• NCSACW
• Some Numbers
• Some History
• Policy Framework and Tools
• Models

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 by
• Developing and implementing a comprehensive program of information gathering and dissemination
• Providing technical assistance

PRODUCTS

• On-Line Training
  • 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
  • A Guide for Judges and Dependency Court Staff – Summer 2005
• Program of In-Depth Technical Assistance
  • Round 1 – Summer 2003 to Fall 2004
    • Colorado, Florida, Michigan, Virginia
    • Assistance to Develop and Implementation State’s Plan to Better Serve this Population of Families
  • Round 2 – Solicitation in Fall 2004
    • Seven States Offered Program, 3 States and 1 Tribe will be selected
• Materials
  • Compendium of Training Curricula
  • Understanding Substance Abuse: A Guide for Child Welfare Practitioners
  • Screening and Assessment for Family Engagement, Retention and Recovery (SAFERR) – Spring 2005

Some Numbers

Children Living With One or More Substance Abusing Parent

(In Millions)

California’s Children

2000 Census: 8.9 Million Children
1999 Estimates of 11%: 980,000 Children with Parent who Needs AOD Treatment
1992 Estimates of ATOD exposure annually: 69,000 Substance-exposed Births

Foster Care Population

52% Increase over 6 Years

Foster Care Population and Persons who First Used Crack or Meth in Past Year

Some History

Timelines

Beginnings

• 1968 – Report of alcoholic mothers with babies with a distinctive, unusual appearance in France
• 1973 – Fetal Alcohol Syndrome named by a team of researchers in Seattle
• Mid 1970s
  • Estimate of the number of children of heroin addicts and children of alcoholics
  • Fanshel reports substance abuse is common among families in child welfare

Early and Mid 1980s

• Impact of crack cocaine in urban centers
• Chasnoff’s group begin to publish research on prenatal effects of cocaine
• 1983 National Institute on Drug Abuse (NIDA) College on Problems of Drug Dependence conference – First Poster Session on Children Prenatally-Exposed to Cocaine

Mid to Late 1980s – Initiating Responses

• Child welfare agencies began responding to an epidemic of kids coming into care and cocaine
• Schools began their efforts to understand prenatally-exposed children
  • 1987 Los Angeles Unified School District develops pilot program to understand educational impact of prenatal cocaine exposure

1990s

• Federal Grant Support Began
  • National Center on Child Abuse and Neglect
    • 94 programs, including Illinois, Connecticut, New Jersey
    • Piloted out-stationing substance abuse counselors in child welfare offices
  • NIDA research efforts
  • SAMHSA Specialized women’s treatment programs
• Between 1997 and 1999
  • Five National Reports on Substance Abuse and Child Welfare

1990s – Reports on the Issues

• Five National Reports on Substance Abuse and Child Welfare
  • Responding to Alcohol and Other Drug Problems in Child Welfare: Weaving Together Practice and Policy (1998)
  • Foster Care: Agencies Face Challenges Securing Stable Homes for Children of Substance Abusers (1998)
  • Healing the Whole Family: A Look at Family Care Programs (1998)
  • No Safe Haven: Children of Substance-Abusing Parents (1999)
  • Blending Perspectives and Building Common Ground: A Report to Congress on Substance Abuse and Child Protection (1999)

Key Barriers Between Substance Abuse, Child Welfare and The Courts

• Beliefs and Values
• Competing Priorities
• Treatment Gap
• Information Systems
• Staff Knowledge and Skills
• Lack of Communication
• Different Mandates

Biggest Challenges: Reconciling the Clocks

The Four Clocks

The First Clock

ASFA Timetable

• Timeliness of intervention versus “Call me Tuesday”
• CFSR’s have documented
  • Case reviews found parental substance use disorders were a factor in 16% to 48% of cases
  • Need for child welfare training in addictions
  • Gaps in services
  • Inadequate assessment and follow up on the underlying needs of families, including substance abuse
  • Substance use disorders in families with repeat cases

National Study on Child and Adolescent Well-Being: Child Welfare Workers’ (CWW) Identification of Substance Abuse

• Of the caregivers who are alcohol dependent
  • 71% are classified by the CWW as not having an alcohol problem
• Of the caregivers who are drug dependent
  • 73% are classified by the CWW as not having a drug problem

• CWW’s misclassify caregivers who are substance dependent most of the time

Minnesota Data

• 2002 Report to the 2004 Legislature
  • Prevalence of Family Conditions at Assessment

  	Alternative Response	Traditional Response
  Alcohol Abuse	7%	18%
  Drug Abuse	3%	19%

The First Clock

ASFA Challenges

• Timeliness of Interventions
• Taking CFSR findings seriously and including remediation strategies in Program Improvement Plans

The Second Clock

TANF Timetable

• Poverty and low-income work affect neglect, which is the majority of all reports
• Neglect is often associated with both substance abuse and poverty
• TANF resources have been used in innovative models for this population
• Treatment aftercare focus on jobs and housing
• TANF reauthorization proposes treatment be counted as a work activity

Recovery Timetable

• “A day at a time for the rest of your life” Recovery is a lifelong process with a disease management approach not emergency care
• Low-dosage non-comprehensive programs do not build on what we know about effective treatment for this population

Recovery Challenges

• Comprehensive services and longer-term supports are critical
  • Clinical treatment, clinical support and community supports
• Recognizing the needs of children of parents in treatment
• The changing nature of drug use patterns and epidemics

The Fourth Clock

Child Development Timetable

• 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

Child Development Timetable

• Every 70 seconds a baby is born in this country who was prenatally exposed to alcohol or illicit drugs

Reconciling the Clocks

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

1. Values and Common Principles

• Issues to Address
  • Who is the Client -- Parent, Child, Family?
  • Can AOD Users/Abusers/ Addicts/Alcoholics be Effective Parents?
  • What is the Goal -- Recovery, Child Safety, Family Preservation, Economic Self-sufficiency?
• How to Begin:
  • Use Tools Such As the Collaborative Values Inventory to Identify and Resolve Differences That Exist Across System
  • Ensure Conversation Happens at Policy, Supervisory and Front-line Levels

2. Daily Practice: Client Intake, Screening and Assessment

• Issues to Address
  • Roles and Responsibilities Across Systems
  • Communication Paths Across Systems
  • Incentives for Prioritization
  • Missing Box Problem

  Too Often We Practice…“Don’t Ask, Don’t Tell”

  Nationally, we have “missing box” problems

  Welfare and Child Welfare Agencies have far less information than they need on substance abuse among their clients

  Alcohol and Drug Treatment Agencies have far less information than they need about the children of their treatment clients

  How to Begin:

  • Clarify Intake Procedures and AOD/Child Safety Screening Protocols
  • Decide on Team, Tool, Method, Roles and Responsibilities to
    • Provide AOD Expertise to Child Welfare Workers in Investigative/Assessment Phases
    • Ensure Parents Seeking Treatment Receive Needed Supports for Child Safety

3. Daily Practice -- Client Engagement and Retention in Treatment

• Issues to Address
  • Outreach and Engagement Strategies
  • Addressing Motivation to Change
  • Cross-system Agreement on Approaches to Relapse
  • Responding to Clients’ Progress in Treatment
• How to Begin:
  • Implement Assessment and Interventions based on Readiness to Change
  • Develop Mechanism to Re-engage Clients in Care
  • Ensure AOD Treatment and CPS Practice is Responsive to Clients’ Individualized Needs and Needed Level of Care

4. Daily Practice -- Services to Children

• Issues to Address
  • Prevention, Early Intervention, and Treatment Services for Children in Contact with CPS
  • Content of Independent Living Programs on Parental Substance Abuse
  • Pediatrics (1999) v.103:1083 – 1155, Special Topics on Children and Adolescents in Families Affected by Substance Abuse
• How to Begin:
  • Develop Partnerships to Respond to Potential Neuro-Developmental Effects of Prenatal Substance Exposure
  • Provide Prevention and Intervention Services to Children and Adolescents
  • Ensure that Youth Receive Appropriate Youth Development Intervention and Activities
  • Ensure that ILP Teens Receive Appropriate Information Related to Risks of Substance Abuse

Other System Supportive Elements

5. Information Sharing and Data Systems
6. Training and Staff Development
7. Joint Accountability and Shared
Outcomes
8. Budgeting, Funding and Program Sustainability

We Know AOD Treatment Pays

• 100 Women
  • Average cost $6,800
• $680,000

30 Women recover with one episode of treatment

• 150 Children
  • Average 1.5 years in out-of-home care @ $24,000 per year
• $5.4 Million

45 Children reunify at 6 months saves $1.1 Million

Foster Care Cost Offset Pays for all 100 Women’s Treatment Nearly 2 Times Over

9. Developing Community Supports
10. Working with Related Agencies

• Primary Health Care
• Domestic Violence
• Trauma
• Mental Health
• Dental Health
• Transportation
• Child Care
• Medicaid
• Housing
• Economic Security
• Education for Mother and Children

Models of Improved Services

Many communities began program models in 1990s

• 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
• Training and Curricula Development
• Family Treatment Courts

The Fifth Clock

Urgency

• Every 70 seconds a baby is born in this country who was prenatally exposed to alcohol or illicit drugs
• Every minute and a half, one of those babies goes home without screening or any effort to begin early intervention
  • A baby and a family we already know are highly at risk
• 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

Responding to Families:Timelines, Clocks and the Future

Notes

1. http://www.arium.org/anthology/kvanbeer/kvbafas.html
2. Chasnoff, I. Cocaine Use in Pregnancy, New England Journal of Medicine, 1985
3. Barth, R. (2003). Substance Abuse Findings from the NSCAW Presented at NCSACW Researchers’ Forum. December.
4. Grella, C. (2003). Presentation at the NCSACW Researchers’ Forum. December