Building community and client-level relationships to support families with infants or young children affected by substance abuse

Lessons Learned from

Abandoned Infants Assistance Projects

Amy Price, MPANational AIA Resource Center

University of California at Berkeley510-643-8383

amyprice@berkeley.edu

Oneta Templeton McMann, LCSWChildren's Mercy Hospitals & Clinics

Social Work & Community Services Department Kansas City, MO

816-234-3113omcmann@cmh.edu

AIA Legislation

In 1988 Congress passed the Abandoned Infants Assistance Act to address needs of infants or young children who are abandoned or at-risk of abandonment due to HIV and/or substance abuse

Act reauthorized in 1991 and 1996. In 2003, AIA Act reauthorized through FY

2008 as part of the Keeping Children and Families Safe Act

National AIA Resource Center Funded by Children’s Bureau since 1991 Part of UC Berkeley’s Center for Child & Youth

Policy Mission: to enhance the quality of social and

health services delivered to children who are abandoned or at-risk of abandonment due to the presence of drugs and/or HIV in the family. The Resource Center provides training, information, support, and resources to service providers who assist these children and their families.

Brief Description of AIA Projects

Projects funded by Children’s Bureau in 4-year cycles since 1991

Currently 26 AIA projects in 18 states and DC

20 comprehensive services, 4 kinship caregiver projects, and 2 recreation projects

Flexible funding Comprehensive, home-based services

General Goal of AIA Projects

Prevent abandonment and promote permanency, well-being, and safety for children affected by substance abuse and/or HIV/AIDS

Cross-Site Evaluation

AIARC contracts with University of Missouri-Kansas City, Institute for Human Development to conduct annual client-level, cross-site evaluation—client characteristics, services, completion rates, basic outcomes

Description of Clients Served

Referred from health care providers, child welfare agencies or treatment providers

Single women with infants/young children Multiple Risk Factors:

Poor and uneducated with limited resources Almost one-quarter with no prenatal care Drug use during pregnancy

Client Risk Factors continued…

Domestic Violence reported for more than 50% More than one-third have history of abuse,

psychiatric illness, criminal conviction, and/or history of child removed from custody

29% of children low or very low birth weight Majority involved in CPS at intake

Primary Service Needs Primary medical care Parenting support Mental health services Drug treatment/recovery support Transportation Financial support/food/clothing Housing Child development services Case management/service coordination

Example: The TIES Program Team for Infants Endangered by Substance Abuse

Funded as demonstration under federal AIA and local COMBAT tax

Governed by multi-agency consortium with single identified grantee agency

Intensive, home-based, community focused intervention with families affected by substance abuse or HIV

Professional staff provide direct services and care coordination of myriad agency services

TIES Program Objectives

To enhance continuing community collaboration To identify/address needs of all children in enrolled

families To develop an individualized, comprehensive, culturally

appropriate plan with each family To promote permanency for each child in enrolled

families

TIES Program Components

Professional social work staff provides: In-home counseling Transportation Parenting education Linkage to community services Drug treatment support Women’s Support Group

Key Issue: Relationship Building

With community partners Formal and informal To address community needs To address individual families’ needs

With families With gatekeeper With extended family as possible With family service providers Involves rapport building and service provision

Parallel Process

Parallel processes in work with community partners and individual families Build rapport/address trust issues Establish goals Identify strengths and challenges Acknowledge long term or chronic barriers Build positive supports

Internal and External Re-assess

Identifying Community Partners

What do your clients need that you can’t provide?

Does someone in the community provide it? Why should they collaborate with you? Don’t forget independent landlords and

employers; religious and fraternal organizations

Establishing Partnerships

Develop shared mission Clarify roles and expectations Establish process for information sharing

and regular communication Conduct cross-training/education Form multi-agency advisory boards or task

forces

Fostering Collaborative Relationships

Hold regular meetings Provide training, education, outreach Participate in local task forces or

“transagency” collaboratives Be responsive and respectful

Lessons Learned In Building Collaboration

Involve action oriented decision makers from key organizations

Build trust, but not at the  expense of compromising professional values

Affirm professional differences, welcome dialogue that engenders more thoughtful decisions and plans of action

Recognize that health care, child welfare, and AOD treatment philosophies have different premises

Create an environment where problem solving is the norm and group is action oriented

Create or fine tune existing data collection system to meet the needs of the planning and implementation process

More Lessons Learned Record your goals, philosophy and action plans Meet regularly and track all action plans to resolution

or revise the plan Be prepared to handle conflict, embrace it -- it is your

friend! Heighten recognition of windows of opportunity for

collaboration and seize them when they occur Pay attention to the regulatory details, and advocate

for legislation when needed Recognize accomplishments and celebrate victories

Strategies for Building Relationships with Families

Peer workers & mentors Small caseloads Couple new participants with more

seasoned program participants Provide concrete services to address

immediate needs Motivational interviewing and solution

focused therapy

Core Issues in Relationships

Do not judge Respect families Ask families and listen to what they say Allow families to set their own goals Work with families, not for them Recognize strengths and expertise of families Provide clear, honest information

Interpersonal or Counseling

Strategies Identify current interpersonal strengths Build a relationship of positive regard without accepting

destructive behavior by: Being consistent & persistent Balancing confrontation with support Communicating honestly about difficult issues Encouraging behavior related to family goals

Support alcohol and other drug treatment Provide parenting training and coaching Encourage discussion of relinquishment of children, when

appropriate

Build Positive External Support Identify existing support network Connect family’s efforts with positive

consequences Role model problem-solving & social skills Work with significant other & extended family

members Promote adult and child health care Promote family planning Encourage other healthy social supports Provide opportunities for family to “give back”

IT’S ALL ABOUT THE

RELATIONSHIP