Helping them get ready: Active client engagement through a Recovery Support Specialist in a Family Drug Court

Transcription

1 Helping them get ready: Active client engagement through a Recovery Support Specialist in a Family Drug Court Presented by: The Family Recovery Program, Inc. Dr. Jocelyn Gainers, CAC-AD, AS Executive Director Dr. Tara Doaty-Mundell, Clinical Supervisor

2 Learning Objectives: Increase participant knowledge surrounding roles and responsibilities of a Recovery Support Specialist. Increase participant understanding of the variety of tasks that a Recovery Support Specialist performs to support program engagement efforts. Increase participant identification and implementation of evidenced-based and trauma-informed strategies used by Recovery Support Specialists for client engagement and retention. Introduce and implement The Family Recovery Program s Six-Steps to Support Client Engagement and Retention for clients preparing to enter FTC, preparing to embark in an abstinent lifestyle, and plan for long-term reunification.

3 The History of The Family Recovery Program, Inc.

4 The Family Recovery Program, Inc. A Brief History 2005-Visit to a family dependency court in San Diego California Pilot Program-2 Case Managers /Judge Martin Welch presiding Voluntary Program- One year in length Public and Private funding Staff of 24 Independent non-profit as of 11/2012 National Peer Learning Court FTC DC Child and Family Services Administration Parent Mentors Peer Recovery Advocates Partnerships Policy Team Cross System Training Housing Programs Barrier busters Transportation Education Housing Documents Employment Childcare

5 Services Provided Intensive substance abuse case management 24 hour drug treatment referral and placement Immediate supportive housing through local recovery housing providers Onsite licensed Mental health clinician, Psychiatrist and Nurse through Hope Health Systems, Inc. Immediate transportation assistance through local cab company and bus tokens Assistance with Medications Onsite evidence based parenting programs Random drug testing Incentive Store Referrals to agencies focused on client life improvement Comprehensive reports for the court and other partners Weekly hearings before Judge Robert Kershaw On-site active Alumni Group and other supportive groups On-site educational opportunities Peer Recovery Advocates CASA-Court Appointed Special Advocates Opportunity!

6 Who do we serve? (Baltimore City FRP) Parents of children ages 0-10 that have been removed by the Baltimore City Department of Social Services. Children have to be drug-exposed or there must be a showing of neglect due to the parents substance abuse. Parents may be referred in at the Emergency Shelter hearing, Preliminary hearings, Adjudication/Disposition hearings, Initial 6-Month reviews, FRP Friday court hearings and up until the 10 month Permanency Planning hearing. Horizon Program- Non-court involved program however clients must be referred through DSS and have substance abuse concerns.

7 Who do we serve? ( DC Family Treatment Court) Parents, ages 18 and older, with children age 0-18 who have never been adjudicated neglected Agree to enter FTC at the disposition hearing Have a substance-related child welfare allegation in the current petition and stipulate to such allegation Non-custodial parents with a substance abuse problem that impacts their ability to parent, and agree to such finding by the Court and be a custodial option for the child named in the petition

8 FRP Staff Baltimore City Family Recovery Program 6 Certified Addictions Counselors 2 Trainees Resource Coordinator DC Family Treatment Court 4 Recovery Specialists 1 Recovery Specialist Supervisor Peer Recovery Advocate/Re-engagement Specialist Data Specialist 2 Parent Mentors Clinical Supervisor Specimen Collectors Support Staff

9 Funding Sources The Maryland Opportunity Compact Department of Human Resources Office of Problem Solving Courts DC Child and Family Services Foster Care Court Improvement Project The Krieger Fund Governor s Office of Crime Control and Prevention

10 The Roles and Responsibilities of a Recovery Support Specialist

11 The Roles & Responsibilities of the Recovery Support Specialist Utilizes a trauma-informed approach Coordinates services with partner agencies Accompanies clients to court appointments, meetings with the Department of Social Services Monitors client compliance and progression through FTC, drug treatment, and mental health treatment

12 Parent Engagement Barriers

13 Intrapersonal Parent Barriers to FTC Engagement Interpersonal Sociocultural Structural Systemic CENTER FOR SUBSTANCE ABUSE TREATMENT, 2009

14 Barriers to Engagement (females) High levels of shame associated with their drug use Initiated into drug use by their partners More likely to have co-occurring psychiatric disorders Child rearing responsibilities Limited incomes, education, job skills Social ties

15 Health problems Intrapersonal barriers Psychological issues Cognitive functioning Motivational status Treatment readiness

16 Understanding client development

17 Activity I: Decisional Balancing Exercise Created to assist the client with analyzing the pros and the cons associated with entering treatment or not entering treatment. Counselors are more likely to discover barriers Can be used for looking at the benefits and costs of two sides of any argument. CUNNINGHAM ET AL., 2006

18 Interpersonal barriers Relational issues (significant relationships) Family dynamics Support systems

19 Understanding Client Relationships

20 Sociocultural barriers Cultural differences (norms and expectations) Racism Bias Disparities Societal attitudes Attitudes of providers

21 Structural barriers Program characteristics (policies and procedures) Program design Program restrictions

22 Safety Incorporating a Trauma-Informed Approach Trustworthiness and Transparency Peer support Collaboration and mutuality Empowerment, voice and choice Cultural, Historical, and Gender Issues SAMHSA, 2010

23 Systemic Barriers Larger systems (Federal, state and local agencies) policies and laws Health insurance companies Economy Drug trafficking patterns

24 Healing Neen

25 Engagement Strategies & Efforts

26 Engagement strategies & efforts Employing a Recovery Perspective Adopting a Multi-Problem Viewpoint Implementing a Phased Approach to Treatment Addressing Specific Real-Life Problems Early in Treatment CENTER FOR SUBSTANCE ABUSE TREATMENT, 2005

27 Engagement strategies & efforts Plan for Client Barriers Utilize Support Systems Quality of counselor-client relationship Authentic care CENTER FOR SUBSTANCE ABUSE TREATMENT, 2009

28 Recovery is: A Recovery Perspective Long-term process of internal change Internal change occurs through several stages of change CENTER FOR SUBSTANCE ABUSE TREATMENT, 2005

29 Adopt a Multi-Problem Viewpoint Substance Abuse Parenting Mental Health Education Employment Legal Housing Support Systems CENTER FOR SUBSTANCE ABUSE TREATMENT, 2005

30 Develop a phased approach to treatment Engagement Stabilization Treatment Continuing Care (Aftercare) CENTER FOR SUBSTANCE ABUSE TREATMENT, 2005

31 Address specific real-life problems Early Identification Intensive Services Specialized Interventions Education & Development of Problem Solving Skills CENTER FOR SUBSTANCE ABUSE TREATMENT, 2005

32 Self-Motivating Statements Cognitive recognition of the problem Affective expression/concern about the problem A direct intention to address the problem Optimism about ability to change the problem CENTER FOR SUBSTANCE ABUSE TREATMENT, 2009

33 Intensity of Services Plan for Barriers Length of Services Time to Treatment CENTER FOR SUBSTANCE ABUSE TREATMENT, 2009

34 Utilization of Support Systems Mutual Self-Help Movement Building Community CENTER FOR SUBSTANCE ABUSE TREATMENT, 2009

35 FRP s Six Steps to Support Client Engagement & Retention

36 FRP s Six Steps to Support Client Engagement & Retention Listen Learn Collaborate Connect Implement Evaluate

37 Listen Reflective Listening Asking Relevant Questions Use of Healthy Communication Strategies I feel Statements

38 Learn Client identifies personal strengths & triggers Ability to devise and implement a plan for highlighting strengths Ability to devise and implement a plan for addressing challenges (triggers)

39 Collaborate Formation & Implementation of Recovery Services Plan with client Peer Support Opportunities

40 Comprehensive Case management Comprehensive case management helps bridge the gap between services and agencies Services need to match the clients needs rather than force the client to fit into the specific services offered by the agency. Outreach Needs assessment Planning and resource identification Service linkages Monitoring and ongoing assessment Client advocacy

41 Connect Matched Service Providers Accountability of Client and Recovery Specialist Inclusion of Family & Sober Living Activities

42 Creation of Realistic Timeframes Implement Supporting Client throughout each Stage of Change Informing Partner Providers

43 Evaluate Creation of Check-In Agenda Assessment of Client Progress & Feedback Identification of Additional Supports Needed

44 Organizational processes that improve engagement Case managers should follow up with clients who don t show for scheduled appointments Providing peer mentors Ensuring that clients are scheduled for an appointment in a timely manner Promote parent centered care Use evidence based practices Reduce waiting time between request for service and first contact

45 Why is this the most important time?

46 Key engagement milestones Initial staff interaction Pre-program engagement Contingency management WISDOM, HOFFMAN ET AL., 2009

47 References Cunningham JA, Sobell LC, Gavin DR, Sobell MB, Breslin FC. Assessing motivation for change: Preliminary development and evaluation of a scale measuring the costs and benefits of changing alcohol or drug use. Psychology of Addictive Behaviors. 1997;11(2): Center for Substance Abuse Treatment. Comprehensive Case Management for Substance Abuse Treatment. Rockville, MD: Substance Abuse and Mental Health Services Administration; 1998a. Treatment Improvement Protocol (TIP) Series 27. HHS Publication No. (SMA) Morgenstern J, Blanchard KA, McCrady BS, McVeigh KH, Morgan TJ, Pandina RJ. Effectiveness of intensive case management for substance-dependent women receiving temporary assistance for needy families. American Journal of Public Health. 2006;96(11): Wisdom, Hoffman, Rechberger, Seim, & Owens (2009) Women focused treatment agencies and process improvement: Strategies to increase client engagement. Women & Therapy, 32,