# Presentation: 887925

## Women, Children and Methamphetamine

**	****Sharon Amatetti, M.P.H****	****Nancy K. Young, Ph.D.**
**	****SAMHSA, CSAT****	****	****National Center on Substance**
**	****	****	****	****	****Abuse and Child Welfare**
**Presented at The Methamphetamine Summit: **
**Methamphetamine Treatment: Effective Practices**
**May 25, 2006**

**4940 Irvine Blvd, Suite 202****	****	****	****        ****	****714-505-3525**
**Irvine, CA  92620****	****	****	****    www.ncsacw.samhsa.gov**

**Notes:**
Update for Florida, and put Sharon A. on as co-presenter.

## 45% of admissions are women
	     This is a higher percentage of women  
       admissions than for any other drug except 
       tranquilizers
 methamphetamine -  ~ 1:1                                      
 cocaine - 1:2  
 heroin - 1:2+
 marijuana & alcohol - 1:3 

Since women are often caretakers of children, more children are likely affected

**	****     **This is a higher percentage of women
-        admissions than for any other drug except
-        tranquilizers
-  methamphetamine -  ~ 1:1
-  cocaine - 1:2
-  heroin - 1:2+
-  marijuana & alcohol - 1:3
**Since women are often caretakers of children, more children are likely affected**

**Gender Differences**

- Source: Vaughn, C. (2003)

## Methamphetamines as Primary Substance by Gender and Pregnancy Status: 1994-2004

**Percent of Total Admissions**

- Source: Analysis of Treatment Episode Data Set (TEDS) Computer File

**Notes:**
Women are more likely than men to report meth/amphetamines as their primary substance at admission. This trend has remained constant over the years.  

## Female Treatment Admissions States with Highest Percentage of Meth/Amphetamine as Primary Substance

- Source: Analysis of Treatment Episode Data Set (TEDS) Computer File

**Notes:**
This slide takes a closer look at the female treatment admissions.  It shows that the percentage for which meth/amphetamine is the primary substance at admission is strikingly higher in many western and midwestern States. The national average overall was 8.2% in 2004 – although for women it was 11.9% and for men it was 6.6%.  These States far exceed that number.  Next highest States in 2004 were: 10. Wyoming, 11. Arizona, 12. Washington and 13. Montana.

## Meth/Amphetamine Admissions By Gender - 2004

- Source: Treatment Episode Data Set (TEDS)

**Notes:**
Unlike other drugs, the gender breakdown for meth/amphetamine admissions is nearly equal among men and women.  However, when you look at teens, the picture is more disturbing, with females representing the majority of such admissions.

## Trends in Primary Substance UseTreatment Admissions for Pregnant Females by Primary Substance 1994-2004 

**Trends in Primary Substance Use**Treatment Admissions for Pregnant Females by Primary Substance 1994-2004** **

**Percent of Pregnant Women’s Admissions for ****Meth/Amphetamine**** and ****Marijuana**** More than Doubled over 10 Years**

- Source: Analysis of Treatment Episode Data Set (TEDS) Computer File

**Notes:**
Background/context: The percentage of females pregnant at admission has remained relatively constant at about 4%.  For 2004, the total number of females pregnant at admission was 20,984.
The graph shows an interesting trend:  from 1994 to 2004, alcohol (from 27% to 16%) and cocaine (38% to 21%) as primary substance for pregnant women at admission has gone down, while marijuana (8% to 19%) and methamphetamine (8% to 21%) have increased.  Heroin has remained relatively constant, with a slight increase (16% to 20%).
In addition (not reflected in any graph), when you look at age-group breakdowns for all pregnant female admissions with meth/amphetamines as the primary substance, the percentage who are 18-24 years old has increased from 40% in 1994 to 47% in 2004 – so providers are dealing with more younger pregnant females who use meth.

## Use During Pregnancy

| Substance Used (Past Month) | 1st Trimester | 2nd Trimester | 3rd Trimester |
| --- | --- | --- | --- |
| Any Illicit Drug |  |  |  |
| Alcohol Use |  |  |  |
| Binge Alcohol Use |  |  |  |

- SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003

- State prevalence studies report 10-12% of infants or mothers test positive for alcohol or illicit drugs at birth

- Vega et al (1993).  Profile of Alcohol and Drug Use During Pregnancy in California, 1992.

**Notes:**
SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003
Applied to survey percentages to 4,093,000 births in 2002
State Prevalence Studie
California		11.35% tested positive for drugs or alcohol	     	Statewide random screening 1992
Hawaii		12.7% testing positive for drugs			1996 random screening
South Carolina	12.1% used alcohol and drugs (urine) 		Sample in 1991
			22.4% (meconium) 25.8% (both methods)

## Infant Development, Environment, and Lifestyles (IDEAL)2004 Data Collection from Known High Use Communities

**Percent of Infants Exposed**

- Methamphetamine and Other Substance Use During Pregnancy: Preliminary Estimates From the Infant Development, Environment, and Lifestyle (IDEAL) Study. Maternal and Child Health Journal (2006).

**Notes:**
Arria, A.M., Derauf, C., Lagasse, L.L., Grant, P., Shah, R., Smith, L., Haning, W., Huestis, M., Strauss, A., Grotta, S.D., Liu, J., and Lester, B. (2006). Methamphetamine and Other Substance Use During Pregnancy: Preliminary Estimates From the Infant Development, Environment, and Lifestyle (IDEAL) Study. Maternal and Child Health Journal. 
From my Children’s Bureau speech:
This is an on-going study in four cities that are known to have high rates of methamphetamine use: Honolulu, Los Angeles, Oklahoma City, and Des Moines. 
They asked mothers about their use during pregnancy and the also tested the infant’s meconium at birth. 
They found that in these high use cities, alcohol and tobacco were found in 1 out of 5 and 1 out of 4 infants. Marijuana was found in 1 out of 17 infants; methamphetamine was found in 1 out of 20 infants. 
And here we are again to that 11% figure – 1 out of 10 births in our country are exposed to an illicit drug.
Clearly not all of those children belong in out-of-home care, but I happen to be one that believes we need to know them, we need to be offering services to their families, we need to be providing early intervention to them. And, we need to recognize that if the child comes into foster placement at age 1 or 2 or 3, or even older, and their mother has a substance use disorder, we need to be recognizing that this child was likely exposed to substances during pregnancy and may need specific developmentally-appropriate interventions to ameliorate any long-term neurodevelopmental effects.

## Gender Differences and Implications for Treatment

## Considerations for Treating Women Addicted to Methamphetamine

- Co-occurring mental health problems
- Trauma
- Body image

- Source: M.L. Brecht, Ph.D. (2004)

## Scores at Baseline 

**Behavior Symptom Inventory **(**BSI**)
- Scores at Baseline

- Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005

**Notes:**
Women have higher scores on mental health problems than men at time of entry to treatment for meth.

## Beck Depression Inventory (BDI) 

**Beck Depression Inventory **(**BDI**)
- Scores at Baseline

- Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005

**Notes:**
These are very significant differences.  Represent differences in depression at treatment admission.

## Self-Reported Reasons for Starting Methamphetamine Use 

**Self-Reported Reasons for Starting Methamphetamine Use**

- Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005

**Notes:**
These differences explain why so many women use meth.

## Gender Differences and Implications for Treatment

- Co-occurring mental health issues complicate treatment and require longer duration for treatment
- Violence linked to meth use is related to trauma and safety needs which must be addressed in treatment
- Body image and nutrition need to be addressed

## Histories of Violence among Clients Treated for Methamphetamine

- Persons in tx for meth reported high rates of violence
- 85% women
- 69% men
- The most common source of violence:
- For women, was a partner (80%)
- For men, was strangers (43%)
- History of sexual abuse and violence
- 57% women
- 16% men

- Source: Cohen, J. (2003)

## Prevalence of Co-Occurring Problems, and Violence and Trauma 

- Women in treatment 2X more likely to have history of sexual and physical abuse than general population
- Women who are dependent on meth usually have more severe problems than their male counterparts in many areas of their life
- Speaks to the need for comprehensive, and trauma-related services
- Source:  CSAT TIP 36

## Screen carefully for 
Psychological problems
Abuse and violence

Recognize pervasive gender differences

Address substance abuse and psychological problems in an integrated treatment model

- Psychological problems
- Abuse and violence
- Recognize pervasive gender differences
- Address substance abuse and psychological problems in an integrated treatment model

- Judith Cohen, Ph.D. Presentation to NASADAD June 2005

**Gender Differences and  Implications for Treatment **

## Children of Parents with Substance Use Disorders

- So how many are there?

## Children Living with One or More Substance-Abusing Parent

**Notes:**
I always start with this slide – it points out one of the fundamental problems for child welfare
This is from the Report to Congress – Blending Perspectives and Building Common Ground. It shows the variety of ways that “Children of Substance Abusers” can be define – parent used in past  year, etc.
The one I think is import – hit bar again and box comes up around the 8.3 million, that translates to 11% of the kids in our country. The one I think is important is this 8.3 million children that live with a parent who is dependent on alcohol or needs treatment for drugs. This translates to 11% of the kids in our country or 500,000 kids in NY. (NY 2003 Child population was 4,532,748 * 11% = 498,602 children living with a parent)
If 11% of kids, 3 out of every elementary school classroom are going home to a parent who is alcoholic or needs treatment for illicit drug abuse, how do child welfare handle this issue when that same family comes to their attention due to abuse or neglect..
What’s the right standard for when the child should be removed in the context of parental addiction? What’s the right standard for when a child can be returned home in the context of 11% of the children?
We might not like that so many of our children are living in these environments, but that is the environment that we are working in and we need to take that into account when we are devising policies and practices that work with these families.

## COSAs and Child Abuse/Neglect Victims

**In Millions**

**0         2          4         6          8         10**

## How Big a Problem is Methamphetamine in CWS Caseloads?

- We don’t really have the numbers...

## Persons who Initiated Substance Use by Year

## What is the Relationship?

**It is not solely the use of a specific substance that affects the child welfare system; it is a complex relationship between **
**The substance use pattern**
**Variations across States and local jurisdictions regarding policies and practices**
**Knowledge and skills of workers **
**Access to appropriate health and social supports for families**

**Notes:**
I think we are dealing with a long-standing relationship that is complex and is made up of several factors
The substance use pattern
The variations among states and communities in their policies and practices about parental substance use
Clearly the knowledge and skills of workers to intervene with families who often have multiple challenges—not just substance use
And finally, the access in any one community to appropriate health and social supports for families is a critical factor in these relationships.
So I would warn us to not repeat some of the mistakes of the crack epidemic, making assumptions about parents, families and the impact on children; Rather, we need to learn from our past experiences and bring those lessons into our approaches with families who are affected by multiple substances and challenges.

## How Many Parents in Treatment have Children? How Many are “At Risk” of Child Abuse or Neglect? How Many are involved with Child Welfare Services?

- We don’t really have the numbers...

## Parents Entering Publicly-Funded Substance Abuse Treatment

- Had a Child under age 18		     	59%
- Had a Child Removed by CPS	     	22%
- If a Child was Removed, Lost
- 	Parental Rights			 		10%

- Based on CSAT TOPPS-II Project

## Past Year Substance Use by Youth Age 12 to 17

- Office of Applied Studies, SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

**Compared to African-American Youth, Caucasians were more likely to use alcohol (41.4% versus 29.8%) and illicit drugs (36.2% versus 26.7%)**

## Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment by Foster Care Status

- Office of Applied Studies, SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care

## Source: M.L. Brecht, Ph.D., presented at NASADAD Annual Meeting, June 2005

## Risks to Children When Parents Use Methamphetamine

## Different Situations for Children

- Parent uses or abuses methamphetamine
- Parent is dependent on methamphetamine
- Parent “cooks” small quantities of meth
- Parent involved in trafficking
- Parent involved in super lab
- Mother uses meth while pregnant

- Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

**Notes:**
We wanted to streamline this group of slides, and take off the word “six” in title.

## Each situation poses different risks and requires different responses
Child welfare workers need to know the different responses required
The greatest number of children are exposed through a parent who uses or is dependent on the drug 
Relatively few parents “cook” the drug

- Child welfare workers need to know the different responses required
- The greatest number of children are exposed through a parent who uses or is dependent on the drug
- Relatively few parents “cook” the drug

- Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

- Different Situations for Children

## Parent Uses or Abuses Meth

- Risks to safety and well-being of children:
- Parental behavior under the influence: poor judgment, confusion, irritability, paranoia, violence
- Inadequate supervision
- Inconsistent parenting
- Chaotic home life
- Exposure to second-hand smoke
- Accidental ingestion of drug
- Possibility of abuse
- HIV exposure from needle use by parent

- Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

## Parent Is Dependent on Meth

- Risks to safety and well-being of children:
- All the risks of parents who use or abuse, but the child may be exposed more often and for longer periods
- Chronic neglect is more likely
- Household may lack food, water, utilities
- Chaotic home life
- Children may lack medical care, dental care, immunizations
- Greater risk of abuse
- Greater risk of sexual abuse if parent has multiple partners

- Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

## Parent “Cooks” Small Quantities of Meth

- All the risks of parents who use or are dependent on meth, with added risks of manufacturing:
- Chemical exposure and toxic fumes
- Risk of fire and explosion
- Children more at risk:
- Higher metabolic rates
- Developing bone and nervous systems
- Thinner skin than adults which absorbs chemicals faster
- Children tend to put things in their mouth and use touch to explore

- Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

- Source: Mason (2004)

**Notes:**
While the number of parent’s who cook is relatively small compared to the number that use, living in a meth lab is extremely dangerous, especially for children.

## Parent Involved in Trafficking

- Presence of  weapons
- Possibility of violence
- Possibility of physical or sexual abuse by persons visiting the household
- Possibility of incarceration and permanency issues for children

- Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

- Parent Involved in Super Lab

- Lower likelihood of children on the site
- Increased likelihood of parental incarceration

**Notes:**
The lifestyle that goes with trafficking is very dangerous.

## Number of Children in Meth Labs

|  | 2000  | 2001  | 2002  | 2003  |
| --- | --- | --- | --- | --- |
| Number of incidents 
 | 8,971  | 13,270  | 15,353  | 14,260  |
| Incidents with children present 
 | 1,803  | 2,191  | 2,077  | 1,442  |
| Percent with children present | 20%  | 16.5% | 13.5% | 10% |
|  |  |  |  |  |
| Children taken into protective custody  | 353 | 778  | 1,026  | 724  |
|  |  |  |  |  |
|  |  |  |  |  |
|  |  |  |  |  |

- Source:  El Paso Intelligence Center

**4 years = 2,881; all children ~1,200,000**

**Notes:**
Labs include small home labs and large scale superlabs.

The data is trending down, but we don’t know if that is because of a shift in the resources to finding the labs, or something else.

May be more consolidation of super labs supplying more people.  Children less likely to be present at Super labs.

## Field medical assessment
A medically trained professionals determines if the child discovered at the scene of a meth lab seizure needs emergency medical care

Immediate care protocol
Based on findings of the field assessment, immediate care is provided within 2-4 hours for those medical problems that cannot wait 24 hours to be treated at the baseline exam. 

- A medically trained professionals determines if the child discovered at the scene of a meth lab seizure needs emergency medical care
- Immediate care protocol
- Based on findings of the field assessment, immediate care is provided within 2-4 hours for those medical problems that cannot wait 24 hours to be treated at the baseline exam.

- Source: Colorado DEC

- Medical Interventions for Children

## Baseline assessment protocol
Conducted at a pediatric facility within 24 hours of lab seizure to ascertain a child’s general health

Initial follow-up care protocol
Follow-up visit within 30 days to re-evaluate child’s health status and any latent symptoms

Long-term follow-up care protocol
Follow-up visit within 12 months of baseline assessment to monitor physical, emotional and developmental health, identify any late developing problems, and provide appropriate intervention 

- Conducted at a pediatric facility within 24 hours of lab seizure to ascertain a child’s general health
- Initial follow-up care protocol
- Follow-up visit within 30 days to re-evaluate child’s health status and any latent symptoms
- Long-term follow-up care protocol
- Follow-up visit within 12 months of baseline assessment to monitor physical, emotional and developmental health, identify any late developing problems, and provide appropriate intervention

- Source: Colorado DEC

- Medical Interventions for Children

## Mother Uses While Pregnant

- Scope of the problem:
- An estimated 10% to 11% of all newborns are prenatally exposed to drugs or alcohol; this amounts to 400,000 to 480,000 newborns per year
- Only about 5% of prenatally exposed newborns are placed in out-of-home care; the rest go home without assessment and services

- Sources: Vega; SAMHSA, OAS, National Survey of Alcohol and Drug Use During Pregnancy, 2002 and 2003

## MOST GO HOME.

- 	80-95% are undetected and go home without assessment and needed services.

- Many doctors and hospitals do not test, or may have inconsistent implementation of state policies
- Tests detect only very recent use
- Inconsistent follow-up for woman identified as AOD using or at-risk, but with no positive test at birth
- CAPTA legislation raises issues of testing and reporting to CPS

**Notes:**
The answer is of course that...
These issues are now being raised with changes to the Child Abuse Prevention and Treatment Act (CAPTA) within the Keeping Families Safe Act of 2003.  These changes include a requirement that states have policies and procedures requiring health care providers to notify CPS of “infants born and identified as being affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure.”  States must also develop a “plan of safe care” for such infants.  The law does not require reporting of children prenatally exposed to legal substances such as alcohol and tobacco.  Nothing in the law, however, prevents states from requiring such reporting.
Whatever side of the debate you sit on regarding testing and reporting of substance exposed births, I would expect that we can agree on the need for a comprehensive response – whether the lead be taken by child welfare, public health or AOD services – because, even though these kids may go home and miss becoming part of the system at birth, we continue to find that these kids come back into one of several systems later.

## Mother Uses Meth While Pregnant

- Risk to child depends on frequency and intensity of use, and the stage of pregnancy
- Risks include birth defects, growth retardation, premature birth, low birth weight, brain lesions
- Problems at birth may include difficulty sucking and swallowing, hypersensitivity to touch, excessive muscle tension (hypertonia)
- Long term risks may include developmental disorders, cognitive deficits, learning disabilities, poor social adjustment, language deficits

- Sources: Anglin et al.  (2000); Oro & Dixon, (1987); Rawson & Anglin (1999); Dixon & Bejar (1989); Smith et al. (2003); Shah (2002)

## Mother Uses Meth While Pregnant

- Observed effects may be due to other substances, or combination of substances, used by the mother
- For example, if the mother also smokes, growth retardation may be significant
- Observed effects may be complicated by other conditions, such as the health, environmental, or nutritional status of the mother

- Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005

## Mother Uses While Pregnant

- Shah, R.** **(2005, June). From NASADAD presentation

- Home environment is the critical factor in the child’s outcome
- Consequences can be mediated

**Notes:**
The home environment depends on the parent’s engagement and success in treatment.  The home environment is the critical factor for the child.  In addition the child’s social, emotional, developmental and psychological needs must also be addressed.   Address the child’s need has an impact on the parent’s treatment as well because coping with the issues of recovery and the challenges of a child with unmet or undetected special needs can pose barriers for parents trying to maintain a safe and stable home for their child. 

## Practice Models

## 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

**Notes:**
In Summarizing those reports, we found they typically mention several key barriers between the systems

Beliefs and values that workers come with
Competing priorities for innovations 
A very real treatment gap that means clients compete with each other for treatment space as do workers compete with each other to get their clients into too scarce slots
Information systems that can’t talk to each other and few formal systems in how workers should or could be communicating 
Staff knowledge and skills to work with these families
A very real communication gap about families who need services and how they are doing in care
Different mandates of what each system is funded to do

## Models of Improved Services

**Models of Improved Services**

**Family Treatment Courts**

**Training and Curricula Development**

**Persons in Recovery act as Advocates for Parents**

**Multidisciplinary Teams for Joint Case Planning**

**Counselor Out-stationed at Child Welfare Office**

**Paired Counselor and Child Welfare Worker**

**Notes:**
** This work and efforts in other sites began to draw on the expertise of people in recovery to act as advocates for parents in the child welfare system. 
I have to tell you that in 1996, Laura Feig Radel who many of you know from the Office of the Assistant Secretary for Planning and Evaluation, and I sat in a meeting passing back and forth a piece of paper with a list of program models that we could name that were putting initiatives together to better address the child welfare and substance abuse issues. Probably not a very scientific method of classification but at that time, we named about 7 models and about 20 locations with programs up and running. 
For example, Delaware paired a substance abuse counselor with a child welfare worker; many communities, including the state of New Jersey established a system of outstationed substance abuse counselors in child welfare offices who acted as technical advisors to child welfare workers; 
Many communities also established multidisciplinary case planning efforts; sites began to draw on the recovery community for its expertise; 

there was much emphasis on developing training and curricula to train front-line practitioners and finally, family treatment courts emerged.
These innovators and leaders provided the lessons with two common themes in their programs: experimenting with staffing patterns and drawing on persons in recovery who provided some type of increased case management and recovery management for parents.

## More Advanced Models of Team Efforts

**Workers out-stationed in collaborative settings: at courts, at CWS agencies, at treatment agencies**
**Increased recovery 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 responses to children’s needs**

## Common Ingredients of Family Treatment Courts

- System of identifying families
- Earlier access to assessment and treatment services
- Increased management of recovery services and compliance
- System of incentives and sanctions
- Increased judicial oversight

**Notes:**
Including an improved system of identifying families who need assistance.
Each have tried to ensure earlier access to treatment services and have increased or changed the recovery management in the case.
They’ve set up a system of incentives and sanctions and implemented that through a system of increased judicial oversight.
In a plenary session to close the conference tomorrow afternoon we’re very fortunate to hear from Judge Milliken who began the first county-wide systemic reform to address parental substance abuse in San Diego county.
And Dr. Sharon Boles will present the evaluation data from Sacramento County’s system-wide reforms that include a dependency drug court modeled on the work of Judge Milliken.

## Judicial Oversight Models 

- Integrated  (e.g., Santa Clara, Reno, Suffolk)
- Both dependency matters and recovery management conducted in the same court with the same judicial officer
- Dual Track (e.g., 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

## Judicial Oversight Models 

- Parallel (e.g., 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

## Sacramento, California Model of Effective Child Welfare and Substance Abuse Services 

**Comprehensive training—**to understand substance abuse and dependence and acquire skills to intervene with parents** **
**Early Intervention Specialists—**Social workers trained in motivational enhancement therapy are stationed at the family court to intervene and conduct preliminary assessments with *ALL* parents with substance abuse allegations at the first court hearing
**Improvements in Cross-System Information Systems**—to ensure that communication across systems and methods to monitor outcomes are in place as well as management of the county’s treatment capacity

## Prioritization of Families in Child Protective Services—County-wide policy to ensure priority access to substance abuse treatment services
Specialized Treatment and Recovery Services (STARS)—provides immediate access to substance abuse assessment and engagement strategies conducted by staff trained in motivational enhancement therapy. STARS provides intensive management of the recovery aspect of the child welfare case plan and routine monitoring and feedback to CPS and the court
Dependency Drug Court—provides more frequent court appearances for ALL parents with allegations of substance use.

**Specialized Treatment and Recovery Services (STARS)**—provides immediate access to substance abuse assessment and engagement strategies conducted by staff trained in motivational enhancement therapy. STARS provides intensive management of the recovery aspect of the child welfare case plan and routine monitoring and feedback to CPS and the court
**Dependency Drug Court**—provides more frequent court appearances for *ALL* parents with allegations of substance use.

**Sacramento, California Model of Effective Child Welfare and Substance Abuse Services **

## Treatment Discharge Status by Primary Drug Problem***

*****p<.001**

## 24-Month Child Placement Outcomes by Parent Primary Drug Problem

**n.s.**

## Time in Out of Home Care at 24-Months after Court Order to Participate in DDCby Parent’s Primary Drug Problem

**Notes:**
There are no differences among primary substances used by parents in terms of the length of time that children were in out of home care. Overall they have significantly reduced the time in care compared to the comparison group.
So, treatment does work...parents do recover, children do reunify.

Now let’s look at some of the differences for women who enter substance abuse treatment for methamphetamine dependence.

## National Center on Substance Abuse 
and Child Welfare 

A Program of the 
Substance Abuse and Mental Health 
Services Administration
Center for Substance Abuse Treatment
and the
Administration on Children, Youth and Families
Children’s Bureau
Office on Child Abuse and Neglect

**and Child Welfare**** **
**A Program of the**** **
**Substance Abuse and Mental Health **
**Services Administration**
**Center for Substance Abuse Treatment**
**and the**
**Administration on Children, Youth and Families**
**Children’s Bureau**
**Office on Child Abuse and Neglect**

**Notes:**
** I’d like to take just a moment to introduce to you the National Center on Substance Abuse and Child Welfare. We are coming up on our 2 year anniversary next month and we are quite pleased with the progress that is underway. 
Many of you may know that the NCSACW is co-funded by the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment and the Administration for Children, Youth and Families’ Children’s Bureau, Office on Child Abuse and Neglect. 

## NCSACW Products

*Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers -*
- 	A short monograph for front-line workers
- On-Line Training
- Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals
- Understanding Addiction and Recovery: A Guide for Child Welfare Professionals
- Coming in 2007: Understanding Substance Abuse and Child Welfare Issues: A Guide for Judicial Officers

**Notes:**
Publication and on-line training.  Free of charge.

## Contact NCSACW

- _[www.ncsacw.samhsa.gov](http://www.ncsacw.samhsa.gov/)_
**	****Project Director:**
**	****Nancy Young, Ph.D.**
**	****714-505-3525**
**Government Project Officer:**
**	****Sharon Amatetti, SAMHSA/CSAT**
**	****240-276-1694**
**	**_[sharon.amatetti@samhsa.hhs.gov](mailto:sharon.amatetti@samhsa.hhs.gov)__ _

## January 30, 2007
Pre-conference symposium on substance-exposed infants with Dr. Ira Chasnoff
January 31 to February 2, 2007
 National Conference
Disneyland Hotel, Anaheim California
 Sign up for information at  
     conference@cffutures.org

- Pre-conference symposium on substance-exposed infants with Dr. Ira Chasnoff
- January 31 to February 2, 2007
-  National Conference
- Disneyland Hotel, Anaheim California
-  Sign up for information at
-      **conference@cffutures.org**

**ANNOUNCING**

**Notes:**
Use your conference graphic.