Bringing Systems Together to Promote Family Recovery: In-Depth Technical Assistance (IDTA) The National Conference on Substance Abuse, Child Welfare and the Courts September 14-16, 2011 National Harbor, MD Cathleen Otero, MSW, MPA Linda Carpenter, M.Ed. Christine S. Kiesel, Esq. Robert M. Long, L.C.P.C., L.A.D.C., C.C.S. Peter Panzarella, MS, MS, LADC, LPC Agenda National Center on Substance Abuse and Child Welfare (NCSACW) In-Depth Technical Assistance (IDTA) Lessons from the Field: State of Maine State of New York State of Connecticut Discussion 4940 Irvine Blvd., Suite 202 Irvine, CA 92620 714-505-3525 ncsacw@cffutures.org www.ncsacw.samhsa.gov 2 Children and Family Futures (CFF) Technical Assistance Programs National Center on Substance Abuse and Child Welfare (NCSACW) Technical Assistance Overview Children and Family Futures (CFF) Cathleen Otero SAMHSA & ACYF National Center on Substance Abuse and Child Welfare ACYF Regional Partnership Program DOJ Office of Juvenile Justice and Delinquency Prevention In Depth Technical Assistance Children Affected by Methamphetamine http://www.cffutures.org 1
US DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Administration for Children and Families www.samhsa.gov NCSACW In-Depth Technical Assistance Sites (IDTA) NCSACW Children Affected by Methamphetamine Sites (CAM) Children s Bureau Regional Partnership Grants (RPG) OJJDP Family Drug Courts (OJJDP) A Program of the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment and the RPG Sites (53Sites) Array of Services (11) Child Focused (8) Administration i ti on Children, Youth and Families Children s Bureau Office on Child Abuse and Neglect Drug Courts (10) System-Wide Collaboration (9) Treatment Focused (9) Tribal (6) NCSACW CAM Sites (12) NCSACW IDTA Sites (20 Sites) 16 States 3 Tribal Communities 2 Counties OJJDP Grantees (22 Sites) FY 2009 (14 ) FY 20100 (8) Sites 6 Levels of Technical Assistance Technical Assistance Level One: Information and Sharing of Models 1471 requests Level Two: Expert Consultation and Research 415 requests Level Three: Development of Issue- Specific Products 366 requests Level Four: Strategic Planning, Training Resources and Facilitation 20 States 3 Tribes 3 Counties 65 Grantees 10 Pre-IDTA September 2002 through September 2010 7 Objectives 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 8 2
Types of TA Products Collaborative Practice and Policy Tools Collaborative 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 and collaborative at facilitation On-line courses, training materials Longer-term strategic planning and development of protocols and practice models 9 Ten Element Framework A method to organize collaborative activities in specific practice and policy areas 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 10 To Obtain a copy and for a presentation on the full SAFERR model: To obtain a copy and to view presentations on the issue of Substance- Exposed Infants: http://www.ncsacw.samhsa.gov/improving /daily-practice-client.aspx http://www.ncsacw.samhsa.gov/resources /substance-exposed-infants.aspx http://www.cffutures.org/presentations p 3
NEW! Child Welfare Training Toolkit 6 modules, each containing: Trainer Script PowerPoint Presentation Handouts Case Vignettes Available at NO CHARGE http://www.ncsacw.samhs a.gov/training/default.asp x http://womenandchildren.treatment.org/documents/final_funding_paper_508v.pdf http://womenandchildren.treatment.org/documents/family_treatment_paper508v.pdf Family Centered Treatment for Women with Substance Use Disorders Webinar: http://www.cffutures.org/webinars/family-centered-treatment-women-substance-usedisorders Online Training Resources All trainings are 1) Available at no cost, 2) Issued a Certificate of Completion and 3) Eligible for CEUs 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 In-Depth Technical Assistance (IDTA) Overview Linda Carpenter 4
IDTA Goal IDTA Sites, N=21 To work with state, tribal, local child welfare, substance abuse, and dependency court professionals to improve outcomes for families that are affected by substance use disorders and involved in the child welfare system by: Facilitating cross-system collaboration Developing effective policy, practice and organizational changes TEXT PAGE What is IDTA? Team Structure and Functions OVERSIGHT COMMITTEE IDTA is: 18-month program facilitated by a Consultant Liaison (CL) Application and acceptance process CORE TEAM IDTA can: Set priorities for practice and policy changes Use data to inform policy and practice changes Identify expected outcomes and how they will be measured Develop protocols and implementation plans ADVISORY COMMITTEE Scope of Work to Achieve Priority Outcomes NCSACW VIA CONSULTANT WORKGROUP WORKGROUP WORKGROUP WORKGROUP 5
Summary of Products Developed from IDTA Strategic Planning Interagency Agreements Cross-system s stem Shared Values and Guiding Principles Communication Protocols Self-Assessment Tools Logic Models Evaluation Plans Best Practice Tool Kits and Compendiums Screening, Assessment and Collaborative Practice Protocols Multi-system Training Plans Project Marketing Materials Lessons from the Field: State of Maine Bob Long Administrator for Access, Substance Abuse, and Outcome Management Services Kennebec Behavioral Health For sample products: http://www.ncsacw.samhsa.gov/technical/idta.aspx 21 Developing a System for Universal Substance Abuse Screening and Assessment for Families Referred to Child Welfare The Maine Experience The Foundation Some Facts No Safe Haven: Children of Substance-Abusing Parents (CASA Report-1/1999) While parents abuse alcohol and other drugs at lower rates than do persons without children, 11% of US children (8.3mil. persons) live with at least one parent who is either alcoholic or in need of treatment for the abuse of illicit drugs. (DHHS Report to Congress on Substance Abuse and Child Protection-4/1999) 6
The Foundation Some Facts Most studies find that for between 1/3 and 2/3 of children involved with the child welfare system; parental substance abuse is a contributing factor. (DHHS Report to Congress on Substance Abuse and Child Protection-4/1999) The Foundation Some Facts The final report of Maine s Commission on Child Abuse in November, 2000 recommended building collaborative relationships to address the interconnected issues of child abuse and neglect, domestic violence and substance abuse and addiction The abuse of alcohol, tobacco, and illicit drugs is the nation s number one health problem. (Robert Wood Johnson Report- 2/2001) The Foundation Events In January 2001, five year old Logan Marr was in custody of the Department of Health and Human Services (DHHS) because of substantiated child welfare allegations involving substance abuse by a parent. Tragically, she died while living in a DHHS foster home. The Foundation Events At the same time, a study commissioned by the state's Office of Substance Abuse (OSA) showed early detection and intervention resulted in better substance abuse treatment outcomes. This prompted OSA to engage the Muskie School's Institute of Child and Family Policy to undertake the Substance Abuse and Protocols Project. 7
The Foundation Events In March 2001, the project issued a preliminary i report that concluded one of the key factors in effective and efficient substance abuse services is found in appropriate and reliable screening and evaluation and the project could not find a common standard or process of substance abuse screening and evaluation. The Foundation Events The report recommended that As part of developing practice protocols, the two departments should develop a system that provides reliable, clear and uniform methods for screening and evaluating substance abuse. The Vehicle SA/CW Committee The Vehicle SA/CW Committee In November 2001, the Office of Substance Abuse (OSA) and the Department of the Human Services (DHS) established the Substance Abuse and Child Welfare Committee. The creation of this committee represented a commitment from the top administrators responsible for substance abuse and child welfare to develop a uniform system of screening and assessment. In addition to their support, this initiative was endorsed by the Legislature's Health and Human Services Committee. The commitment of elected officials and top administrators, combined with the participation of leading professionals in substance abuse and child welfare, simultaneously gave the committee creditability and access to decision- makers. Since this Committee was established, DHHS and OSA have been merged into one agency called the Department of Health and Human Services (DHHS). 8
Screening Early on, the Committee established criteria that reflected the necessary components of a screening tool. DHHS staff supported a uniform screening process, but insisted the tool be brief, reliable, and that it requires minimal training. Through the course of examining various screening tools and models for systems collaboration, the Committee undertook various initiatives. Screening Ultimately, the Committee decided to adopt the UNCOPE, a six question tool developed by Norman Hoffman, PHD of Evince Clinical Assessments. The instrument, while not having been used extensively in child welfare situations, met the committee's objective of using a tool that was short and easy to administer yet valid and reliable. Assessment/Evaluation In 2004 & 2005, the committee began addressing the issues related to substance assessment and evaluation outlined in the Substance Abuse and Protocols Project s March 2001 preliminary report. Based on the project s recommendation to establish a more consistent substance abuse assessment process for cases involving child abuse, the committee developed report guidelines for substance abuse assessment and evaluation. Assessment/Evaluation The combination of having a uniform screening tool and a common assessment process would address two key elements outlined in the preliminary report. 9
Assessment/Evaluation In 2005-2006, 2006, assessment, evaluation, and report writing activities were conducted using the guidelines were piloted by small group providers with established relationships with several of the DHHS district offices. Parents involved with Maine DHHS- Child Protective Services were referred based on the UNCOPE assessment process. Screening/Assessment/Evaluation The State of Maine was invited to attend the IDTA Cross Site Meeting sponsored by the National Center on Substance Abuse and Child Welfare (NCSACW), held in Sacramento, CA in March 2006. Screening/Assessment/Evaluation The IDTA from NCSACW resulted in: expanding the Committee membership to include the courts, other providers, training institutes, and tribal representatives mapping the first 30 days of a child welfare referral to identify specific linkage points between the child welfare, substance abuse, and the courts, and implementing a universal substance abuse screening in family assessments. Screening/Assessment/Evaluation In July of 2007, with technical assistance from NCSACW, the committee issued a report- Universal Substance Abuse Screening for Families in the Child Welfare System. The report provided a description of the process, policy, and practice requirements for implementing universal screening for substance abuse in all families referred to the child welfare system and the availability of the specialized substance abuse & child welfare assessment & evaluation. 10
Screening/Assessment/Evaluation The Committee s July 2007 report also outlined lessons learned, and identified next steps. In 2008, the committee decided to develop statewide network of willing providers to use the guidelines and provide the eight Maine DHHS districts with the specialty substance abuse/child welfare assessment, evaluation, and report. Screening/Assessment/Evaluation In 2009, the committee in conjunction with DHHS established the Families Affected by Substance Abuse (FASA) and established a process for identifying, training, and managing a FASA provider network. This included developing protocols related to referrals to the network, reimbursement, and quality assurance, and sustainability. Next Steps In 2010, the committee began to address issues related to the abuse of and addiction to prescription medications. In addition, the committee instituted an initiative related to understanding the various aspects of Medication Assisted Therapy (M.A.T.), primarily related to methadone and suboxone. Next Steps In 2011, the committee is beginning i to review the initiatives developed and implemented over the past three years in relation to sustainability. This will include establishing areas of responsibility within DHHS regarding managing and maintaining the: UNCOPE Screening and Referral process, FASA Provider Network, and developing a compliance and quality assurance process related to the elements outlined in the Memo of Understanding. 11
Conclusion Maine has a system for universal substance abuse screening and assessment of families referred to its DHHS- Child Protective Services and Community Intervention Program (CIP) Services The road to developing this system was filled with twists t and turns. Successfully navigating through these required: persistence, tenacity, strategic initiatives, ongoing collaboration, and adequate good fortune. Lessons Learned The lessons learned in Maine may assist other jurisdictions in their own planning efforts to improve outcomes for children and families affected by the impact of the misuse, abuse, dependence and addiction to a variety of ever evolving substances of abuse. These lessons will be the focus of a workshop to be presented today that will also include information related to the UNCOPE screening and referral process, the report guidelines for substance abuse assessment and evaluation, the FASA provider network, medication assisted therapy, and sustainability. Contact Information Bob Long Administrator for Access, Substance Abuse, and Outcome Management Services Kennebec Behavioral Health 66 Stone Street Augusta, Maine 04330 Phone-(207)-626-3455 Ext 2000 E-mail-blong@kbhmaine.org Lessons from the Field: New York State: Partnership for Family Recovery Christine Sabino Kiesel, Esq. Assistant Coordinator NYS Child Welfare Court Improvement Project 12
A Partnership Between 2006- New York State selected for In-Depth Technical Assistance (IDTA) from the National Center on Substance Abuse and Child Welfare Goal- Improving outcomes for families impacted by substance use disorders in the child welfare, family court and chemical dependency systems. Key Collaborative Partners Advisory Group Composition Partnership for Family Recovery Goals Association of Substance Abuse Providers (ASAP) NYS Office of Temporary and Disability Assistance (OTDA) NYC Administration for Children s Services (ACS) NYS Public Welfare Association (NYPWA) Family Court Judges Family Court Chief Clerks & Treatment Court Coordinators State and local agencies providing services to families Improve timeliness of reunification Improve timeliness to other permanency outcomes Reduce foster care re-entry rates of children exited to reunification Reduce foster care re-entry rates of children exited to a relative Improve engagement, retention and completion of addiction services for families 13
Objectives To assist those working with families engaged in the three systems stems to approach their work with shared values To identify ways to engage families that will support better outcomes, reduce recidivism and interrupt intergenerational involvement in these systems Objectives To examine how cases flow through each system: to identify points of intersection, to assess opportunities for maximum impact of an integrated approach. Acknowledgments Pre-existing Collaborations Statewide Family Treatment Courts Enhanced Multi-disciplinary Practices Collocation Project (OCFS-OASAS) Fiscal Environment High Caseloads Child and Family Service Review (CFSR) Link Project supports current PIP Strategy involving Court/Agency Collaboration Project supports family engagement strategies Project compatible with Family Assessment Response (FAR) May be part of Local PIP Performance Indicators Affected 14
Court System Data of Interest 14,353 Neglect Cases Filed in 2009 outside of NYC 1,330 screenings done through FTCs outside of NYC for AOD 33% eligible but declined 27% eligible and participated 40% ineligible What s In It For Me? The Court System Better outcomes for families experiencing substance use disorder Better informed provider network and service providers Enhance collaborative efforts already underway What s In it For Me? (Continued) Enhance collaborative efforts already underway Is your program culturally competent? Is your program targeting all eligible respondents? Is your program providing families with appropriate resources in the community? Is your program lacking cohesiveness within the team? Local Rollout 2 Counties Engaged 5 More Invited This Fall Local Adaptations have included Utilize treatment courts to capacity Explore how to use treatment court methods in nontreatment court cases Universal Screening (GAINS SS) Multi-system Training Celebrating Families 15
CONTACT INFORMATION Christine Sabino Kiesel, Esq. Assistant Coordinator NYS Unified Court System Child Welfare Court Improvement Project 200 Elizabeth Street Utica, New York 13501 phone: (315) 266-4254 fax: (315 798-6472 e-mail: ckiesel@courts.state.ny.us Lessons from the Field: State of Connecticut Peter Panzarella, MA, MS, LADC, LPC Director of Substance Abuse Service CT Department of Children and Families CONNECTICUT IDTA Readiness for IDTA New Britain Pilot 2006 Substance Abuse Managed Service System Weekly meetings are held for case discussions and updates. Develop a plan of action through collaborative problem solving and resource identification Community Networking SAMSS is facilitated by DCF with active participation from DMHAS, ABH and local treatment providers. 16
CT IDTA Started in February 2008 NCSACW Department of Children and Families Department of Mental Health and Addiction Services Advanced Behavioral Health (ABH) - Project SAFE Treatment Providers from all 3 Areas Judicial Branch - Court Services Officers, Administrative Judge CCPA - Private Attorneys, Chief Child Protection Attorney CT Environmental Context Judicial Branch - Unified Court System DCF - Consolidated Children s Agency DMHAS - Adult Mental Health and Addiction in a single State Agency No County Government CT not a Dependency Drug Court state CT IDTA CT IDTA DCF Mission: The mission of the Department of Children and Families is to protect children, improve child and family well-being and support and preserve families. These efforts are accomplished by respecting and working within individual cultures and communities in Connecticut, and in partnership with others. Department of Mental Health and Addiction Services (DMHAS) Overview: DMHAS promotes and administers comprehensive, recovery-oriented services in the areas of mental health treatment t t and substance abuse prevention and treatment throughout Connecticut. 17
CT IDTA Department of Mental Health and Addiction Services (DMHAS) Mission: To improve the quality of life of the people of Connecticut by providing an integrated network of comprehensive, effective and efficient i mental health and addiction services that foster selfsufficiency, dignity and respect. CT IDTA Judicial Branch Court Operations The Superior Court Operations Unit supervises the Superior Court s Field Operations in the J.D, G.A. Juvenile, Housing and Small Claims Clerk s Offices. Court Operations also provides case support activities in the form of case flow management and policy implementation and management. CT IDTA CT IDTA Advanced Behavioral Health, Inc. A non-profit behavioral health management company that specializes in: Utilization management Provider network administration Research R hand ddissemination i i of fbest practices Health information technology Advanced Behavioral Health, Inc. Mission: "To manage and provide a continuum of behavioral health care and related services that ensures high quality, accessible, cost-effective services that t improve the quality of life for those served." 18
Why it Matters? Alternative model to Dependency Drug Courts Focus on outcomes for all three systems Results Based Accountability Re-directed current resources for Recovery Specialist Voluntary program (RSVP) RSVP model fits within state policy for a recovery oriented system of care model Addresses federal/state laws and policies for timely permanency for children CT IDTA May November 2008 Work Group development of a CT Recovery Practice Model Information Sharing Policies and Practice Resources Staff Development CT IDTA November 14, 2008 Cross Systems Training i Event 100+ attendees from all three systems in each of the Areas. Morning agenda focused on overviews of each system and a presentation of a draft Recovery Specialist Model. Afternoon agenda focused on breakout by Area and discussion questions related to current collaboration and what is needed to implement the model. Creative Solutions We Employed to Overcome Hurdles Inclusive private bar people in recovery private providers Re-direction of current resources no new cost Creation of case level and systemic communications methods - SAMMS Cross Training events for various levels Build consensus see where are the barriers and make changes 19
What We Accomplished Lessons Learned Memorandum of Agreement Engagement of the Judicial Branch, Attorney General and Private bar Implementing a new service model in 3 sites Team leadership meets monthly and continues System Cross training Joint funding of a Evaluation Pay attention to evaluation plan early Engage the court and private bar early Develop a strong core team with agency leadership participants Learn each other s culture and language Connect to other Initiatives court improvement, recovery, etc Lessons Learned Post-IDTA: Where We are Today Focus on developing relationships and agreements Choose a joint concrete project Implementation assistance needed One year is too short Implementation takes three to four years Develop follow up assistance CORE Group Continues to meet monthly Joint Funding of University of CT Health Center Community Medicine as an evaluator Integration and expansion of RCM/RSVP CT DEC and the Three Headed Dragon presentation - Contact Marilou Giovannucci from the Court Operations RSVP Program and Evaluation presentation- Contact Holly Hassett from ABH 20
Contact Information Peter Panzarella, MS, MA, LADC, LPC Director of Substance Abuse Service Connecticut Department of Children and Families 860-550-6527 peter.panzarella@ct.gov Closing Linda Carpenter Accomplishments and Products Universal screening protocol (PDF - 131 KB) - By design, every family touched by the child welfare system will be screened for substance abuse, utilizing the same screening instrument and procedural guidelines. The Screening and Assessment for Family Engagement in Recovery (SAFER) Initiative: Screening and Assessment for Family Engagement in Recovery, Memorandum of Understanding (PDF - 177 KB) The Screening and Assessment for Family Engagement in Recovery (SAFER) Initiative: Screening and Assessment for Family Engagement in Recovery, Statement of Shared Values (PDF - 31 KB) The Screening and Assessment for Family Engagement in Recovery (SAFER) Initiative: Screening and Assessment for Family Engagement in Recovery, Shared Outcome Statement (PDF - 40 KB) Accomplishments and Products New York s Partnership for Families in Recovery used the IDTA to focus on developing tools to assist local jurisdictions to broaden collaborative, family-centered practice to improve outcomes for families at the intersection of child welfare, substance abuse, and the courts. The IDTA process in New York yielded a set of collaborative practice guidance tools targeted to various organizational levels within the three lead systems, including: Executive Summary (PDF - 115 KB)- directed to Commissioners and high-level policy makers. New York Gearing Up to Improve Outcomes for Families: A Collaborative Practice Guide for Managers and Supervisors in Child Welfare, Chemical Dependency Services, and Court Systems - for mid-level managers that provides more in-depth background to support the recommended practice approach. 83 84 21
Accomplishments and Products System-specific, two-sided laminate cards - for quick reference use by front-line staff in each of the three lead systems in their daily practice with families. Practice Guide for Child Welfare Professionals (PDF - 130 KB) Practice Guide for Family Courts Professionals (PDF - 83 KB) Practice Guide for Chemical Dependency Services Professionals (PDF - 52 KB) Multi-System Training Framework (PDF - 170 KB) - to support cross-system collaboration and knowledge dissemination, with particular emphasis on the practices promoted in the collaborative practice guide. http://www.ncsacw.samhsa.gov/technical/idta-new-york.aspx Cathleen Otero, MSW, MPA Deputy Project Director Children and Family Futures National Center on Substance Abuse and Child Welfare 4940 Irvine Blvd., Suite 202 Irvine, CA 92620 Phone: 1 (866) 493-2758 E-mail: cotero@cffutures.org Contact Information Linda Carpenter, M.Ed. Program Director Children and Family Futures, National Center on Substance Abuse and Child Welfare, In-Depth Technical Assistance 4940 Irvine Blvd., Suite 202 Irvine, CA 92620 Phone: 1 (866) 493-2758 E-mail: lcarpenter@cffutures.org 85 TEXT PAGE 86 National Center on Substance Abuse and Child Welfare How do I access technical assistance? Visit the NCSACW website for resources and products at http://ncsacw.samhsa.gov Complete the contact form on the website Questions and Discussion Email us at ncsacw@cffutures.org 87 22