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    1. 1 “A Proposed Curriculum: A Child Welfare Model for Keeping Children Safe in Families Affected by a Substance Use Disorder ” Milton R. Ayala, LMSW Title IV-E National Roundtable Conference Galveston, Texas May 27, 2011 Milton.Ayala@dfps.state.tx.us

    2. 2 Overview Introduction Unit 1: Child Welfare Unit 2: Substance Use Disorders Unit 3: Casework Conclusion

    3. 3 Objective Participants will be able to develop a curriculum for an elective course on child welfare and substance use disorders.

    4. 4 Background National Data In 2005, it was estimated that 9.2 million children in the United States lived in a household where a parent or other adult used illicit drugs [1] In 2005, it was estimated that alcohol and drug abuse were caregiver factors for more than 75 % of children who entered foster care [1] In 2006, it was estimated that 10-11% of newborns were exposed to or born addicted to alcohol or a controlled substance (400-440,000 infants) [2] In 2011, prenatal screening studies documented 15-20% of newborns were exposed to alcohol, tobacco, or illegal drugs prior to birth [3]

    5. 5 CPS Data In 2010, the number of families served (Investigation, Family Based Safety Services, and Substitute Care) = 194,058 [1] In 2010, the number of families with substance abuse involvement served = 85,819 (44.2%) [1] In 2010, of the 15,067 families served whose children were in substitute care, the % of familial caregivers with a substance abuse person characteristic = 66.3% [1] Texas State Child Fatality Review Team Committee Fatality Reviews: In 2009 in Texas, there were 900 deaths resulting from alcohol-related accidents. Of the 900 deaths, 13 % (117) were children. [2] In 2011, substance abuse among caregivers has been identified as one of several major risk factors involved in child maltreatment deaths. [2] Background: Texas Data

    6. 6 Data is for inpatient admissions Data shows convergence of reason for admission over time Alcohol does not play the prominent role it played in 1987 Admissions have increased for all types of substances; but the % has decreased Data is for inpatient admissions Data shows convergence of reason for admission over time Alcohol does not play the prominent role it played in 1987 Admissions have increased for all types of substances; but the % has decreased

    7. 7 PCC = poison control calls DPS = Department of Public Safety (State Highway Patrol) % Purity = the potency of methamphetamine over time; potency has generally increased There has been an overall decrease in the methamphetamine use and manufacture in the state of TexasPCC = poison control calls DPS = Department of Public Safety (State Highway Patrol) % Purity = the potency of methamphetamine over time; potency has generally increased There has been an overall decrease in the methamphetamine use and manufacture in the state of Texas

    8. 8 Federal Child Abuse Prevention and Treatment Act-2003 (CAPTA) Key Provisions States need to enact “…provisions or procedures for the reporting of known and suspected instances of child abuse and neglect…” [1] Health care providers involved in the delivery or care of a substance exposed newborn need to notify the Child Protective Services System (CPS) [1] Referrals of children involved in the CPS system from birth to age three are to be made to Early Childhood Intervention Services (ECI) [1]

    9. 9 Timelines Federal Adoption and Safe Families Act (ASFA)-1997 Promote adoption of children in foster care Texas Timelines Investigation = 60 days Family Based Safety Services = 270 days (regular FBSS case) DFPS as Temporary Managing Conservarorship up to: 365 days with an extension of 180 days Recovery = Years Recovery is a process of change in beliefs, values, skills, and the establishment of an environment that leads to a substance free lifestyle. [

    10. 10 SUD Defined Substance use disorder (SUD) – includes the spectrums of substance abuse and dependence as defined by the diagnostic criteria of the American Psychological Association, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV): [1] Substance use – the consumption of legal or illegal, (or both), psychoactive substances. Substance abuse – a pattern of substance use that results in at least one of four consequences: (1)failure to fulfill role obligations, (2) use places one in danger (e.g., driving under the influence), (3)legal consequences occur, or (4) interpersonal/social problems result Substance dependence – a pattern of use resulting in at least three of seven dependence criteria as specified in the DSM-IV: (1) tolerance, (2) withdrawal, (3) unplanned use, (4) persistent desire or failure to reduce use, (5) spending a great deal of time using, (6) sacrificing activities to use, or (7)physical/psychological problems related to use.

    11. 11 Unit 1: Child Welfare Chapter: Knowing the Family from the Perspective of a Child Protective Services (CPS) Caseworker In Texas, in an Investigation, caseworkers use the 6 Questions from the Child Safety: A Guide for Judges and Attorneys (intended for information gathering purposes) Q1-What is the nature and extent of the maltreatment? Q2-What are the circumstances that accompany the maltreatment? Q3-How do the children in the family function? Q4-How does the parent discipline the children? Q5-What are the overall parenting practices? Q6-How does the parent manage his/her life? Lund, T.R., & Renne, J. (2009). Child Safety: A Guide for Judges and Attorneys,p.3.

    12. 12 Q6-How does the parent manage his/her life? Areas that could be addressed in the subtitle are: SUDs Mental Health Communications and social skills Coping and stress management Problem solving Decision making Budget management Health and wellness Cultural norms Relationships Domestic violence Employment Familial expectations

    13. 13 Unit 1: Child Welfare continued Chapter: Introduction to the Enhanced Family-Centered Safety- Decision Making (EFCSDM) CPS Practice Model [1] Articulate difference between safety and risk Elaborate on differences between safe child versus unsafe child Explain the concepts of: Safety threats Child vulnerability Protective capacities [1] Lund, T.R., & Renne, J. (2009). Child Safety.

    14. 14 Unit 2: SUD Chapter: Understanding Addiction Subtitle: The Science of Addiction: A Brain Disease Chapter: Treatment Subtitle: Effectiveness of Treatment and Recovery Detoxification Inpatient Rehabilitation Outpatient Treatment Subtitle: Psycho-pharmacologic Management Subtitle: Faith-Based Interventions Chapter: Drug Testing Subtitle: Instant versus Laboratory Tests Subtitle: Substances and Detection Periods Subtitle: False Positive Results Chapter: Health Insurance Portability and Accountability Act (HIPAA)

    15. 15 Unit 3: CPS Casework with SUD Caregivers Chapter: Family Engagement Strategies Subtitle: Motivational Interviewing Chapter: Information Gathering Tools direct and open questions active listening observation collateral contacts case reading drug test

    16. 16 Unit 3 : CPS Casework with SUD Caregivers continued Chapter: Protective Measures Specific to SUD Caregivers: home free of alcohol and drugs (part of a safety plan) referral for screening, treatment (part of a family plan) psycho-pharmacological management, if appropriate (part of a family plan) parenting education (part of a family plan) Submit to immediate drug test (part of a safety plan); (total abstinence for a “user” or “abuser” of a substance; pattern of negative readings for an addicted individual (part of a family plan) relapse prevention plan to include child safety measures (part of a family plan) identification of an abstinent-sober caregiver or monitor (part of a safety plan and can be included in the family plan) mechanism for daily reporting and tracking of urges and relapses in place (part of a family plan)

    17. 17 Unit 3 : CPS Casework with SUD Caregivers continued (if appropriate) safety plan (if appropriate) parental-child safety placement (if appropriate) removal Teaching point: a safety plan deals with immediate threats to child safety; the plan will state the" how” interventions/measures to keep the child safe A family plan keeps the child safe while working to reduce risk factors Subtitle: Family Drug Treatment Court

    18. 18 Unit 3: CPS Casework with SUD Caregivers continued Chapter: CPS Caseworker’s Expectations of Treatment Increase caregiver’s protective capacities and decrease safety threats Treatment focus: cognitive behavioral emotional

    19. 19 Unit 3: CPS Casework with SUD Caregivers continued Chapter: Arriving at Case Closure: “Factors Controlled” home free of drugs and alcohol no new concerns or allegations involving new safety threats children’s basic needs are being met caregiver is abstinent or has established a pattern of negative drug readings addicted caregiver is involved in treatment or recovery support groups relapse child safety plan in place psycho-pharmacological management, if appropriate

    20. 20 Unit 3: CPS Casework with SUD Caregivers continued positive reports from providers, children and collaterals and the parent final drug test is negative and no new “hit” on a final criminal check support network in place existence of a abstinent-sober caregiver or monitor other than the SUD caregiver mechanism for daily self monitoring and reporting in place completion of parenting education that focused on parenting skills in the absence of illicit drugs and/or alcohol CPS family plan has mitigated safety threats and the caregiver has increased or enhanced his/her protective capacities; and the caregiver is willing and capable of protecting the child against safety threats

    21. 21 Take Away Messages A SUD caregiver could pose threats to child safety. Undergraduate and graduate social work and human services/ health care departments should consider the importance of offering an elective course or training on child welfare and substance use disorders. It takes all of us to keep children safe.

    22. 22 “Happy trails to you…”

    23. 23 Questions

    24. 24 Handout: Resources and Additional Information Adoption and Safe Families Act of 1997. Retrieved from: http://www.acf.hhs.gov/programs/cb/laws_policies/cblaws/public_law/pl105_89/pl105_89.htm Breshears, E.M., Yeh, S. & Young, N.K. Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers. U.S. Department of Health and Human Services. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2009. Center for Substance Abuse Treatment. Substance Abuse Specialists in Child Welfare Agencies and Dependency Courts Considerations for Program Designers and Evaluators. HHS Pub. No. (SMA) 10-4557 Rockville, MD: Substance Abuse and Mental Health Services Administration, 2010 Lund, T.R., & Renne, J. Child Safety: Guide for Judges and Attorneys. American Bar Association, 2009. National Institute of Drug Abuse (NIDA). Principles of Drug Addiction Treatment. NIH Pub. No. 09-4180, 2009 NIDA. The Science of Addiction. NIH Pub. No. 07-5605, 2007.

    25. 25 Handout: Resources and Additional Information National Institute of Drug Abuse (NIDA). Principles of Drug Addiction Treatment. NIH Pub. No. 09-4180, 2009 NIDA. The Science of Addiction. NIH Pub. No. 07-5605, 2007. Office of Child Abuse and Neglect. The Child Abuse and Prevention and Treatment Act, 2003. Young, N. K., Nakashian, M., Yeh, S., & Amatetti, S. Screening and Assessment for Family Engagement, Retention, and Recovery (SAFERR), p.H-7. DHHS Pub. No. 0000. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2006. Young, N. K., Gardner, S., Otero, C., Dennis, K., Chang, R., Earle, K., & Amatetti, S. Substance-Exposed Infants: State Responses to the Problem. HHS Pub. No. (SMA) 09-4369. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2009.

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