NCSACW Technical Assistance: Lessons Learned from Four States and Guidance to States and Communities

1. NCSACW Technical Assistance: Lessons Learned from Four States and Guidance to States and Communities Nancy K. Young, Ph.D., Director Joe Anna Sullivan, IDTA Program Manager Shaila Yeh, M.S.W., Associate 4940 Irvine Blvd, Ste 202 Irvine, CA 92620 Phone: 714-505-3525 Fax: 714-505-3626 Email: www.samhsa.gov Putting the Pieces Together: 1st National Conference on Substance Abuse, Child Welfare and the Dependency Court Baltimore, MD July 15, 2004

2. Developing Knowledge and Providing Technical Assistance to Federal, State, Local Agencies and Tribes to Improve Outcomes for Families with Substance Use Disorders in the Child Welfare and Family Court Systems

3. Underlying Values Daily Practice-Screening and Assessment Daily Practice-Client Engagement and Retention in Care Daily Practice-AOD Services to Children Joint Accountability and Shared Outcomes 10 Elements for Cross-System Linkages Among CWS, ADS and Dependency Court • Information Sharing • Training/Staff Development • Budgeting/Program Sustainability • Building Community Supports • Working with Related Agencies and Support Systems From CSAT Technical Assistance Publication (TAP) 27: Navigating the Pathways *Revised March 2003

4. Program of In-Depth TA

5. In-Depth TA Program • Goal - Improve outcomes for families by: • Assisting selected states in the development of a scope of work and strategic plan • Supporting and guiding states in the implementation of plan • Providing access to other resources and expertise

6. In-Depth TA Program • Each state assigned a Consultant Liaison (CL) available approximately 30 hours per month (offsite and some onsite) • Focus on statewide impact • Support state in forming multi-system leadership team capable of developing and implementing policy and practice change

7. Cont. • Support state in developing and implementing sustainable policies and programs • Catalyst for Change

8. In-Depth TA Program • Solicitation for Requests released in April 2003 • State and Territory CWS and ADS Directors • CIP Directors • 5 Nominated Tribes • States/Territories/Tribes needed to demonstrate sustainable collaborative efforts between substance abuse, child welfare, tribes and family judicial systems

9. In-Depth TA Program • Sites Selected • Colorado • Florida • Michigan • Virginia

10. In-Depth TA Program • Consultant Liaisons • Elizabeth Breshears - Michigan • Kari Demetras - Virginia • Mary Nakashian - Colorado • Joe Anna Sullivan - Florida • Nicolette Pach – Judicial Consultant

11. Process of IDTA

12. In-Depth TA Program • Initial planning calls with each state, consultant liaison, IDTA manager and NCSACW staff (July and August, 2003)

13. In-Depth TA Program • Kick Off meetings – Two days of intensive, onsite work with state team to develop the scope of work Colorado – August 6 & 7, 2003 • Virginia – September 8 & 9 • Michigan – September 11 & 12 • Florida – September 18 & 19

14. Process of IDTA • Scope of Work for In-Depth TA • Developed by each site’s statewide team during Kick Off • SOW defines roles and responsibilities of state team, NCSACW and Consultant Liaison • SOW reviewed and approved by Federal Project Officer

15. Process of IDTA • The Contract • SOW includes: • Statement of Purpose or Mission • Work Products and Outcomes • Action Steps and Target Dates • Who is Responsible

16. Tools of Collaboration

17. Collaborative Values Inventory • What Do We Believe about Alcohol and Drugs, Services to Children and Families and Dependency Courts? • Assesses how much a group shares ideas about values that underlie its work • Helps surface issues that may not be raised if collaborative begins work with emphasis on programs and operational issues • Facilitates discussion around areas of common agreement and divergent views • Supports work toward consensus on principles as basis of state or local priorities for implementing practice and policies changes

18. Collaborative Capacity Instrument • Reviews and Assesses the Status of Linkages Across ADS and CWS Agencies and Dependency Courts • Self-assessment for ADS and CWS agencies and dependency courts preparing to work together or who are seeking to move to a new level of cooperation • Designed to elicit discussion among and within both sets of agencies and the court

19. Summary of State Products What Are the States Working On? The Elements of Collaboration – moving from the conceptual to applied practice

20. Summary of State Products Values and Principles • All states are working on formalizing collaboration through MOUs or other agreements – common values & principles • Most intend to issue a state-level MOU/agreement and encourage or require their development at the local level • MOU as marketing tool

21. Summary of State Products Daily Practice: Screening, Assessment, Engagement & Retention • All states are looking at core elements of screening, assessment, engagement and retention and developing protocols • Defining communication streams and practices • CO – survey to identify most important elements for daily practice (a little marketing too!)

22. Summary of State Products Daily Practice: Screening, Assessment, Engagement & Retention • FL – Model of Preferred Practice • Influence child casework overall • Multidisciplinary, family-focused and cross-system • Ongoing function of assessment • Linkages to other needed partners • MI and VA – protocols will include detailed implementation plans

23. Summary of State Products Daily Practice: Services to Children of Substance Abusers • Holistic and comprehensive approach to family and child needs • EPSDT and services to children

24. Summary of State Products Joint Accountability and Shared Outcomes • Establishing cross-system common goals and measurable outcomes for families • Evaluating what is to come from In-Depth TA and the collaboration

25. Summary of State Products Joint Accountability and Shared Outcomes • Evaluating the implementation of plans across system partners • Multi-tasking – other evaluation needs such as CFSRs and legislated reports

26. Summary of State Products Information Sharing and Data Systems • All states are working on improving information quality and quantity within and across systems • Data systems cost money – existing springboards • Track needs, services, progress and success throughout family’s involvement with services

27. Summary of State Products Budget and Program Sustainability • Funding is tight everywhere – new dollars are scarce • Develop funding map to maximize existing funds • Lay low – good time for planning and development activities • Pilot programs – can’t afford one time shots • Build a structure to support collaborative work

28. Summary of State Products Training and Staff Development • Joint, cross-system training needed to implement new protocols • Use existing resources • Women’s work and training are never done

29. Summary of State Products Working with Related Agencies • Essence of collaboration and In-Depth TA • Who am I related to? • Who do I need to get to know better to serve families? • When and how do we work together? • Agencies exist at many levels – state-level work as a means of modeling to local communities

30. Summary of State Products Working with the Community and Supporting Families • Family focus in all states • FL and VA – explicitly looking at community resources and mentoring opportunities to achieve and support lifelong recovery and healthy families

31. It’s All About Healthy Families

32. Lessons LearnedA Panel Discussion • Kari Demetras • Liz Breshears • Mary Nakashian • Nicolette Pach • Joe Anna Sullivan, moderator

33. Q: Why work to build collaborative policies, programs and relationships? • Better outcomes for families – ability to respond to a broader range of needs • Better use of scarce resources • No one system has the skills, training or time to respond comprehensively to whole family’s needs • Collectively, multiple systems possess much greater knowledge about families • Collectively, multiple systems have a wider range of service and response options

34. More benefits of collaboration … • With assistance from other systems, Child welfare will be better able to address CFSR deficiencies and Program Improvement Plan strategies • Better address new CAPTA requirements for substance exposed newborns • Teamwork brings a wealth of perspectives and strengths • Multidisciplinary casework is better able to assess the needs and strengths of families • Together we can help families recover and stay together

35. Q: What should we consider in getting started? • How many families involved with child welfare have substance use disorders impacting placement or child safety and risk decisions? • How many substance abuse treatment clients have children who may be at risk of abuse or neglect? • Does child welfare have the funds and expertise to adequately provide all substance abuse treatment needed by families and required to meet reasonable efforts standards? • In times of tight budgets, retrenching and planning for the future is a great use of time • Even if there is no new money, what can we do differently without new money?

36. Q: Who should be at the table? • The basics: child welfare, substance abuse prevention and treatment, dependency court – but consider mental health, domestic violence, law enforcement, TANF and Medicaid, etc. • Co-equality of participants (no system “trumps” another at this table) • Reach high and low, near and far (State and local gov’t staff, policy and program planners, service providers, consumers, etc.)

37. Q: How do we create a workplan? • Retreat (off-site if possible) • Consider establishing a core group of 3-6 to plan for the meeting • Allocate at least two days for the initial meeting • Bring in a neutral outsider to facilitate • Be task oriented – know what you want to accomplish

38. More on workplans • Agree on discrete products that should come out of your plan • Good plans are measurable, include reasonable timelines, and indicate who is in charge of the various action steps • Agree on a method to monitor progress: who, when, how

39. Q: How might we structure work processes and meetings? • Identify leadership • Consider having levels of participation: • Leader • Core team • Work horses • Advisors • Share the work through specific work groups (ad hoc or standing?) • Let purpose drive frequency, length and meeting format

40. Q: What challenges might be anticipated? • Lack of a common language • Perception that it’s too difficult or not worth it • Competing priorities • Staff turnover • No new funds • Data/Information Blanks

41. Never, never, never, never, never, never give up.

42. SAFERR 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

43. Rationale • Goals of DHHS in the 1999 Report to Congress, Blending Perspectives and Building Common Ground; • Assuring timely access to comprehensive substance abuse treatment services • Improving the ability to engage and retain clients in care and to support ongoing recovery • One of NCSACW’s most common technical assistance requests • In-Depth TA State applications consistently mentioned the need for assistance with this area • Lack of tested models and instrumentation

44. Development • October – Key Expert Meeting • November – Review and Input from Community Expert Panel • December – Review at NCSACW Researchers’ Forum • February – Shared with In-Depth TA State Teams

45. Purpose • To introduce the concepts of screening and assessment for family engagement, retention and recovery • To provide guidance to States and communities to make appropriate adaptations that lead to improved outcomes for children and families

46. Organization Assessment is a continuum and series of tasks to determine: • Presence and Immediacy • Is there an issue present? • What is the immediacy of the issue? • Nature and Extent • What is the nature of the issue? • What is the extent of the issue? • Developing and Monitoring Change, Transitions and Outcomes of Treatment and Case Plans • What is the response to the issue? • Are there demonstrable changes in the issue? • Is the family ready for transition? • Did the interventions work?

47. Premises • Limited information exists on the crossover issues • CWS cannot and should not do it alone • Assessment cannot be “siloed” • Assessment if not a one-time process • Assessment must attend to culture and gender • It’s the team not the tool • Joint training is fundamental

48. Premises • People make decisions, tools don’t • The role of supervisors is critical • Timing is essential for earliest intervention • It’s about the whole family • Child development assessments are crucial • There is no research-based answer • This is rocket science

49. Definitions of Terms and Processes

50. Definitions of Terms and Processes