# Presentation: 734744

## Methamphetamine: The Child Welfare Impact and Response Overview of the Issues 

**Presented by**
**Nancy K. Young, Ph.D., Director**
**National Center on Substance Abuse and Child Welfare**
**May 8, 2006**
**4940 Irvine Blvd., Ste 202    Irvine CA  92620  714-505-3525  Fax: 714-505-3626**
**ncsacw.samhsa.gov**

## Ways to Look at the Data

**New users**
**Those that initiate substance use in a given year; monitor to estimate future problems**
**Persons who meet criteria for substance abuse or dependence**
**Began to experience consequences and problems and need treatment**
**Persons who were admitted to treatment**
**Those that met abuse/dependence criteria and were admitted to publicly funded treatment programs**

## 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**

## Methamphetamine Use in Past Year among Persons Aged 12 or Older, by State: 2002, 2003, and 2004 

## Methamphetamine Use in Past Month Among Persons Aged 12 or OlderBy Dependence and Abuse: 2002, 2003, and 2004 

- The percentage of current methamphetamine users who met criteria for substance abuse or dependence doubled between 2002 (27.5%) and 2004 (59.3%)

## Treatment Admissions by Primary Substance 

- Source: Treatment Episode Data Set (TEDS) – Highlights 2004

## 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.  

## 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 D****oubled 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.

## Different Risks to Children Based on Type of Parental Involvement

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

- 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

## 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 Risks to Children Based on Type of Parental Involvement**

## 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

## 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

- 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

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

**Percent of Infants Exposed**

## Mother Uses While Pregnant

**	**
- Home environment is a critical factor in the child’s outcome
- Many of the consequences can be mediated

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

**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. 

## Parent “Cooks” Small Quantities of Meth

- All the risks of parents who use or are dependent on meth, with added risks of manufacturing the drug:
- Chemical exposure
- Toxic fumes
- Risk of fire and explosion

- 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:**
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.

## Environmental Methamphetamine Exposure and Risks

- Toxic effects of manufacturing
- 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: Mason (2004)

## Parent Involved in Trafficking

- Presence of  weapons
- Possibility of violence
- Possibility of physical or sexual abuse by persons visiting the household
- Higher possibility of becoming a child of an incarcerated 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

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

## Parent Involved in Super Lab

- Lower likelihood of children on the site
- Higher likelihood of being a child of an incarcerated 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

## 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  |

**Number of Children in Meth Labs**

- Source:  El Paso Intelligence Center

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

**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.

## 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 and family members’ needs

## Lessons and Challenges of Out-stationed Substance Abuse Counselors

- _Primary Roles and Responsibilities_
- Clinical Consultation and Interpretation
- Referral and Brokering
- Engaging Clients in Treatment
- Cross-training
- Creating Awareness

## Lessons and Challenges of Out-stationed Substance Abuse Counselors

- _Environment and Context_
- Who Is the Customer?
- Specific Qualifications
- Clear Policies, Protocols and Location
- Clear Supervisory Relationships
- Clear Functions for the Substance Abuse and Child Welfare Agencies and/or the Overall County

## 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

## Judicial Oversight Court 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

## 
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

- 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

**Judicial Oversight Court Models**

## Five Components of Reform

	1.		Comprehensive cross-system joint training
	2.		Substance Abuse Treatment System of Care
	3.		Early Intervention Specialists
	4.		Recovery Management Specialists (STARS)
	5.		Dependency Drug Court

Reforms have been implemented since 1994; Fully operational since October 2002

**	****1.****	****	****Comprehensive cross-system joint training**
**	****2.****	****	****Substance Abuse Treatment System of Care**
**	****3.****	****	****Early Intervention Specialists**
**	****4.****	****	****Recovery Management Specialists (STARS)**
**	****5.****	****	****Dependency Drug Court**
**Reforms have been implemented since 1994; Fully operational since October 2002**

**Sacramento County’s Comprehensive Reform**

## 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

## National Alliance of Drug Endangered Children (DEC)

- Formed in October 2003
- Provides multi-disciplinary training for communities interested in starting or expanding DEC programs
- _[www.nationaldec.org](http://www.nationaldec.org/)_

## Gender Differences and Implications for Treatment

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

## Histories of Violence among Clients Treated for Methamphetamine

- Persons in treatment for methamphetamine reported high rates of violence
- 85% women vs. 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 vs. 16% men

- Source: Cohen, J. (2003)

## Abuse During Lifetimefrom a Women’s Treatment Population

***** significant difference between women and men p < .001**

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

**Abuse During Lifetime****from a Women’s Treatment Population**

## Age That Physical Violence Began

|  | Women | Men |
| --- | --- | --- |
| Total reports of violence |   365 | 324 |
|                 Percent of total N |   70% | 80% |
| Began between 1 and 10 yrs.  |   158 | 135 |
| Began between 11 and 18 yrs. |   207 | 189 |

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

## Age That Sexual Abuse Began

|  | Women | Men |
| --- | --- | --- |
| Total reports of sexual abuse |    307 | 58 |
|              Percent of total N |    56% | 14% |
| Began between 1 and 10 years |    134 | 34 |
| Began between 11 and 18 years |    173 | 24 |

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

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

- Women in treatment 2 times 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

## Gender Differences and Implications for Treatment

- Sexual behavior linked to methamphetamine is a significant clinical issue that needs to be addressed in women-only groups
- 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

## 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

- 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 we are 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. 

## To improve outcomes for families by promoting effective practice, and organizational and system changes at the local, state, and national levels
Developing and implementing a comprehensive program of information gathering and dissemination

Providing technical assistance

- Developing and implementing a comprehensive program of information gathering and dissemination
- Providing technical assistance

- Mission

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

**Notes:**
You have a handout in your materials on our technical assistance program and how to reach us as well as an announcement of our first on-line curricula. 
This on-line training is directed to substance abuse counselors and explains child welfare services and the dependency court. It takes about 4 hours to complete, it is free of charge and comes with 4 hours of CEUs for those that are interested. Our second on-line curricula will be released in a few months and targets child welfare workers and explains addiction and recovery.
You can visit our website and leave us your email address if you are not currently on our distribution list to receive announcements of our products and activities and we look forward to hearing more from you.