Methamphetamine and Child Welfare: Trends, Lessons and … · Methamphetamine and Child Welfare:...

1

Sharon Amatetti, MPHSAMHSA, Center for Substance Abuse Treatment

Nancy K. Young, Ph.D., DirectorNational Center on Substance Abuse and Child Welfare

Jay Wurscher, DirectorOregon Child Welfare Addiction Services

Methamphetamine and Child Welfare: Trends, Lessons and Practice

Implications

Presented at CWLA National ConferenceMarch 1, 2006

2

Part IBackground and Context

3

Scope of the Problem

4

Meth use has increased Use has spread from the West Accounts for a small percentage of the

total number of people affected by drug and alcohol problems

The impact of meth use on child welfare varies widely among States and among Counties

Scope of the Problem

5

05

1015202530354045505560

Rat

e

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Source: Treatment Episode Data Set (TEDS)

Meth/Amphetamine Treatment Admission RatePer 100,000 Population Aged 12 or Older - 1993-2003

6Admissions per 100,000 population

Eastward Spread of Methamphetamine

7Admissions per 100,000 population

Eastward Spread of Methamphetamine

8

Alcohol 42% Heroin/Other Opiates 18% Marijuana 15% Cocaine 14% Meth/Amphetamine and 7%

Other Stimulants

Treatment Admissions by Primary Substance - 2003


9

Methamphetamine is affecting communities that have not experienced prior stimulant drug problems

Child welfare agencies are dealing with more cases involving methamphetamine

Impact of Increasing Methamphetamine Use

10

35.0

65.07.1

22.2

3.2

55.3

5.30.920.72.30.9

0%10%20%30%40%50%60%70%80%90%

100%

Cocaine/Crack Meth/Amphetamine

White Hispanic African American Asian/PI Native Amer/AK Native OtherSource: Treatment Episode Data Set (TEDS)

Smoked Cocaine/Crack and Meth/AmphetamineTreatment Admissions by Race/Ethnicity

11

Meth/Amphetamine & Cocaine Treatment AdmissionsAccording to Census Division 2003 RATE per 100,000

0102030405060708090

100110120130140150160170180190200210

NewEngland

MiddleAtlantic

East No.Central

West NoCentral

SouthAtlantic

East So.Central

West SoCentral

Mountain Pacific

Cocaine/Crack Meth/Amphetamine/Other Stimulants

Rat

e pe

r 100

,000


12

47% of admissions are womenThis is a higher percentage of women admissions than for any other drug except tranquilizers methamphetamine - ~ 1:1 cocaine - 1:2 heroin - 1:2+ marijuana & alcohol - 1:3

Since women are often caretakers of children, more children are likely affected

Gender Differences

Source: Vaughn, C. (2003)

13

0%

5%

10%

15%

20%

25%

30%

35%

40%

To lose weight To relieve depression

*p< .001

Male Female

Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005

Self-Reported Reasons for Starting Methamphetamine Use

14

Treatment AdmissionsMeth/Amphetamine as Primary Substance by Gender

2.9%

6.1%

3.3%

6.8%

3.3%

6.9%

4.5%

8.8%

6.0%

11.0%

0%

2%

4%

6%

8%

10%

12%

1995 1997 1999 2001 2003

Male Female


15

Meth/Amphetamine AdmissionsBy Gender - 2003

55%

45%

30%

70%

44%

56%

0%

10%

20%

30%

40%

50%

60%

70%

All ages 12-14 year-olds 15-17 year-olds

Male Female


16

Female Treatment AdmissionsStates with Highest % of Meth/Amphetamine as Primary Substance

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Hawaii Nevada Idaho California Utah Nebraska

1997 1999 2001 2003


17

0%

5%

10%

15%

20%

25%

30%

35%

1995 1997 1999 2001 2003Cocaine Alcohol Heroin/Opiates Marijuana Meth/Amphet/Stimulants

Trends in Primary Substance UseTreatment Admissions for Pregnant Females by Primary Substance 1995-2003

Percent of Women’s Admissions for Meth/Amphetamine and Marijuana Nearly

Doubled over 8 Years


18

0

50

100

150

200

0 60 120 180Time (min)

% o

f Bas

al D

A O

utpu

t NAc shell

EmptyBoxFeeding

Source: Di Chiara et al.

FOOD

100

150

200

DA

Con

cent

ratio

n (%

Bas

elin

e)

MountsIntromissionsEjaculations

15

0

5

10

Copulation Frequency

SampleNumber

1 2 3 4 5 6 7 8 9 1011121314151617

ScrScrBasFemale 1 Present

ScrFemale 2 Present

Scr

Source: Fiorino and Phillips

SEX

Natural Rewards Elevate Dopamine Levels

19

0100200300400500600700800900

10001100

0 1 2 3 4 5 hrTime After Amphetamine

% o

f Bas

al R

elea

seDADOPACHVA

Accumbens AMPHETAMINE

0

100

200

300

400

0 1 2 3 4 5 hrTime After Cocaine

% o

f Bas

al R

elea

se

DADOPACHVA

Accumbens COCAINE

0

100

150

200

250

0 1 2 3 4 5hrTime After Morphine

% o

f Bas

al R

elea

se Accumbens

0.51.02.510

Dose (mg/kg)MORPHINE

0

100

150

200

250

0 1 2 3 hrTime After Nicotine

% o

f Bas

al R

elea

se

AccumbensCaudate

NICOTINE

Source: Di Chiara and Imperato

Effects of Drugs on Dopamine Levels

20

Effects of Methamphetamine Addiction

21

Short-Term Effects of Methamphetamine

PSYCHOLOGICALConfidenceAlertnessMoodSex driveEnergyTalkativeness

BoredomLonelinessTimidity

PHYSICALHeart rateRespirationBlood pressurePupil sizeSensory acuityEnergy

AppetiteSleep Reaction time

Source: Judith Cohen, Ph.D., Presentation to NASADAD, June 2005

22

MethamphetamineChronic Physical Effects

Tremors Weakness Headaches Sweating Coughing

Dry Mouth Oily skin/complextion Burned lips/sore nose Dental Weight Loss/Anorexia

23

MethamphetamineChronic Psychological Effects

Confusion Concentration Hallucinations Fatigue Memory loss Insomnia

Irritability Paranoia Panic reactions Depression Anger Psychosis

Source: Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005

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Decreased ability to: Recognize and recall words and picturesMake inferencesManipulate information Ignore irrelevant information Learn from experience

Users and people in early recovery may find it difficult to: Pay attention Comprehend spoken and written information Remember information

Cognitive Effects

Source: Simon (1999)

25

Rate of recovery is associated with severity of abuse and days of abstinence.

Study documented significant recovery with Meth abusers who were able to stay drug free for at least 9 months.

After 4 years of abstinence, no deficits in:Memory Learning Attention Executive functionMotor function

Cognitive Effects

Sources: Lundahl et al. (2004); Volkow et al. (2001)

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Risks to Children When Parents Use Methamphetamine

27

Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior Year

0

100,000

200,000

300,000

400,000

500,000

600,000

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

0

100,000

200,000

300,000

400,000

500,000

600,000

Children in Foster Care** New Crack Users* New Methamphetamine Users*

New Female Crack* New Female Meth*

28

Six Different Situations for Children

Parent uses or abuses methamphetamine

Parent is dependent on methamphetamine

Mother uses meth while pregnant

Parent “cooks” small quantities of meth

Parent involved in trafficking

Parent involved in super lab

Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

29

Each situation poses different risks and requires different responses

Child welfare workers need to know the different responses required

The greatest number of children are exposed through a parent who uses or is dependent on the drug

Relatively few parents “cook” the drug


Six Different Situations for Children

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Parent Uses or Abuses Meth

Risks to safety and well-being of children: Parental behavior under the influence: poor judgment,

confusion, irritability, paranoia, violence Inadequate supervision Inconsistent parenting Chaotic home life Exposure to second-hand smoke Accidental ingestion of drug Possibility of abuse HIV exposure from needle use by parent


31

Parent Is Dependent on Meth

Risks to safety and well-being of children: All the risks of parents who use or abuse, but the child

may be exposed more often and for longer periods Chronic neglect is more likely Household may lack food, water, utilities Chaotic home life Children may lack medical care, dental care,

immunizations Greater risk of abuse Greater risk of sexual abuse if parent has multiple

partners


32

Mother Uses Meth While Pregnant

Risk to child depends on frequency and intensity of use, and the stage of pregnancy

Risks include birth defects, growth retardation, premature birth, low birth weight, brain lesions

Problems at birth may include difficulty sucking and swallowing, hypersensitivity to touch, excessive muscle tension (hypertonia)

Long term risks may include developmental disorders, cognitive deficits, learning disabilities, poor social adjustment, language deficits

Sources: Anglin et al. (2000); Oro & Dixon, (1987); Rawson & Anglin (1999); Dixon & Bejar (1989); Smith et al. (2003); Shah (2002)

33

Mother Uses Meth While Pregnant

Observed effects may be due to other substances, or combination of substances, used by the mother

For example, if the mother also smokes, growth retardation may be significant

Observed effects may be complicated by other conditions, such as the health, environmental, or nutritional status of the mother


34

Mother Uses While Pregnant

Scope of the problem:

An estimated 10% to 11% of all newborns are prenatally exposed to drugs or alcohol; this amounts to 400,000 to 480,000 newborns per year

Only about 5% of prenatally exposed newborns are placed in out-of-home care; the rest go home without assessment and services

Sources: Vega; SAMHSA, OAS, National Survey of Alcohol and Drug Use During Pregnancy, 2002 and 2003

35

Mother Uses While Pregnant

Shah, R. (2005, June). From NASADAD presentation

Home environment is the critical factor in the child’s outcome

Consequences can be mediated

36

Parent “Cooks” Small Quantities of Meth

All the risks of parents who use or are dependent on meth, with added risks of manufacturing the drug:

Chemical exposureToxic fumesRisk of fire and explosion


37

Environmental Methamphetamine Exposure and Risks

Toxic effects of manufacturing Children more at risk:

Higher metabolic ratesDeveloping bone and nervous systemsThinner skin than adults which absorbs

chemicals fasterChildren tend to put things in their mouth and

use touch to explore

Source: Mason (2004)

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Parent Involved in Trafficking

Presence of weapons

Possibility of violence

Possibility of physical or sexual abuse by persons visiting the household


39

Parent Involved in Super Lab

Lower likelihood of children on the site


40

2000 2001 2002 2003

Number of incidents 8,971 13,270 15,353 14,260

Incidents with children present

1,803 2,191 2,077 1,442

Percent with children present

20% 16.5% 13.5% 10%

Children taken into protective custody

353 778 1,026 724

Number of Children in Meth Labs

Source: El Paso Intelligence Center

4 years = 2,881; all children ~1,200,000

41

National Alliance of Drug Endangered Children (DEC)

Formed in October 2003

Provides multi-disciplinary training for communities interested in starting or expanding DEC programs

www.nationaldec.org

http://www.nationaldec.org/�

42

Multidisciplinary DEC TEAMS

Medical and Mental Health Services trained in diagnosing and treating children exposed to neglect

and abuse, possible chemical hazards, and trauma

Child Protective Services determine the course of the child welfare investigation and share

information with law enforcement officers, district attorneys’ offices, and health care and mental health agencies.

Law Enforcement must act to ensure the immediate safety of the children present,

ensure that children are placed in a safe environment with a responsible caretaker.

43

DEC Team (cont.)

Public Safety Fire department personnel and hazardous materials

professionals, play a key role in documenting conditions of child endangerment, including the potential for fire or explosion, presence of hazardous materials, improper storage of chemicals, and poor ventilation.

Prosecution Prosecutors are responsible for filing and supporting charges of

child endangerment. In cases in which one parent or caregiver is not charged with endangerment but lesser charges are levied, the prosecutor can play an important role in safeguarding the child’s welfare by influencing the terms of probation. These terms often include drug treatment, parenting classes, and other rehabilitative measures.

44

Treatment for Methamphetamine

45

CSAT’s Methamphetamine Treatment Project

Largest randomized clinical trial of treatment for meth dependence

• Intensive outpatient setting

• Three to five visits per week of comprehensive counseling for at least the first three months

• Cognitive behavioral approach

• Contingency management

46

Matrix Model Treatment Outcomes Of 10 MA-abusing persons entering treatment (UA results):

6 still MA-abstinent12 months after treatment

After treatment: DC 6mo. 12mo.

Still MA-abstinent: 6.5 6.9 5.9

Source: Rick Rawson, Ph.D. Presentation to SAMHSA, August 2005

47

Similar Outcomes

Treatment outcomes do not differ from other drugs of abuse

Treatment outcomes have more to do with the quantity and quality of treatment than type of drug abused

48

Gender Differences and Implications for Treatment

Co-occurring mental health problems

Trauma

Body image

49

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

Somatiza

tion

Obsess

ive-C

ompuls

ive

Interp

erson

al Sen

sitivi

ty

Depres

sion

Anxiety

Hostility

Phobic

Anxiet

y

Parano

id Idea

tion

Psych

oticis

m

all significant at p< .001

Mea

n B

SI S

core

FemaleMale

Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005

Behavior Symptom Inventory (BSI)Scores at Baseline

50

Histories of Violence among Clients Treated for Methamphetamine

Persons in treatment for methamphetamine reported high rates of violence• 85% women• 69% men

The most common source of violence:• For women, was a partner (80%)• For men, was strangers (43%)

History of sexual abuse and violence:• 57% women• 16% men

Source: Cohen, J. (2003)

51

Prevalence of Co-Occurring Problems, and Violence and Trauma

• Women in treatment 2 times more likely to have history of sexual and physical abuse than general population

• Women who are dependent on meth usually have more severe problems than their male counterparts in many areas of their life

• Speaks to the need for comprehensive, and trauma-related services

Source: CSAT TIP 36

52


Sexual behavior linked to methamphetamine is a significant clinical issue that needs to be addressed in women-only groups

Co-occurring mental health issues complicate treatment and require longer duration for treatment

Violence linked to meth use is related to trauma and safety needs which must be addressed in treatment

Body image and nutrition need to be addressed

53

Threats of violence and reduced cognitive capacity to manage activities of daily living suggest that a period of residential treatment orreferral to safe houses or supervised housing may be indicated.

Intensive outpatient treatment should be coupled with additional supports such as transportation, meals, child care.

Gender specific treatment is indicated given women’s histories of trauma and violence


54

What Predicts Longer Abstinence?

Longer time in treatment (e.g. those with 4 or more mo. of treatment have more than double the rate of 24-48 mo. abstinence)

More sessions per month of individual counseling Treatment, intervention and case planning need to

account for short-term effects, especially cognitive deficits and verbal communication

Drug Court involvement Family involvement

M.L. Brecht, Ph.D., et al. (2005)

Longer abstinence following treatment for women with:

55

Summary

56

Summary

Methamphetamine is a dangerous drug with serious physical, cognitive, and health consequences

The effects of long-term use are reversible with prolonged abstinence

Treatment for methamphetamine is as effective as treatment for other drugs

57

A high percentage of methamphetamine users are women of child-bearing age

Meth accounts for 7% of treatment admissions nationally, but in some States 30- 44% of women admitted were admitted for methamphetamine

Summary

58

Scope of the problem:The number of meth users is small

compared to other drugs and alcohol

Admissions increased through 2003

Communities that have not experienced prior drug problems may lack the resources to handle a meth problem

Meth use may be leveling off

Summary

59

Parents’ use of methamphetamine puts their children at risk

The best outcome for both child and parent is achieved when:

The parent receives immediate, effective treatment and comprehensive services

The child receives immediate assessment and services, as well as follow-up services

Summary

60

Child welfare workers must distinguish between

Children whose parents use meth, and Children whose parents manufacture meth

They must learn the established medical protocols for children present in meth labs

Summary

61

We need early diagnosis and intervention for children affected by meth before and after birth

We need comprehensive, timely, and state-of-the-art treatment for parents referred to treatment as a condition of keeping or reunifying with their children

We need information systems that capture the necessary data to support effective approaches

Summary

62

For Further Information

63

SAMHSA Resources

Treatment Improvement Protocols (TIP 33)

Best Practice Guidelines for Treatment of Substance Abuse

Researched, Drafted, and Reviewed by Substance Use Disorder Professionals

64

KAP Keys & Quick Guide

Developed to accompany the TIP Series

Based entirely on TIP #33

Designed to meet the needs of busy clinicians for concise, easily accessed “how-to” information

http://www.samhsa.gov

SAMHSA Resources

http://www.samhsa.gov/�

65

SAMHSA Resources

SAMHSA’s Addiction Technology Transfer Centers (ATTC)

Pacific Southwest ATTChttp://www.psattc.org/events/cates/I/presentations/index.html

Methamphetamine 101: Etiology and Physiology of an Epidemic

http://www.psattc.org/events/cates/I/presentations/index.html�

http://www.psattc.org/events/cates/I/presentations/index.html�

66

ATTC’s Introduction to Evidence-Based Treatments for Methamphetamine

CD-ROM Learning Tools

DVD Training Module

Produced by: Applied Behavioral Health Policy at the University of Arizona for the Pacific Southwest ATTC

web www.psattc.org

http://www.psattc.org/�

67

A Program of the

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatmentand the

Administration on Children, Youth and FamiliesChildren’s Bureau

Office on Child Abuse and Neglect

68

NCSACW Mission

To improve outcomes for families by promoting effective practice, and 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

69

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)

NCSACW Consortium

70

Recent NCSACW Products

Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers(A short monograph for front-line workers)

On-Line Training – Now AvailableUnderstanding Child Welfare and the Dependency

Court: A Guide for Substance Abuse Treatment Professionals

Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Child Welfare Professionals

71

Contact NCSACW

www.ncsacw.samhsa.govProject Director:Nancy Young, Ph.D.714-505-3525

Government Project Officer:Sharon Amatetti, SAMHSA/[email protected]

http://www.ncsacw.samhsa.gov/�

mailto:[email protected]�

72

Part IIModel Programs

73

Signs of Use and Warning Signs for Workers

74

Euphoria Grinding of teeth Rapid breathing Sweating Hyperactivity Tremor - shaking hands Rapid or pressured speech Depression - when drug wears off Irritability, paranoia, suspiciousness Hallucinations Presence of drug paraphernalia

Signs of Methamphetamine Use and Use of Other Stimulants

Source: Crowell & Webber (2001)

75

Warning Signs for Workers

Client is extremely irritable, suspicious, or argumentative, or there is an escalation of irritability

Regular client does not appear to know who worker is

Evidence of paranoid thinking, delusions

Client verbalizes implicit or explicit threat against worker


76

Scratch marks or scabs, particularly on client’s hands and arms - may be evidence of tactile hallucinations and indicate a prior episode of stimulant psychosis Severe damage to teeth and gums Drawn face and underweight Strong chemical odor - may indicate

manufacturing of meth

Other Severe Signs of Meth Use


77

Methamphetamine: Implications for Workers

78

Denial = Super-memory Imprinting

Memory imprinting increases in power as dopamine activity increases.

Addicts remember the “good-times” and fail to remember the “bad-times”.

79

Research on Cognitive Impairments of MA addicts Ability to manipulate

information (multi-relational or “synthesis”).

Ability to make inferences.

Ability to ignore irrelevant information.

Ability to learn new or recall information.

80

“Methamphetamine: Snapshot Phenomenon”Wurscher & Martin

81

Oregon’s Response

82

Oregon Child Welfare 1997-99

60% of CW families A&D involved

54% of CW families DRUG involved

68% of CW DRUG families METH

#1 reason for termination –

No recovery - 46% METH

83

Oregon Child Welfare 2004

875,790 children ages 0-18

46,524 reports of suspected abuse

10,622 FOUNDED abuse cases

9.6% ^ over previous year

73.8% ^ since 1994

9.4% ^ in POPULATION since 1994

50% of removals METH related

84

Current Oregon Issues

Meth Labs almost eliminated

Meth Addiction Higher than ever

2003 - 30% reduction in A&D TX

Foster Care Population Growing

Meth cases most CHAOTIC

85

What Labs ARE NOT

Chernobyl– Meth Labs are not radioactive.

Fatal to CPS Workers– Meth Labs will not kill you.

86

Oregon METH Response

Collaborate & Integrate

Separation of issues – Labs & Addiction

Governor’s METH Task Force

Drug Endangered Child Response

DEC Teams & OADEC

Addiction Recovery Teams - ART

Family Involvement Team - FIT

87

DEC - Drug Endangered Child Team Partners

DHS Child Welfare

Local Law Enforcement

Meth Lab Law Enforcement

Criminal Prosecuting District Attorneys

Child Welfare Attorneys

Local Medical Staff - Hospitals

88

DEC Collaboration Issues

LEA will seek evidence for charges and arrest.

DA’s will seek prosecution on both drug charges and child maltreatment.

DEC Collaboration requires CPS to play active role in this process while advocating for the best outcomes for children.

Can be conflicts in process.

89

CPS Requirements – On Site

Focus - on Your CPS Safety Assessment

Gather Info from Site Safety Officer

Determine De-Contamination Need/Plan

Focus - Be the Social Worker, not the Police Officer.

Stay Behind the Police Barriers

Transport Children Safely

90

Addiction Recovery Teams

DHS & Contract Collaboration

DHS staff person assigned to A&D

Contracted A&D Counselor

Contracted Outreach Worker

Other Integrated Services

Must be on site at child welfare

91

Family Involvement Team

FIT Team

Portland – Multnomah County

A&D CW Services at the court

On site DHS & A&D at all times

On site transport & child visit

Treatment Program Case Managers

ASFA attentive & accountable

92

ADVANTAGES – ART & FIT

All providers believe in RECOVERY

Immediate focus on A&D TX needs

Tracking clients toward recovery

Relapse response with Outreach

FIT – services offered at court

FIT – TX site case management

93

ADVANTAGES – ART & FIT

Parent focused service

Caseworkers feel supported

Treatment programs OK with CW

Clients stick with TX

Recovery modeled – Parent Mentors

Reunited video asfavideo.org

94

ADVANTAGES ART - FIT

Defense bar buys in

Judges recommend & mandate services

Negates punitive casework

Promotes clinical approaches

Drug testing seen as intervention

Recovery is modeled to caseworkers

95

Oregon Resource People

Jay WurscherAlcohol & Drug Services CoordinatorOR Dept of Human ServicesSalem [email protected]

Samantha ByersFamily Involvement Team/Parent MentorsOR Dept of Human ServicesPortland, OR503-988-5464, [email protected]

96

Sacramento County’s Response

97

Program Context

Sacramento County population: 1.5 million

In 2004, there were approximately 7,000 substantiated child abuse/neglect referrals, in Sacramento1.

An estimated 70 to 80% of child welfare cases involve families affected by substance use

Source: Center for Social Services Research, University of California at Berkeley

98

Sacramento County Prior to STARS and Dependency Drug Court

Reunification rate about 20-25%

Parents unable to access AOD treatment

Social workers, attorneys, courts often uninformed on parent progress

Drug testing not uniform and results often delayed

99

Sacramento County After STARS and Dependency Drug Court

Reunification rates at 40–45 percent

Reunification is occurring faster

Parents truly have “treatment on demand”

All parties involved in the case are informed at every stage of treatment

All parents receive random observed “instant” drug testing

1. Comprehensive cross-system joint training2. Substance Abuse Treatment System of Care3. Early Intervention Specialists4. Recovery Management Specialists (STARS)5. Dependency Drug Court

Reforms have been implemented over the past eleven years

Five Components of Sacramento County’s Comprehensive Reform


1. Comprehensive cross-system joint training

Three Levels of 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

2. Substance abuse treatment system of care

Managed wait list

Immediate access to substance abuse services Group services expansion and implementation

of pre-treatment groups


3. Early Intervention Specialists

Review of every court petition to determine if substance use disorders may be present

Immediate access to intervention and assessment at court hearings

Immediate authorization of publicly-funded treatment services


4. Recovery Management Specialists (STARS) Motivational enhancement Gender-specific services Immediate access to recovery management and treatment services Provider orientation of providing hope and

accountability Compliance monitoring—twice monthlies


5. Dependency Drug Court

Parallel system to dependency petition 30, 60 and 90-day compliance hearings Structured incentives for compliance

and sanctions for non-compliance Voluntary participation in on-going

services


106

Sacramento CountyDependency Drug CourtEvaluation Findings

4940 Irvine Boulevard, Suite 202Irvine, CA 92620714.505.3525Fax 714.505.3626www.cffutures.org

Parents and Children in Evaluation

111

173

324

432

249

429

274

485

050

100150200250300350400450500

Comparison CO YR 1 CO YR 2 CO YR 3

Parents = 847 Children = 1,346

Total Mothers and Fathers in DDC Evaluation

0

100

200

300

400

500

600

Mothers Fathers

73.4%

26.6%

109

Primary Drug Problem*

41.1

52.9

17.916.3

21.415.0

7.1 2.712.5 11.1

0.0 2.00

20

40

60

80

100

Per

cen

t

Meth Alcohol Marijuana Heroin Cocaine/crack Other

Comparison Court Ordered*p<.001

112

50.5

86.4

0

20

40

60

80

100

Pe

rce

nt

Comparison Court Ordered*p<.001

Treatment Admission Rates*

Percent of Mothers and Fathersby Treatment Completion

66.0%71.6%

34.0%28.4%

0

10

20

30

40

50

60

70

80

Completed Left & Unsatisfactory Progressn.s.

114

27.2

42.1

31.8

22.9

13.3

5.41.7

14.118.5

5.17.5 10.4

0

10

20

30

40

50

60

70

80

Per

cent

Reunified Adoption Guardianship ContinuedFR/FC

Long-termPlacement

Other

Comparison CO YR 1*Significantly more Court Ordered Year 1 children reunified at 24 months than comparison children. Significantly more Year 1 children were in continued FR/FC at 12 months (with less in long term placement or guardianship) than the comparison groups.

24-Month Placement Outcomes*

115

Time to Reunification

210.8187.1

266.1 266.6

300.7284.0

0

50

100

150

200

250

300

Days

12 Months 18 Months 24 Months

Comparison Court Ordered

24-Month Cost Savings

27.2% - Reunification rate for comparison group children 42.1% - Reunification rate for court-ordered DDC group

children 63 Additional DDC children reunified 33.1 – Average months in out-of-home care for comparison

group children 8.6 - Average months to reunification for court-ordered

DDC children

$2,953,639 estimated savings in out-of-home care costs

117

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