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

Children and Family Futures4940 Irvine Boulevard, Suite 202

Irvine, CA 92620714.505.3525 Fax 714.505.3626

www.ncsacw.samhsa.gov

Children’s BureauPermanency Partnership Forum VII

May 19 to 21, 2003

Permanency Outcomes forChildren Affected by Substance

Abuse

Work Shop Overview• NCSACW• Scope of Issue• Policy Tools for Solutions• Models of Changed Practice• Issues for Children• Models of Family Drug Courts

Developing Knowledge and Providing Technical Assistance

to Federal, State, Local Agencies and Tribesto Better Serve Families with Substance Use

Disordersin the Child Welfare and Family Court Systems

and theAdministration on Children, Youth and

FamiliesChildren’s Bureau

Office on Child Abuse and Neglect

A Program of theSubstance Abuse and Mental Health

Services AdministrationCenter for Substance Abuse Treatment

NCSACW's goal

• To promote effective practice, organizational, and system changes at the local, state, and national levels by– Developing and implementing a

comprehensive program of information gathering and dissemination

– Providing technical assistance

A Consortium Approach Children and Family Futures - implementing

the NCSACW under contract with CSAT and ACYF

CWLA – Child Welfare League of America

NASADAD – National Association of State Alcohol and Drug Abuse Directors

NCJFCJ – National Council of Juvenile and Family Court Judges

APHSA – American Public Human Services Association

NICWA – National Indian Child Welfare Association

Tasks Conduct Marketing and Public Conduct Marketing and Public

AwarenessAwareness Collection and Dissemination of Collection and Dissemination of

InformationInformation Develop MaterialsDevelop Materials Develop Web-based Access to Develop Web-based Access to

Information and TutorialsInformation and Tutorials Conduct Conferences and MeetingsConduct Conferences and Meetings Provide Technical AssistanceProvide Technical Assistance

By inverting the cliché, it communicates

that we can only see what we are prepared to see Child abuse was “discovered” when, doctors added social workers to their teams Until then, doctors didn’t allow the possibility that parents were hurting their kids because they didn’t know what to do next

“Believing is seeing”

Diane L. Coutu, “Sense and reality: A conversation with celebrated psychologist Karl E. Weick,” Harvard Business Review. April 2003. pp. 84-90.

Social workers said, “Sure, child abuse happens, and we know how to handle it by providing child protective services”

At that point the physician teams could afford to see child abuse, because then they knew how to deal with it.

The greater the repertoire of responses you have on your team,

the more things you can do.

The Power of Teams

The Power of Teams

Only when social workers really connect with substance abuse counselors do they “know what to do next” when alcohol and other drugs are a part of the problem

Then they can, as Weick puts it, “afford to see” substance abuse, because they have a response to it

Only when substance abuse counselors connect with child development and family services workers do they have a sense of the full force of family dynamics in helping parents recover

And only when family support staff connect with income support workers do they know what to do next when poverty is a part of the problem

The Power of Teams

CHILDREN

PATHS OF EXPOSURE

FAMILY COMMUNITY MEDIA

ENVIRONMENTAL

IN UTEROPERSONAL

USE

Paths of a Child’s Exposure to Alcohol and Other Paths of a Child’s Exposure to Alcohol and Other DrugsDrugs

LEGALAlcoholTobacco

Prescription Drugs

ILLEGALUnderage Alcohol

andTobacco

Illicit Use of Prescriptions

Restricted Drugs

Impact of AOD on Children

The Two Most Significant Risks to Children of Substance Users: They Have Poorer Developmental

Outcomes They Are at High Risk of Substance

Abuse Themselves1

Children of Substance Abusers Exhibit Depression and Anxiety More Often Than Children from Non-addicted Families2

1. Department of Health and Human Services, Blending Perspectives and Building Common Ground, April 19992. National Association for Children of Alcoholics, Children of Addicted Parents: Important Facts, http://www.nacoa.org

National Estimates of Children Living With

At Least One Substance Abusing Parent

4.5

2.8

6.2

7.5

8.3

8.4

10.6

0 2 4 6 8 10 12

Need Treatment for Illicit Drug Abuse

Dependent on Illicit Drugs

Dependent on Alcohol

Dependent on AOD

Dependent on Alcohol and/or NeedsTreatment for Illicit Drugs

Used Illicit Drug in Past Month

Used Illicit Drug in Past Year

In Millions

COSAs and Child Abuse/Neglect Victims

Millions0 2 4 6 8 10

0.3

0.9

1.8

3.0

8.3

Placed in Out of Home Care

Child Victims

Investigations

Abuse/Neglect Reports

Living with Alcoholic/Addict Parent

67% and 32% Substantiated

*Child Maltreatment 2001

California Parents Entering Publicly-Funded Substance Abuse

Treatment

• Had a Child under age 18 59.0%

• Had a Child Removed by CPS 24.5%

• If a Child was Removed, Lost Parental Rights 36.9%– Treated in Outpatient 32.5%

– Treated in Residential 44.7%

– Treated with Methadone 73.6%

Key Barriers Between Substance Abuse,

Child Welfare and The Courts

• Beliefs and Values• Competing Priorities • Treatment Gap• Information Systems• Staff Knowledge and Skills• Lack of Communication• Different Mandates

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

Information Sharing & MIS

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 2003From CSAT Technical Assistance Publication (TAP) 27: Navigating the Pathways *Revised March 2003

How to Connect the AOD, CWS, Court Systems: Elements of System Linkages*

Policy Tools Development of Policy Tools to

Facilitate Collaborative Work Across Systems

Collaborative Values Inventory Collaborative Capacity Instrument Matrix of Progress in Linking

Substance Abuse and Child Welfare Services

Key CFSR Outcomes with Implicationsfor Substance Abusing Families

• Families Have Enhanced Capacityto Provide for Their Children’s Needs

• Children Receive Appropriate Services to Meet Their Educational Needs

• Children Receive Adequate Services to Meet Their Physical and Mental Health Needs

Families Have Enhanced Capacityto Provide for Their Children’s

Needs

• Improved Screening and Assessment Protocols and Effective Communication Paths Across Systems– Standardized Screening Tools– Partnering for AOD Expertise– Standardized Monitoring & Reporting

Tool– Joint Case Planning

Families Have Enhanced Capacityto Provide for Their Children’s

Needs

• Engaging and Retaining Parents in Care– Use of Motivational Interviewing and

Stages of Change– Use of Persons in Recovery as Members

with Family Team– Use of Substance Abuse Staff to Increase

Recovery Management– Increased Judicial Oversight– Preserving Relationships with Birth

Parents Regardless of Type of Permanency Outcome

Models of Changed Practice Workers out-stationed in

collaborative settings Increased case management and

monitoring of recovery progress New methods and protocols on

sharing information Increased judicial oversight and

family drug treatment courts New priorities for treatment access

for child welfare-involved families New safe and sober housing

initiatives

Children Receive Appropriate Services to Meet Their Educational, Physical and Mental Health

Needs

• Services for Children and FamiliesBased on Developmental Stages

– Prenatal and Birth Primary Health Care– Infants Bonding and Attachment– Toddlers Developmental Interventions– School Readiness Language, LD and

Behavior– Latency COSA Group Interventions– Pre-Adolescent Targeted Prevention– Adolescence Intervention & Treatment– Transition to Adulthood COSA Coping and Life

Skills

Children’s Service Models

• Define At Risk Births– Primary Care 4 Ps – Parents, Partner, Past,

Pregnancy

– Hawaii Healthy Start Risk Factors

• Developmental Screening• Early Childhood Education

– Free to Grow – RWJ Program

– Starting Early Starting Smart - SAMHSA

• Parent Training– Nurturing Parents – Institute for Health &

Recovery - Boston

Children’s Service Models

• Children of Substance Abusers– The 7 C’s – NACOA.ORG

•I didn’t Cause it•I can’t Cure it•I can’t Control it•I can Care for myself by•Communicating my feelings•Making healthy Choices•And by Celebrating myself

• Integrated – Santa Clara– Both dependency matters and

recovery management conducted in the same court with the same judicial officer

Models of Family Treatment Courts

• Dual Track – San Diego– Dependency matters and

recovery management conducted in same court with same judicial officer during initial phase

– If parent is noncompliant with court orders, parent may be offered DDC participation and case may be transferred to a specialized judicial officer who increases monitoring of compliance and manages only the recovery aspects of the case

Models of Family Treatment Courts

• Parallel - Sacramento– Dependency matters are heard

on a regular family court docket – Specialized court services

offered before noncompliance occurs

– Compliance reviews and recovery management heard by a specialized court officer

Models of Family Treatment Courts

Significantly Less Criminal & CPS Recidivism Among FDTC Parents in Five

Sites

0 10 20 30 40 50 60

Arrested AfterCase Inception*

Subsequent CPSReport

Investigated*

Subsequent CPSInvestigationsSubstantiated*

FDTC Comparison

Percent of Parents in 18 Months*p<.05

Average Days to PermanencySacramento County

Dependency Drug Court

0

100

200

300

400

500

600

Comparison All DDC

Reunified All Permanency

p<.001n=90 n=146

Nancy & Sid’s Top 10 List for Foster and Adoptive Parents*

1. Keep a journal of everything2. Get on the wait list for the best

services in town3. Live on the internet with other

parents4. To ask “can he understand” after

being told he can hear5. Be prepared to have a 3rd or 4th

job—case management—we are their best advocates and know them better than any professional

*Personal Experience not NCSACW

6. Knowing the mental health diagnoses of birth parents is critical

7. Children of bi-polar parents with ADHD symptoms should be treated as bi-polar

8. Schools will usually first say No, hire an advocate for I.E.P.

9. Know that adopted kids have a “hole in their heart”

10.Take time for yourselves—don’t mortgage your marriage

Nancy & Sid’s Top 10 List

The Most Important Clock

The Clock that is Ticking on Us How long do we have to act if our

families have 24 months to work and 12 months to reunify?

Taking this clock seriously means that we build the needed bridges between systems with a sense of urgency and a timetable that start now