National Center on Substance Abuse

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1 National Center on Substance Abuse and Child Welfare Bringing Systems Together for Family Recovery, Safety and Stability September 24, 2009 Presented by: Cathleen Otero, MSW, MPA Deputy Director, NCSACW 1,000 Children 750 Parents 60% of Parents Need Assessment % Go for Assessment % Need Treatment % Go to First Session 90 30% Complete 90 Days - 30 Dropoff Points 50% Reunify - 15 Frequently Cited Barriers Differences in values and perceptions of primary client Timing i differences in service systems Knowledge gaps among staff working in the systems Lack of tools for effective engagement in services Intervention and prevention needs of children Lack of effective communication Data and information gaps Categorical and rigid funding streams as well as services and treatment gaps 3 Suggested Strategies Develop principles for working together Create on-going dialogues and efficient communication Develop cross-training opportunities Improve screening, assessment and monitoring practice and protocols Develop funding strategies to improve timely treatment access Expand prevention services to children Develop improved cross-system data collection 4 1

2 Developing knowledge and providing technical assistance to federal, state, local agencies and tribes to improve outcomes for families with substance use disorders in the child welfare and family court systems A Program of the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment and the Administration on Children, Youth and Families Children s Bureau Office on Child Abuse and Neglect NCSACW Goals Navigating the Pathways Published by CSAT To improve outcomes for families by promoting effective practice, and organizational and system changes at the local, state, and national levels To develop and implement a comprehensive program of information gathering and dissemination To provide technical assistance A framework for defining elements of collaboration To define linkage points across systems: where are the most important bridges we need to build? Methods to assess effectiveness of collaborative work To assess differing values To assist sites in measuring their implementation 2

3 Collaborative Practice and Policy Tools Ten Element Framework A method to organize collaborative activities in specific practice and policy areas Elements of System Linkages The Ten Key Bridges Mission 1. Underlying Values and Priorities Collaborative Values Inventory An anonymous way to explore values and beliefs to facilitate the development of common principles using web based data collection Collaborative Capacity Instrument An anonymous way to assess the strengths and challenges in each of the areas of system linkages using web based data collection Matrix of Progress in System Linkages A practice based approach that specifies characteristics of advance collaboration practice in the elements of system linkages 2. Screening and Assessment 6. Information Systems Children, Family, Tribal, and Community Services 3. Engagement and Retention 7. Training and System Tools System Elements 4. Services for Children 8. Budget and Sustainability 5. Community and Family Support 9. Working with Other Agencies Screening and Assessment for Family Engagement, Retention and Recovery SAFERR A guidebook to develop effective communication across systems while engaging families in services Outcomes 10. Shared Outcomes and Systems Reforms TEXT PAGE Objectives Technical Assistance Technical Assistance To share knowledge across systems the three systems: substance abuse, child welfare, dependency court To promote understanding of cross systems issues and to advance cross-system collaboration To increase awareness and adoption of cross systems approaches To facilitate communication across systems To improve outcomes for children and adults Collaboration practice and policy tools Information and sharing of models Expert consultation and research Development of issue-specific products Monographs, white papers, fact sheets Training resources On-line courses, training materials Longer-term strategic planning and development of protocols and practice models

4 Technical Assistance Technical Assistance Information and Sharing of Models Materials Publications Referrals to experts Peer to peer consultation Involves identifying and using existing knowledge, materials, products, and resources Collectingand disseminating information from sites who have implemented practice and policy changes Expert Consultation and Research Background research/data analysis Conference calls with expert consultants Analyzing CCI/CVI scores Annotated bibliography and custom literature searches Compiling resources and data on specific topics (e.g. peer mentors, methamphetamine) Development of Issue Specific Products Materials Publications Referrals Involves identifying and using existing knowledge, materials, products, and resources Collectingand disseminating information from sites Training and Facilitation Group Facilitation Conference Presentation Legislative or commissioner hearings or meetings On site training Web based training courses with CEUs Training curricula and materials Technical Assistance Regional Partnership Grants and In-Depth Technical Assistance Sites In-Depth Technical Assistance In Depth Technical Assistance Application and acceptance process 15 month program facilitated by a Consultant Liaison Sets priorities for practice and policy changes Develops protocols and implementation plans 15 Tribal Governments County Government Regional Partnership Grantee 4

5 National Center on Substance Abuse and Child Welfare Technical Assistance Resources 2. Screening and Assessment Elements of System Linkages The Ten Key Bridges Mission 1. Underlying Values and Priorities Children, Family, Tribal, and Community Services 3. Engagement and Retention 4. Services for Children 5. Community and Family Support 6. Information Systems 7. Training and System Tools System Elements 8. Budget and Sustainability 9. Working with Other Agencies Outcomes 10. Shared Outcomes and Systems Reforms Underlying Values and Principles of Collaboration Collaborative Capacity Instrument Collaborative Values Inventory Synthesis of Cross System Values and Principles: A National Perspective IDTA Memoranda of Understanding and statements of shared values and principles Screening, Assessment, Engagement and Retention Screening and Assessment for Family Engagement, Retention ti and Recovery (SAFERR) IDTA protocols & engagement resources Substance Abuse Specialists in Child Welfare Agencies and Dependency Courts: Considerations for Program Designers and Evaluators Utilizing Drug Testing in the Context of Child Welfare (in development) 5

6 Screening and Assessment for Family Engagement, Retention and Recovery Screening and Assessment for Family Engagement, Retention and Recovery (SAFERR) Provides screening and assessment tools Includes guidelines for communication and collaboration across the systems responsible for helping families Assists with developing cross-system communication protocols Services to Children, Working with Related Agencies and Building Community Supports Substance Exposed Infants: State Responses SAFERR Appendix on screening and assessment tools for children and youth IDTA Parent Partner program materials Family Centered Treatment for Women with Substance Use Disorders TEXT PAGE Services to Children Multiple Opportunities for Intervention Commonly noted consequences for children Fetal Alcohol Syndrome (FAS) Alcohol-related neuro-developmental disorders (ARND) Physical health consequences Lack of secure attachment Psychopathology Behavioral problems Poor social relations/skills Deficits in motor skills Cognition and learning disabilities Child 4. Ensure infant s safety and respond dto infant s needs 5. Identify and respond to the needs of Infant Preschooler Child Adolescent Policy and Practice Framework: Five Points of Intervention 1. Pre-pregnancy awareness of substance use effects 2. Prenatal screening and assessment 3. Identification at Birth System Linkages System Linkages Initiate enhanced prenatal services Parent Respond to parents needs Identify and respond to parents needs TEXT PAGE 6

7 Training and Staff Development Training and Staff Development NCSACW online tutorials Participant workbooks and supervisor handbooks IDTA State examples of training initiatives The Child Welfare-Substance Abuse Connection: A Compendium of Training Curricula and Resources Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Legal Professionals New! Participant workbooks and supervisor handbooks developed by the State of Utah Online Training Implementing Online Tutorials I have completed the tutorial training, and utilized the information to help educate new child protective service workers. The information is very useful, understandable, and very specific to the issues and concerns that child welfare workers will encounter, and how these should be handled. -Direct Service Provider Available at no charge at TEXT PAGE Available for free PDF download at TEXT PAGE 7

8 On-Line Training Available at no cost Upon completion of the tutorial: Certificate awarded CEUs and CLEs are available Visit Training and Related Products Understanding 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 Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Legal Professionals 29 Training and Staff Development Substance Use Disorders, Mental Disorders and Co-Occurring Disorders Training i Package (in development) State Legislator information resources webpages (in development) Budgeting and Program Sustainability White Paper on Funding Comprehensive Services for Families with Substance Use Disorders in Child Welfare and Dependency Courts Funding Family-Centered Treatment for Women With Substance Use Disorders Detailed tables of Federal funding sources for comprehensive services Sustainability discussion guide for Regional Partnership Grants IDTA State strategic plans for continued efforts Joint Accountability, Shared Outcomes and Information Systems SAFERR communication protocols IDTA State communication protocols and examples of data system improvements A Review of Alcohol and Drug Issues in the States' Child and Family Service Reviews and Program Improvement Plans 8

9 Joint Accountability, Shared Outcomes and Information Systems How Do I Access Technical Assistance? Guide to Cross-System Data Sources for State and Tribal Child Welfare, Substance Abuse Treatment, and Court Systems (In Development) May 16, 2008: Connecting the Dots: How States and Counties Have Used Existing Data Systems to Create Cross System Data Linkages com/webinars shtml#may16 Visit the NCSACW website for resources and products at us at ncsacw@cffutures.org RPG report on cross-system indicators and data sources 9

10 Bringing Systems Together for Family Recovery, Safety, and Stability Working together. Whether you work in Child Welfare, Substance Abuse Treatment, or the Courts, it takes everyone working together to improve outcomes for families affected by substance use disorders. Learning together. Understanding each system s practices and procedures and learning to speak each other s languages will help everyone work together more effectively for the benefit of families. We can help. The National Center on Substance Abuse and Child Welfare offers technical assistance, training, and informational tools to support your efforts to collaborate. To find out more: Visit our Web site at U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Administration for Children and Families

11 Look What NCSACW Has to Offer u Web Site with Information, Resources, and Materials u Consultation on Building Collaboration among Substance Abuse Treatment, Child Welfare Agencies, and the Court Systems u Free Accredited Online Courses for Professionals Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Child Welfare Professionals Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Legal Professionals Collaboration in Action. Child welfare, substance abuse treatment and court professionals in States, Tribes, Counties, and communities across the country are coming together on behalf of families. They are: Developing Memoranda of Understanding and shared values statements to guide their collaboration Putting screening and assessment protocols in place to enhance parent engagement and retention in services Identifying the special needs of children affected by substance abuse Creating data systems and information sharing protocols that can support crosssystem case management Finding creative ways to fund comprehensive family centered services. Visit our Web site at to review examples of these and other available tools.

12 Framework and Policy Tools for Improving Linkages Between Alcohol and Drug Services, Child Welfare, and Dependency Courts The ultimate goal of the professionals who work with children and families affected by substance use disorders and involved in the child welfare system is to facilitate positive outcomes for these families. Ideally, the parent will receive effective treatment for the substance use disorder so that the child can remain with the parent, while the well-being of the child is fully supported throughout the parent s recovery process. Achieving this outcome requires intensive collaboration by multiple agencies working with the family. NCSACW helps child welfare agencies, substance abuse treatment providers, and dependency courts to establish cross-system collaboration that sets the stage for positive outcomes. To carry out this work, NCSACW has developed a ten-element framework for collaboration and a set of three policy tools that support the framework. The Framework: Ten Elements of System Linkages For cross-system collaboration to be effective and sustainable, each system child welfare, substance abuse treatment, and the courts must be engaged in each of these ten areas: Underlying values and principles of collaborative relationships Daily practice: client screening and assessment Daily practice: client engagement and retention in care Daily practice: services to children of substance abusers Joint accountability and shared outcomes Information sharing and data systems Budgeting and program sustainability Training and staff development Working with related agencies Working with the community and supporting families Why Are these Ten Factors Important? Underlying values and principles of collaborative relationships The partners in cross-system collaboration must create effective relationships with one another. The values held at the organizational level and by individual participants affect the likelihood of agreement on critical issues. The discussion of values is the cornerstone of a collaborative relationship. Daily practice in AOD screening and assessment Each of the collaborating agencies must be aware of screening and assessment issues. Relevant agencies must determine whether the parent has a substance abuse problem, assess the nature of the problem and the most effective treatment, and determine what information should be communicated to the other agencies. Daily practice in engaging and retaining parents Each of the collaborating agencies has the opportunity to encourage the parent to stay in the recovery process and meet the requirements imposed on them. Many obstacles confront parents who want to keep their families together while they deal with substance abuse. Judges can respond in a way that supports continued engagement in recovery and the court process; the parent s attorney can make sure the parent knows the consequences of their actions. Daily practice in services to children A family systems approach is necessary when substance abuse services are provided to parents with children in the child welfare system. A parent s substance use disorder has a tremendous impact on the children, who need continuing skilled support. When residential care is warranted, it must be a priority to 1

13 keep parents and their children together, if appropriate. Without effective intervention, the children of substance abusers may repeat the parent s pattern. The special needs of children of substance abusers must be addressed in prevention and intervention programs. Joint accountability and shared outcomes The collaborative partners need to establish joint accountability and agree upon goals. The outcomes that they develop together guide the work of the collaborative; they demonstrate that the collaborative has achieved interagency agreement on desired results. Without agreement on shared outcomes, each of the partners is likely to measure its own progress as it did prior to collaboration, focused on its own perspective. Shared information systems Shared information is the prerequisite for joint accountability. Joint information systems form the basis of communicating across systems and are necessary to track progress toward shared goals. Effective communication and information sharing provide the guideposts that gauge the effectiveness of the collaborative s programs. Budgeting and program sustainability The collaborative partners must tap the full range of funding resources available to the state or community so that it can develop stability over time for its innovative approaches. Training and staff development Cross-training at all levels administrative, management, and line-level staff is essential to ensuring cooperation between key players in the systems. Working with other agencies Many parents with alcohol and other drug problems also require the assistance of services other than substance abuse and child welfare to address the complex issues affecting their families. The primary partners must form relationships with mental health, domestic violence, primary health, housing, legal, and employment-related services. Working with the community and supporting families Community-based organizations have been shown to be great resources. They can mobilize community members and have a role in preventing child abuse and substance abuse, as well as providing on-going support after formal services have ended. Policy Tools The Matrix of Progress in Building Linkages Among Alcohol and Drug Agencies, Child Welfare Services, and the Dependency Court is a tool for assessing collaboration across systems. The Matrix of Progress identifies benchmarks for improving the system linkages by specifying the fundamentals of improved practice, good practice, and best practice for each of the ten elements in the framework. The Collaborative Values Inventory (CVI) is a questionnaire that serves as a neutral, anonymous way of assessing how much a group shares the values that underlie its work. The CVI is designed to identify issues that may not be raised if the collaborative begins its work together without clarifying the underlying values of its members. The Collaborative Capacity Instrument (CCI) is a self-assessment tool designed to elicit intra- and interagency discussion about progress in addressing specific issues and about prioritizing programs and policy plans. Screening and Assessment for Family Engagement, Retention, and Recovery (SAFERR) provides guidance for using efficient screening and assessment tools and communication strategies that support sound and timely decisions about the safety of children and about the treatment and recovery of parents. It also includes methods for developing collaborative relationships between the systems to help improve outcomes for these families. These tools are available on the Children and Family Futures website ( for use by States and communities. This Framework and Policy Tools was published in the SAMHSA Publication No.SMA , Navigating the Pathways: Lessons and Promising Practices in Linking Alcohol and Drug Services With Child Welfare, Technical Assistance Publication (TAP) Series #27, April

14 Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers Discusses the relationship of alcohol and drugs to families in the child welfare system Provides information on the biological, psychological, and social processes of alcohol and drug addiction to help staff recognize when substance abuse is a risk factor in their cases Describes strategies to facilitate and support alcohol and drug treatment and recovery Available Online View or download Understanding Substance Abuse and Facilitating Recovery at the NCSACW website: PHD1092 Order Free Copies You may order printed copies of Understanding Substance Abuse and Facilitating Recovery from: National Clearinghouse for Alcohol and Drug Information Call , or online at Select Quick Find and Order, inventory number PHD1092 Child Welfare Information Gateway Call , or online at Click on Online Catalog, select Title Index, and click on U National Center on Substance Abuse and Child Welfare fax ncsacw@cffutures.org A service of the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT) and the Administration on Children, Youth and Families (ACYF) Children's Bureau, Office on Child Abuse and Neglect (OCAN).

15 Screening and Assessment for Family Engagement, Retention and Recovery (SAFERR) Presents the SAFERR model for helping staff of public and private agencies respond to families affected by substance use disorders Provides screening and assessment tools to help caseworkers make sound, timely decisions about the safety of children Includes guidelines for communication and collaboration across the systems responsible for helping families Download SAFERR or Order Free Copies Download a PDF copy from Order printed copies from: National Clearinghouse for Alcohol and Drug Information - Call and ask for SAFERR, SMA , or - Order online at - click on Quick Find & Order and type Screening in the Title box Child Welfare Information Gateway - Call and ask for SAFERR, SMA , or - Order online at - click on Online Catalog, select Title Index, and click on S Publication Number SMA National Center on Substance Abuse and Child Welfare fax ncsacw@cffutures.org A service of the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT) and the Administration on Children, Youth and Families (ACYF) Children's Bureau, Office on Child Abuse and Neglect (OCAN).

16 ANNOUNCING TWO NEW ONLINE RESOURCES FROM THE CENTER FOR SUBSTANCE ABUSE TREATMENT Family-Centered Treatment for Women with Substance Use Disorders History, Key Elements and Challenges This monograph introduces the concepts and evolution of the field in providing a family-centered treatment approach for women and their families. It examines the role of family in the context of treatment for women and addresses the treatment needs of children and the inclusion of fathers, husbands, and other family members in treatment planning. The discussion includes key principles, components of service needs, modalities of treatment delivery, and challenges and solutions to establishing and operating family-centered treatment programs. Funding Family-Centered Treatment for Women with Substance Use Disorders This resource paper is a companion to the Family-Centered Treatment monograph and assists treatment providers and State substance abuse agencies to identify and access potential sources of funding for comprehensive familycentered treatment. The paper includes definitions of funding terminology and current methods of advanced cross-system funding strategies. Highlights of the experiences and insights of one organization, SHIELDS for Families, in developing an effective comprehensive services financing strategy are provided. Finally, concrete steps on getting started and recommendations for treatment providers and State agencies are provided. Both papers can be downloaded from the CSAT Treatment Improvement Exchange (TIE) Website at