Child Welfare and Substance Abuse:Current Issues and Innovations

National Association of State Alcohol and Drug Abuse Directors Annual MeetingMiami, Florida
June 2005
Nancy K. Young, M.S.W., Ph.D.

• A Sense of Satisfaction

  We have much to feel good about in our efforts to combine forces to help children and families affected by substance use disorders and child abuse or neglect

• A Sense of Urgency

  At the same time, we need a much greater sense of urgency in building on these victories to enter into the next phase of getting serious and getting to scale

Topics

• NCSACW
• Children with Prenatal Substance Exposure
• Children of Substance Abusers who are also Victims of Child Abuse and/or Neglect
• Children in the Child Welfare System with their own Substance Use Disorder
• Future Trends

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

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
• 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

Connecting AOD, CWS, Court Systems: Elements of System Linkages*

• Underlying Values
• Screening and Assessment
• Client Engagement and Retention in Care
• AOD Services to Children
• Joint Accountability and Shared Outcomes
• Information Sharing & Management
• Training and Staff Development
• Budgeting and Program Sustainability
• Building Community Supports
• Working with Related Agencies and Support Systems

  From CSAT Technical Assistance Publication (TAP) 27: Navigating the Pathways *Revised March 2003

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

PRODUCTS

• 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

Children with Prenatal Substance Exposure

Number of Children Prenatally Exposed to Substances

SAMHSA, OAS, National Survey on Drug Use and Health, 2002 and 2003 reported:

State and local prevalence studies report 10-12% of infants or mothers test positive for alcohol or illicit drugs at birth^5,6

Number of Children Prenatally Exposed to Substances

Where did they all go?

Most Go Home

90%+ 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
• Child Abuse Prevention and Treatment Act (CAPTA) Amendments of 2003 raises issues of identifying infants and reporting to Child Protective Services

Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments

• Policies and procedures (including appropriate referrals to child protection service systems and for other appropriate services) to address the needs of infants born and identified as affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure, including a requirement that health care providers involved in the delivery or care of such infants notify the child protective services system of the occurrence of such condition in such infants, except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse; or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii));
• The development of a plan of safe care for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))

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)

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

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
• Youths who have ever been in foster care had higher rates of any illicit drug use than youths who have never been in foster care (33.6 vs. 21.7 percent)
• Youths aged 12 to 17 who were in need of substance abuse treatment in the past year were more likely to have received treatment if they have ever been in foster care

Future Trends

TANF Opportunities

• Treatment aftercare focus on jobs and housing
• TANF reauthorization proposes treatment be counted as a work activity
• Does your state define the child welfare population as a “needy family” under TANF
• Can use TANF to pay for treatment

Funding Opportunities

• Models of Cross-system funding for joint initiatives
  • Title IV-E Waiver projects

Child and Family Service Reviews

• Taking CFSR findings seriously and including remediation strategies in Program Improvement Plans
  • New round of CFSRs begin this summer – contact your state’s child welfare lead to get involved

Timeliness of Interventions

ASFA Challenges

• Early recognition of Substance Use Disorders
• Timeliness of Interventions
  • “Call me Tuesday”
  • “Your life has just begun”

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

Timeliness of Interventions

ASFA Challenges

• Early recognition of Substance Use Disorders
• Timeliness of Interventions
  • “Call me Tuesday”
  • “Your life has just begun”

A timely message of hope

The Voice of a Child

The Fifth Clock

Urgency

• The fifth clock is the one that is ticking on us…it measures how fast we get it…how rapidly we respond to human needs that grow larger by the day
• We have to measure what we do against what needs doing, not against what we did last year

Child Welfare and Substance Abuse: Current Issues and Innovations

• http://www.arium.org/anthology/kvanbeer/kvbafas.html
• Chasnoff, I. Cocaine Use in Pregnancy, New England Journal of Medicine, 1985
• Barth, R. (2003). Substance Abuse Findings from the NSCAW Presented at NCSACW Researchers’ Forum. December.
• Office of Applied Studies. (2004). Results from the 2003 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 04–3964, NSDUH Series H–25). Rockville, MD: Substance Abuse and Mental Health Services Administration. http://oas.samhsa.gov/2k5/FosterCare/FosterCare.htm
• Office of Applied Studies. (2003). Results from the 2002 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 03–3836, NHSDA Series H–22). Rockville, MD: Substance Abuse and Mental Health Services Administration at http://oas.samhsa.gov/2k3/pregnancy/pregnancy.htm
• Office of Applied Studies. (2002). Results from the 2001 National Household Survey on Drug Abuse: Volume I. Summary of national findings (DHHS Publication No. SMA 02-3758, NHSDA Series H-17). Rockville, MD: Substance Abuse and Mental Health Services Administration. http://www.drugabusestatistics.samhsa.gov/2k3/children/children.htm Hamilton BE, Martin JA, Sutton PD. (2003) Births: Preliminary data for 2002. National vital statistics reports, 51 (11), Hyattsville, Maryland: National Center for Health Statistics at http://www.cdc.gov/nchs/data/nvsr/nvsr51/nvsr51_11.pdf
• Vega, W., Noble, A., Kolody, B., Porter, P., Hwang, J. and Bole, A. (1993). Profile of Alcohol and Drug Use During Pregnancy in California, 1992: Perinatal Substance Exposure Study General Report. Sacramento, CA: CA Dept of Alcohol and Drug Programs
• National Institute on Alcoholism and Alcohol Abuse. (2000). Tenth Special Report to Congress on Alcohol and Health. Washington, DC: Department of Health and Human Services at http://www.niaaa.nih.gov/publications/10report/intro.pdf
• National Institute of Drug Abuse. (1998). Prenatal Exposure to Drugs of Abuse May Affect Later Behavior and Learning. NIDA Notes, 13 (4) at http://www.drugabuse.gov/NIDA_Notes/NNVol13N4/Prenatal.html