METHAMPHETAMINE AND CHILD WELFARE: National Statistics and Clermont County, Ohio Experience

1. METHAMPHETAMINE AND CHILD WELFARE: National Statistics and Clermont County, Ohio Experience Background Will Meth affect your county? Will Meth affect your Child Welfare Department Explanation of Ohio Boards’ Role and Funding Current Status of Substance Abuse Treatment Services and Priorities for Services in Clermont County, Ohio

2. WHAT IS METHAMPHETAMINE? Methamphetamine is a powerful central nervous system stimulant that strongly activates multiple systems in the brain. Use of Methamphetamine can lead to psychosis, eating and sleeping disorders, dental deterioration, and skin scratching. Methamphetamine is more toxic than other drugs, but if an addict completes treatment and stays abstinent, brain function returns to normal in about 24 months.

3. BRIEF HISTORY OF METHAMPHETAMINE USE Abundant in West/Southwest for decades In 1979, key ingredients outlawed in U.S. Ephedrine method simplified production Internet spread the formula Production moved to rural areas Laws restricting sale of ephedrine products impacting production New supply from Mexico Historically, shooting or snorting only option for ingestion; in early 1990’s, smoking methamphetamine greatly expanded demographics and increased addiction liability 1990’s conversion from meth hydrochloride to meth freebase; smoking spread use to women and adolescents1990’s conversion from meth hydrochloride to meth freebase; smoking spread use to women and adolescents

4. The Faces Of Meth

5. APPROACHES TO METHAMPHETAMINE PROBLEM Supply intervention Precursor control Treatment Law enforcement Prevention Prevention Example: Montana Meth ProjectPrevention Example: Montana Meth Project

6. Meth Stats National Stats From the NACo Survey 40% of all child welfare officials report an increase in out of home placements because of meth in the last year 87% of law enforcement agencies report increases in meth related arrests (starting three years ago) NACo Survey of 500 County law enforcement officials in 44 states consider methamphetamine their primary drug problem. Recently, there has been a decrease nationally in methamphetamine lab busts (due to effects of laws restricting access to needed ingredients), but access to drug still high. Ohio Stats According to the Ohio Attorney General Ohio had 345 meth lab busts in FY 04 More in FY 05

7. Where are the Meth Labs in Ohio??

9. How has Meth Impacted Clermont County??

10. Our local law enforcement has done a tremendous job in identifying these labs and making life safer for the people of this county Part of making it safer brings those children into our systemOur local law enforcement has done a tremendous job in identifying these labs and making life safer for the people of this county Part of making it safer brings those children into our system

11. Clandestine Labs Discovered in Clermont County 2004 30 Methamphetamine labs busted 84 persons arrested on meth related charges 2005 42 Methamphetamine labs busted 88 persons arrested on meth related charges 2006 (thru June 30th) 24 Methamphetamine labs busted 38 persons arrested on meth related charges

12. Children Removed From Meth Labs in Clermont County 2003 # of children removed – 30 # placed with relatives - 10 # placed in foster care – 20 Estimated cost - $430,000 2004 # of children removed – 40 # placed with relatives - 15 # placed in foster care – 25 Estimated cost - $540,000 2005 # of children removed – 40 # placed with relatives - 10 # placed in foster care – 30 Estimated cost - $613,000

13. Community Killer As a direct result of the growing methamphetamine problem in Clermont County more than 100 kids, at a cost of more than a million dollars, entered our system in the last 3 years… Other systems also have incurred a cost Working with Lead Clermont and local tv personality to develop some public service announcements about the dangers of methOther systems also have incurred a cost Working with Lead Clermont and local tv personality to develop some public service announcements about the dangers of meth

14. Clermont Stats Clermont County led the state of Ohio in the discovery of meth labs in 2003, we were second in 2004 From January of 2003 to January of 2004 we saw a 37% increase in the number of children in Foster Care…the increase was due, almost exclusively to Meth Placement costs in Clermont County went from $ 3.6 million dollars in 2001 to $6.4 million in 2004. Much of the increase can be associated with the increase in drug abuse We currently investigate about one meth lab case a week We failed in an attempt to pass a Replacement Levy to address the additional costs – we found that while people were sympathetic to the children they were not sympathetic to the drug addicted parents- we subsequently passed a levy in May 2006 shifting focus away from Meth A recent survey of registered voters showed 57.2% identified the sale and abuse of Meth as a major problem in Clermont County. Another 26.5% identified it as somewhat of an issue for the county.

15. Other impacts on Children’s Services Clothing vouchers – children can’t take anything from a meth lab with them to their foster home Medical examinations Staff time – investigator, ongoing worker, transportation worker, court personnel, assistant prosecutor, public defender Worker safety (both with clients who are using meth and by being exposed to the toxic chemicals) Lack of adequate treatment programs

16. Who are these Children and What Happens to them?? Often the children are forced by their parents to be INVOLVED in the production of the methamphetamines Most of the children taken from homes with meth labs are young-under the age of 8yrs old Often other relatives are also involved in the “family business”…thus when removed many end up in foster care Many of the parents are unable to kick the addiction to the drug and end up losing permanent custody of their children Depending on the circumstances of the lab, these children may be affected emotionally, psychologically, and physically…FOR LIFE At this point, the long term effects of exposure to meth for children is unknown

17. What are we Doing?? CPS staff working closely with the Sheriff’s Department & community partners Multi-Discipline training for our staff (SWORTC, Sheriff’s Department). Training included staff from CPS, Mental Health, Home visitors, Board of Health Established a committee to address these issues: Meth kits Protocol for medical treatment Policies for staff safety (ex: no pregnant workers assigned to these cases.) Look to other states who have had this issue for an extended period of time Educating the public about this crisis Launched “Death2Meth.com” website Produced a local documentary on the meth issue in Clermont County – called “Deadly Ice” Provided testimony to Sub-Committee on Criminal Justice, Drug Policy & Human Resources Continue to work with the Ohio department of Job & Family Services to develop meth awareness Commissioner Proud is now a member of NACo’s national “Meth Action Task Force” Task force has established the “PETE-V” philosophy (Prevention, Education, Treatment, Enforcement, and Victims) Commissioner Proud and Director McCartney members of Ohio’s Advisory Committee on Methamphetamine This group successfully lobbied the general assembly to pass Senate Bill 53 which restricted the sale of pseudoephedrine in Ohio

18. There is a growing awareness of the Impact of Meth NACo has made Meth a priority Meth was featured as the cover story in Newsweek Magazine (8/8/05) and many other publications Meth was the focus of sub-committee on Criminal Justice, Drug Policy and Human Resources…. Locally….we lauched a website… www.death2meth.com and Clermont County was featured on NBC Nightly News… The Federal Government launched the website www.methresources.gov

19. The Website www.death2meth.com

21. The National News NBC Nightly News

23. The Documentary “Deadly Ice” Clermont County Office of Public Information

25. Summary Will Meth effect your county? Yes the extent is up to you Will Meth effect your Children’s Services Yes begin the partnerships now Meth is a community, state and national problem Meth tears at the fabric of our society Meth is devastating to the people who make or use it, and the communities that they do it in We must make it unpopular to use it or make it…

27. The News is NOT ALL BAD

28. MYTH AND REALITY OF TREATMENT FOR METHAMPHETAMINE MYTH: Clients addicted to methamphetamine do not complete treatment and do not recover. REALITY: Data show that methamphetamine treatment completion rates are not very different than those for other addictive drugs. People addicted to methamphetamine can and do recover. If methamphetamine addicts complete treatment, they are no more or less likely to require re-admission to treatment program, lose their job or be arrested than those who were treated for other drug use. “Good news – some of the bad news about methamphetamine is wrong.” 1. Quote: Tom Morton – Washington – Star Tribune 2. Treatment Works – People Recover1. Quote: Tom Morton – Washington – Star Tribune 2. Treatment Works – People Recover

29. Alternative View of Current Methamphetamine Situation A report released in June by The Sentencing Project, an advocacy group, states that methamphetamine use is dangerous but not the national threat portrayed by political and law enforcement officials. Not an epidemic – “highly localized”, even though more widely used than 10 years ago. Positive outcomes achievable for people with primary methamphetamine addiction. “Mischaracterizing impact of methamphetamine by exaggerating prevalence and consequences.” Ryan King, June 15th Associated Press storyRyan King, June 15th Associated Press story

30. SAMHSA Treatment Episode Data Number of people admitted to addiction treatment programs for methamphetamine use rose 25% between 2002 and 2004. Methamphetamine users: 8% of treatment admissions nationally. 20% or more in Arkansas, California, Hawaii, Idaho, Nevada, Oklahoma and Utah.

31. Lifetime, Past Year, and Past Month Methamphetamine Use among Persons Aged 12 or Older: 2002-2004

32. Methamphetamine Users High rate of use among women and the homosexual community (45% of admissions are women – higher percentage of women admissions than for any drug except tranquilizers). Traditionally considered Caucasian drug – mainly blue collar. Increasing use among Hispanic and Asian population. Use highest among the 25-34 age group. 18-24, 22.2%; 25-34, 31.5%; 35-44, 25.3%18-24, 22.2%; 25-34, 31.5%; 35-44, 25.3%

33. Methamphetamines as Primary Substance by Gender and Pregnancy Status: 1994-2004 Women are more likely than men to report meth/amphetamines as their primary substance at admission. This trend has remained constant over the years. Women are more likely than men to report meth/amphetamines as their primary substance at admission. This trend has remained constant over the years.

34. IMPACT on CHILDREN Since women more likely caretakers of children, more children affected by methamphetamine. 80-90% of children in homes where methamphetamine manufactured test positive for drug. Methamphetamine in children’s systems due to inhaled fumes, direct contact with drug, second hand smoke, or direct ingestion. Children uniquely susceptible because of their natural curiosity (touching, putting things in mouth), because their nervous systems and brains are still developing, and because thinner skins absorb chemicals faster than adults. Greatest number of children exposed through parent who uses or is dependent on the drug. Relatively few parents “cook” the drug, although those that do risk to children is chemical exposure and toxic fumes, as well as fire and explosion. Greatest number of children exposed through parent who uses or is dependent on the drug. Relatively few parents “cook” the drug, although those that do risk to children is chemical exposure and toxic fumes, as well as fire and explosion.

35. Impact on Fetal Development Exposure early in pregnancy: fetal death, small size for gestational period. Exposure later in pregnancy: learning disabilities, poor social adjustment.

36. Parents Entering Publicly Funded Substance Abuse Treatment 59% had child(ren) under 18. 20% had child(ren) removed by Children’s Protective Services. 10% who had child(ren) removed lost their parental rights. (Based on CSAT TOPPS-II Project)

37. Various Scenarios of Methamphetamine Use Impacting Children Parent uses or abuses methamphetamine. Parent dependent on methamphetamine. Parent “cooks” small quantities of methamphetamine. Parent involved in trafficking. Parent involved in super lab. Mother uses methamphetamine while pregnant. Each situation poses different risks and requires different responses. Child welfare workers and treatment staff need to know the risks and responses.

38. Parent Uses or Abuses Methamphetamine – 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 secondhand smoke. Accidental ingestion of drug. Possibility of abuse. HIV exposure from needle use by parents.

39. Parent Dependent on Methamphetamine All the risks of parents who use/abuse, but children 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.

40. Parent Involved in Manufacturing, Trafficking, etc. All the previous risks. Exposure to the drug. Possible fire or explosion. Presence of weapons. Possibility of violence. Possibility of physical or sexual abuse by persons visiting the household. Possibility of parent incarceration and permanency issues for children.

41. Relationship of Methamphetamine Use and Child Welfare Not solely use of specific substance that affects child welfare system – it’s complex relationship between: Substance use pattern. Variations across state and local jurisdictions regarding policies and practices. Knowledge and skill of workers. Access to appropriate health and social supports for families.

42. Substance Abuse Treatment Services Outpatient Individual Counseling Group Counseling Intensive Outpatient (IOP) Day Treatment Detoxification (outpatient and inpatient) Residential/Inpatient 12 Step Programs (AA, NA)

43. Recommended Treatment Approaches Psychosocial Treatment Contingency Management Technique employing systematic delivery of positive reinforcement for desired behaviors (e.g., vouchers or rewards earned for methamphetamine-free urine sample). Relapse Prevention Matrix Model Manualized, 16 week, non-residential program Includes individual counseling, cognitive behavior therapy, motivational interviewing, family education groups, urine testing, and participation in 12 step program.

44. Effective Methamphetamine Treatment Components Minimum of 6 months -1 year of treatment. Structured, intensive and comprehensive. Focus on coping mechanisms. Cognitive and behavioral in nature.

45. Strategies for Working with Methamphetamine Abusing Parents Use of Motivational Interviewing Techniques Role modeling Accountability

46. Obstacles to Client Change Late stage addiction. Resistance to the “System”. Lack of hope. Methamphetamine addicts often dismissed in dependency cases or prejudged. Methamphetamine affects brain chemistry, often leading to reduced memory and attention rates.

47. Limitations on Current Treatments Training and development of knowledgeable clinical personnel are essential elements to successfully address challenges of treating methamphetamine users. Training alone is insufficient if funding necessary to deliver the recommended treatment is not available. Treatment funding policies that promote short duration or non-intensive outpatient services are inappropriate for providing adequate treatment for methamphetamine users.

48. Models of Improved Services Many communities began program models in the 1990’s. Paired counselor and child welfare worker. Counselor out-stationed at Child Welfare office. Multidisciplinary teams for joint case planning. Persons in recovery act as advocates for parents (peer support). Training and curricula development. Family Treatment Courts.

49. More Advanced Models of Team Efforts Workers out-stationed in collaborative settings: at courts, at child welfare agencies, at treatment agencies. Increased recovery management and monitoring of recovery process. New methods and protocols on sharing information. Increased judicial oversight and family drug courts. New priorities for treatment access for child welfare involved families. New responses to children’s needs.

50. Sacramento, California Model of Effective Child Welfare and Substance Abuse Services Comprehensive training – to understand substance abuse and dependence and acquire skills to intervene with parents. Early Intervention Specialists – social workers trained in motivational enhancement therapy stationed at Family Court to intervene and conduct preliminary assessments with ALL parents with substance abuse allegations at the first court hearing. Improvements in Cross-System Information Systems – to ensure that communication across systems and methods to monitor outcomes are in place, as well as management of the County’s treatment capacity.

51. Sacramento, California Model of Effective Child Welfare and Substance Abuse Services (cont.) Prioritization of Families in Child Protective Services (CPS) – county-wide policy to ensure priority access to substance abuse treatment services. Specialized Treatment and Recovery Services (STARS) – to provide immediate access to substance abuse assessment and engagement strategies conducted by staff trained in motivational enhancement therapy. STARS provides intensive management of the recovery aspect of the child welfare case plan and routine monitoring and feedback to CPS and the Court. Dependency Drug Court – to provide more frequent court appearances for ALL parents with allegations of substance abuse.

52. Recommendations Improve data systems that help paint a better picture of addiction and child welfare issues. Improve intervention for children. Improve and increase availability of staff training. Increase timely access to addiction treatment. (Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 28, 2005)

53. Cost Issues re: Increased Substance Abuse and Methamphetamine Treatment Policy makers may view cost of providing substance abuse treatment services prohibitively high. Estimates state as few as 10% of those needing substance abuse treatment actually receive treatment – costs of meeting needs too high. Focus on costs savings that balance treatment costs when treatment readily available – costs savings due to reduced crime, increased work productivity, decreased health costs, decreased child welfare involvement.

54. Cost Issues re: Increased Substance Abuse and Methamphetamine Treatment (cont.) Research by Ettner et al. confirms previous studies, finding that treatment of substance abuse results in net benefits. “Benefit vs. Cost in the California Treatment Outcome Project: Does Substance Abuse Treatment pay for itself?” Every dollar invested in substance abuse treatment yields $7 worth of economic benefits to society. Study looked at effects of treatment on medical care, mental health services, criminal activity, employment earnings, and government payments (e.g., TANF/welfare).

55. Future Directions Family-Based Methamphetamine Treatment Access Act of 2006 – providing resources and tools to reduce substance abuse among mothers and non-violent offenders. White House Drug Policy Office – goal to cut methamphetamine use by 15% and increase seizures of methamphetamine labs by 25%.

56. Resources NATIONAL CENTER ON SUBSTANCE ABUSE AND CHILD WELFARE (NCSACW) 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 www.ncsacw.samhsa.gov

57. Contact Information Bob Proud, Clermont County Commissioner bproud@co.clermont.oh.us (513) 732-7300 Karen Scherra, Executive Director of Clermont County Mental Health & Recovery Board kscherra@ccmhrb.org (513) 732-5400 Tim McCartney, Director, Clermont County Department of Job & Family Services mccart04@odjfs.state.oh.us (513) 732-7212