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
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
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
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
Number of Children Prenatally Exposed to Substances
Infants with prenatal substance exposure
|
~410,000 |
| Total child victims under 1 year old |
~86,000
|
Total children under 1 year old entering out-of-home-care
|
~41,000 |
Where did they all go?
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
Potential Consequences for Children
- 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
Areas of Child Development Affected by Parental Substance Use Disorders
Research has shown that these effects can manifest themselves in multiple areas,
including:
- 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
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)
| Used Illicit Drug in Past Year |
10.6 |
| Used Illicit Drug in Past Month |
8.4 |
| Depending on Alcohol and/or Needs Treatment for Illicit Drugs |
8.3 |
| Abused or Dependent on Alcohol or Illicit Drug in Past Month |
6.0 |
| Dependent on AOD |
7.5 |
| Dependent on Alcohol |
6.2 |
| Dependent on Illicit Drugs |
2.8 |
| Need Treatment for Illicit Drug Abuse |
4.5 |
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
- CWW’s misclassify caregivers who are substance dependent most of the
time
- 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
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
| |
Ever Been in Foster Care |
Have Never Been in Foster Care |
Need for Alcohol Treatment |
10.4 |
6.9 |
Need for Illicit Drug Treatment |
13.1 |
5.3 |
Need for Alcohol or Illicit Drug Treatment |
17.4 |
8.8 |
Children in the Child Welfare System with their own SUD
- 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
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
Opportunities
- 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: Elements of System Linkages*
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
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
- 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
- C hanges 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
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