Promoting Permanency for Children Affected by Substance Abuse

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

2. Work Shop Overview • NCSACW • Scope of Issue • Policy Tools for Solutions • Models of Changed Practice • Issues for Children • Models of Family Drug Courts

3. 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 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

4. 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

5. 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

6. 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

7. “Believing is seeing” By inverting the cliché, it communicates 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 Diane L. Coutu, “Sense and reality: A conversation with celebrated psychologist Karl E. Weick,” Harvard Business Review. April 2003. pp. 84-90.

8. The Power of Teams 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.

9. 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

10. The Power of Teams 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

11. ILLEGAL Underage Alcohol and Tobacco Illicit Use of Prescriptions Restricted Drugs LEGAL Alcohol Tobacco Prescription Drugs PERSONAL USE IN UTERO ENVIRONMENTAL CHILDREN COMMUNITY FAMILY MEDIA Paths of a Child’s Exposure to Alcohol and Other Drugs PATHS OF EXPOSURE

12. 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 Themselves1 • Children of Substance Abusers Exhibit Depression and Anxiety More Often Than Children from Non-addicted Families2 1. Department of Health and Human Services, Blending Perspectives and Building Common Ground, April1999 2. National Association for Children of Alcoholics, Children of Addicted Parents: Important Facts, http://www.nacoa.org

13. InMillions National Estimates of Children Living With At Least One Substance Abusing Parent

14. 67% and 32% Substantiated COSAs and Child Abuse/Neglect Victims Millions 0 2 4 6 8 10 *Child Maltreatment 2001

15. 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%

16. 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

17. 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 Information Sharing & MIS Training/Staff Development Budgeting/Program Sustainability Building Community Supports Working with Related Agencies and Support Systems How to Connect the AOD, CWS, Court Systems: Elements of System Linkages* From CSAT Technical Assistance Publication (TAP) 27: Navigating the Pathways *Revised March 2003

18. 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

19. Key CFSR Outcomes with Implicationsfor Substance Abusing Families • Families Have Enhanced Capacityto 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

20. Families Have Enhanced Capacityto 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

21. Families Have Enhanced Capacityto 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

22. 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

23. 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

24. 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

25. 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

26. Models of Family Treatment Courts • Integrated – Santa Clara • Both dependency matters and recovery management conducted in the same court with the same judicial officer

27. 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

28. 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

29. Significantly Less Criminal & CPS Recidivism Among FDTC Parents in Five Sites *p<.05 Percent of Parents in 18 Months

30. Average Days to PermanencySacramento County Dependency Drug Court n=90 n=146 p<.001

31. 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 3rd or 4th job—case management—we are their best advocates and know them better than any professional *Personal Experience not NCSACW

32. Nancy & Sid’s Top 10 List • 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

33. 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