Common Core 3 - Amazon Web Services · K3. The trainee will recognize the relationship between...

TrainingVersion3.2|2017

CommonCore3.0KeyIssuesinChildWelfarePractice:SocialWorkeras

Practitioner

TraineeGuide

CaliforniaCommonCoreCurriculum|KeyIssuesinChildWelfarePractice:SocialWorkerasPractitioner|February1,2017TraineeGuide 2

TableofContentsTableofContents.............................................................................................................................................2

IntroductiontoCommonCore.........................................................................................................................3

CurriculumIntroduction...................................................................................................................................4

Agenda.............................................................................................................................................................5

LearningObjectives..........................................................................................................................................6

PendulumSwingActivity..................................................................................................................................7

TheCycleofAddiction......................................................................................................................................8

TeenDatingViolence.....................................................................................................................................10

BehavioralHealthResources..........................................................................................................................11

CultureandBehavioralHealth.......................................................................................................................13

AlternativeTreatmentModalities..................................................................................................................15

TheCaliforniaGuidelinesfortheUseofPsychotropicMedicationinFosterCare........................................18

PsychotropicMedicationScenario.................................................................................................................19

JohnsonVignette............................................................................................................................................20

IntersectionofKeyIssues...............................................................................................................................21

HealingNeenDiscussionQuestions...............................................................................................................22

StagesofChangeandtheChildWelfareSocialWorker’sTasks.....................................................................23

GeneralHomeVisitSafetyTips......................................................................................................................24

CaseScenario.................................................................................................................................................26

PersonalLearningStatement.........................................................................................................................28


IntroductiontoCommonCore

CommonCorecurriculumandtrainingfornewchildwelfareworkersinCaliforniaisdesignedtobegeneralizableacrossthestate,coverbasicchildwelfareknowledgeandskills,andisimportantforallCWSpositionswithinanagency.California’sCommonCoreCurriculumforChildWelfareWorkersistheresultoftheinvaluableworkandguidanceofagreatmanypeoplethroughoutthechildwelfaresysteminCaliforniaandacrossthecountry.Itwouldbeimpossibletolistalloftheindividualswhocontributed,butsomegroupsofpeoplewillbeacknowledgedhere.TheContentDevelopmentOversightGroup(CDOG)asubcommitteeoftheStatewideTrainingandEducationCommittee(STEC)providedoverallguidanceforthedevelopmentofthecurricula.ConvenedbytheCaliforniaSocialWorkEducationCenter(CalSWEC)andtheCaliforniaDepartmentofSocialServices(CDSS),CDOGmembershipincludesrepresentativesfromtheRegionalTrainingAcademies(RTAs),theUniversityConsortiumforChildrenandfamiliesinLosAngeles(UCCF),andLosAngelesCountyDepartmentofChildrenandFamilyServices.InadditiontoCDOG,aCommonCore3.0subcommitteecomprisedofrepresentativesfromtheRTAs,theResourceCenterforFamily-FocusedPractice,andcountiesprovidedoversightandapprovalforthecurriculumdevelopmentprocess.Alongtheway,manyotherpeopleprovidedtheirinsightandhardwork,attendingpilotsofthetrainings,reviewingsectionsofcurricula,orprovidingotherassistance.California’schildwelfaresystemgreatlybenefitsfromthiscollaborativeendeavor,whichhelpsourworkforcemeettheneedsofthestate’schildrenandfamilies.TheChildren’sResearchCenterprovidedtechnicalsupportaswellasTheStructuredDecisionMakingSystemthatincludestheSDM3.0PolicyandProcedureManualandDecisionMakingTools.TheseresourcesareusedincompliancewithCRCcopyrightagreementswithCalifornia.Additionally,contentinthiscurriculumhasbeenadaptedfromCRC’sSDM3.0classroomcurriculumtomeetthetrainingneedsinCalifornia.IncompliancewiththeIndianChildWelfareAct(1978)andtheCaliforniaPracticeModel,socialworkersmustidentifyAmericanIndian/AlaskaNativechildreninthesystem.ForanoverviewofImplementingtheIndianChildWelfareActview:https://www.youtube.com/watch?v=BIQG65KFKGsThecurriculumisdevelopedwithpublicfundsandisintendedforpublicuse.Forinformationonuseandcitationofthecurriculum,pleasereferto:http://calswec.berkeley.edu/CalSWEC/Citation_Guidelines.doc

FORMOREINFORMATIONonCalifornia’sCoreCurricula,aswellasthelatestversionofthiscurriculum,pleasevisittheCaliforniaSocialWorkEducationCenter(CalSWEC)website:http://calswec.berkeley.edu


CurriculumIntroduction

This2-daycurriculumfocusesonintroducingpractitionerstotheirroleinworkingwithfamiliesexperiencingsubstanceusedisorders,intimatepartnerviolenceandbehavioralhealthissues.Throughoutthetraining,thetrainerwillguidethetraineesthroughtheactivitiesandfacilitateactiveparticipationinthedevelopmentofknowledgeandskillsrelatedtoengagingwithfamiliesaroundtheseissues,teamingwithfamilymembersandtheirsupports,andassessingforthesekeyissues.


Agenda

Day1–6hours

Segment1:Welcome 9:00–9:45

Segment2:PersonalBiasandtheRoleoftheChildWelfarePractitioner 9:45–10:45

Break 10:45–11:00

Segment3:Strength-basedPracticeinChildWelfare 11:00–12:00

Lunch 12:00–1:00

Segment4:IntersectionofKeyIssues 1:00–3:45

Break 2:45–3:00

Segment5:Wrapup 3:45–4:00

Day2–6hours

Segment6:WelcomeBack 9:00–9:30

Segment7:“Wherethereisbreath,thereishope” 9:30–12:00

Break 10:15–10:30

Lunch 12:00–1:00

Segment8:StagesofChange 1:00–2:15

Break 2:15–2:30

Segment9:RoleoftheSocialWorkerasPractitioner 2:30–3:30

Segment10:TransferofLearning 3:30-3:45

Segment11:Wrapup 3:45–4:00


LearningObjectives

KNOWLEDGE

K1. Thetraineewillidentifythestagesofchangeandstrategiesforengagingandmotivatingfamilymembersexperiencingsubstanceusedisorder,intimatepartnerviolence,and/orbehavioralhealthissues.

K2. Thetraineewilldescribetheroleofthechildwelfarepractitionerworkingwithserviceproviders,including:a. Facilitatingaccesstosubstanceusedisorder,intimatepartnerviolence,andbehavioralhealthservices

forparents/caregivers,youth,andchildrenb. Recommendations,management,andongoingservicesforparents/caregivers,youth,andchildren

(includingpsychotropicmedication)c. Psychotropicmedication:overmedication,interactionwithotherprescriptions,monitoringongoinguse,

individualrights,anddocumentationthatidentifiescurrentmedicationsandprescribingdoctorsK3. Thetraineewillrecognizetherelationshipbetweensubstanceusedisorders,intimatepartnerviolence,and/or

behavioralhealthissuesandidentifyeffectsinparents,familymembersandchildren.K4. Thetraineewillidentifyhowpersonalbiasesrelatedtosubstanceusedisorder,intimatepartnerviolenceand

behavioralhealthissuesmayimpactengaging,assessinganddevelopingplanswithchildren,youthandfamilies.K5. Thetraineewilldescribehowusingstrength-basedapproachesandculturallyrelevantsupportsand

interventionscanimproveoutcomesforfamiliesstrugglingwithsubstanceusedisorders,intimatepartnerviolence,and/orbehavioralhealthissues.

SKILLSS1. Usingavignette,thetraineewillbeabletoidentifytrauma-informedactionstoprovidesafetyandservicesto

supportfamiliesthatexperiencesubstanceusedisorders,intimatepartnerviolence,andbehavioralhealthissues,including:

a. Protectivecapacitiesandactionstoprovidesafetyi. TeamMeetingsii. UseoftheSafetyNetwork

b. Servicestosupportthefamilyi. Substanceusedisorderservicesii. Intimatepartnerviolenceservicesforboththesurvivorandthepersonwhobattersiii. Behavioralhealthservicesiv. Educationalandcounselingservicesforyouthwhohaveasubstanceusedisorderorareinvolved

inintimatepartnerviolence.S2. Usingavignette,thetraineewillbeabletorecognizeindicatorsofteendatingviolenceandengage,assess,and

developasafetyplan.VALUESV1. Thetraineewillsupporttheinvolvementoffamiliesindecision-makingprocessesaboutsubstanceusedisorder,

intimatepartnerviolence,and/orbehavioralhealthissues.V2. Thetraineewillfosterstrength-basedapproachesandculturallyrelevantsupportsandinterventionstoaddress

substanceusedisorder,intimatepartnerviolence,andbehavioralhealthissues.V3. Thetraineewillencourageworkinginpartnershipsprovidingmulti-disciplinaryandcross-systemservicesin

ordertoprotectandsupportthesafetyofchildren,youth,youngadults,andfamiliesthatexperiencesubstanceusedisorder,intimatepartnerviolence,and/orbehavioralhealthissues.


PendulumSwingActivity

Readthefollowingstatementsandcircleyourinitial“gut”response:

1. Parentswhousedrugsand/oralcoholshould/shouldnothavetheirchild(ren).

2. Medicationis/isnotneededtotreatbehavioralhealthissuesifthepersonworkshardintherapy.

3. Peoplewhostayinrelationshipswithintimatepartnerviolenceareweak/strong.

4. Survivorsofintimatepartnerviolenceshould/shouldnotfightbackorleave.

5. Youngadultsexperimentingwithdrugsis/isnotabigdeal.

6. Usingprescriptionmedicationis/isnotsaferthanusingillegaldrugslikemarijuana,methamphetamineor

heroin.

7. Therapyis/isnotthebestwaytotreatbehavioralhealthdisorders.

8. Peoplewhobatteralways/neverchange.

9. Familiesandotherpeoplewhogivemoneytopeoplewithsubstanceusedisordersare/arenotenablingthem.


TheCycleofAddiction1

Cycleofaddictionisanaddictivepatternthatoccurswhenuseofalcoholordrugsoccursinabehavioralpatternthatbecomesincreasinglyoutofthecontroloftheindividualdespitenegativephysicalandlifestyleconsequencesandlessandlesssatisfactionisgainedfromthebehavior.Physicaladdictionordependenceoccurswhenthereisaphysicalreactionfromwithdrawalofaregularlyusedsubstanceandindividualssufferfromrecurrentdesires(cravings)forthedrug.Physicaladdictionmaybeprecededbyincreasedtolerancetotheeffectsofalcoholordrugs,requiringincreasingamountsofthesubstancetoachievedesiredeffectsandpatternsofabusiveoraddictiveuse.Modelsoftheprogressionofaddictioncanbeviewedfromamedicalmodel(viewingaddictionasaprogressive,fataldisease),asocialmodel(fromthe12-Stepperspective),andapsychologicalmodel(acontinuumbetweenemotionalpainandeuphoria).Allthreemodelsaresimilarindefiningthebehavioralprogressionofaddictionthataredescribedbelow.Addictionprogressesfromearlystagesinvolvingperiodicexperimentationtooccasionaluse,regularuse,habitualuse,addiction,orabuseresultinginavarietyofnegativeconsequencessuchasphysicaldisease,familyproblemssuchasfamilyviolence,childabuseandneglect,andfamilydysfunction,problemswithemployment,andlawenforcementproblems.Interventioncanoccuratanystageintheprogressionofthecycle.EarlyStages:Fromastartingpointofnon-use,theindividualengagesinsocialuseorexperimentationonaperiodicbasis.Duringthisstage,theindividuallearnsthatchemicalscanprovideatemporaryandpredictablemoodswingawayfrompaintowardafeelingofwellbeing.Featuresofthisstageinclude:

• Usetocalmanxietyandrelieveemotionalstressandpain• Adaptationtousingamountthatresultsindesiredeffect• Increaseintoleranceovertime• Increaseinamountsusedduringsocialsituationsorbeforeanevent• Thoughtsaboutnextuseofsubstance.

Socialusersmayremaininthisstage,learningtousethesubstanceatappropriatetimesandplaces,todevelopself-imposedrulesaboutusethatareadheredto,tocontroltimes,quantities,andoutcomesofuseofsubstances,andmaysufferoccasionalphysicaleffects(hangover)butnoguiltaboutuse.MiddleStages:Socialuseprogressestoastagewheretheindividualbeginstolosecontroloftheiruseandtheoutcomeofuseisnolongerpredictable.Theindividualmaybegintorationalizetheirsubstanceusebecausecontinueduseplacesemotionalpressureduetotheconflictbetweenbehaviorandtheperson’svaluesystem.

1AdaptedfromSubstanceAbuseandChildWelfarePractice,CentralCaliforniaPublicSocialServicesTrainingAcademy,November2011


Featuresofthisstageinclude:

• Growingpreoccupationandanticipationofuse• Lifestylechangestosupportcontinueduse• Effortstocontrolusethroughself-imposedrulesthatareregularlybroken• Sneakingordishonestyaboutuse• Useinisolation• Projectingofguiltorshameaboutuseintoaggressionorblaming.

Onaphysicallevel,thisindividualmaysufferfrommemoryblackoutswhileundertheinfluence,experiencingmultiplephysicaleffectsincludingmorningtremorsandtheneedtousesubstancesinthemorning.Thepersonatthisstagemayneglecttheirnutritionalneedsinfavorofsubstanceuse.LateStages:Atthisstage,useofthechemicalisnecessaryfortheindividual’ssurvival,ratherthantoachievethegoalofwellbeing.Physicaladdictioncanoccurbutisnotnecessary.Theindividualmayconsideremploymentandfamilyresponsibilitiesasinterferingwithuseofsubstances.Featuresofthisstageinclude:

• Geographicescapeanddisappearance• Lengthyandsuccessiveboutsofuse• Increasingawarenessofusebyothers• Actionsinconflictwithvaluesorbeliefs

Therewillberadicaldeteriorationoffamilyrelationshipsandcapacitytoholdajob,repeatedcontactwithlawenforcementrelatedtouseofsubstances,anddeteriorationofhealthuntildeathoruntilarrestorinterventionoccurs.

(Sources:1995LecturebyDr.W.West,ChapmanUniversity,VernonE.Johnson,D.D.(1986)“Intervention:AStepbyStepGuideforFamiliesandFriendsofChemicallyDependentPersons,”Dr.CharlesM.Peterson:“DifferencesinAlcoholMetabolismBetweenMenandWoman.”HarveyB.MilkmanandLloydDederer,TreatmentChoicesforAlcoholismandSubstanceAbuseandPathways,ValleyPresbyterianHospital’sAlcoholismTreatmentProgram.)


TeenDatingViolence

WhataretheEarlyWarningSignsofTeenDatingViolence?Researcherswhostudyteendatingviolencehaveidentifiedseveralearlywarningsignsthatadatingrelationshipmightbelikelytoturnviolent.Thesewarningsignsdonotmeanarelationshipwilldefinitelyturnviolent.However,ifyounoticeseveraloftheminyourrelationshiporpartner,youmayneedtore-evaluateyourdatingrelationship.

Thesewarningsignsinclude:

p Excessivejealousy.p Constantcheckinginwithyouormakingyoucheckinwithhimorher.p Attemptstoisolateyoufromfriendsandfamily.p Insultingorputtingdownpeoplethatyoucareabout.p Istooseriousabouttherelationshiptooquickly.p Hashadalotofbadpriorrelationships-andblamesalloftheproblemsonthepreviouspartners.p Isverycontrolling.p Thismayincludegivingyouorders,tellingyouwhattowear,andtryingtomakeallofthedecisionsforyou.p Blamesyouwhenheorshetreatsyoubadlybytellingyouallofthewaysyouprovokedhimorher.p Doesnottakeresponsibilityforownactions.p Hasanexplosivetemper(“blowsup”alot).p Pressuresyouintosexualactivitywithwhichyouarenotcomfortable.p Hasahistoryoffighting,hurtinganimals,orbragsaboutmistreatingotherpeople.p Believesstronglyinstereotypicalgenderrolesformalesandfemales.p Youworryabouthowyourpartnerwillreacttothethingsyousayoryouareafraidofprovokingyourpartner.p Ownsorusesweapons.p Refusestoletyoutoendtherelationship.


BehavioralHealthResources2

OutsideoftheWesternworldview,mentalhealthandphysicalhealtharenotonlyseenasinseparable,theyarealsoconsidereddeeplyconnectedtocommunityhealth,totheearth,andtothelivingandthedead.ThismeansthataWestern‘talktherapy’or‘mentalhealth’interventionmaynotbeunderstoodorinterpretedinthesamewaybysomeonewhohasadifferentculturalperspective.It’simportanttoconsiderthefollowingwhenaddressingmentalhealthormentalillnessinthecontextofculture:

1. PerspectiveoftheServiceProvider:Noneofusisobjective;weareformedbytheculturesinwhichweareraisedandinwhichwecurrentlylive.Byvirtueofourrolesinchildwelfare,wealsoholdsomelevelofpowerandauthorityincontrasttomost,ifnotall,ofthechildren,youthandfamiliesweserve.

2. PerspectiveoftheChildorAdultFamilyMemberbeingserved:Childrenandfamiliesservedbychildwelfarefrequentlyhavehistoriesoftrauma,whetherone-timeorongoing.Immigrantfamilieshaveoftensurvivedwars,aswellaspoliticalandsocialunrest.

Childwelfareworkers(CWW)areinauniquepositiontohelpassesshowculturalinfluencesmightbeaffectingthebehaviorofthechildrenandfamilieswithwhomtheywork.Insomeinstances,theymayevenbeabletoshowthatthebehaviorthatothersseeasindicativeofmentalillnessinmainstreamcultureisnotconsideredasignofmentalillnessinaparticularindividual’sculture.Andinotherinstances,workerswillbeabletohelpchildrenand/oradultfamilymembersmanageandovercomesymptomsofmentalillnessbycallinguponsomeofthefamily’suniqueculturalresourcesandsystemsofsupports.TheCWWmustalwaysevaluatementalhealthissuesintheirculturalcontext.Forexample,certainminoritygroupsmayevidenceparanoia,whichinfactisbaseduponrealexperiencesofprejudice,discrimination,orevenpersecution.Avoidjumpingtoconclusionsthatsomeoneismentallyillbecausetheyexpresssomesuspiciousness.Ifthepersonexpressesdistrust,itisimportanttobeempatheticandtotryandunderstandthesituationfromtheotherperson’spointofview.Similarly,infamilieswheretherehasbeeninterpersonalordomesticviolence,acultureofdistrustdevelopsandisnourishedbytheabuserwhoisolatesthefamilyandoftenplaysoninsecuritiestokeepmembersofthefamilyinadistrustingmode.Thistypeofparanoiaisnotbasedindelusionbutinlearnedbehavior.Understandingtheoriginsofthebehaviorsandthepurposeitserveswithintheculturecanmakeourworkwithchildren,youthandfamiliesmoreeffective.Therearesomeculturalritualsthatinvolveseeminglypsychoticbehaviorssuchashallucinations,talkingintongues,and/oralteredstatesofconsciousness.Examplesofthisinvariousculturescomeinavarietyofforms.Forinstance,NativeAmericancultureswhichemployavisionquestintheirspiritualpractices,fundamentalistreligionsthatbelievethespiritofGodspeaksthroughtheminonlyalanguageGodcanunderstand,hearingthevoicesofthedeadasaguardianangelorvisitorfromtheotherside,areallcommonpracticesindifferentculturesrepresentedintheUS.Takeninisolation,anyoftheseexamplescouldappeartobedelusionsorhallucinations.AsreportedintheSurgeonGeneral’sMentalHealthReport(1999),culturalvariationsmustbeconsideredwheninterpretingsignsandsymptomssuchashallucinations,delusions,orbizarrebehaviors.AstheSurgeonGeneralnotes,“amongmembersofsomeculturalgroups,‘visions’or‘voices’ofreligiousfiguresarepartofnormalreligious

2AdaptedfromMENTALHEALTH&MENTALDISORDERS(Version2.1,February2015)CaliforniaCommonCoreforChildWelfareWorkers


experience.Inmanycommunities,‘seeing’andbeing‘visited’byarecentlydeceasedpersonarenotunusualamongfamilymembers.”Finally,inexaminingculturalimplicationstheCWWmustunderstandtheculturethatexistsinmentalhealthserviceprovision.Theattendanceofregularappointmentsandpossibleperiodichospitalizationsofamentalhealthnatureareanintegralpartofthisculture.Medicationregimens,prescriptionsandpharmaciesbecomecommonplace.Caretakingfamilymembers,casemanagers,therapists,physicians,transportationtechnicians,daytreatment/partialhospitalizationtechniciansandmorebecomeregularfiguresintheculturethathasarisenaroundinterventionswithpeoplelivingwithmentalillness.Thestigmaanddiscriminationassociatedwiththementallyillarealsopartoftheculture.Itisnotdissimilartothecultureofthemedicallyfragileorthechronicallyillmedicalpatient.However,theonemajordifferenceisthestigmaassociatedwiththebeliefthatsomehowthementallyillpersonisnotas“good”insomewayaseveryoneelse.Whether“good”referstoabilitytocontributeinemploymentsettingortoabilitytoparentortoabilitytomanagehis/herownaffairs,thestigmaisgreaterformentalhealthconcernsthanformostmedicalconcerns.ImplicationsforChildWelfarePractice:§ Strivetoviewallsignsandsymptomsthroughtheculturallensofthechild,youthorfamily.§ Examineone’sownbiasesaboutmentalillnessandhowthesebiasesmayaffectpracticewithfamilieslivingwith

mentalillness.§ Considersupportingtheuseofalternativemodalitiesinconjunctionwith‘talktherapy’thatareculturallyrelevant-

orareofinterestto-thechildren,youthandfamilieswithwhomwework.


CultureandBehavioralHealth3

CulturalFormationInterview4Whileoriginallydesignedformentalhealthprofessionalstouseinmakinganassessmentoftheindividualsorfamiliestheyworkwith,questionsfromtheCulturalFormulationInterviewcanbeusedbychildwelfareworkerstodelvemoredeeplyintosomeofthebeliefsandvalueswhichchildren,youthandfamiliesholdaboutmentalhealthandmentalillness,treatment,andsupport.

INTRODUCTION“IwouldliketounderstandtheproblemsthatbringyouheresothatIcanhelpyoumoreeffectively.Iwanttoknowaboutyourexperienceandideas.Iwillasksomequestionsaboutwhatisgoingonandhowyouaredealingwithit.Pleaseremembertherearenorightorwronganswers.”

CULTURALDEFINITIONOFTHEPROBLEM1:Whatbringsyouheretoday?Iftheindividualgivesfewdetailsoronlymentionssymptomsoramedicaldiagnosis,askfurther:Peopleoftenunderstandtheirproblemsintheirownway,whichmaybesimilartoordifferentfromhowdoctorsorotherpeopledescribetheproblem.Howwouldyoudescribeyourproblem?2:Sometimespeoplehavedifferentwaysofdescribingtheirproblemtotheirfamily,friends,orothersintheircommunity.Howwouldyoudescribeyourproblemtothem?3:Whattroublesyoumostaboutyourproblem?

CULTURALPERCEPTIONSOFCAUSE,CONTEXT,ANDSUPPORT4:Whydoyouthinkthisishappeningtoyou?Whatdoyouthinkarethecausesofyour[PROBLEM]?Promptfurtherifrequired:Somepeoplemayexplaintheirproblemastheresultofbadthingsthathappenintheirlife,problemswithothers,aphysicalillness,aspiritualreason,ormanyothercauses…5.Whatdoothersinyourfamily,yourfriends,orothersinyourcommunitythinkiscausingyour[PROBLEM]?6.Arethereanykindsofsupportthatmakeyour[PROBLEM]better,suchassupportfromfamily,friends,orothers?7.Arethereanykindsofstressesthatmakeyour[PROBLEM}worse,suchasdifficultieswithmoney,orfamilyproblems?Sometimes,aspectsofpeople’sbackgroundoridentitycanmaketheir[PROBLEM]betterorworse.Bybackgroundoridentity,Imean,forexample,thecommunitiesyoubelongto,thelanguagesyouspeak,whereyouoryourfamilyarefrom,yourethnicbackground,yourphysicalcharacteristics(skincolor,bodyand/orfacialhair,markingsonthebody),yourgenderorsexualorientation,yourfaithorreligion,oryourabilitiesordisabilities.3AdaptedfromMENTALHEALTH&MENTALDISORDERS(Version2.1,February2015)CaliforniaCommonCoreforChildWelfareWorkers4AdaptedfromtheDiagnostic&StatisticalManualofMentalDisorders,FifthEd.,pp.752-754.


8.Foryou,whatarethemostimportantaspectsofyourbackgroundoridentity?9.Arethereanyaspectsofyourbackgroundoridentitythatmakeadifferencetoyour[PROBLEM]?10.Arethereanyaspectsofyourbackgroundoridentitythatarecausingotherconcernsordifficultiesforyou?

CULTURALFACTORSAFFECTINGSELF-COPINGANDPASTHELP-SEEKING11.Sometimespeoplehavevariouswaysofdealingwithproblemslike[PROBLEM].Whathaveyoudoneonyourowntocopewithyour[PROBLEM]?12.Often,peoplelookforhelpfrommanydifferentsources,includingdifferentkindsofdoctors,helpers,orhealers.Inthepast,whatkindsoftreatment,help,adviceorhealinghaveyousoughtforyour[PROBLEM]?Whattypesofhelportreatmentweremostuseful?Notuseful?13.Hasanythingpreventedyoufromgettingthehelpyouneed?(Forexample,money,work,orfamilycommitments,stigmaordiscrimination,orlackofservicesthatunderstandyourlanguageorbackground?)

CULTURALFACTORSAFFECTINGCURRENTHELP-SEEKING14.Whatkindsofhelpdoyouthinkwouldbemostusefultoyouatthistimeforyour[PROBLEM]?15.Arethereotherkindsofhelpthatyourfamily,friends,orotherpeoplehavesuggestedwouldbehelpfulforyounow?16.Sometimesdoctors(orotherserviceproviders)andindividuals/familiesmisunderstandeachotherbecausetheycomefromdifferentbackgroundsorhavedifferentexpectations.Haveyoubeenconcernedaboutthisandisthereanythingwecandotoprovideyouwiththesupport(s)youmightneed?


AlternativeTreatmentModalities5

ACUPUNCTUREAcupunctureisatraditionalmedicinethat’sbeenpracticedforthousandsofyears.Althoughmethodscanvary,ittypicallyinvolvesinsertionofthinmetalneedlesthroughtheskinleadingtostimulationofspecificpointsonthebody.Atleast3millionadultsnationwideuseacupunctureeveryyear,accordingtothelatestestimates.Thereareveryfewsideeffectsandamongotherthings,itiseffectiveincontrollingsometypesofpainandimprovingresponsetoconventionaltherapiesusedtotreatdepression.6,7ARTTHERAPYArttherapyisabehavioralhealthtreatmentmodalityinwhichthearttherapistworkswithpeopletouseartmakingtoaddressspecificconcerns(includingmanagingbehaviorandaddictions,developingsocialskills,improvingrealityorientation,reducinganxiety,andincreasingself-esteem).8Arttherapycanbeespeciallyhelpfulintreatingtraumarelatedchallenges:“Manyverbalandnonverbalmethodsusedinarttherapysupportthesuccessfulneurobiologicalprocessingof…traumaticnarrativeandimagery,asdosensorimotorexperiencesthatengagethenonverbalcomponentsofaperson’straumaticmemory.”9CHIGUNG(akaQIGONG)ChiGung(alsoknownasQigong)involvesaseriesoffocusedmotionsandposturesdoneinconcertwithspecificbreathingpatterns.Themovementsandbreathingarecompletedwithagoalofmindfulnessthatservestoimproveandstrengthenphysicalandemotionalregulation.Studiesshowthatpractitionersexperiencepositiveeffectsincludingimprovedbloodpressure,heartrate,andlungfunction,aswellasimprovementsinbloodtestresultsrelatedtocholesterolandtriglycerides.Emotionally,practitionersexperiencestressreductionandimprovedcapacitytocopewithanxiety.10DANCEMOVEMENTTHERAPYDancemovementtherapy(DMT)usesmusicandsimplemovementtoachievesensorystimulationandlow-impactexercise.InuseinWesterntreatmentsettingssincethemid20thcentury,DMThasshownpromiseasatreatmentformilddepressionandmaybenefitthosewhohaveemotionalandphysicalsymptomsrelatedtotrauma.Itisalsousedtohelpimproveresponsestomoretraditionaltreatmentsformedicalproblems(e.g.,cancer,heartdisease,neurologicalproblems,andchronicpain,amongothers).11EXERCISEStudiesshowthatevenmildphysicalexercise(e.g.,15minutesoflowimpactcycling),canhavepositivebenefitsrelatedtophysicalhealth,emotionalwell-being(includingfeelinghappier,exhibitingamorepositiveaffect,findinghope,resolvingidentityrelatedconcerns,andtakinganactiveroleinrecoveryprocesses),andcognitiveability(improvedmemoryandcapacityforrecall).12,13

5AdaptedfromMENTALHEALTH&MENTALDISORDERS(Version2.1,February2015)CaliforniaCommonCoreforChildWelfareWorkers6Vickers,A.;Cronin,A.;Maschino,A.;Lewith,G.;MacPherson,H.;Foster,N.;Sherman,K.;Witt,C.;Linde,K.(2012).Acupunctureforchronicpain:Individualpatientdatameta-analysis.ArchivesofInternalMedicine172(19):1444-1453.7Kwon,C.;Choi,E.;Kim,J.;Chung,S.(2015).TrendsofTuinatherapyondepressionanditsefficacy.JournalofOrientalNeuropsychiatry,26:3,pp.251-266.8AmericanArtTherapyAssociation,2013.http://arttherapy.org/upload/whatisarttherapy.pdf9Hass-Cohen,N.;Findlay,J.;Carr,R.;&Vanderlan,J.(2014).“Check,changewhatyouneedtochangeand/orkeepwhatyouwant”:Anarttherapyneurobiological-basedtraumaprotocol.ArtTherapy31:2,69-78.10Matos,L.;Sousa,C.;Gonçalves,M.;Gabriel,J.;Machado,J.;andGreten,H.(2015).Qigongasatraditionalvegetativebiofeedbacktherapy:Long-termconditioningofphysiologicalmind-bodyeffects.BioMedResearchInternational,v.2015.11Jeong,Y.;Hong,S.;Lee,M.;Park,M.;Kim,y.;andSuh,C.(2005).Dancemovementtherapyimprovesemotionalresponsesandmodulatesneurohormonesinadolescentswithmilddepression.InternationalJournalofNeuroscience,115:12,1711-1720.12Hogan,C.;Mata,J.;Carstensen,L.(2013).Exerciseholdsimmediatebenefitsforaffectandcognitioninyoungerandolderadults.PsychologyandAging,Vol28(2):587-594.


HERBALMEDICINEUsingplantsforcurativepurposesisatraditionalformoftreatmentusedforcenturiesthatisstillcommontoday.Althoughsometimesseenasanalternativetreatment,manymainstreampharmaceuticalsaredevelopedusingplant-basedcomponents.Thereisevidencethatherbalremediescanbeeffectivefortreatingavarietyofconcerns;forexample,recentresearchidentifiedvalerianaandhopsashelpfulforrelievingstressrelatedsymptoms.14HYPNOTHERAPYHypnotherapycanbeusedasatherapeuticinterventionthatengagesthesubconsciousmindindrivingchangeinthoughts,feelings,oractions.Researchfindingssupportuseofhypnotherapytotreatemotionaldistress,pain,andsurgicalrecovery,andtodecreaserelianceonpainmedication.15MASSAGE(E.G.,TUINA,etc.)Recentresearchindicatesthatmassagepracticessuchastuinacanbemoreeffectivethanconventionaltreatmentforrelievingsymptomsofdepressionandextendingtreatmentbenefitsovertime.Furthermore,usedinconjunctionwithconventionaltreatmentssuchasanti-depressantmedication,tuinacanimproveoutcomesovereitherindividualtreatmentusedalone.16MINDFULNESSPRACTICE(E.G.,MINDFULNESS-BASEDINTERVENTIONS,MBIs)MindfulnesspracticeoriginatedinEasterntraditionsandreferstointentionallyseekingaheightenedlevelofawarenessorconsciousnessbyseekingtomaintainaclearfocusonthepresentmomentandaccepttheexperiencesthatexistinthatmoment.Mindfulnesspracticecanbeusedinconventionalpsychotherapythroughidentifiedmindfulness-basedinterventionsthatservetoimprovefeelingsofwell-beinganddecreasespecificsymptomssuchasstressrelatedsymptoms.RecentresearchshowsthatMBIsareeffectiveintreatingconcernssuchasanxiety,depression,stress,andchronicpain.17MUSICTHERAPYMusictherapyusessharedmusicrelatedactivitytobuildatherapeuticbondbetweenthetherapistandparticipanttoallowfornon-verbalexpressionandprocessingofemotions.Researchidentifiespositivebenefitssuchasimprovedgeneralmentalstateandimprovedsocialfunctioningformusictherapy,especiallywhenusedinconjunctionwithotherinterventions.Inparticular,musictherapyhasdecreasednegativesymptomsamongpeoplewithschizophreniaanddecreasedsymptomsofdepression.18SHAMANS/SHAMANISM(aformofIndigenousHealers,FolkHealers,TraditionalHealers)Historically,theshamanservedasareligiousleaderandhealerusingdance,music,andalteredstatesofconsciousnesstopromoteimprovedemotionalandphysicalhealth.Similartotheconnectionsmadeinartandmusictherapy,atherapeuticconnectionbetweenshamanandindividualismadenon-verballyfacilitatingexpressionofemotionsthroughacatharticevent.19T’AICHICH’UAN(akaTAIJIorTAICHI)TaiChiisaChinesemartialartpracticedforbothitsdefensetraininganditshealthbenefits.Itinvolvessequencesof

13Soundy,A.;Freeman,P.;Stubbs,B.;Probst,M.;Coffee,P.;Vancampfort,D.(2014).Thetranscendingbenefitsofphysicalactivityforindividualswithschizophrenia:Asystematicreviewandmeta-ethnography.PsychiatryResearch,220:1-2,11-1914Gasparinia,M.;Aurilia,C.;Lubian,D.;Testa,M.(2016).Herbalremediesandtheself-treatmentofstress:AnItaliansurvey.EuropeanJournalofIntegrativeMedicine,8:4,pp.465-470.15S.Tefikow,S.;Barth,J.;Maichrowitz,S.;Beelmann,A.;Strauss,B.;Rosendahl,J.(2013).Efficacyofhypnosisinadultsundergoingsurgeryormedicalprocedures:Ameta-analysisofrandomizedcontrolledtrials.ClinicalPsychologyReview,33:15,pp.623-636.16Kwon,C.;Choi,E.;Kim,J.;Chung,S.(2015).TrendsofTuinatherapyondepressionanditsefficacy.JournalofOrientalNeuropsychiatry,26:3,pp.251-266.17Gu,J.;Strauss,C.;Bond,R.;Cavanagh,K.(2015).Howdomindfulness-basedcognitivetherapyandmindfulness-basedstressreductionimprovementalhealthandwellbeing?Asystematicreviewandmeta-analysisofmediationstudies.ClinicalPsychologyReview,37.pp.1-12.18Gühne,U.;Weinmann,S.;Arnold,K.;Becker,T.;Riedel-Heller,S.(2015).S3guidelineonpsychosocialtherapiesinseverementalillness:evidenceandrecommendations.EuropeanArchivesofPsychiatryandClinicalNeuroscience,265:3,pp.173-188.19Clift,S.Camic,P.(Eds.).(2016)OxfordTextbookofCreativeArts,Health,andWellbeing:InternationalPerspectivesonPractice,Policy,andResearch.OxfordUniversityPress:Oxford,UK.


flowingmovementscoupledwithchangesinmentalfocus,breathing,coordination,andrelaxation.Itisanevidence-basedinterventionthatcanreducedepressivesymptoms,stress,anxiety,andmooddisturbances.Someresearchhasalsoshownbenefitsrelatedtoinsomniaandsubstanceabuse.20YOGAYogaisaformofmindfulnesspracticethatfacilitatespassagethroughprescribedsetsofbodymovementswithafocusonbalance,strength,stretching,andbreathing.Researchshowsthatyogahasapositiveimpactonphysicalhealthandfitness,cognition,executivefunction,andabilitytoconcentrate.Yogahasalsobeenshowntohavepositiveimpactonemotionalstatesbyimprovingself-regulatorycapacitiesanddecreasingstressrelatedsymptomssuchasrumination,intrusivethoughtsandemotionalarousal.21

20Abbott,R.andLavretsky,H.(2013).TaiChiandQigongfortheTreatmentandPreventionofMentalDisorders.PsychiatricClinicsofNorthAmerica,36:1,pp.109-119.21ShirleyTelles,S.;Singh,N.;Bhardwaj,A.;Kumar,A.;Balkrishna,A.(2013).Effectofyogaorphysicalexerciseonphysical,cognitiveandemotionalmeasuresinchildren:arandomizedcontrolledtrial.ChildandAdolescentPsychiatryandMentalHealth,37:37.


TheCaliforniaGuidelinesfortheUseofPsychotropicMedicationinFosterCare

ComponentsofaTreatmentPlanThedevelopment,implementation,andexecutionofaTreatmentPlanincludes,butisnotlimitedto,thefollowingindividuals:thechild;thechild’sparents(whenappropriate),thechild’scaregiver,theprescriber,carecoordinator,therapist,schoolstaff,CWSsocialworker,pediatrician,attorney,publichealthnurse,probationofficer,casemanager,CASA,andothermembersofthechild’ssupportnetworkorCFT(asindicated).

Abestpractice(MaloneLocalio,Huangetal.,2012,RadleyFinkelstein&Stafford,2006)27,treatmentplanincludesthefollowing:

a. Thechild’sdiagnosis(ifindicated)andaconceptualizationofthechild’semotional,cognitive,and/orbehavioraldysregulationbasedonthechild’shistoryofabuse,neglect,and/orremovalfromthehome.

b. Thechild’sbaselinestrengthsandneeds.

c. Targetsymptoms:statedinpracticalandeverydaylanguageasagreedtobythechild,family,andtheirsupportnetworkorCFT.

d. Client-drivenshortandlongtermtreatmentgoals:statedinwaysthatcanbeobservedandmeasuredonaregularbasisbyspecifiedmeans.

e. Treatmentinterventions:evidence-supportedtreatments;additionalpsychosocialinterventionssuchassubstanceabusepreventionortreatment,casemanagement,informalmentalhealthservices,educationalorbehavioralservices,and/orextra-curricularandrecreationalactivities.Allidentifiedtreatmentsandinterventionsshouldhavestartdates.Psychotropicmedications(ifpartoftheTreatmentPlan)alsoshouldincludeare-assessmentdate.Ifmedicationsareutilized,thedosageandmedicationmonitoringschedulemustbespecified.

f. Treatmentandinterventionperiodicreviewandreassessment:formaltreatments,e.g.(HHS1996)

evidence-supportedpsychotherapeutictreatmentsaswellaspsychotropicmedications,areperiodicallyreviewedbythechild,family,andadditionalsupportivecollaterals(e.g.,theChildandFamilyTeam)asindicated.

g. UpdatedmedicationtreatmentplansmustbecommunicatedasanattachmenttotheJV220,aswellasshared

withthechild/youth,family,caregiver,andchildwelfaresocialworkerand/orprobationofficerfordistributiontoallnecessarypartiesinaccordancewithHIPAA(HHS1996).


PsychotropicMedicationScenario

Tyler,ayouthyouhavebeenworkingwithforthelast6months,tellsyouthathehasbeen“cheeking”hisRisperdalmedicationforthelastmonth.Hetellsyouhefeelsbetterwithoutthemedsandhiscareproviderhasnotreportedanyproblembehaviors.

Howwouldyourespond/handlethis?


JohnsonVignette

TheJohnsonfamilyiscomprisedof:

Julie,motherCharles,fatherJoey(age1)Kathy(age3)

Thecasewasopenedbythechildwelfareagencyasavoluntaryfamilymaintenancecase.Theagencyreceivedareferralregardingaviolentfightbetweentheparentswherethefather,whowasintoxicatedandadmittedtodrinkinga6-packofbeer,hadstruckthemotheronthefacewhileholdingJoey.

Youhavebeenassignedthiscaseandseethefollowingnotesinthefilefromtheinitialinvestigatingsocialworker:

Issuesandconcerns:- Substanceabuseofparents(mother–methandfather–alcohol)- Lackofmedicalcareforthechild- Mother’smentalhealth/instability- Parent’sIntimatePartnerViolence

Younotethefollowing:Twoweeksbeforetheinitialreferralfortheintimatepartnerviolenceincidentbetweentheparents,themotherwashospitalized(5150)fortryingtostabherselfwithaknifeinfrontof3-year-oldKathy.Areferralwasnotreceivedforthisincident.JoeyandKathybothhavesevereasthmaandhadnotseenthepediatricianfor3monthsdespitetheirwheezingpriortotheagency’sintervention.Thechildrenhavesinceseenthepediatricianandaretakingmedicationfortheirasthma.

Currentstatusoftheparents:

Motheriscurrentlyina90-dayin-patientsubstanceabusetreatmentfacilitywiththetwochildrenandfatheristakingabatterer’sclasstoaddressintimatepartnerviolence.


IntersectionofKeyIssues

BehavioralHealthandSubstanceUseDisorders

1. Co-occurrenceofspecificmentalhealthconditionandsubstanceabuseproblem2. Dualdiagnosisisatermforwhensomeoneexperiencesamentalillnessandasubstanceabuseproblem

simultaneously.3. Becausetherearemanycombinationsofdisordersthatcanoccur,thesymptomsofdualdiagnosisvarywidely.

Thesymptomsofsubstanceabusemayinclude:

a. Withdrawalfromfriendsandfamilyb. Suddenchangesinbehaviorc. Usingsubstancesunderdangerousconditionsd. Engaginginriskybehaviorswhendrunkorhighe. Lossofcontroloveruseofsubstancesf. Doingthingsyouwouldn’tnormallydotomaintainyourhabitg. Developingtoleranceandwithdrawalsymptomsh. Feelinglikeyouneedthedrugtobeabletofunction

SomeNotes:ü Eithersubstanceusedisordersorbehavioralhealthissuescandevelopfirst.ü Apersonexperiencingabehavioralhealthconditionmayturntodrugsandalcoholasaformofself-medication

toimprovethetroublingmentalhealthsymptomstheyexperience.ü Researchshows,though,thatdrugsandalcoholonlymakethesymptomsofmentalhealthconditionsworse.ü Aboutathirdofallpeopleexperiencingbehavioralhealthissuesandabouthalfofpeoplelivingwithsevere

mentalillnessesalsoexperiencesubstanceusedisorder.Thesestatisticsaremirroredinthesubstanceusedisorderscommunity,whereaboutathirdofallpeoplewhoabusealcoholandmorethanhalfofallpeoplewhoabusedrugsreportexperiencingabehavioralhealthdiagnosis.

ü Menaremorelikelytodevelopaco-occurringdisorderthanwomen.Otherpeoplewhohaveaparticularlyhighriskofco-occurringdisordersincludeindividualsoflowersocioeconomicstatus,militaryveteransandpeoplewithmoregeneralmedicalillnesses.

IntimatePartnerViolenceIntersectionwithSubstanceUseDisordersü Itistwoproblems–onedoesn’tcauseorexplaintheotherü Disinhibitionü Victimself-medicationü Similaritiesanddifferencesincharacteristicsü One-thirdtoone-halfofbatterersalsohaveAODproblemü WomenwhoabusesubstancearemorelikelytobeDVvictimsü OverlapofIPVandAODproblemsis50%ü Incidentsmorelikelytoresultindeath

Useofsubstancesinthepersonwhobatterers

ü It isknownthatmanyIPVepisodesinvolvealcoholordrugconsumption.o KaufmanKantorandStraus(1990)foundover20%ofmalesweredrinkingpriortothemostrecentand

severeactofviolence.Fals-Stewart(2003)foundthatondaysofheavydruguse,physicalviolencewas11timesmorelikely.

o VictimsofIPVreportthattheoffenderhadbeendrinkingorusingillicitdrugs(Miller,1990;Roberts,1998).Miller(1990)reportedthatoffendersofIPVtypicallyusealcoholandhaveadualproblemwithdrugs.


HealingNeenDiscussionQuestions

SEGMENT1:

• WhatwastheimpactofBarbara’ssubstanceusedisorderonNeen?

• Thinkingaboutthewomen’sstoriesyoujustheard,whataresomeofthewaysthatsubstanceusedisorder,intimatepartnerviolence,andbehavioralhealthissuescontributedtotheirincarceration?Thinkaboutthisfromachild’sperspectiveaswellasanadult’sperspective.

SEGMENT2:

• DescribetherelationshipbetweenAdverseChildhoodExperiences(ACEs)andsubstanceusedisorders,intimatepartnerviolence,andbehavioralhealthissues.

• HowissubstanceuseasymptomoftheunderlyingneedforNeen?

• DescribetherelationshipbetweenACEsandsomeofthebehavioralhealthissuesthatwereshared.Howdothebehavioralhealthissuespresentthemselves?

• Whataresomeofthewaysthat“systems”causedmoretraumatoNeen?Howdoyouthinkthisimpactedherabilitytotrustpeoplewhosaidtheywantedtohelpher?

• Asasocialworker,howwouldyouapproachNeen,knowingwhatyoudoaboutherpast?Howwouldyoudeveloprapportwithher?

• Thinkingaboutthechildwelfaresystem,whataresomeofthewaysthatoursystemcausestrauma,whichmaytriggeryouthorparents,leadingtocontinuedsubstanceuse,relapse,orbehavioralhealthsymptoms?

SEGMENT3:

• WhataresomeofyourthoughtsabouthowNeeninteractswithBarbara?

• DoyouhaveanyworriesaboutNeenhavingcontactwithBarbara?Ifso,howdoesthisimpactNeenandherdaughter?

SEGMENT4:

• Whatrolewouldthesocialworkerplayinaddressingsubstanceusedisordersandbehavioralhealth(ifthiswasafamilyyouwereworkingwith)?

• Howcansocialworkersbetraumainformedwhenhelpingfamiliesaddresssubstanceusedisorders,intimatepartnerviolence,andbehavioralhealth?

• Howdidsubstanceusedisorder,intimatepartnerviolence,andbehavioralhealthintersectinNeen’sstory?Howwerethethreekeyissuesinter-related?

• WhataboutNeen’sstoryimpactedyouthemost?

• WhataboutNeen’sstoryinspiredyou?


StagesofChangeandtheChildWelfareSocialWorker’sTasks22

Parent’sStage StageDescription Tasks

Pre-contemplation Noperceptionofhavingaproblemorneedingtochange

Increaseparent’sunderstandingofrisks andproblemswithcurrentbehavior;raiseparent’sdoubtsaboutbehavior

Contemplation Initialrecognitionthatbehaviormaybeaproblemanduncertainaboutchange

Discussreasonstochangeandtherisksof notchanging(e.g.,removalofchild)

Decisiontochange/Preparation

Consciousdecisiontochange;somemotivationforchangeidentified

Helpparentidentifybestactionstotake forchange;supportmotivationforchange

Action Takesstepstochange Helpparentimplementchangestrategy andtakesteps

Maintenance Activelyworksonsustainingchangestrategiesandmaintaininglong-termchange

HelpparenttoidentifytriggersofSUDandusestrategiestopreventrelapse

Relapse(mentionedinvideoaspartofMaintenance)

Slips (lapses) from change strategy orreturns to previous problem behaviorpatterns(relapse)

Helpparentre-engageinthecontemplation,decision,andactionstages

22ProtectingChildreninFamiliesAffectedbySubstanceUseDisorders.U.S.DepartmentofHealthandHumanServices,AdministrationofChildren,YouthandFamilies,Children’sBureau,OfficeonChildAbuseandNeglect.(2009)Pg.47


Visit Safety Tips

GeneralHomeVisitSafetyTips23

Familiesexperiencingmultipleissues(e.g.,SUDs,behavioralhealthconcerns,intimatepartnerviolence,criminalbehavior)canposeasafetyconcernforchildwelfaresocialworkersgoingintohomestoassessriskandsafety.Whileonahomevisit,socialworkersshouldrememberthefollowingsafetytips:

• Ensurethatyoursupervisorknowsthetimeandplaceoftheappointmentandtheexpectedtimeofreturn.• Dressappropriatelyandinamannerthatblendsintothecommunity.• Walkclosetobuildingsorclosetothecurbinanefforttohaveatleastonesafeside.Stayawayfrombushes,

alleys,anddarkcorners,ifpossible.• Knowtherouteinandoutoftheareabyexaminingamaporbytalkingwithothersbeforehand.Donotwander

orappearlostorconfused.• Parkasclosetothehomeaspossibleandinawaythathelpsensureaneasyexit.Keepthecarkeysinhand

whileenteringandexitingthehomesotheyareeasilyavailable.• Beawareofyoursurroundingsatalltimes.Enterandleavehomescarefully,noticingdoors,windows,neighbors,

loiterers,andanythingoranyonethatmaybearisktosafety.• Ifunsureofthesafetyorsurroundingsofthelocation,movetoanotherspotbysuggestingtakingabreakor

gettingacupofcoffeeandfinishtalkingthere.• Attempttokeepaclearpathtoanexit.• Beawareofdogsthatmayposeathreat.• Followyourintuitionandtakeactioniffeelingafraidorthreatened.Leavethehomeorcall911ifnecessary.• Haveaccess,ifpossible,totechnologythatmayassistwithsafetyissues(e.g.,GPSsystems,cellphones).

Insituationswheredrugsandalcoholmaybeanissueinthefamilyorthesurroundingcommunity:

• Gotothehomewithanothercaseworkerorlawenforcementofficer,particularlyifthehomeisinanareaknownforahighrateofcriminaldrugactivity.

• Knowthelocalsignsthatindicateadrugdealisoccurring.Insuchsituations,donotenterthehomewithoutlawenforcementpersonnel.

• Beawareofhomesorotherlivingenvironmentsthatmaybeusedasaclandestinedrugfactory.Donotattempttoinvestigatesuchplacesalone,andimmediatelycontactthepoliceorsheriffifsuchalabissuspected.Anyonewithoutpropertrainingandprotectivegearshouldstayatleast500feetawayfromanysuspectedlaboratory.Thefollowingaresignsofapossiblelab:o Strongorunusualchemicalodorso Laboratoryequipment,suchasglasstubes,beakers,funnels,andBunsenburnerso Chemicaldrumsorcansintheyardo Ahighvolumeofautomobileorfoottraffic,particularlyatoddhours

23ProtectingChildreninFamiliesAffectedbySubstanceUseDisorders.U.S.DepartmentofHealthandHumanServices,AdministrationofChildren,YouthandFamilies,Children’sBureau,OfficeonChildAbuseandNeglect.(2009)Pg.30


o New,highfenceswithnovisiblelivestockorotheranimals.• Ifoneorbothparentsappeartobeintoxicated,high,incoherent,orpassedout,ensurethesafetyand

supervisionofthechildren.Oncethathasbeenaccomplished,itisappropriatetorescheduletheappointment.Itmaybeappropriatetocallthesupervisorforguidance.


CaseScenario

PARTI:

LisaandTomareanAfricanAmericannon-marriedcouplewhoarelivingtogetherwiththeir5children.TheirchildrenareMonique(age8),Tommy(age7),Robert(age4),Delilah(age1),andVanessa(age6months).LisaandTom’schildreninitiallycametotheattentionoftheDepartmentofSocialServiceswhenDelilahandLisatestedpositiveformethamphetamineatthetimeofDelilah’sbirth.PriortoDelilahbeingborn,theDepartmenthadreceived6priorreferralsallegingneglectandsubstanceabusebytheparents.Oneofthepreviousreferralsforneglectwasfounded,butthefamilywasreferredtocommunityresourcesandacasewasnotopened.

AfterLisaandDelilahtestedpositiveformethamphetamine,aTeamDecisionMakingMeetingwasheld.Itwasdeterminedthatplacementofthechildrenwasnecessary.AftertheTDMmeeting,apetitionwasfiledonbehalfofDelilah,Monique,Tommy,andRobertandtheywereremovedfromthecareoftheirparents.Thechildrenwereplacedwiththeirmaternalaunt,whohasbeenasourceofsupportforthefamily.

BothLisaandTomwereorderedtoparticipateinFamilyReunificationServices,whichincludedinpatientsubstanceabusetreatmentforLisaandout-patientsubstanceabusetreatmentforTom.TomandLisawerealsoorderedtoparticipateinparenting,amentalhealthassessmentandrecommendedtreatment,andadomesticviolenceassessmentandrecommendedtreatment.

Whilethechildrenwereinoutofhomecare,theparentsparticipatedintheircourt-orderedservicesandregularlyvisitedwiththechildren.Theyhadsomesetbacksearlyonduetopositivedrugtestsbuthavebeenreceivingpositiveprogressreportsfromserviceprovidersoverthelast6months.Additionally,Lisagavebirthtoanotherchild,Vanessa.Vanessawasnotdrugexposedandherparentshavebeenmeetingherneeds.Shewasnotremovedfromtheircare.Atthe12-monthreviewhearing,Monique,Tommy,Robert,andDelilahwerereturnedhomeonanextendedvisitandFamilyMaintenancewaseventuallyordered.

ThefamilyhasbeenparticipatinginFamilyMaintenanceServicesforthepasttwomonths.Tomisworkingfulltimeandthefamilyhasamoderatelyfurnishedapartment.LisastaysathomewiththechildrenwhileTomworks.Thechildrenappeartobewell-caredforwhenthesocialworkerseesthemandtheystatetheyarereallyhappytobehomewiththeirmomanddad.

Thismorning,thesocialworkerreceivedatelephonecallfromLisa.Shestatedshehasmissedherlasttwodrugtests.Thisisnewinformation,asthesocialworkerhadnotyetrequesteddrugtestingresultsforthefamilythismonth.Whenaskedwhyshehadmissed2drugtests,Lisastateditisbecauseshethoughtthetestwouldbepositiveformethamphetamineifshetested.Lisaadmittedtousing3timesinthepasttwoweeks.Shestatedshehasbeenreallystressedoutwithcaringforallofthechildren.Shehasbeenexperiencingalotofanxietylately,especiallysincetherehavebeensomeargumentsbetweenherandTomaboutmoneyandthekids.Therehasbeensomeyelling,butnothingphysical.LisasaidthechildrenwerenotwithherwhensheusedandthattheywerewithTomorhersister.LisatoldthesocialworkerthatTomdoesnotknowaboutwhathashappened.Shewantshelptoaddressherrelapse.


PARTII:

ThesocialworkerhasmadearrangementstogotoLisa’shometospeakwithher.Monique,Tommy,andRobertareallinschool.DelilahandVanessaspentthenightatJenny’s(maternalaunt)houselastnightandarestillthere.

Whenthesocialworkerarrives,shefindsthehousetobealittlemessy,butitdoesnotappeartoposeathreattothechildren’ssafety.Thereisnoevidenceofdrugparaphernaliaordrugsinthehome.Lisastartstocrywhensheseesthesocialworker.Inordertohelpfigureoutwhatcanhappennext,thesocialworkerneedstounderstandmoreaboutwhatpromptedLisatousedrugs.

PARTIII:

AfterthesocialworkermetwithLisa,shehelpedLisatotalkwithJennyandTomaboutwhatwasgoingon.TheyagreedthatJennywouldpickMonique,Tommy,andRobertupfromschoolandbringthembacktoherhouse.ShealsoagreedtokeepDelilahandVanessaforanothernight.TomwasveryangrywithLisaandagreedtostaywithhissisteruntilameetingwiththesafetyteamcouldbescheduled.

Ateamdecision-makingmeetingwasheldthenextday.LisabroughtherN/Asponsorwithhertothemeeting,aswellashernext-doorneighborwhosometimeshelpswiththekids.Tom,Jenny,andJenny’shusbandalsocometothemeetingtodiscusstherecentrelapseandifasafetyplancouldbedeveloped.


PersonalLearningStatement

Some questions I still have about Key Issues in Child Welfare Practice are…

I can find more information about Key Issues at my agency by…

As a result of this training I will…

My key take away from this training is…

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