# Presentation: 404811

## Child Welfare and Substance Abuse:Current Issues and In-Depth TA

**The NGA Center for Best Practices**
**Institute on Child Welfare****Miami, Florida**
**June 16, 2005**

**	****4940 Irvine Boulevard, Suite 202****	****	****	**** ****	**** 714-505-3525     **
**	****Irvine, CA  92620 ****	****	****	****	****               **_[www.](http://www.ncsacw.samhsa.gov/)__[ncsacw](http://www.ncsacw.samhsa.gov/)__[.](http://www.ncsacw.samhsa.gov/)__[samhsa](http://www.ncsacw.samhsa.gov/)__[.](http://www.ncsacw.samhsa.gov/)__[gov](http://www.ncsacw.samhsa.gov/)_

## Presenters

- Joe Anna Sullivan, NCSACW
- Mary Chaliman, Michigan
- Karen Mooney, Colorado

## 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**

## MISSION
To improve outcomes for families by promoting effective practice, 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

- To improve outcomes for families by promoting effective practice, 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

## NCSACW Consortium

- American Public Human Services Association (APHSA)
- Child Welfare League of America (CWLA)
- National Association of State Alcohol and Drug Abuse Directors (NASADAD)
- National Council of Juvenile and Family Court Judges (NCJFCJ)
- National Indian Child Welfare Association (NICWA)

## Children with Prenatal Substance Exposure

## Infants with prenatal substance         ~410,000 

- exposure

***Where did they all go?***

- Number of Children Prenatally Exposed to Substances

- Total child victims under 1 year old     **~****86,000**

- Total children under 1 year old	     **~****41,000 **entering out-of-home-care

## Most Go Home

- 	More than 80% 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

## Prenatal substance exposure
Fetal alcohol syndrome, fetal alcohol spectrum disorder, neuro-developmental disorders

Postnatal environment factors 
Violence or traumatic events
Drug and/or alcohol seeking behaviors
Illicit drug sales or manufacturing
Lack of adult interpersonal support systems
Community effects such as living in poverty
Lack of proper health care
Inconsistent caregivers

- Fetal alcohol syndrome, fetal alcohol spectrum disorder, neuro-developmental disorders
- Postnatal environment factors** **
- Violence or traumatic events
- Drug and/or alcohol seeking behaviors
- Illicit drug sales or manufacturing
- Lack of adult interpersonal support systems
- Community effects such as living in poverty
- Lack of proper health care
- Inconsistent caregivers

- Potential Consequences for Children

## Areas of Child Development Affected by Parental Substance Use Disorders

- Physical health consequences
- Lack of secure attachment
- Language delays and communication disorders
- Psychopathology
- Behavioral problems
- Poor social relations and skills
- Deficits in motor skills
- Cognition and learning disabilities

- Research has shown that these effects can manifest themselves in multiple areas, including:

## Children of Substance Abusers who are also Victims of Child Abuse and/or Neglect

## Children Living With One or More Substance Abusing Parent

**In Millions**

## 71% of caregivers who are alcohol dependent are classified by the CWW as not having an alcohol problem
73% of caregivers who are drug dependent are classified by the CWW as not having a drug problem

- 73% of caregivers who are drug dependent are classified by the CWW as not having a drug problem

- CWW’s misclassify caregivers who are substance dependent most of the time

- Documenting Substance Use Disorders in Child Welfare

- Children and Family Service Reviews (CFSRs)
- Parental substance use disorders were a factor in 16% to 48% of cases

## Children in the Child Welfare System with their own Substance Use Disorder

## Percentages of Past Year Substance Use    among 12 to 17 Year Olds by Foster Care Status

**www.oas.samhsa.gov**

## Children of substance abusers need in-depth assessments and interventions that respond to their developmental status and the special needs created by substance use disorders in their family 
grief, loss, separation, attachment  
Adolescents who may have begun their own substance use – Few Independent Living Programs under Chafee Bill include prevention or intervention for children of substance abusers aging out of foster care

- grief, loss, separation, attachment
- Adolescents who may have begun their own substance use – Few Independent Living Programs under Chafee Bill include prevention or intervention for children of substance abusers aging out of foster care

- Children in the Child Welfare System with their own SUD

## Challenges and Opportunities

## Crises/Opportunities

- Methamphetamine epidemic
- Continuing prenatal substance exposure
- CAPTA amendments and requirements to report to CPS
- Need for better data systems to identify children and parents
- Connecting to child abuse/neglect prevention
- CFSR and new rounds of reviews

## Challenges for Cross-system Collaboration

- Child safety – Treatment privacy & advocacy
- ASFA Timelines – Recovery takes a lifetime
- Accountability for parental actions – Client Readiness
- Single System Funding
- Staff and Leadership Turn-over
- Special “Project-itis” and Sustainability

##  TANF reauthorization

-  TANF reauthorization
- Does your State define child welfare as “Needy Families?”
- Title IV-E Access
- Waivers for treatment
- Case management funding
- Foster care providers

## Policy Framework and Tools

- 10 Element Framework
- Collaborative Values Inventory
- Collaborative Capacity Instrument
- Matrix of Progress in Linkages
- Screening and Assessment for Family Engagement, Retention and Recovery  -- SAFERR

## Connecting AOD, CWS, Court Systems: 

- Training and Staff Development
- Budgeting and Program Sustainability
- Building Community Supports

- Connecting AOD, CWS, Court Systems:
- Elements of System Linkages*

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

- Underlying Values
- Screening and Assessment
- Client Engagement and Retention in Care
- AOD Services to Children

- Joint Accountability and Shared Outcomes

- Working with Related Agencies and Support Systems

## Four Components of System Reform 

- Comprehensive cross-system joint training
- AOD basics for all staff – 4 days required
- AOD screening, brief intervention, motivational enhancement and AOD treatment – 4 days required of all case carrying workers
- Group intervention skills – 4 days required of all ADS staff and voluntary for any CPS division staff
- Early Intervention Specialists
- Immediate access to intervention and assessment at the court hearings

## Recovery Management Specialists
Motivational enhancement
Immediate access to recovery management and treatment services
Compliance monitoring
Dependency Drug Court
30, 60 and 90-day compliance hearings
Structured incentives for compliance and sanctions for non-compliance
Voluntary participation in on-going services

- Motivational enhancement
- Immediate access to recovery management and treatment services
- Compliance monitoring
- Dependency Drug Court
- 30, 60 and 90-day compliance hearings
- Structured incentives for compliance and sanctions for non-compliance
- Voluntary participation in on-going services

- Four Components of System Reform

## PRODUCTS

- Free On-Line Training with CEUs
- Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals – **Now Available**
- Understanding Addiction and Recovery: A Guide for Child Welfare Workers
- Understanding Families with Substance Use Disorders: A Guide for Judges and Attorneys working with Families in Family/Juvenile Court

## PRODUCTS

- Materials
- Compendium of Training Curricula
- Understanding Substance Abuse: A Guide for Child Welfare Practitioners
- Draft White Paper on Funding Substance Abuse and Child Welfare Services
- Draft White Paper on Implementing the 2004 Substance Abuse Amendment in the Child Abuse Prevention and Treatment Act (CAPTA)

## PRODUCTS we’re working on...

- State Policies regarding Substance Exposed Infants
- Guidance to States and Communities on:
- Screening and Assessment for Family Engagement, Retention and Recovery (SAFERR)
- Methamphetamine and child risk and safety assessments
- The use of drug testing in child welfare practice
- Medication assisted treatment for opiate dependence and implications for child welfare

## PRODUCTS

- Program of In-Depth Technical Assistance
- Round 1 – Summer 2003 to Fall 2004
- Colorado – Licensing/certification of providers who specialize in child welfare population and protocol for improving services
- Florida – Regional contracts to ensure local-level system linkages and preferred practice model
- Michigan – Revised SACWIS to prioritize SUDs
- Virginia – Comprehensive 5-year plan
- Round 2 – Winter 2005 to Spring 2006
- Arkansas, Massachusetts, Minnesota and Squaxin Island Tribe at Puget Sound

## MICHIGAN

- Mary Chaliman

## Michigan Department of Human Services

- State run, county  administered - 83 counties
- 19,020 children in foster care system
- 65% of families with children in foster care have substance abuse needs
- 16 Substance Abuse Coordinating Agencies
- Family Drug Courts:
- 2 operational
- 2  in planning stages
- 3 show level of interest

## Michigan Challenges

- Budget deficits in each of the last 3 fiscal years
- Changes in leadership and early retirements
- Sustaining and increasing provision of TA to counties to facilitate the development of local collaborations
- Competing collaborative efforts

## Progress related to IDTA 

- Endorsement from State Directors
- Pursuit of more Family Treatment Drug Courts
- Work plan development for presentations
- Communications protocol for professionals
- Consolidation & Coordination

## Benefits to Child Welfare

- Representation on the Methamphetamine Task Force and Drug Endangered Children Teams
- Representation on the FASD state team
- TA training for staff on family drug treatment court and FASD
- Revision of Family Assessment of Needs and Strengths to accurately score SA needs

## Next Steps

- Re-engage leaders to champion efforts
- Evaluate effectiveness of community treatment programs with new SACWIS capabilities
- Spread best practices
- Provide educational and resource links in worker manuals

## COLORADO

- Karen Mooney

## Child Welfare

- Juvenile and Family Court

- Substance Abuse Treatment

## Challenges to Collaboration

- Different priorities between systems
- Different levels of motivation for change
- Values were different

## Impact of TA 

- Motivation to get things done
- Added legitimacy to our process
- Gave us background and encouragement

## Impact of TA (2)

- Required planning and execution of tasks
- Final product was Protocol

## Outcomes

- Protocol was finalized
- New treatment population added to substance abuse treatment regulations
- New requirement of women’s programs that they screen for child safety issues at intake and periodically thereafter
- New trainings incorporating Protocol elements

## Lessons:

- Local buy-in critical
- Stable leadership needed at all phases
- Identify and utilize culture carriers
- Don’t give up

## Lessons (2)

-    Availability of appropriate treatment (programs for women and children) is insufficient to meet need

- Photo used with kind permission of Robert Clark, photographer