2018 Annual LADCP Training Conference

Transcription

1 2018 Annual LADCP Training Conference April 4, 2018 New Orleans, LA Working Together Differently

2 Working Together Differently What is it going to take? To better serve more children and families Ensure best practices Systems Change

3 Big 7 - Key Ingredients for an Effective Family Drug Court Improving Family Outcomes Strengthening Partnerships Family Drug Courts Phil Breitenbucher, MSW Director, Family Drug Courts Programs Center for Children and Family Futures

4 U.S. Department of Justice Office of Justice Programs Office of Juvenile Justice and Delinquency Prevention working for youth justice and safety Acknowledgement This presentation is supported by: Grant #2016-DC-BX-K003 awarded by the Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice. This project was supported by Grant #2016-DC-BX-K003 awarded by the Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this publication/program/exhibition are those of the author(s) and do not necessarily reflect those of the Department of Justice. ojjdp.gov

5 Our Mission To improve safety, permanency, well-being, and recovery outcomes for children, parents, and families affected by trauma, substance use, and mental health disorders.

6 Center for Children and Family Futures Initiative Inventory National FDC Training and TA Program Statewide System Improvement Program Prevention and Family Recovery Program National Center on Substance Abuse and Child Welfare Children Affected by Methamphetamine In-Depth Technical Assistance (IDTA) Quality Improvement Center for Collaborative Community Court Teams Research and Evaluation Regional Partnership Grants Rounds I-4 Peer Learning Court Program Funded by OJJDP Funded by DDCF and TDB Substance-Exposed Infants IDTA Funded by ACF/CB, SAMHSA Funded by ACF/ACYF, CB

7 Session Format Closer Look FDC Ingredients (7) Best Practice Highlights Learning Exchange Discussion Highlight Resources

8 The Need to Do Better for Families Substance use disorders (SUDs) can negatively affect a parents ability to provide a stable, nurturing home and environment. Most children involved in the child welfare system and placed in out-of-home care have a parent with a SUD (Young, Boles & Otero, 2007). Families affected by parental SUDs have a lower likelihood of successful reunification with their children, and their children tend to stay in the foster care system longer than children of parents without SUDs (Gregorie & Shultz, 2001). The lack of coordination and collaboration across child welfare, substance use disorder treatment and family or dependency drug court systems has hindered their ability to fully support these families (US Depart. of Health and Human Services, 1999).

9 7 System of identifying families Timely access to assessment and treatment services Increased management of recovery services and compliance with treatment Improved family-centered services and parent-child relationships Increased judicial oversight Systematic response for participants contingency management Collaborative non-adversarial approach grounded in efficient communication across service systems and court Sources: 2002 Process Evaluation and Findings from 2015 CAM Evaluation

10 How are they identified and assessed? How are they supported and served? How are cases and outcomes monitored?

11 7 System of identifying families Timely access to assessment and treatment services Sources: 2002 Process Evaluation and Findings from 2015 CAM Evaluation

12 Most sit on top of an unchanged system Separate from larger system As a marginal reform strategy Where Do FDCs Fit in the Larger System?

13 Timely and structured screening and identification of parental substance use in child welfare cases is critical. 61% of confirmed drug or alcohol dependence among substantiated abuse or neglect cases are missed by front line CWS social workers (Gibbons, Barth, & Martin, 2005) There is no time to lose given the ASFA, recovery, and development time clocks

14 Who Do FDC s Work For?

15 Risk and Need Assessment Risk is the likelihood and imminence of risky behavior (e.g., abuse, neglect, other criminal behavior) Risk factor is something related to the behavior that precedes it (and you can use to predict it) Risk Assessment is a process of using risk factors to estimate the likelihood (i.e. probability) of an outcome in a particular population (Kraemer et al., 1997) Note: A risk assessment should be more than scoring an instrument Should inform likelihood, case planning, and risk management Needs Assessment Specifically clinical assessment of substance or mental health disorders

16 Central 8 Risk Factors 1. Criminal History 2. Antisocial Attitudes 3. Antisocial Personality 4. Peer Associations 5. School/Employment 6. Substance Use Disorder 7. Living Situation 8. Family/Marital Age Disabilities Parent STATIC Parent/Child DYNAMIC Child risk factors for abuse STATIC Predict recidivism for BOTH: Child abuse/neglect Criminal behavior Clients have a variety of needs: Subset of risk factors Dynamic, live, and changeable Criminogenic Needs

17 Static Versus Dynamic Risk Factors (Criminogenic Needs) Static risk factors are the most predictive but by definition cannot change and do not inform case planning Examples: age at first use, current age (younger), number of prior allegations, parent abused as a child Dynamic risk factors can change, do inform case planning, and improve prediction above solely static risk factors Examples: antisocial peers, living situation, domestic violence, extent and nature of substance use, employment, school Important to be aware: engagement in the child welfare system actually predicts MORE abuse most likely due to increased attention and reporting by case workers

18 Studies show equivalent or better outcomes: Co-occurring mental health problems Unemployed Less than a high school education Criminal history Inadequate housing Risk for domestic violence Methamphetamine, crack cocaine, or alcohol Prior CWS history Who Do FDC s Work For? (e.g., Boles & Young, 2011; Carey et al. 2010a, 2010b; Worcel et al., 2007)

19 The Adoption and Safe Families Act The Adoption and Safe Families Act ASFA (PL ) Time Clock (PL )

20 Conflicting Timetables Child Welfare 12-month timetable for reunification Parent-Child Relationship attachment, loss, and separation Treatment and Recovery ongoing process that may take longer

21 What Do We Mean by Systematic Approach? Objective & Systematic Subjective & Informal Clearly defined protocols and procedures, with timelines and communication pathways (who needs to know what and when) Eligibility criteria based on clinical and legal assessments Match appropriate services to identified needs I refer all my clients to FDC because I know the people there I only refer clients who really want to participate Let me know when you get in the program I prefer to refer clients who are doing well on their CWS case plan I refer all my clients with a drug history to the FDC

22 Referral into CWS Hotline What Do We Mean by Timely? A Model for Early Identification, Assessment, and Referral CWS Safety and Risk Assessment Referral to FDC or Appropriate LOC Detention Hearing Jurisdictional- Dispositional Hearing AOD Screening & Assessment Typical Referral to FDC or Other LOC Warm Hand-off (at multiple points) Status Review Hearing

23 Percent Reductions in Recidivism 50% 40% 30% 20% 10% Drug Courts in Which Participants Entered the Program Within 50 Days of Triggering Event Had 63% Greater Reductions in Recidivism 0% 39% Participants enter program within 50 days of arrest N=15 24% Participants enter program within 50 days of arrest N=26 Note: Difference is significant at p<.05

24 Best Practice Highlight For quality implementation Use of standardized tools Integrated cross-system approach

25 Process Screening Primary Question Tools Is substance use a factor? Yes or No? UNCOPE, CAGE Assessment How severe is the substance use disorder? DSM-5 Criteria Treatment Does level of treatment match the identified need? ASAM Continuum of Care

26 70 60 PARENTAL AOD AS REASON FOR REMOVAL IN THE US PERCENT U.S. National Maine UNCOPE Oklahoma UNCOPE Great variability across states ranging from <10% to over 60% Source: AFCARS Data, Source: AFCARS Data Files

27 Levels of Treatment Services Across A Continuum of Care Early Intervention Services Intensive Outpatient Medically Managed Intensive Inpatient Outpatient Services Residential Source: American Society of Addiction Medicine, 2016

28 Diagnosing Substance Use Disorders The FDC should ensure that structured clinical assessments are congruent with DSM-5 diagnostic criteria Experimental Use DSM-5 NO USE USE/MISUSE MILD MODERATE SEVERE DSM-5 Criteria (11 total)

29 7 System of identifying families Timely access to assessment and treatment services Increased management of recovery services and compliance with treatment Sources: 2002 Process Evaluation and Findings from 2015 CAM Evaluation

30 Better Outcomes for Children and Families: Ensure parents enter substance use disorder treatment quickly, ideally within days of child welfare petition (Green et al., 2007) Retain high-need parents in treatment for at least 15 months (Green et al., 2007; Roche, 2005; Worcel et al., 2007)

31 Time To & Time In Treatment Matters In a longitudinal study of mothers (N=1,911) Entered substance use disorder treatment faster after their children were placed in substitute care Stayed in treatment longer Completed at least one course of treatment Significantly more likely to be reunified with their children Source: Green, Rockhill & Furrer (2007)

32 Best Practice Highlight For quality implementation Recovery Coaches or Recovery Specialists to provide enhanced early recovery support and engagement

33 Functions of Recovery Support LIASON 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

34 Titles and Models Peer Mentor Peer Specialist Peer Providers Parent Partner Experiential Knowledge, Expertise Recovery Support Specialist Substance Abuse Specialist Recovery Coach Recovery Specialist Parent Recovery Specialist Experiential Knowledge, Expertise + Specialized Trainings What does our program and community need?

35 Median Length of Stay in Most Recent Episode of Substance Use Disorder Treatment After RPG Entry by Grantee Parent Support Strategy Combinations No Parent Support Strategy Intensive Case Management Only Intensive Case Management and Peer/ Parent Mentors Intensive Case Management and Recovery Coaches Median in Days

36 70% 60% 50% 40% 30% 20% 10% 0% Substance Use Disorder Treatment Completion Rate by Parent Support Strategies 46% 46% No Parent Support Strategy Intensive Case Management Only 56% Intensive Case Management and Peer/ Parent Mentors 63% Intensive Case Management and Recovery Coaches

37 Recovery Support Matters A Randomized Control Trial Cook County, IL (n=3440) Timely Comprehensive Assessment Early access to treatment Ryan, Perron, Moore, Victor, Park, (2017) Timing matters: A randomized control trial of recovery coaches in foster care, Journal of Substance Abuse Treatment

38 Recovery Support Matters A Randomized Control Trial Cook County, IL (n=3440) Timely Comprehensive Assessment Recovery Coach Early access to treatment Ryan, Perron, Moore, Victor, Park, (2017) Timing matters: A randomized control trial of recovery coaches in foster care, Journal of Substance Abuse Treatment

39 Practice Innovation: Recovery Support Alameda, CA: All petitions reviewed for substance use by specialized trained court clerks Recovery Support Specialist attends hearings Engagement at the earliest point improves treatment outcomes

40 Drug Courts That Required Greater Than 90 Days of Abstinence Had 3 Times Greater Reduction in Recidivism and Substantial Cost Savings % Reductions in Recidivism 40% 30% 20% 10% 0% 37% Participants are clean at least 90 days before graduation N=57 14% Participants are clean LESS THAN 90 days before graduation N=9 Note: Difference is significant at p<.05

41 SAMHSA s Working Definition What Is Recovery? Recovery is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. Recovery is not treatment! Access to evidence-based substance use disorder treatment and recovery support services are important building blocks to recovery.

42 Health Overcoming or managing one s disease(s) or symptoms and making informed, healthy choices that support physical and emotional wellbeing Four Major Dimensions Home Maintaining a stable and safe place to live Purpose Conducting meaningful daily activities, such as a job, school, or volunteerism, and having the independence of income and resources to participate in society Community Having relationships and social networks that provide support, friendship, love, and hope

43 Effective Substance Use Disorder Treatment National al Institute on Drug Abuse, 2012 Is readily available Attends to multiple needs of the individual Versus a singular focus on the substance use Uses engagement strategies to keep clients in treatment Uses counseling, behavioral therapies In combination with medications if necessary Addresses co-occurring conditions Uses continuous monitoring

44 Resource: Quality Treatment Assessment Designed to help CWS and Court professionals increase their knowledge of effective treatment Part 1: Overview of Effective Treatment provides a brief summary of principles of effective substance use disorder treatment and comprehensive family-centered care. Part 2: Discussion Questions Professionals can use questions to begin ongoing dialogue with community treatment providers about operations and services. These questions will help professionals gain a better understanding of available treatment in the community and how it may (or may not) align with their clients needs.

45 Drug Courts That Used One or Two Primary Treatment Agencies Had 76% Greater Reductions in Recidivism Fewer treatment providers is related to greater reductions in recidivism > 10 Number of agencies % reduction in recidivism Note: Difference is significant at p<.05

46 Length of Stay in Treatment Why It Matters Research shows that clients with severe substance use disorders require three months (90 days) in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment For families involved in child welfare due to a parent s substance use disorder, treatment retention and completion are the strongest predictors of reunification Green, Rockhill, & Furrer, 2007; Marsh, Smith, & Bruni, 2010

47 FTC Participants Spent Significantly Longer in Treatment Average Number of Days in Treatment Graduates CAM Comparison YEAR 2 YEARS 3 YEARS Number of Years from CAM Entry

48 FTC Participants Were Significantly More Likely to Complete Treatment Percent of Individuals with Successful Treatment Completion 100% 75% 50% 25% 0% Graduates CAM 87% 83% 77% 68% 58% 42% 31% 30% 23% 1 YEAR 2 YEARS 3 YEARS Number of Years from CAM Entry

49 Drug Courts That Require a Minimum of 12 Months Length of Stay Had Double the Cost Savings % Increase in Cost Savings 29% LOS 12 Months or Greater N = 43 13% LOS Less Than 12 Months N=10 Note: Difference is significant at p<.1

50 View the Recorded Webinar! Includes Team Discussion Guide! Visit:

51 7 System of identifying families Timely access to assessment and treatment services Increased management of recovery services and compliance with treatment Improved family-centered services and parent-child relationships Sources: 2002 Process Evaluation and Findings from 2015 CAM Evaluation

52 Relationships Child wellbeing occurs in the context of relationships Adult recovery should have a parent-child component

53 FDC Practice Improvements Approaches to child well-being in FDCs need to change In the context of parent s recovery Child-focused assessments and services Familycentered treatment (includes parentchild dyad)

54 Parent-Child: Key Service Components Developmental & behavioral screenings and assessments Quality and frequent visitation Early and ongoing peer recovery support Parent-child relationship-based interventions Evidence-based parenting Trauma Community and auxiliary support

55 Best Practice Highlight For quality implementation Implement parent-child services (parenting, therapeutic, attachment based) Ensure frequent and quality parenting time

56 Considerations for Selecting a Parenting Program Have you conducted a needs assessment? What do families need? How will it help achieved desired outcomes? Have realistic expectations of their ability to participate - especially in early recovery? Does it have a parent-child component? Is it evidence-based for this population? Do you have staffing and logistical support for successful implementation?

57 Parenting Programs Specific to Families Affected by Substance Use Disorders Celebrating Families - Strengthening Families - Nurturing Program for Families in Substance Abuse Treatment and Recovery - Please visit: California Evidence-Based Clearing House - National Registry of Evidence-Based Programs and Practices -

58 Facilitating Quality Parenting or Family Time Parenting time or Family time (vs. visitation) Visitations as a right and need (vs. reward, incentive) Frequency and duration guided by the needs of the child and family (vs. capacity of CWS, logistics) Concrete feedback on interaction (vs. observation, surveillance) Permanency as the goal (vs. good visits) Is the visitation plan moving family closer to achieving reunification? Are real-life parenting and reasons for removal being addressed? Collaboration and communication with family, treatment providers, service providers, and foster parents

59 Better Outcomes for Children and Families: Provide parenting classes that teach participants effective child caretaking, supervision, and disciplinary skills (Carey et al., 2012) Provide specialized services for families affected by methamphetamine, including neuropsychological testing and individualized educational plans for children, in-home support services for parents, and parentchild interaction therapy (Kissick et al., 2015) Administer evidence-based family counseling

60 View the Recorded Webinar!! Visit:

61 7 System of identifying families Timely access to assessment and treatment services Increased management of recovery services and compliance with treatment Improved family-centered services and parent-child relationships Increased judicial oversight Systematic response for participants contingency management Sources: 2002 Process Evaluation and Findings from 2015 CAM Evaluation

62 Better Outcomes for Children and Families: Schedule frequent status hearings o Judicial Officer or Administrative Review Ensure judges speak directly to participants in court Treats them with respect and dignity Expresses support and optimism for their recovery Lloyd, M.H., et al., 2014; Somervell et al., 2005; Worcel, et al., 2007

63 The judge was the single biggest influence on the outcome, with judicial praise, support and other positive attributes translating into fewer crimes and less use of drugs by participants (Rossman et al., 2011) Positive supportive comments by judge were correlated with few failed drug tests, while negative comments led to the opposite (Senjo and Leip, 2001) The ritual of appearing before a judge and receiving support and accolodes, and tough love when warranted and reasonable, helped them stick with court-ordered treatment (Farole and Cissner, 2005, see also Satel 1998)

64 Best Practice Highlight For quality implementation Strategic use of judicial interaction Deliver range of responses to behavior

65 Percent Reduction in Recidivism Drug Courts That Held Status Hearings Every 2 Weeks During Phase 1 Had 50% Greater Reductions in Recidivism 50% 40% 30% 20% 10% 0% 46% Drug court has review hearings every two weeks N=14 31% Drug court has review hearings more or less often N=35 Note: Difference is significant at p<.1

66 Drug Courts That Have Judges Stay Longer Than 2 Years Had 3 Times Greater Cost Savings 30% Percent Increase in Cost Savings 20% 10% 25% 8% 0% Judge is on bench at least 2 years Judge is on bench LESS THAN 2 years Note: Difference is significant at p<.05

67 Judges Who Spent at Least 3 Minutes Talking to Each Participant in Court Had More Than Twice the Savings Percent Reduction in Recidivism 50% 40% 30% 20% 10% 0% 43% Judge spends at least 3 min. per participant N=23 17% Judge spends LESS THAN 3 min. per participant N=12 Note: Difference is significant at p<.05

68 Drug Courts Where the Judge Spends an Average of 3 Minutes or Greater per Participant During Court Hearings had 153% Greater Reductions in Recidivism Note 1: Difference is significant at p<.05

69 Addiction is a brain disorder The longer time in treatment, the greater probability of a successful outcome Purpose of sanctions and incentives is to keep participants engaged in treatment

70 Consistent for individuals similarly situated (phase, length of sobriety time) Avoid singular responses, which fail to account for other progress Aim for flexible certainty

71 Timing is everything; delay is the enemy Intervening behaviors may mix up the message Brain research supports behavioral observation; dopamine reward system responds better to immediacy

72 Drug Testing Drug testing is most frequently used indicator for substance use in CWS practice Indicate whether an individual has used a tested substance within a detectable time frame A drug test alone cannot determine the existence and severity of a substance use disorder, child safety, or parenting capacity

73 40% Drug Courts Where Drug Tests Are Collected at Least Two Times per Week in the First Phase Had a 61% Higher Cost Savings Percent Increase in Cost Savings 30% 20% 10% 29% 18% 0% Participants drug tested at least 2X per week N=53 Participants tested LESS often than 2X per week N=12 Note: Difference is significant at p<.15 (Trend)

74 Drug Courts Where Drug Test Results are Back in 48 Hours or Less had 68% Higher Cost Savings 40% Percent Increase in Cost Savings 30% 20% 10% 32% 19% 0% Drug tests are back within 48 hours N=21 Drug tests are back in LONGER THAN 48 hours N=16 Note: Difference is significant at p<.05

75 7 System of identifying families Timely access to assessment and treatment services Increased management of recovery services and compliance with treatment Improved family-centered services and parent-child relationships Increased judicial oversight Systematic response for participants contingency management Collaborative non-adversarial approach grounded in efficient communication across service systems and court Sources: 2002 Process Evaluation and Findings from 2015 CAM Evaluation

76 Best Practice Highlight For quality implementation Ensure information flow within FDC Team and Governance Structure Develop data dashboard/ Monitor case and program outcomes

77 The Collaborative Structure for Leading Change Oversight/Executive Committee Steering Committee FDC Team Membership Director Level Information flow Management Information Level flow Front-line staff Meets Quarterly Monthly or Bi-Weekly Weekly or Bi-Weekly Primary Functions Ensure long-term sustainability and final approval of practice and policy changes Remove barriers to ensure program success and achieve project s goals Staff cases; ensuring client success

78 FDC Team Membership Meets Primary Functions Front-line staff Weekly or Bi-Weekly Staff cases; ensuring client success

79 Family Drug Courts: The Core Team Child Welfare Substance Use Disorder Treatment Court Screen for substance use and refer to services Coordination with ongoing dependency cases Monitor and report on progress of clients and compliance with case plan Perform assessments Develop treatment plans Provide substance use disorder treatment that matches client need Monitor and report on treatment progress of clients Judicial Oversight Referral mechanism: Attorney, CASA, Coordinator Client advocacy and legal guidance FDC program oversight and coordination

80 Steering Committee Membership Management Level Meets Monthly or Bi-Monthly Primary Functions Remove barriers to ensure program success and achieve project s goals

81 Five Standing Agenda Items for Steering Committee Meetings 1. Data dashboard 2. Systems barriers 3. Funding and sustainability 4. Staff training and knowledge development 5. Outreach efforts

82 Oversight/Executive Committee Membership Meets Primary Functions Director Level Quarterly or Semi-Annually Ensure long-term sustainability; review and use data reports; give final approval of practice and policy changes

83 % Reduction in # of Rearrests Drug Courts Where Treatment Communicates with the Court via had 119% Greater Reductions in Recidivism Yes N=31 Treatment communicates with court via No N=14 Note: Difference is significant at p<.10

84 Drug Courts That Used Paper Files Rather Than Electronic Databases Had 65% LESS Savings Percent Increase in Cost Savings 40% 30% 20% 10% 0% Program uses paper files N=8 20% 33% Program has electronic database N=3 Note: Difference is significant at p<.05

85 Drug Courts That Required All Team Members to Attend Staffing Had 50% Greater Reductions in Recidivism and 20% Greater Savings Percent Reduction in Recidivism 50% 40% 30% 20% 10% 0% 42% All team members attend staffings N=31 28% All team does NOT attend staffings N=28 Note 1: Difference is significant at p<.05 Note 2: Team Members = Judge, Both Attorneys, Treatment Provider, Coordinator

86 Systems Walk-Through Screening Assessment Referral Monitoring

87 Data Dashboard What needles are you trying to move? What outcomes are the most important? Is there shared accountability for moving the needle in a measurable way, in FDC and larger systems? Who are we comparing to?

88 Total number of cases that resulted in investigation and those with a screening Number and percentage of parents referred for assessment Number and percentage who received an assessment Number and percentage referred to treatment and FDC Number and percentage admitted (attended at least one session) to treatment and to FDC Number and percentage in treatment for at least 90 days Drop-Off Points Number and percentage completing treatment Payoff Number and Percentage Reunified / Remained at Home 96

89 Drug Courts Where Review of the Data and Stats Has Led to Modifications in Drug Court Operations Had a 131% Increase in Cost Savings Percent Increase in Cost Savings 40% 30% 20% 10% 37% 16% 0% Program reviews their own stats N=20 Program does NOT review stats N=15 Note: Difference is significant at p<.05

90 Drug Courts Where the Results of Program Evaluations Have Led to Modifications in Drug Court Operations Had a 100% Increase in Cost Savings 50% Percent Increase in Cost Savings 40% 30% 20% 10% 0% 36% Used evaluation to make modifications to program N=18 18% Did NOT use evaluation to make modifications N=13 Note: Difference is significant at p<.05

91 Q&A and Discussion

92 Contact Information Improving Phil Breitenbucher, Family MSW Director, FDC Outcomes TTA Program (714) Strengthening Partnerships Acknowledgement This presentation is supported by: The Office of Juvenile Justice Improving and Delinquency Prevention Office Family of Justice Programs Outcomes (2016-DC-BX-K003) Strengthening Partnerships Points of view or opinions expressed in this presentation are those of the presenter(s) and do not necessarily represent the official position or policies of OJJDP or the U.S. Department of Justice.