CENTRAL EAST ATTC REGIONAL LEADERSHIP INSTITUTE

1. CENTRAL EAST ATTC REGIONAL LEADERSHIP INSTITUTE “ Design an integrated strength based case planning process for women and their children in the court system with co-occurring disorders”

2. Chele W. Robinson BA, MA, CAC I & II, LPC, LSWA, CPP, CDDC, NCCS ProtégéDavid FreemanMentor GOVERNMENT OF THE DISTRICT OF COLUMBIA DEPARTMENT OF HEALTH Addiction Prevention and Recovery Administration Family Treatment Court Program/Community Action Group 3323-13th Street S.E. Washington, D.C. 20032 (202) 373-0650

3. Project Goal: To decrease the recidivism rate, reduce the number of parental revocations and/or new allegations of neglect, improve retention rate and safe housing by establishing a comprehensive, integrated and seamless treatment model of care. Project Description: The project will address the women in the Family Treatment Court Program and their special need for integrated services by extending the length of stay in the program. The development of the program structure shall be based on the ASAM criteria. The focus of the project is on providing wrap around services to include trauma and PTSD through recovery group processes whereas the women have a voice in their recovery. This project will enhance the knowledge of how important integrated services and the length of stay will improve the outcomes for substance abusing women in the court system with co-occurring disorders.

4. The Family Treatment Program is a reunification program based on the Drug Court model. Family Dependency Treatment Courts began in Reno, Nevada, in 1995, seek to do what is in the best interest of the family by providing a safe and secure environment for the child while intensively intervening and treating the parent’s substance abuse and other co-morbidity issues. In 1997, congress passed the Adoption and Safe Families Act (ASFA). The primary goal is to provide for the safety, permanent placement, and well being of children and families. To promote efficiency in permanency planning based on the best interests of the child, AFSA mandates that courts finalize permanent placement no later than 12-months after the child enters foster care. AFSA requires courts to begin termination of parental rights after the child has been removed from the home for 15of the last 22 months. (Office of the Federal Register, 2000)

5. The Family Treatment Court Program is a nine-month residential treatment program with a six-month continuing care component for women and their children referred by Child and Family Service Agency because the women admitted to child abuse/neglect due to substance abuse.The women must stipulate to the allegations of neglect and voluntarily enter the program. The women are deemed eligible by the referring Social Worker, undergo a screening process that includes criminal background check and mental/physical screening. Once the women have completed detox they are admitted into the residential facility. Following a 60 day adjustment period up to four children under the age of 10 can join their mother in the facility.

6. The Social Worker deems the family eligible for FTC by using the following criteria: Eligibility Criteria • Must be 21 years of age or older• D.C. residents• No serious physical abuse (fractures, burns)• No allegation of sexual abuse• Mother has children under age 11• No criminal record• No voluntary manslaughter• No child sex crime or abuse• Cruelty to children• Murder• Assault w/ dangerous weapon• Mayhem• Assault on a police officer• Carjacking• Robbery• Arson• Possession of an unregistered firearm• Carrying a concealed weapon

7. FTC/CAG currently offers the following services on site as well as community based services: • Individual counseling • Relapse prevention groups • Drug education groups • Black Parenting groups • Psychotherapy groups • Behavior Modification groups • Life skills groups • Anger Management groups • Domestic Violence groups • St. Elizabeth Interns provide therapy • DMH provide individual therapy • NA meetings • Court/review hearings every two weeks

8. # Of women placed in transitional housing 30 # Of relapses-5 # Of parental revocations-6 # Of new cases-1 # Of women returned to original home-18 #Of relapses-11 # Of parental revocations-8 # Of new cases-1 # Of women moved into own home-11 # Of relapses-8 # Of revocations-7 # Of new cases-3 Since the inception of the program (June 2003) 91 admissions 24 relapses 26 incompletes 5 new casesof child neglect # Of women who experienced trauma-32 # Of women with mental health issues-37 # Of women who did not complete 6 months-12 # Of women who did not complete 12 months- 26

9. Feedback from an open forum and a survey given to the alumni, recent graduates and current residents on program needs: • Consistent mental health services with one consistent therapist • More intensive counseling • Confidentiality • Education (GED, trade school) • Employment readiness • Cognitive restructuring • More empathy from staff • Family involvement • Budgeting and spending counseling • Escrow account • More time in Detox • More time in residential treatment • Preparation to reenter into the community • More domestic violence counseling • Relationship building/rebuild self esteem

10. The Plan To provide effective integrated and comprehensive substance abuse treatment services for women with children in the court system with co-occurring disorders based on an individualized treatment plan. The program shall offer a service package to decrease the lapses/relapses, reduce the number of parental revocations and new cases, offer consistent mental health services and improve retention rate. The FTC program shall be based on the American Society of Addiction Medicine (ASAM) criteria: Develop an individualized treatment plan based on the American Society of Addiction Medicine (ASAM) Patient Placement Criteria. In 1991 the Patient Placement Criteria for the Treatment of Psychoactive Substance Use Disorders was published (Hoffman et al, 1991). These criteria for admission, continued stay and discharge define four levels of care are outlined in three treatment practices. 1. Pre-treatment assessment is completed to determine appropriate placement. 2. Treatment matching “ to ensure that each individual receives the kind of treatment most likely to produce a positive outcome” (Institute of Medicine, 1990) 3. To improve treatment matching and effectiveness treatment outcomes are measured on a regular basis. “The Institute of Medicine, (IOM) defined four levels as essential to a continuum of care: inpatient, residential, intermediate and outpatient.”

11. Proposal 5-year plan: Increase the length of stay 90-day detoxification 2-years residential treatment 2-years transitional treatment 6-months continuing care 6-months community care Changes proposed based on outcomes and input from the women in FTC: Increase length of stay PTSD/trauma groups Trauma sensitive services Family therapy Incorporate Family team meetings Relationship therapy Meal planning and preparation Techniques on helping with homework Consistent mental health services Budgeting included in life skills Structured idle time Housing Transportation Group Structure Continuous case management Increased teamwork Team commitment Convince the stakeholders to increase services Staff commitment

12. 90-day detox Stabilization and Stages of Change Phase Screenings Assessments Medical screen Mental health screen Family Team meeting HISTORY: CFSA Court services Health/medical Mental health Substance Abuse Family Education Sexual/physical abuse Emotional abuse Housing Employment Community Loss of family member/close friend Phases of Recovery

13. 2-year Residential Phase: Revise/review Treatment Plan Annual physical exam Annual eye exam 6-month dental exam Case management Identify children’s needs Integrate children’s needs Engage family members in Family Team meetings Connect w/mental health therapy to include trauma/PTSD Phases of treatment Parenting Prepare for employment Money management Structured Activities Communication skills and behaviors Individual and Group Counseling NA/AA Meetings 2-year Transitional: Revise/review treatment plan Annual physical exam Annual eye exam 6-month dental exam Case management Continue mental health services Job training, GED preparation, and educational opportunities Structured Activities Family team meetings Individual and Group Counseling NA/AA Meetings Identify a network of support An Individualized Treatment Plan will be developed based on the information collected during the detox phase and reviewed/revised based on client goals and needs.

14. 6-months- Continuing Care: Revise/review Treatment Plan Annual Physical eye exam dental exam Case management Employment Mental health services Family team meetings NA/AA meetings Counseling Prepare for the community Structured Activities Discharge planning 6-months- Community Care: Review discharge plan Annual physical eye exam dental exam Continue case management Community monitoring Continue Mental Health Services Full-time Stable Employment No transportation issues Counseling NA/AA meetings Family involvement

15. REFERENCES 1 . Holly Hills, PhD April 2004 The Special needs of Women with Co-Occurring Disorders Diverted from the Criminal Justice System by 2. Mee-Lee, D. M.D., Placement Criteria and Patient-Treatment Matching 3. Meghan, M., Wheeler, M.S. and Carson L. Fox, Jr., JD Family Dependency Treatment Court: Applying the Drug Court Model In Child Maltreatment Cases 4. Monchick, R., Scheyett, A. and Pfeifer, J. Drug Court Case Management Role, Function, and Utility 5. Mueser, K. T., Noordsy, D., Drake, R., Fox, L. Integrated Treatment for Dual Disorders 6. Najavits, L. M. Seeking Safety- A Treatment Manual for PTSD and Substance Abuse 7. Principles of Drug Addiction Treatment A Research-Based Guide NIH Publication No. 99-4180 8. Screening, Assessment, and Treatment Planning for Persons With Co-Occurring Disorders Drug Court Practitioner Fact Sheet 9. Substance Abuse Treatment for Adults in the Criminal Justice System TIP 44 10.Substance Abuse Treatment for Persons With Co-Occurring Disorders, A Treatment Improvement Protocol TIP 42