Recovery Support in Your FDC: Building and … Recovery...Christine Munroe, BSW Peer Mentor...
Transcript of Recovery Support in Your FDC: Building and … Recovery...Christine Munroe, BSW Peer Mentor...
Jane Pfeifer, MPA
Rosemary Soave MSW, LCSW
Christine Munroe, BSW
Tara Doaty-Mundell, PhD
Hilary Kushins, MSW, JD
NADCP | July 2015
Children and Families
Family Drug Courts
Stronger Together
Recovery Support in Your FDC:
Building and Sustaining Hope
Through Creative Partnerships
This presentation is supported by:
The Office of Juvenile Justice and Delinquency Prevention Office of Justice Programs
(2013-DC-BX-K002)
Points of view or opinions expressed in this presentation are those ofthe presenter(s) and do not necessarily represent the official positionor policies of OJJDP or the U.S. Department of Justice.
Acknowledgement
Mission: to improve outcomes for children and families by providing training and technical assistance that supports planning and implementation of comprehensive Family Drug Courts.
National Family Drug
Court TTA Program
• Understand the importance of providing parents comprehensive recovery support services to achieve goals of safety, reunification, and permanency
• Learn strategies to implement a peer mentor program and the community context for intervention and role in sustaining long-term recovery
• Identify strategies to leverage local resources to design and implement an evaluation of a mentor parent program for FDC
Learning Objectives
Rethinking Treatment
Readiness
Addiction as an elevator
Re-thinking “rock bottom”
“Raising the bottom”
Brain Science
of Addiction
We know more about
ASAM Definition of Addiction
“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”
Adopted by the ASAM Board of Directors 4/12/2011
A Treatable Disease
• Substance use disorders are a preventable, treatable disease
• Discoveries in the science of addiction have led to advances in drug abuse treatment that help people stop abusing drugs and resume their productive lives
• Similar to other chronic diseases, addiction can be managed successfully
• Treatment enables people to counteract addiction's powerful disruptive effects on brain and behavior and regain areas of life function
Functions of Recovery SupportLIAISON
• Links participants to ancillary supports;
identifies service gaps
TREATMENT BROKER
• Facilitates access to treatment by addressing
barriers and identify local resources
• Monitors participant progress and compliance
• Enters case data
ADVISOR
• Educates community; garners local support
• Communicates with FDC team, staff and
service providers
Titles and Models
• Recovery Support Specialist
• Substance Abuse Specialist
• Recovery Coach
• Recovery Specialist
• Parent Recovery Specialist
• Peer Mentor
• Peer Specialist
• Peer Providers
• Parent Mentor
What does our program and community need?Your FDC needs to ask:
Experiential Knowledge,
ExpertiseExperiential Knowledge, Expertise +
Specialized Training
102130
151
200
0
50
100
150
200
250
No Parent SupportStrategy
Intensive CaseManagement Only
Intensive CaseManagement and
Peer/ Parent Mentors
Intensive CaseManagement andRecovery Coaches
Median in Days
Median Length of Stay in Most Recent Episode of Substance Abuse
Treatment after RPG Entry by Grantee Parent Support Strategy
Combinations
46% 46%
56%63%
0%
10%
20%
30%
40%
50%
60%
70%
No Parent SupportStrategy
Intensive CaseManagement Only
Intensive CaseManagement and
Peer/ Parent Mentors
Intensive CaseManagement andRecovery Coaches
Substance Abuse Treatment Completion Rate by
Parent Support Strategies
Holding Hope Peer Mentors in the
Family Treatment Drug Court
Rhode Island
Family Treatment Drug Court
Presenters:
Rosemary Soave, LCSW
Christine Munroe, BSW
History of RI FTDCSteering Committee 2001 – Key Stake Holders, State and Community Leaders
• Chief Judge, RI Family Court
• Child Protective Services Staff
• Department of Human Services
• Department of Behavioral Health Developmental Disabilities and Hospitals
• Offices of RI legal Services and Public Defender
• Court Appointed Special Advocate (CASA)
• Brown Center/VIP program
Funding of RI FTDC
Inaugural FTDC hearing September 2002
• DHHS SAMHSA/CSAT – funded the design and implementation of the FTDC 2002 – 2004 new court
• DOJ/OJP Grant Award 2005
• HRSA/Abandoned Infants Act Grant 2001- 2009 Partnership between RI Family Court and WIH
• RI State Funding 2009 - present
• DOJ/OJP Expansion Grant Award 2013 – 2016 increased FTDC staff and program (45 participants)
Getting Started at RI FTDC
• Reside in Rhode Island, parents of children newborn to age 18
• Substance use and or history of substance use
• CPS involvement, goal of DCYF case plan is reunification
• Voluntary Program-consent to participate
Criteria for Participation
• Treatment Providers
• Self-referral
• Family Court
• Community Agencies
• Women & Infants Hospital
Referrals
FTDC is available to moms and dads
FTDC Collaboration and Intervention
• Comprehensive case management – Intensive case monitoring by FTDC Clinical Care Coordinator (CC’s)
• Frequent court status reviews, CC’s keep current on parental progress to assess strengths and vulnerabilities to make recommendations about permanency planning
• Submits progress reports at status hearings to FTDC Team members (Judges, CASA, Attorneys, CPS)
• Expedite additional referrals so families have access to services they need in their work towards reunification
Therapeutic, case management, team approach, non-punitive
Integrating Evaluation and Services
• “Self-correcting” model of evaluation
• Evaluator attends FTDC staff meetings and monthly FTDC court hearings
• Evaluation team provides reports to staff re: active participants, phases
• Outcome data reports provided at least semi-annually
2013 – OJJDP Grant Award
• National focus on the role of peers in recovery
• RI received federal grant for a Peer Recovery Center (Anchor)
Expanded FTDC Staffing and Resources
Designed and Implemented FTDC Peer Mentor Component
Past attempts in implementing a mentor component encountered numerous challenges (parental availability, transportation, and child care)
• Clinical Care Coordinators
• Peer Mentor Coordinator
• Toxicology Technician
• Parent Handbook
Peer Mentor Coordinator
Qualifications
• Lived experience
• Certified Peer Recovery Specialist
• Supervised by the FTDC Coordinator
Responsibilities
• Screen and train Peer Mentors
• Supervise Peer Mentors
• Attend all staff meetings/integrated with the team
Peer to Peer Mentors
The Peer to Peer Mentor’s role is to:
• Share their personal experience of the Family Treatment Drug Court
• Answer questions about the process
• Support, encourage and empower FTDC families
Peer Mentor Qualifications
• Must be committed to a recovery lifestyle
• Must be a graduate of the RI Family Treatment Drug Court
• Must have placement of their children with no CPS involvement
• Must have no pending criminal cases or charges
Peer Mentor Responsibilities
• Work in collaboration with the FTDC Clinical Care Coordinators and Peer Mentor Coordinator
- Supervision with the Peer Mentor Coordinator
• Attend trainings
- Confidentiality, Boundaries, Ethics, Roles…
• Provide recovery support information
- Self-help meetings, bus schedules, recovery centers
• Assist in obtaining other resources
- Emergency vouchers, food pantries, furniture banks, etc.
Peer Mentor Program Challenges
• Conflicts with parent’s work and/or school schedule
• Transportation
• Conflict with pick up time for school age children
• Child Care for infant and toddlers
• Mentor relapse
HOPE Questions
• An attempt to capture the role that Peer Mentors can play in facilitating an increase in hopefulness as a result of treatment and participation in FTDC services
• Adapted from the HOPE Screen developed by Anadarajah. G. & Hight. E. (2000). Spirituality and medical practice: Using the HOPE questions as a practical tool for spiritual assessment. www.aafp.org/
• Administered by Peer Mentor Coordinator at enrollment and 6 months follow-up
RI FTDC HOPE Screen
Spiritual Resources: What are your sources of HOPE or comfort? What helps you during difficult times?
Organized Religion: Are you a member of an organized religion? What religious practices are important to you?
Personal Spirituality: Do you have spiritual beliefs, separate from organized religion? What spiritual practices are most helpful to you
Effects on Treatment: Is there any conflict between your beliefs and treatment you are receiving? Do you hold beliefs or follow practices that you believe that may affect your treatment?
H
PO
E
HOPE Screen Findings
• Often a difficult conversation at enrollment, many new to recovery have a fear of religion and fear of judgment
• Highlights lack of supports, resources of participants
• Participants misunderstand difference between spirituality and religion
• Peer Mentor prompted questions about holistic practices and meditation, still difficult
Community Collaboration
Behavioral Health Treatment Providers
• Specialized residential, day, outpatient programs for women
• Providers of co-occurring behavioral health treatment
• Other substance abuse treatment providers
• Medically Assisted Treatment (methadone, suboxone)
Services
• Peer Recovery Services
• Home-Based Services
• Community Visitation Programs
• Community Health Centers
Current Context for Services
• FTDC provides for therapeutic, comprehensive care coordination in a unique team approach. Participants do not have to continue to tell their “story”. Coordinated collaboration across service systems
• Care Coordination includes tracking progress and facilitating additional services/resources (if required) as case progresses
• Current lack of treatment resources – with increased availability of health insurance, demand for services has put pressure on system
• Role of FTDC team in sustaining HOPE when services are not available
Lessons Learned from RI FTDC
• Intervene Early
- Maximize parents’ opportunities to engage in services
- Instill hope
• Connect families to services matched to their identified needs
• Provide ongoing support – consistent staff
• Coordinate with all social and ancillary service providers to increase collaboration
Future Goals/Opportunities
• Evaluate success of Peer Mentor Program
• Identify additional supports needed for Peer Mentors and participants
• Expand use of parent handbook (“home work”)
• Offer social activities
• Enhance integration with community resources
Skills Building – Key Takeaways
• Involve your Evaluator – integral part of the team
• Importance of clinical and team supervision
• Leverage former participants - provide support and advocacy; navigate recovery community
• Don’t re-create the wheel – learn from what others have done and developed
Contact Information
Rosemary Soave, LCSWFamily Treatment Drug Court CoordinatorRI Family Treatment Drug CourtOne Dorrance PlazaProvidence RI [email protected]
Christine Munroe, BSWPeer Mentor CoordinatorRI Family Treatment Drug CourtOne Dorrance PlazaProvidence RI [email protected]
The Role of Recovery Support Specialist in FDCTara Doaty-Mundell, PhD, Clinical Supervisor, The Family Recovery Program, Inc. Baltimore, Maryland
The Family Recovery Program of Baltimore, Maryland
• Baltimore City has been classified as the “heroin capital of America”
• In 2009, heroin accounted for 48% of all drug-related deaths in Baltimore City
• Estimated that 66% of children in foster care in Baltimore City have a direct linkage to parental substance abuse
(NIDA, 2013)
“To help parents who have lost custody of their children because of drugs and/or alcohol break free from addiction and reunite their families quickly by connecting parents with substance abuse treatment and a full range of supportive services, including mental health care, transportation, housing assistance and case management”
Primary Goal:
Long-term family reunification
FRP Mission
The Family Recovery Program of Baltimore, Maryland
Eligibility
• Over age 18
• Have children between ages of 0-10
• Child(ren) removal has to be for at least one night from the Baltimore City Department of Social Services for reasons substantially related to substance abuse
The Family Recovery Program of Baltimore, Maryland
• Demographics:
– Located in East Baltimore City
– The only FDC in Baltimore City
– Two locations—Baltimore City and Washington, DC
– Majority of clients reside below the poverty line
– Over 50% of clients have criminal records
• Executive Director
• Program Supervisor
• Clinical Supervisor
• Community Resource Specialist
• Case Managers
• Recovery Support Specialists
• Program Liaison/Court Coordinator
• Urinalysis Technician
• Peer Recovery Advocate/Re-Engagement Specialist
Staff
The Role of the Recovery Support Specialist
• Provide comprehensive assistance to clients at various stages of recovery
• Co-facilitate the creation and implementation of a client’s Recovery Plan
• Participate in collaborations with partner agencies
Recovery Plan
• Completed within 30 days; 1:1
• Expand view of recovery beyond just treatment – includes reunification and other domains
• Uploaded into system; accessible to team
• Client progress referenced during staffing
• Updated every 30 days
Domains
• Drug treatment
• Mental health
• Education & employment
• Visitation
• Sober activities
• Housing concerns
Building Skills – A Checklist
Acknowledge expertise of specialist
Importance of clinical supervision
Train for trauma
Client survey and benchmarks
Importance of follow-up plan
Contact Information
Tara Doaty-Mundell, PhD, Clinical Supervisor
The Family Recovery Program, Inc. Baltimore, Maryland
MENTOR PARENT PROGRAMHilary Kushins, MSW, JD
Dependency Advocacy Center
Drug Court & Training Programs Manager
Santa Clara County, California
DEPENDENCY WELLNESS COURT (DWC)
• Started in1998
• Judge, attorneys, Social Services, Dept. of Alcohol and Drug Services, attorneys
• Voluntary program
• Limited resources and few participants
• Off the record, informal. Same judge for legal and drug court hearings (unless contested)
1998
DWC, CONTINUED• In 2007, received 5 year federal grant to
expand drug court, Family Wellness Court
• First Five matching funds
• Expanded partners from original drug court, including DAC and Mentor Parents, First Five, domestic violence/trauma specialist, CASA, and mental health
• The Oversight Committee met monthly, consisting of heads of all represented agencies on drug court team to address issues as they arose in drug court on a policy level
• Grant ended in 2012. Partners committed to continuing model, with strong judicial leadership
DEPENDENCY WELLNESS COURT (DWC)
2007
DWC NOW
• Merged drug court from 1998 and federal grant drug court to one drug court, DWC, in 2012 when federal grant ended
• Voluntary program
• Separate drug court and legal hearings with different judicial officers (parallel model)
• 120 active parents at any given time
• 2 full days per week
• Challenges of evaluating DWC
• Oversight Committee continues to meet on a regular basis
DEPENDENCY WELLNESS COURT (DWC)
Today
• Peer mentoring program
• Employees of parents' attorney firm (Dependency Advocacy Center)
• Communications with clients covered under attorney client privilege
• 5 mothers, 3 fathers
• Director and clinical supervisor
• Average caseload 25 clients
• Work 30 hours per week
MENTOR PARENTS
• Committed to clean and
sober lifestyle and raising
healthy families
• Successful graduate of
dependency drug court
• Successfully reunified with
their children and had their
dependency case dismissed
• No pending criminal cases
or charges
• Willing to share their story
CRITERIA TO BE A MENTOR
• Recruit eligible parents into DWC
• Establish professional boundaries
• Provide only referrals or facilitate service delivery of court ordered programs directly related to recovery
• Provide support at drug court and legal hearings and throughout dependency court process
• Maintain confidential communications (protected under attorney client privilege)
ROLES AND RESPONSIBILITIES
• Participate in various trainings, including DFCS, CASA
• Integral part of committees where policy gets decided (Oversight)
• Educate new DWC team members
• Participate in trainings for DFCS (court report writing, engaging fathers), CASA (birth parent perspective, understanding addiction)
ROLE THEY PLAY IN THE SYSTEM
Leading by example
• Began as one volunteer for 5 hours a week, first drug court graduate
• Dept. of Alcohol and Drug Services (DADS) first funder and focused on mothers
• Mentors included in 2007 federal grant: 4 mentors (inc. 2 fathers) and one manager
• Dept. of Mental Health (DMH) then funded 2 more mentors in 2009
• Federal Evaluation - mentor program one of the most effective pieces of the drug court program
• Federal grant expired, Santa Clara Board of Supervisors (BOS) continued funding for Mentor Parent Program
• Current funding: 70% BOS, 24% DMH, 6% DADS
FUNDING
EVALUATION –PARTNERED RESEARCH
• The CW-PART is a collaborative project between School of Social Work at SJSU and local agencies working with children and families
• Teams of students work under supervision of faculty to focus on research questions defined as priorities to local agencies
• Development was funded through California Social Work Education Center
CHILD WELFARE PARTNERSHIP FOR RESEARCH AND TRAINING CW-PART
• Faculty leads work with agency to define research projects
• Students complete research over academic year
• Findings are provided to county through research summaries
HOW IT WORKS
WHY THE PARTNERED MODEL?
• It provides learning opportunities for students
• Helps address questions of interest to agencies
• Supports capacity building
CAPACITY BUILDING - CONSULTATION
• Assistance in development of logic model
• Problem-solving related to evaluation infrastructure and protocols
• Development and piloting of evaluation instruments for DAC/MPP
- Client satisfaction survey
- Self-sufficiency assessment
RESEARCH/EVALUATION PROJECTS
• Evaluation of unique contribution of mentor parent program
‒Qualitative interviews/surveys with stakeholders
‒Client satisfaction and client engagement surveys
• Evaluation of outcomes
‒Re-unification and re-entry
‒ Increase self-sufficiency
• Website: https://sites.google.com/a/sjsu.edu/cw-part/
THEORY: EXCERPTS FROM MPP “LOGIC MODEL”
SHORT-TERM OUTCOMES
•Engagement and retention in DWC
•Engagement in MPP support services
•Access to treatment and other services
LONG-TERM OUTCOMES
• Successful reunification at MPP program completion
• Reduction in recurrence of maltreatment/ reduced days in foster care
• Long-term sobriety
INTERIM OUTCOMES
• Increased self-sufficiency in recovery, legal status, social support, and other life domains
• Engagement in self-help/recovery
• Abstention/ reduction in substance abuse
ILLUSTRATION: MEASURING SELF-SUFFICIENCY PROJECT
• Identification of domains through focus groups with Mentor Parents
• Pilot adapted version of Self-Sufficiency Matrix
• Report back and feedback on challenges, and/or discoveries in administering the Self-Sufficiency Matrix
SELF-SUFFICIENCY MATRIX FINDINGSBaseline Scores Post scores
(12 months)
Self-Sufficiency Domains Mean (SD) Mean (SD) p-value
Housing 1.55 (0.85) 3.47 (1.39) <.001
Employment 1.09 (0.39) 2.16 (1.29) <.001
Mobility (transportation) 1.34 (0.60) 2.69 (1.42) <.001
Life Skills 2.39 (1.09) 4.00 (1.02) <.001
Family/Social Relations 2.22 (1.04) 3.66 (1.07) <.001
Community Involvement 1.87 (0.88) 3.71 (0.96) <.001
Parenting Skills 1.93 (1.08) 3.78 (0.94) <.001
Legal 2.84 (1.49) 3.77 (1.28) <.004
Substance Abuse 2.38 (1.43) 4.56 (0.88) <.001
HIGHLIGHTS OF PARTNERSHIP OUTCOMES
• Documentation of MPP impact on DWC engagement and increased self-sufficiency
• Documentation of relationship between MPP participation/contact hours and reunification
• Evaluation findings used in report to funders
• Parallel consultation to address data collection instruments and infrastructure with DWC; influencing practice in other therapeutic courts
BOTTOM LINE – SKILLS BUILDING
• Create visibility with your mentors. What committees can they sit on? Who should they meet with? Where does policy get decided?
• Who can the mentors train? Social workers? Judges? Team members? Increases visibility of the program and establishes support from stakeholders.
• Evaluate your program. What do you want to measure? How will you measure it? What data do you need to collect? Who can help you get that data?
• Create mutually beneficial partnerships to sustain program. Which university / college / community college is near you? Is there a school of social work near you?
• Have both hard data to back up your program and a mentor to publicly share their story: a winning combination for potential funders.
CONTACT INFORMATION
Hilary Kushins, MSW, JDDependency Advocacy CenterDrug Court and Training Programs Manager111 W. Saint John Street, Ste. 333CSan Jose, CA 95113Phone: (408) [email protected]
Q&A AND DISCUSSION
COMPLETE YOUR EVALUATION
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Session SB-23
Children & Family FuturesNADCP | July 2015
Children and Families
Family Drug Courts
Stronger Together
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2015
1. Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers
2. Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals
3. Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Legal Professionals
Please visit: http://www.ncsacw.samhsa.gov/
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Resources
Family Drug Court Online Tutorial
FDC 101 – will cover basic knowledge of the FDC model and operations
Jane Pfeifer, MPASenior Program AssociateChildren and Family Futures(714) [email protected]
Contact Information