# Presentation: 489084

## Engaging Parents in Treatment, Recovery and Parenting:

Effective Strategies of 
Specialized Treatment and Recovery Services (STARS)

** **
**Effective Strategies of **
**Specialized Treatment and Recovery Services **(**STARS**)

## Slide 2

## Program Context

- Sacramento County population: 1.5 million
- In 2004, there were approximately 7,000 substantiated child abuse/neglect referrals, in Sacramento1.
- An estimated 70 to 90% of child welfare cases involve families affected by substance use
- Over 50% of those cases are methamphetamine related.

- 1. Center for Social Services Research, University of California at Berkeley

**Notes:**
Beginning in 1997, following several highly publicized deaths, a concerted effort was made to remove children who were living with parents using drugs.  

## Sacramento County Prior to STARS and Dependency Drug Court

- Reunification rate about 18-20%
- Parents unable to access AOD treatment
- Social workers, attorneys, courts often uninformed on parent progress
- Drug testing not uniform and results often delayed

## Five Components of Reform

- Comprehensive cross-system joint training
- Substance Abuse Treatment System of Care
- Early Intervention Specialists
- Recovery Management Specialists (STARS)
- Dependency Drug Court

**In the Last Decade Sacramento Has ****Implemented Comprehensive Reforms**

## Sacramento County after STARS and Dependency Drug Court

- Reunification rates at 40–45%
- Reunification is occurring more quickly – almost twice as fast
- Parents truly have “treatment on demand”
- All parties involved in the case are informed at every stage of treatment
- All parents receive random observed “instant” drug testing

## Sacramento County Drug Court Model

**Sacramento County Drug Court Model**

## 
	Myth  

	Clients addicted to methamphetamine 
		do not complete treatment

**	****Myth **** **
**	**Clients addicted to methamphetamine
- 		do not complete treatment

**Notes:**
 There is a myth that people addicted to methamphetamine do not complete treatment.

However, an analysis of residential treatment completion data for publicly-funded treatment admissions demonstrated that methamphetamine treatment completion rates are not very different than those for other illicit drugs. 

## 
	Reality

	Data show that methamphetamine 	treatment completion rates are not 	very different than those for other 	addictive drugs

**	****Reality**
- 	Data show that methamphetamine 	treatment completion rates are not 	very different than those for other 	addictive drugs

**Notes:**

 In fact, during State Fiscal Year 2001 57% of youth and 65% of adults, who were admitted for methamphetamine addiction, completed chemical dependency treatment. 

 Treatment completion rates are derived from the discharge type summary information in the divisions management information system - TARGET.

## Treatment Discharge as it Relates to Sacramento Child Welfare

## STARS Goals

- Effect client change by removing barriers to treatment and providing support coupled with strict accountability.
- Provide CPS/Dependency Courts with accurate and reliable documentation regarding client progress through treatment.

## STARS Services

**Offer support and monitoring of AOD related case activities**
**Immediate access to recovery management and treatment services**
**Liaisons among clients, CWS, AOD, treatment providers and the Court**
**Compliance monitoring - twice monthly reports for the Dependency Drug Court**
**Funded through local tobacco litigation settlement funds (30%), used to match State and Federal Title IV-E case management funds (70%)**

**STARS Services**

## The 5 Points of STARS Success

**Servant **
**Leadership**

**Positivism**

**Customer **
**Service**

**Professionalism**

**Integrity**

## Obstacles to Client Change

- Late-stage addiction
- Resistance to “the system”
- Lack of hope
- Methamphetamine addicts are often dismissed in dependency cases or prejudged.
- Methamphetamine affects brain chemistry often leading to reduced memory and attention rates.

**Notes:**
Discuss how it is at this time that addicts are most likely to binge 

## Barriers Specific to Men

- The child welfare case often originates with the mother, creating or reinforcing father’s denial
- Men are less likely to be able to ask for help or show vulnerability
- Women dominate the social services field
- Women often dominate co-ed treatment
- Fathers don’t have healthy role models

## Achieving Our Goals

- Program Philosophy
- Support
- Intake
- Intangibles

## STARS Philosophy

- Our belief is that when we combine an empathetic, supportive environment with one that stresses accountability, we are able to create change in a profound way
- Each parent we work with is encouraged to accept responsibility for every action he/she participates in

**Notes:**
The program is set up to provide clients with the opportunity to be accountable for themselves.  

## Providing Support

- Recovery Specialist acts almost as a “personal trainer”
- Support specific not only to gender but to the substances abused.
- Recovery Specialists don’t allow clients to give up after a mistake or relapse
- Recovery Specialist helps to bring methamphetamine addicts past “the wall” or depression that accompanies recovery.

**Notes:**
For Methamphetamine Recovery Specialist provides calendars etc.

The wall occurs at about the 45-90 day mark.

## Intake

- Parent is immediately assessed for AOD issues at Detention Hearing.
- Each parent is assessed individually, helping to break denial surrounding significant other.
- Facility location

**Notes:**
Early Intervention Specialist – a trained CPS Social Worker
STARS is located across the street from Courthouse
Intake occurs instantaneously

## 
Rapid intake

Immediate access to treatment

Immediate contact with Recovery Specialist – gender specific

- Rapid intake
- Immediate access to treatment
- Immediate contact with Recovery Specialist – gender specific

**Intake**

**Notes:**
Clients are often much more honest at STARS and this is due to the positive environment we provide.  Mothers and Fathers always in separate Tx programs

## Treatment Access

- Instant assessment and referral to APPROPRIATE treatment
- Removing barriers to ENTERING treatment
- Active support for parents, such as helping to phone for appointment, driving parents to first appointment
- Immediate re-assessment upon relapse or treatment failure

## Effective Methamphetamine Treatment Components

- Minimum of six months to one year of treatment
- Structured, intensive and comprehensive
- Focus on “coping mechanisms”
- Cognitive-behavioral in nature

## Three Strategies for Working with Methamphetamine-Abusing Parents 

- Use of Motivational Interviewing Techniques
- Role-modeling
- Accountability

## Motivational Interviewing

- Alternative to theory that denial and resistance must be smashed
- Described as “dancing” not “wrestling”
- Works well with men as it eliminates the power struggle

**Notes:**
Dr. William Miller and Stephen Rollnick

## Incorporating the Principles of Motivational Interviewing

- Express empathy
- Support self-efficacy
- Roll with resistance
- Develop discrepancy

## Role Models

- Recovery Specialists are:
- Certified addiction specialists
- Believable and approachable
- Comfortable with some self-disclosure
- Non-punitive in approach

**Notes:**
STARS practices a great deal of role-modeling as an agency.  We dress professionally, act professionally and attempt to visibly show the client and example of how a “man” acts.

## Intangibles

- Belief in redemption and recovery
- Overcome prejudices that exist
- We give 100% for client’s 100%
- Passion

## LovePassion Hope

## Slide 29