregon Early Intervention Program/ASQ:SE Project http://eip.uoregon.edu/asq.html 541-346-0807 • Child and Adolescent Functional Assessment Scale (CAFAS) hodges@provide.net • Denver II for developmental screening, 303-355-4729/ 800-419-4729 • Certified Lactation Counselor www.healthychildren.cc