# Presentation: 734745

## Permanency Outcomes for

**Nancy K. Young, Ph.D., Director**
**National Center on Substance Abuse and Child Welfare**
**Children and Family Futures**
**4940 Irvine Boulevard, Suite 202**
**Irvine, CA  92620**
**714.505.3525  Fax 714.505.3626**
**www.ncsacw.samhsa.gov**

**Children’s Bureau**
**Permanency Partnership Forum VII**
** ****May 19 to 21, 2003**
**Permanency Outcomes for**
**Children Affected by Substance Abuse**

## Work Shop Overview

- NCSACW
- Scope of Issue
- Policy Tools for Solutions
- Models of Changed Practice
- Issues for Children
- Models of Family Drug Courts

## Developing Knowledge and Providing Technical Assistance 

**to Federal, State, Local Agencies and Tribes**
**to Better Serve Families with Substance Use Disorders**
**in the Child Welfare and Family Court Systems**

## NCSACW's goal
To promote effective practice, organizational, and system changes at the local, state, and national levels by
Developing and implementing a comprehensive program of information gathering and dissemination
Providing technical assistance

**To promote effective practice, organizational, and system changes at the local, state, and national levels by**
**Developing and implementing a comprehensive program of information gathering and dissemination**
**Providing technical assistance**

## A Consortium Approach
Children and Family Futures - implementing the NCSACW under contract with CSAT and ACYF
CWLA – Child Welfare League of America
NASADAD – National Association of State Alcohol and Drug Abuse Directors
NCJFCJ – National  Council of Juvenile and                  Family Court Judges
APHSA – American Public Human Services Association
NICWA – National Indian Child Welfare Association

**Children and Family Futures**** - ****implementing the NCSACW under contract with CSAT and ACYF**
**CWLA**** – ****Child Welfare League of America**
**NASADAD**** – ****National Association of State Alcohol and Drug Abuse Directors**
**NCJFCJ ****– ****National  Council of Juvenile and                  Family Court Judges**
**APHSA**** – ****American Public Human Services Association**
**NICWA**** – ****National Indian Child Welfare Association**

**Notes:**
Assembled a consortium of national organizations and leaders

to facilitate communication among the service systems working with families affected by substance use disorders in the child welfare and family court systems

Represent the various constituents and stakeholders in the work of NCSACW, including
	families
	professionals and national leaders
	on practice and policy issues in substance abuse, child welfare, family courts, the Tribes, and policymakers

**	****Tasks**
**Conduct Marketing and Public Awareness**
**Collection and Dissemination of Information**
**Develop Materials**
**Develop Web-based Access to Information and Tutorials**
**Conduct Conferences and Meetings**
**Provide Technical Assistance**

## “Believing is seeing”

**	****that we can only see what we are ****	**** ****	****prepared to see**
** **
**Child abuse was “discovered” when, doctors ****	****added social workers to their teams**
** **
**Until then, doctors didn’t allow the possibility ****	****that parents were hurting their kids ****	****because *****they didn’t know what to do next***
** **

**“****Believing is seeing”**

- Diane L. Coutu, “Sense and reality: A conversation with celebrated psychologist Karl E. Weick,” *Harvard Business Review*. April 2003. pp. 84-90.

## Social workers said, “Sure, child abuse happens, and we know how to handle it by providing child protective services”

 At that point the physician teams could afford to see child abuse, because then they knew how to deal with it. 

The greater the repertoire of responses 
you have on your team, 
the more things you can do.

** ****At that point the physician teams could afford to see child abuse, *****because then they knew how to deal with it.***** **
***The greater the repertoire of responses ***
***you have on your team, ***
***the more things you can do*****.**

**The Power of Teams**

## The Power of Teams

**Only when social workers really connect with substance abuse counselors do they “know what to do next” when alcohol and other drugs are a part of the problem**
**Then they can, as Weick puts it, “afford to see” substance abuse, because they have a response to it  **

## Only when substance abuse counselors connect with child development and family services workers do they have a sense of the full force of family dynamics in helping parents recover

And only when family support staff connect with income support workers do they know what to do next when poverty is a part of the problem

**And only when family support staff connect with income support workers do they know what to do next when poverty is a part of the problem**

**The Power of Teams**

## Paths of a Child’s Exposure to Alcohol and Other Drugs

**PATHS OF EXPOSURE**

**Paths of a Child’s Exposure to Alcohol and Other Drugs**

## Impact of AOD on Children

** ****The Two Most Significant Risks to Children of  **
**	**** ****Substance Users: **
**They Have Poorer Developmental Outcomes**
**They Are at High Risk of Substance Abuse Themselves****1**
** ****Children of Substance Abusers Exhibit**
**	**** ****Depression and Anxiety More Often Than    **
**	**** ****Children from Non-addicted Families****2**** **

- 1. Department of Health and Human Services, *Blending Perspectives and Building Common Ground, *April* *1999
- 2. National Association for Children of Alcoholics, *Children of Addicted Parents: Important Facts, *http://www.nacoa.org

## National Estimates of Children Living With At Least One Substance Abusing Parent

**Notes:**
6,000 CHILDREN IN FOSTER CARE IN 1997

## COSAs and Child Abuse/Neglect Victims

**Millions**

**0         2          4         6          8         10**

***Child Maltreatment 2001**

## California Parents Entering Publicly-Funded Substance Abuse Treatment

**Had a Child under age 18****	****	****   59.0%**
**Had a Child Removed by CPS****	****   24.5%**
**If a Child was Removed, Lost      Parental Rights****	****	****	****     ****	****   36.9%**
**Treated in Outpatient****	****32.5%**
**Treated in Residential****	****44.7%**
**Treated with Methadone****	****73.6%**

## Key Barriers Between Substance Abuse, Child Welfare and The Courts

**Beliefs and Values**
**Competing Priorities **
**Treatment Gap**
**Information Systems**
**Staff Knowledge and Skills**
**Lack of Communication**
**Different Mandates**

##  TANF – Welfare
		24 Months; 60 Months

**	****	****24 Months; 60 Months**

**The Five Clocks**

** ****ASFA - Child Welfare  **
**  ****Permanent Plan at 12 Months**
**  ****File for TPR if in Out-of-Home Care 15 out  **
**    ****of 22 Months, Can File TPR if Abandoned**

** ****	****Recovery**** ****- Lifetime Process, One ****	****Day at a Time**** **

** ****Child Development**

## Underlying Values
Daily Practice-Screening and Assessment
Daily Practice-Client Engagement and Retention in Care
Daily Practice-AOD Services to Children 
Joint Accountability   
   and Shared Outcomes

**Daily Practice-Screening and Assessment**
**Daily Practice-Client Engagement and Retention in Care**
**Daily Practice-AOD Services to Children **
**Joint Accountability   **
**   ****and Shared Outcomes**

**Information Sharing & MIS **
**Training/Staff Development**
**Budgeting/Program Sustainability**
**Building Community Supports**
**Working with Related Agencies and Support Systems**

**From CSAT Technical Assistance Publication (TAP) 27: Navigating the Pathways *Revised March 2003**

**How to Connect the AOD, CWS, Court Systems: **
**Elements of System Linkages*******

## Policy Tools

**Development of Policy Tools to Facilitate Collaborative Work Across Systems**
**Collaborative Values Inventory**
**Collaborative Capacity Instrument**
**Matrix of Progress in Linking Substance Abuse and Child Welfare Services**

## Key CFSR Outcomes with Implicationsfor Substance Abusing Families

**Families Have Enhanced Capacity****to Provide for Their Children’s Needs **
**Children Receive Appropriate Services to Meet Their Educational Needs**
**Children Receive Adequate Services to Meet Their Physical and Mental Health Needs**

## Families Have Enhanced Capacityto Provide for Their Children’s Needs

**Improved Screening and Assessment Protocols and Effective Communication Paths Across Systems**
**Standardized Screening Tools**
**Partnering for AOD Expertise**
**Standardized Monitoring & Reporting Tool**
**Joint Case Planning**

## Families Have Enhanced Capacityto Provide for Their Children’s Needs

**Engaging and Retaining Parents in Care**
**Use of Motivational Interviewing and Stages of Change**
**Use of Persons in Recovery as Members with Family Team**
**Use of Substance Abuse Staff to Increase Recovery Management**
**Increased Judicial Oversight**
**Preserving Relationships with Birth Parents Regardless of Type of Permanency Outcome**

## Models of Changed Practice

**Workers out-stationed in collaborative settings**
**Increased case management and monitoring of recovery progress**
**New methods and protocols on sharing information**
**Increased judicial oversight and family drug treatment courts**
**New priorities for treatment access for child welfare-involved families**
**New safe and sober housing initiatives**

## Children Receive Appropriate Services to Meet Their Educational, Physical and Mental Health Needs

**Services for Children and Families**
**Based on Developmental Stages**
**Prenatal and Birth****	****	****Primary Health Care**
**Infants****	****	****	****Bonding and Attachment**
**Toddlers****	****	****	****Developmental Interventions**
**School Readiness****	****	****Language, LD and Behavior**
**Latency****	****	****	****COSA Group Interventions**
**Pre-Adolescent****	****	****Targeted Prevention**
**Adolescence****	****	****	****Intervention & Treatment**
**Transition to Adulthood****	****COSA Coping and Life Skills**

## Children’s Service Models

**Define At Risk Births**
**Primary Care 4 Ps – ****Parents, Partner, Past, Pregnancy**
**Hawaii Healthy Start Risk Factors**
**Developmental Screening**
**Early Childhood Education **
**Free to Grow – ****RWJ Program**
**Starting Early Starting Smart - ****SAMHSA**
**Parent Training**
**Nurturing Parents – ****Institute for Health & Recovery - Boston**

## Children’s Service Models

**Children of Substance Abusers**
**The 7 C’s – NACOA.ORG**
**I didn’t ****Cause**** it**
**I can’t ****Cure**** it**
**I can’t ****Control**** it**
**I can ****Care**** for myself by**
**Communicating**** my feelings**
**Making healthy ****Choices**
**And by ****Celebrating**** myself**

## Integrated – Santa Clara
Both dependency matters and recovery management conducted in the same court with the same judicial officer

**Both dependency matters and recovery management conducted in the same court with the same judicial officer**

**Models of ****Family**** Treatment Courts**

## 
Dual Track – San Diego
Dependency matters and recovery management conducted in same court with same judicial officer during initial phase 
If parent is noncompliant with court orders, parent may be offered DDC participation and case may be transferred to a specialized judicial officer who increases monitoring of compliance and manages only the recovery aspects of the case 

**Dual Track – San Diego**
**Dependency matters and recovery management conducted in same court with same judicial officer during initial phase **
**If parent is noncompliant with court orders, parent may be offered DDC participation and case may be transferred to a specialized judicial officer who increases monitoring of compliance and manages only the recovery aspects of the case **

**Models of ****Family**** Treatment Courts**

## 
Parallel - Sacramento
Dependency matters are heard on a regular family court docket 
Specialized court services offered before noncompliance occurs
Compliance reviews and recovery management heard by a specialized court officer

**Parallel - Sacramento**
**Dependency matters are heard on a regular family court docket **
**Specialized court services offered before noncompliance occurs**
**Compliance reviews and recovery management heard by a specialized court officer**

**Models of ****Family**** Treatment Courts**

## Significantly Less Criminal & CPS Recidivism Among FDTC Parents in Five Sites 

**Percent of Parents in 18 Months**

***p<.05**

## Average Days to PermanencySacramento County Dependency Drug Court

**p<.001**

**n=90**

**n=146**

## Nancy & Sid’s Top 10 List for Foster and Adoptive Parents*

**Keep a journal of everything**
**Get on the wait list for the best services in town**
**Live on the internet with other parents**
**To ask “can he understand” after being told he can hear**
**Be prepared to have a 3****rd**** or 4****th**** job—case management—we are their best advocates and know them better than any professional**

***Personal Experience not NCSACW**

## Knowing the mental health diagnoses of birth parents is critical
Children of bi-polar parents with ADHD symptoms should be treated as bi-polar 
Schools will usually first say No, hire an advocate for I.E.P.
Know that adopted kids have a “hole in their heart”
Take time for yourselves—don’t mortgage your marriage

**Children of bi-polar parents with ADHD symptoms should be treated as bi-polar **
**Schools will usually first say No, hire an advocate for I.E.P.**
**Know that adopted kids have a “hole in their heart”**
**Take time for yourselves—don’t mortgage your marriage**

**Nancy & Sid’s Top 10 List**

## The Most Important Clock

**The Clock that is Ticking on Us**
**How long do we have to act if our families have 24 months to work and 12 months to reunify?**
**Taking this clock seriously means that we build the needed bridges between systems with a sense of urgency and a timetable that start *****now***