Meeting the Needs of Families in the Child Welfare System Affected by Substance Use Disorders" New England Practice & Policy Kick-Off Webinar September 30, 2014 1:00-2:30 PM (Eastern)
National Center on Substance Abuse and Child Welfare Established in 2002 A national resource center providing information, expert consultation, training and technical assistance to child welfare, dependency court and substance abuse treatment professionals to improve the safety, permanency, well-being and recovery outcomes for children, parents and families
Today s Kick-Off Webinar National perspective of the issues facing child welfare, substance abuse treatment and the courts Regional initiatives launched in the New England region Results from a regional survey to highlight challenges and opportunities of New England states Training and technical assistance resources, including upcoming Webinar Series
Sara J. Becker, PhD New England Addiction Technology Transfer Center Brown University
Current Network Mission Raise awareness of evidencebased and promising treatment and recovery practices Build knowledge and skills to prepare the workforce to deliver state-of-the-art addictions treatment and recovery services Change practice by incorporating these new skills into everyday use for the purpose of improving treatment and recovery outcomes Build alliances among diverse clinicians, researchers, policy makers, funders, and recovery community
National Perspective Nancy K. Young, PhD Director National Center on Substance Abuse and Child Welfare
1997 Adoption and Safe Families Act
5 National Reports There are common issues 1998
A Multifaceted Problem that Needs a Collaborative Solution 1. Differences in values and perceptions of primary client 2. Timing differences in service systems 3. Knowledge gaps 4. Lack of tools for effective engagement in services 5. Intervention and prevention needs of children 6. Lack of effective communication 7. Data and information gaps 8. Categorical and rigid funding streams as well as treatment gaps Summary of 5 National Reports: http://www.ncsacw.samhsa.gov/resources/national-reports.aspx
10 Report to Congress Five National Goals Established 1999
1. Building collaborative relationships 2. Assuring timely access to comprehensive substance abuse treatment services 3. Improving our ability to engage and retain clients in care and to support ongoing recovery 4. Enhancing children s services 5. Filling information gaps 11 Five National Goals Established Blending Perspectives and Building Common Ground (Report to Congress in response to ASFA)
Development of Models Testing Solutions National Center on Substance Abuse and Child Welfare Regional Partnership Grants 2007-2012 - 53 Grantees 2012-2017 - 17 Grantees 2014-2019 - 4 Grantees Children Affected by Methamphetamine 12 Family Drug Courts 2002 2007 2010
8.3 million children * 2002 2007 SAMHSA National Survey on Drug Use and Health (NSDUH)
Statement of the Problem How many children in the child welfare system have a parent in need of treatment? Between 60 80% of substantiated child abuse and neglect cases involve substance use by a custodial parent or guardian (Young, et al, 2007) 61% of infants, 41% of older children who are in out-of-home care (Wulczyn, Ernst and Fisher, 2011) 87% of families in foster care with one parent in need; 67% with two (Smith, Johnson, Pears, Fisher, DeGarmo, 2007)
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Parental AOD As Reason For Removal 2012 70 60 National Average: 30.5% Source: AFCARS Data, 2012 50 46 40 30 20 10 33 23.9 5.4 26.4 12.3 0
Parent and Number of Children with Terminated Parental Rights by Reason for Removal - 2012 Neglect (n=76,374) Parent Alcohol or Drug Abuse (n=42,085) Parent Unable to Cope (n=25,417) Physical Abuse (n=19,659) Inadequate Housing (n=17,713) Parent Incarceration (n=8,273) Abandonment (n=7,434) Child Behavior (n=7,387) Sexual Abuse (n=6,150) Child Alcohol or Drug Abuse (n=3,237) Child Disability (n=5,237 Relinquishment (n=1,974) Parent Death (n=1,187 NE States National Source: AFCARS 2012
Regional Perspective
Regional Partnership Grants (RPG) Lund Family Center (RPG) Commonwealth of Massachusetts (RPG, RPG 2 YR Extension and RPG II) - Family Recovery Project Families And Children Together (RPG II) Penquis Regional Linking Project Children's Friend and Service (RPG) - Project Connect
In-Depth Technical Assistance (IDTA) Adopted Family Engagement Program to improve referral, engagement and retention in substance abuse treatment and other services for child welfare involved families. Adopted UNCOPE as universal screening tool for early identification of parental substance use in child welfare involved families Recovery Specialist Voluntary Program (RSVP) Implemented highly effective Recovery Specialist Voluntary Program (RSVP) for parents who have had a child removed and need support for recovery from drug and/or alcohol abuse
Family Drug Courts (FDCs) Caledonia County Family Treatment Court (3) Adroscoggin Family Drug Court Kennebec Family Dependency Treatment Court Penobscot Family Drug Treatment Court (1) Source: National Association for Drug Court Professionals, 2014 (1) Rhode Island Dependency Treatment Court
We are learning more about improving CHILD and FAMILY OUTCOMES
Focus on parent recovery, engagement and completion of treatment Regional Partnership Grant Programs Grantees stressed the importance of key supportive services to help parents achieve sustained recovery and to reunify with their children. RPG adults accessed treatment quickly: Within 13 days of entering the RPG program, on average 36.4% entered treatment within 3 days Remained in treatment a median of 4.8 months 65.2% stayed in treatment more than 90 days 45.0% completed treatment
Children kept safe Regional Partnership Grants 92.0% of children who were in the custody of their parent or caregiver at the time of RPG program enrollment remained at home through RPG program case closure. The percentage of children who remained at home significantly increased through program implementation from 85.1% in Year 1 to 96.4% in Year 5. Within the first six months following RPG Program enrollment, 95.8% of children experienced no maltreatment.
Children return home and remain at home Safety and Permanency Outcomes (Median Performance) Percentage of Children who had Substantiated Maltreatment within Six Months after RPG Program Enrollment (N=22,558) Discharge to Reunification Median Length of Stay in Foster Care (N=3,340) Percentage of Children Reunified in Less than 12 Months (N=3,627) Percentage of Children Reunified who Re-entered Foster Care in Less than 12 Months (N=3,575) Discharge to Finalized Adoption Median Length of Stay in Foster Care (N=418) Children in RPG Program State Contextual Data 4.2% 5.8% 9.5 months 7.5 months 63.6% 69.4% 5.1% 13.1% 24.2 months 29.3 months
Common Challenges
In which state to you work? (N=63) 53.3% (n=32) 7.1% (n=4) 1.7% (n=1) What is your area of primary responsibility? Child Welfare 50.0% (29) Substance use treatment 19.6% (12) Court, juvenile justice 10.9% (6) Mental health treatment 8.9% (5) Adolescent health 1.8% (1) Other 3.6% (2) 8.3% (n=5) 1.7% (n=1) 28.3% (n=17) What is your role within your organization?) Administrator/Executive leadership 37.3% (22) Manager or Clinical supervisor 32.2% (19) Frontline Clinical Staff/Direct Service 16.9% (10) Judicial Officer, Attorney 1.7% (1) Other: Planner, Contractor, Government 11.9% (7)
In your region, what are the top three general areas of greatest training need? Please select three responses. (N=63) Collaboration across systems (e.g. CWS, AOD, Courts) Retention and engagement of families in treatment Evidence-based interventions for families affected by SUDs 67.2% (N=41) 65.6% 63.9% (N=40) (N=39) Budgeting for and sustaining new initiatives Substance use screening and assessment Tracking and measuring family outcomes 32.8% (20) 32.8% (20) 26.3% (15) Other 3.3% (2) Assessing impact of parental substance abuse on children, especially infants and those under 5 throughout involvement. Budgeting for sufficient staff and services to respond to increased need. Cross training of DCF and providers. All of those, truly!
In your region, what are the top three special topic areas of greatest training need? Please select three responses. (N=63) Trauma-informed approaches to care Opioid abuse and medicationassisted treatment Transition-age youth; aging out of the system 70.5% (N=43) 59.0% (N=36) 52.5% (N=32) Substance-exposed newborns 37.7% (23) Prescription drug abuse 26.2% (16) Minority and underserved populations 17.5% (10) Parental custody rights 13.1% (8) Medicaid/ACA implementation 9.8% (6) Other 8.2% (5) How to assess child safety related to substance abuse/reunification Training and support for foster parents who are asked to care for children impacted by parental substance abuse. CBT skills training for providers Diagnosis Screening and treatment for adolescents
Is there anything else you would like to share about your region s training needs? (Optional) Training being more of a priority We have experienced a large increase in child fatalities and near fatalities associated with opioid use. We feel that we need to review and refine our protocols for safety and risk assessment. Adolescent marijuana and other drug use in RI is extremely high given our small population. There are very few Chemical Dependency Professionals and fewer professionals trained in co-occurring disorders. Agencies have very few staff development dollars available to support training. Everything listed is extremely important. This area is vastly underserved in Rhode Island. The effects that final parity rule/law will have on treatment options
NCSACW Resources and Tools
Cross-System Collaboration Includes collaborative practices and tools for linking substance abuse, child welfare, and family courts. Collaborative Practice Model Matrix of Progress Collaborative Values Inventory Collaborative Capacity Instrument Please visit our resource page: https://www.ncsacw.samhsa.gov/collaboration/default.aspx
Collaborative Values Inventory (CVI) Questionnaire to assess how much a group shares a about the values that underlie its work. Collaborative Capacity Instrument (CCI) Self-assessment by AOD, CWS, and Courts preparing for collaboration Please visit our resource page: http://www.ncsacw.samhsa.gov/improving/improving-linkages-2.aspx
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: www.ncsacw.samhsa.gov National Center on Substance Abuse and Child Welfare Online Tutorials 35
Client Screening, Assessment, Engagement & Retention Please visit our resource page: https://www.ncsacw.samhsa.gov/resources/daily-practice-client.aspx
Resource: Substance Abuse Specialist in Child Welfare Agencies and Dependency Courts 6 State Case Studies To download a copy, please visit: http://www.ncsacw.samhsa.gov/files/substanceabusespecialists.pdf
Resource: Drug Testing in Child Welfare: Practice and Policy Considerations To download a copy, please visit: http://www.ncsacw.samhsa.gov/files/drugtestinginchildwelfare.pdf
Resource: Substance-Exposed Infants: State Responses to the Problem To download a copy, please visit: http://www.ncsacw.samhsa.gov/files/substance-exposed-infants.pdf
Resource: Screening and Assessment for Family Engagement, and Recovery (SAFERR) To download a copy, please visit: http://www.ncsacw.samhsa.gov/files/saferr.pdf
Medication-Assisted Treatment Webinar Series Medication Treatment for Families Affected by Substance Abuse Disorders Please visit: http://www.cffutures.org/presentations/webinars/ category/medication-assisted-treatment-series-mat http://www.cffutures.org/presentations/webinars/ opioid-use-pregnancy-community%e2%80%99sapproach-children-and-recovering-mothers-cha Medication-Assisted Treatment During Pregnancy, Postnatal, and Beyond Opioid Use in Pregnancy: A Community s Approach, The Children and Recovering Mothers (CHARM) Collaborative
Just Released! Assists behavioral health professionals in understanding the impact and consequences for those who experience trauma Discusses patient assessment, treatment planning strategies that support recovery, and building a trauma-informed care workforce To download a copy, visit: http://store.samhsa.gov/shin/content//sm A14-4816/SMA14-4816.pdf
Resources - Transition-Age Youth National Collaborative on Workforce and Disability Policy Brief - http://www.ncwdyouth.info/policy-brief-02 New England Resources: Rhode Island - Adolescent Health Care Transition Program - Office of Special Healthcare Needs at the Dept. of Health: http://www.health.ri.gov/programs/adolescenthealthcaretransition/ Massachusetts - Department of Mental Health Transition Age Youth (TAY) Initiative http://www.mass.gov/eohhs/gov/departments/dmh/transitional-age-youth-initiative.html Connecticut - Dept. of Mental Health & Addictions Services - Young Adult Services Division http://www.ct.gov/dmhas/cwp/view.asp?q=334784 Vermont - Vermont Family Network - resource guide for transition age youth with mental health or substance use issues: http://www.vermontfamilynetwork.org/wp-content/uploads/2012/12/resource-guide-for- Parents-of-Transition.pdf Maine - Maine Youth Transition Collaborative website - http://maine-ytc.org/ New Hampshire - Dept. of Health and Human Services - Young Adult Resource Guide: http://www.dhhs.state.nh.us/dcyf/documents/youngadult.pdf
Introduction The Webinar Series
Webinar #2 Screening and Assessment for Family Engagement and Retention and Recovery Date: TBD
Webinar #3 Conducting Trauma-Informed Systems Assessment Date: TBD
Q&A and Discussion
Contact Information Nancy K. Young, PhD Executive Director National Center on Substance Abuse and Child Welfare nkyoung@cffutures.org (714) 505-3525 Sara J. Becker, PhD New England Addiction Technology Transfer Center Brown University sara_becker@brown.edu (401) 863-6604