STARS Specialized Treatment and Recovery Services

Engaging and Motivating
Fathers in AOD Treatment

Program Summary

• Sacramento County population: 1.5 million
• About 17,000 substantiated child abuse cases
• 70–80% of all cases involve substance abuse

Sacramento County Prior to STARS and Dependency Drug Court

• Reunification rate about 20-25%
  
  Parents unable to access AOD treatment
• Social workers, attorneys, courts often uninformed on parent progress
• Drug testing not uniform and results often delayed

Sacramento County after STARS and Dependency Drug Court

• Reunification rates at 40–45 percent
• Reunification is occurring twice as fast
• Parents truly have “treatment on demand”
• All parties involved in the case are informed at every stage of treatment
• All parents receive random observed “instant” drug testing

STARS Goal

• Affect client change by removing barriers to treatment and providing support
• Provide CPS/Dependency Courts with accurate and reliable documentation

Obstacles to Change

• Late-stage addiction
• Resistance to “The System”
• Lack of hope
• Fathers often dismissed in Dependency cases

Barriers Facing Fathers

• The Child Welfare case often originates with the mother, creating or reinforcing father’s denial
• Men are less likely to be able to ask for help or show vulnerability
• Women dominate the social services field
• Women often dominate co-ed treatment
• Fathers don’t have healthy role models

Achieving our Goals

• Intake
• Support
• Philosophy
• Intangibles

Intake

• Father is immediately assessed for AOD issues at Detention Hearing. Each parent is assessed individually, helping to break denial surrounding significant other.
• Facility location
• Rapid intake
• Immediate access to treatment
• Immediate contact with Recovery Specialist – gender specific

Three Strategies for Working with Fathers

• Use of Motivational Interviewing Techniques
• Role-modeling
• Accountability

Motivational Interviewing

• Alternative to theory that denial and resistance must be smashed
• Described as “Dancing” not “Wrestling”
• Works well with men as it eliminates the power struggle.

Incorporating the Four Principles of Motivational Interviewing in the STARS Program

Expressing Empathy

• Gender specific – men work with men
• Recovery Specialist is in recovery
• Trained to utilize limited self-disclosure
• Willing to provide help “no matter what”

Supporting Self-Efficacy

• Demonstrating that recovery can work
• Alumni groups
• Support group on site
• Motivation, encouragement and support

Roll with Resistance

• Father participates in determination of level of treatment
• Father encouraged to always have a “plan”
• Recovery Specialists never argue
• Support, Support, Support

Develop Discrepancy

• Tap in to father’s desire to be “in charge”
• Point out behaviors and actions inconsistent with healthy fathers

Role Models

• Recovery Specialists are:
  • Certified addiction specialists
  • Believable and approachable
  • Comfortable with some self disclosure
  • Non-punitive in approach

Accountability

• Our belief is that when we combine an empathetic, supportive environment with one that stresses accountability, we are able to create change in a profound way.
• Each father we work with is encouraged to accept responsibility for every action he participates in.

Intangibles

• Belief in redemption and recovery
• Overcome prejudices that exist
• We give 100% for client’s 100%
• Passion

Sacramento Family Treatment Court Evaluation Findings

In the Last Decade Sacramento has Implemented Comprehensive Reforms

Five Components of Reform

1. Comprehensive cross-system joint training
2. Substance Abuse Treatment System of Care
3. Early Intervention Specialists
4. Recovery Management Specialists (STARS)
5. Dependency Drug Court

Five Components of Sacramento County’s Comprehensive Reform

1. Comprehensive cross-system joint training

• Three Levels of 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

2. Substance Abuse Treatment System of Care

• Managed Wait List
• Immediate Access to Substance Abuse Services
  • Group Services Expansion and Implementation of Pre-Treatment Groups

3. Early Intervention Specialists

• Review of every court petition to determine if substance use disorders may be present
• Immediate access to intervention and assessment at court hearings
• Immediate authorization of publicly-funded treatment services

4. Recovery Management Specialists (STARS)

• Motivational enhancement
• Gender-specific services
• Immediate access to recovery management and treatment services
• Provider orientation of providing hope and accountability
• Compliance monitoring—Twice monthlies

5. Dependency Drug Court

• Parallel system to dependency petition
• 30, 60 and 90-day compliance hearings
• Structured incentives for compliance and sanctions for non-compliance
• Voluntary participation in on-going services

Parents and Children in Evaluation (Chart)

Total Mothers and Fathers in DDC Evaluation (Chart)

Mothers: 73.4%
Fathers: 26.6%

Percent of Mothers and Fathersby Education (Chart)

Percent of Mothers and Fathersby Employment Status (Chart)

Percent of Mothers and Fathersby Primary Drug (Chart)

Percent of Mothers and Fathersby Mental Illness at Admission*** (Chart)

Mothers: 34.8%
Fathers: 10.0%

*** p<.001

Percent of Mothers and Fathersby Homeless at Admission*** (Chart)

Mothers: 47.6%
Fathers: 35.7%

*** p<.001

Percent of Mothers and Fathers by Treatment Modality** (Chart)

**p<.01

Percent of Mothers and Fathersby Treatment Completion (Chart)

n.s.

24-Month Placement Outcomes*** (Chart)

***Significantly more Court Ordered Year 1 children reunified at 24 months than comparison children. Significantly more Year 1 children were in continued FR/FC at 12 months (with less in long term placement or guardianship) than the comparison groups.

Time to Reunification (Chart)

***p<.001

24-Month Cost Savings

• Takes into account reunification rates, time of out- of-home care, time to reunification, and cost/month
• 27.2% - Reunification rate for comparison group children
• 42.1% - Reunification rate for court-ordered DDC group children
• 63 Additional DDC children reunified
• 33.1 – Average months in out-of-home care for comparison group children
• 8.6 - Average months to reunification for court- ordered DDC children
• 24.5 month differential
• $2,953,639 estimated savings in out-of-home care costs

A Father’s Perspective

• Change the attitude that it’s the mother’s duty
• Father has a responsibility
• Create support system for the father separate from the mother
• Specific groups targeting fathers
• Recovery independent of reunification

Love

Passion

Hope