# Presentation: 884172

## NIH: Substance Abuse, Child Welfare and Family Court

- NCSACW Research Forum
- Washington, DC
- December 10-11, 2004

- Jerry Flanzer   Services Research  NIDA

## NIH Child Research Interest & Rules

- Children to be included in all studies, unless not appropriate or child-at–risk
- Child Development crucial issue to Public Health
- 100’s of studies on some aspect of child development, infant to adolescent neurobiology
- Etiology of childhood stress and trauma increasingly a concern throughout NIH

- Jerry Flanzer   Services Research  NIDA

## Child Safety First

- Jerry Flanzer   Services Research  NIDA

## RFA OD 99-006Research on Child Neglect

- Cheryl Boyce-NIMH
- Sally Flanzer- ACYF
- Margaret Feerick -NICHD
- Coryl Jones – NIDA
- Susan Martin   - NIAAA

- Jerry Flanzer   Services Research  NIDA

## RFA- One Shot -AWARDED 1960

- 3,000,000 / 15 grants

- Jerry Flanzer   Services Research  NIDA

## NEW PA - RESEARCH ON CHILD NEGLECT Release Date: February 28, 2001 PA NUMBER: PA-01-060

- NIH Office of Behavioral and Social Sciences Research National Institute on Alcohol Abuse and Alcoholism, NIH National Institute of Child Health and Human Development, NIH National Institute on Drug Abuse, NIH National Institute of Dental and Craniofacial Research, NIH National Institute of Justice, Office of Justice Programs, DOJ National Institute of Mental Health, NIH National Institute of Neurological Disorders and Stroke, NIH Children's Bureau, Administration on Children, Youth and Families Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, DOJ Office of Special Education Programs, Department of Education

- Jerry Flanzer   Services Research  NIDA

## Career Development K Awards

- CAREER DEVELOPMENT AWARDS: CHILD ABUSE AND NEGLECT RESEARCH Release Date: August 5, 1999 PA NUMBER: PA-99-133

- Jerry Flanzer   Services Research  NIDA

## Related GrantsChildren and violence; Violence

- RESEARCH ON CHILDREN EXPOSED TO VIOLENCE RELEASE DATE: April 7, 2003 PA NUMBER: PAR-03-096
- SERVICES AND INTERVENTION RESEARCH WITH HOMELESS PERSONS HAVING ALCOHOL, DRUG ABUSE, OR MENTAL DISORDERS August 16, 2002 PA-02-150

- Jerry Flanzer   Services Research  NIDA

## Let’s Be Creative

- Think beyond the “box” of child welfare
- Related concepts:
- Victimology
- Trauma
- Wrap around services in other sectors

- Jerry Flanzer   Services Research  NIDA

## NIH Major Players

- NIDA
- NIAAA
- NIMH
- NICHD
- 50 current projects (child abuse, child neglect, child welfare)

- Jerry Flanzer   Services Research  NIDA

## Themes

- Early Child Abuse/Neglect leading to vulnerabilities: later ATOD, MH, HIV
- 	The Brain, Stress and Neurobiology
- Children with Parents of Substance Abuse Problems (punitive discipline, neglect...)
- Cross Sector Service Issues-(Effect of ASFA and Welfare Reform)

- Jerry Flanzer   Services Research  NIDA

## Early to Later: Abuse to Substance Abuse           

- Jerry Flanzer   Services Research  NIDA

## Child Abuse on The Brain 

- The Brain
- Head Injuries
- Impair Executive Function
- Self-Medication
- Specific Brain Problems
- Poor processing/decision making

- Jerry Flanzer   Services Research  NIDA

**Notes:**
1.      Drug Use May Directly Elicit Aggressive Behavior[1]
Alcohol, cocaine, methamphetamines, phencyclidine and anabolic steroids are particularly linked to aggressive behavior. This may be even truer when the brain is prone to violence due to underlying brain vulnerabilities, due to serious head injuries and such. (areas of brain effected are the prefrontal, anterior cingulate system, dominant temporal lobes and dominant limbic and basal ganglia).

2.      Drug Use May Impair Executive Function and Increase the Likelihood of Aggression

3.      Drug Use May Be Self-Medication of Underlying Brain Problems Involved in Aggression: 0Dually diagnosed use substances to medicate underlying psychological or neurological problems, such as depression, panic symptoms and posttraumatic anxiety.

4.   Certain Brain problems – (anterior cingulate in conjuction with prefrontal lobe problems) exacerbate addictions and potentially violent situations.
The anterior cingulate is the part of the brain associated with shifting attention and cognitive flexibility when impaired, people have problems shifting attention and can get focused on negativity thoughts and feelings.
4.      Drug Use by Victims May be involved in poor decision making processes or provocative behaviors which put the victims in high-risk situations
[1] Amen, Daniel et al (1997) Visualizing the Firestorms in the Brain: An Inside Look at the Clinical and Physiological Connections Between Drugs and Violence Using Brain SPECT Imaging, Vol. 29, October-December, Journal of Psychoactive Drugs.

## Children of parents with substance abuse problems

- Poorer developmental outcomes (physical, intellectual, social and emotional)
- At risk for of substance abuse themselves
- Children who are severely neglected – or who have suffered trauma or constant stress -particularly at an early age – show significant changes in the physiology of their brain. Some reversible with the returning maternal care.

- Jerry Flanzer   Services Research  NIDA

## Children of parents with substance abuse problems-2

- TIMING Placement Pressure varies according to the age of the children involved.:
-  the first eighteen months of life are informing the basis for a considerable amount of both cognitive learning and emotional development.
-  early bonding breaks and cost in later life

- Jerry Flanzer   Services Research  NIDA

## Addicted Parent-1

-        Not available for adequate supervision and parenting
-       Crack – increased chance of placing young infants in foster care
-      *Most women in treatment for drug abuse are single parents of children under 18, who were abused in childhood themselves*

- Jerry Flanzer   Services Research  NIDA

**Notes:**
   For at least four months of initial sobriety/recovery the addicted parent’s brain is unable to think is a futuristic, systemic way
        The preoccupation is with sobriety and with self-recovery
        Depending on history, may be developmentally delayed – an immature parent
        Relapses will delay cognitive clarity and repair...average of two years of recovery before have the unselfish focus of a mother – putting child first.

## Addicted Parent-2

-         Addicted mothers show several deficits in their parenting behaviors...unengaged, uncommunicative with their infants, often use ***threatening and authoritarian disciplinary*** approaches...higher incidence of child abuse and neglect.
-        Concern for the well being of their children is frequently identified as a primary source of motivation for addicted women to seek treatment

- Jerry Flanzer   Services Research  NIDA

## X-Section

- ASFA – Permanency Planning
- Conflicting system values
- Case management issues between systems

- Jerry Flanzer   Services Research  NIDA

## ASFA Timelines:negative affect on parents referred to/or in treatment

- Permanency hearing is intended to determine the child’s plan, which could be: reunification, termination of parental rights; adoption. A parent who is newly in treatment may not yet be able to provide a plan about when he or she will be ready to resume parenting.
- Parents who are attempting to engage in treatment but who cannot find appropriate services are at a distinct disadvantage particularly in the early stages of permanency planning hearings.

- Jerry Flanzer   Services Research  NIDA

## COURT, CPS vs. AOD Practice Implications and realities

- For a cps worker, the client is both the child and the family, in ways that create the difficult choices. For an AOD worker, the world is somewhat simpler: clients are addicts and alcoholics, usually adults, and their status as a parent is generally irrelevant .
- CPS sees AOD treatment as a way to achieve child safety; AOD treatment assists a clients’ functioning as a healthy adult, only one element is parenting.

- Jerry Flanzer   Services Research  NIDA

## Collaboration of three disparate treatment systems- 1

- Substance abusing parents are often treated as individuals in one system while their children are being treated in another without mechanisms to ensure communication, collaboration, and compliance across settings **Hence high tx drop out rate**.
- 	Treatment for women which includes children superior approach! _**More Studies Needed**_

- Jerry Flanzer   Services Research  NIDA

## Collaboration of treatment systems 2

- The competing philosophies of _abstinence and harm reduction:_ complete abstinence is an addict’s only hope of recovery, versus a view that the ultimate impact on the family should determine how parents are treated by protective service systems follow AOD treatment. The abstinence view is stronger in child welfare agencies, while the harm reduction view prevails more often in treatment agencies. _**Need studies on chronic disease management and child welfare!**_

- Jerry Flanzer   Services Research  NIDA

## Whither Family Court

- Jerry Flanzer   Services Research  NIDA

## Family drug courts

- 3 NIDA funded grants on family drug court have clear relationship to CPS activity as part of their design-
- Two are cost studies—
- One intervention study

- Jerry Flanzer   Services Research  NIDA

## NIDA’s Projects

- 26 perinatal sites funded by NIDA in the past
-        Welfare reform (3 current grants)
-       1 Juvenile Drug courts  (Hengeller)
-       0 Family Court

- Jerry Flanzer   Services Research  NIDA

## Montoya- Houston

- Chronic users have great barriers to employment  (regardless of skill level)...As compared to others on welfare

- Jerry Flanzer   Services Research  NIDA

## LIDZ  -Pennsylvania

- Large proportion of substance abusing women in treatment on welfare (TANF) found work – but on poverty line
- Success limited for most- dependent on Medicaid for health care, food stamps and child care subsidies

- Jerry Flanzer   Services Research  NIDA

## Morgenstern – New Jersey

- Intensive Case Management Improves Welfares’ Rates of Entry and Retention in Substance Abuse Treatment
- Specialized Screening Approaches Can Substantially Increase the Identification of Substance Abuse Problems Among Welfare Recipients

- Jerry Flanzer   Services Research  NIDA

## Research Ideas

- NEW MODELS
- Family Drug Courts
- Dedicated Cross-Agency Teams
- Effective Grandmothers
- Confluence of Funds

- Jerry Flanzer   Services Research  NIDA

## Check out

- www.Theresearchassistant.com

- Jerry Flanzer   Services Research  NIDA

## Jerry Flanzer, Ph.D.

- Services Research Branch
- National Institute on Drug Abuse
- Bethesda, Maryland 20092
- Jflanzer@nida.nih.gov
- 301-443-4060

- Jerry Flanzer   Services Research  NIDA