Improving Outcomes for Families Affected by Substance Use Disorders: Policy and Practice Framework and Tools
Nancy K. Young, Ph.D.
Director, NCSACW
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, and 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
Consortium Approach
- 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)
- Foundation of the Policy and Practice Framework and Tools
- Where We’ve Been
- Where We’ve Been
- Foster Care Population
Foundation of the Policy and Practice Framework and Tools
Where We’ve Been
Beginnings – 30 + Years
1960s and early 1970s
- Recognition and naming of Fetal Alcohol Syndrome
- Heroin epidemic
- Hughes Act: Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970
Where We’ve Been
Early and Mid 1980s – Forefront of Media Attention and Beginning of Research Efforts
- Impact of crack cocaine in urban centers
- Chasnoff’s group begin to publish research on prenatal effects of cocaine
- Number of children in foster care escalates
Foster Care Population
| |
1985 |
1986 |
1987 |
1988 |
1989 |
1990 |
1991 |
1992 |
1993 |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
| Children per 1,000 |
4.1 |
4.2 |
4.5 |
5 |
5.6 |
5.9 |
6 |
6.1 |
6.3 |
6.6 |
6.7 |
7 |
7.3 |
7.3 |
7.4 |
7.1 |
7 |
|
|
Foster Care Population and Persons Who First Used Crack or Methamphetamine in Prior Year
| |
1980 |
1981 |
1982 |
1983 |
1984 |
1985 |
1986 |
1987 |
1988 |
1989; |
1990 |
1991 |
1992 |
1993 |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
2004 |
Children in
Foster Care** |
|
|
|
|
|
276,000 |
280,000 |
300,000 |
340,000 |
387,000 |
400,000 |
414,000 |
427,000 |
445,000 |
468,000 |
483,000 |
507,000 |
515,000 |
557,000 |
570,000 |
556,000 |
542,000 |
532,000 |
523,000 |
518,000 |
New
Cocaine |
1280000 |
1185000 |
1213000 |
1484000 |
1226000 |
1222000 |
1042000 |
1053000 |
837000 |
722000 |
703000 |
561000 |
539000 |
571000 |
583000 |
648000 |
693000 |
785000 |
841000 |
851000 |
926000 |
|
|
|
|
New Crack
Users* |
169,000 |
161,000 |
215,000 |
204,000 |
279,000 |
355,000 |
294,000 |
305,000 |
381,000 |
390,000 |
439,000 |
430,000 |
544,000 |
269000 |
424,000 |
519,000 |
366,000 |
421,000 |
355,000 |
373,000 |
471,000 |
369,000 |
|
|
|
New
Methamphetamine
Users* |
|
|
|
|
|
320000 |
338000 |
352000 |
283000 |
240000 |
211000 |
210000 |
261,000 |
357,000 |
352,000 |
360,000 |
382,000 |
353,000 |
454,000 |
360,000 |
380,000 |
326,000 |
323,000 |
|
|
New Female
Crack* |
|
|
|
|
|
103,000 |
124,000 |
68,000 |
126,000 |
152,000 |
171,000 |
129,000 |
172,000 |
119,000 |
168,000 |
191,000 |
136,000 |
132,000 |
132,000 |
117,000 |
193,000 |
158,000 |
|
|
|
New Female
Meth* |
|
|
|
|
|
121,000 |
178,000 |
103,000 |
165,000 |
69,000 |
101,000 |
68,000 |
121,000 |
172,000 |
203,000 |
195,000 |
179,000 |
160,000 |
162,000 |
131,000 |
196,000 |
156,000 |
|
|
|
Where We’ve Been
Mid to late 1990s – Practice Models
- Many communities began program models
- 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
Where We’ve Been
Late 1990s
- Five National Reports over Two Years - 1998
- Responding to Alcohol and Other Drug Problems in Child Welfare: Weaving Together Practice and Policy
- Young, Gardner & Dennis; Child Welfare League of America
- Foster Care: Agencies Face Challenges Securing Stable Homes for Children of Substance Abusers
- General Accounting Office
- Healing the Whole Family: A Look at Family Care Programs
Where We’ve Been
Late 1990s
- Five National Reports over Two Years - 1999
- No Safe Haven: Children of Substance-Abusing Parents
- Center on Addiction and Substance Abuse Columbia University
- Blending Perspectives and Building Common Ground: A Report to Congress on Substance Abuse and Child Protection
- Department of Health and Human Services
Where We’ve Been
Summary of the Five National Reports
- Identified Barriers
1. Differences in values and perceptions of primary client
2. Timing differences in service systems
3. Knowledge gaps
4. Lack of tools for effective engagement in services
5. Intervention and prevention needs of children
6. Lack of effective communication
7. Data and information gaps
8. Categorical and rigid funding streams as well as treatment gaps
Where We’ve Been
Summary of the Five National Reports
- Identified Barriers
1. Differences in values and perceptions of primary client
2. Timing differences in service systems
3. Knowledge gaps
4. Lack of tools for effective engagement in services
5. Intervention and prevention needs of children
6. Lack of effective communication
7. Data and information gaps
8. Categorical and rigid funding streams as well as treatment gaps
Where We’ve Been
Summary of the Five National Reports
- Suggested Strategies
1. Develop principles for working together
2. Create on-going dialogues and efficient communication
3. Develop cross-training opportunities
4. Improve screening, assessment and monitoring practice and protocols
5. Develop funding strategies to improve timely treatment access
6. Expand prevention services to children
7. Develop improved cross-system data collection
Where We’ve Been
Summary of the Five National Reports
- Suggested Strategies
1. Develop principles for working together
2. Create on-going dialogues and efficient communication
3. Develop cross-training opportunities
4. Improve screening, assessment and monitoring practice and protocols
5. Develop funding strategies to improve timely treatment access
6. Expand prevention services to children
7. Develop improved cross-system data collection
Leadership of the Federal Government
Blending Perspectives and Building Common Ground (Report to Congress in response to ASFA)
- Five National Goals Established
- Building Collaborative Relationships
- Assuring Timely Access to Comprehensive Substance Abuse Treatment Services
- Improving our Ability to Engage and Retain Clients in Care and to Support Ongoing Recovery
- Enhancing Children’s Services
- Filling Information Gaps
Leadership of the Federal Government
- 1999 Stakeholders forum called for a central focal point for these efforts
- 2000-2001 Regional forums of state teams
- 2002 Funding of the National Center on Substance Abuse and Child Welfare
CFF and NCSACW Products
Improvements and Revisions in CFF’s Comprehensive Framework and Policy Tools
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
|
1. Values and Common Principles
Issues to Address
- Who is the client -- Parent, Child, Family?
- Can AOD users/abusers be effective parents?
- What is the goal -- Recovery, child safety, family preservation, economic self-sufficiency?
1. Values and Common Principles
Common Strategies
Identify and resolve differences that exist across system
- Ensure conversation happens at policy, supervisory and front-line levels
- Develop common principles for working together
NCSACW Product
- Collaborative Values Inventory
1. Values and Common Principles
Massachusetts Family Recovery Collaborative Acccomplishments
- State level Memorandum of Understanding between agency partners and tribe
- Statement of Shared Values and Guiding Principles
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
- 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
2. Daily Practice -- Client Intake, Screening and Assessment
Common Strategies
- 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
3. Daily Practice -- Client Engagement and Retention in Treatment
Common Strategies
- 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
Client Intake, Screening, Assessment, Engagement and Retention in Treatment
NCSACW Product
- Screening and Assessment for Family Engagement, Retention and Recovery (SAFERR):
Guidance for States and Communities Serving Families with Substance Use Disorders in Child
Welfare Services and Dependency Courts
- Current practice and key factors and processes for child welfare, alcohol and drug services and dependency court systems
- Guidance on developing collaborative efforts to improve outcomes for families.
Client Intake, Screening, Assessment, Engagement and Retention in Treatment
Massachusetts Family Recovery Collaborative Accomplishments
- Draft Protocol on Screening, Assessment, and Communication
- Family Engagement Program Concept Paper and Proposal
4. Daily Practice -- Services to Children
Issues to Address
- Prevention, early intervention, and treatment services for children in contact with CPS
- Independent Living Programs’ content on substance abuse
4. Daily Practice -- Services to Children
Common Strategies
- Develop partnerships to respond to potential neuro-developmental effects of prenatal substance exposure
- Provide prevention and intervention services to children and adolescents
- Provide youth with appropriate youth development intervention and activities
- Ensure that ILP teens receive appropriate information related to risks of substance abuse
NCSACW Product
- Substance Exposed Infants Report
- SAFERR Appendix on children of substance abusers
5. Training and Staff Development
NCSACW Products
- The Child Welfare-Substance Abuse Connection: A Compendium of Training Curricula and Resources
- Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers
- On-line self-tutorials
- Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals
- Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Child Welfare Professionals
- Substance Use Disorders, Mental Disorders and Co-Occurring Disorders Training Package
Other System Supportive Elements
6. Information Sharing and Data Systems
7. Joint Accountability and Shared Outcomes
- SAFERR
- Consortium Workgroup Data Inventory
8. Budgeting, Funding and Program Sustainability
- White Paper on Funding Comprehensive Services for Families with Substance Use Disorders in Child
Welfare and Dependency Courts
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
|
NCSACW Products
Development of a Comprehensive Framework and Policy Tools
- 10 Element Framework
- Collaborative Values Inventory
- Collaborative Capacity Instrument
- Matrix of Progress in Linking Services
- Screening and Assessment for Family Engagement, Retention and Recovery -- SAFERR
NCSACW Products
- Collaborative Capacity Instrument
- A self-assessment by County (and/or State) alcohol and drug and child welfare service agencies
- Designed to elicit discussion among and within agencies about their readiness for collaborative work
- Scale Rating
Disagree = 1
Somewhat Agree = 2
Agree = 3
Not Sure/Don’t know Not included in mean
CCI SUMMARY SCORES: Pre-IDTA
| |
COMMUNITY/
FAMILY |
RELATED
AGENCIES |
BUDGETING |
STAFF
DEVELOP |
INFO
SHARING |
OUTCOMES |
CHILDREN |
ENGAGE/
RETAIN |
SCREEN/
ASSESS |
VALUES |
| Site 1 |
1.59 |
1.82 |
2.24 |
1.874 |
1.621 |
1.762 |
2.2685 |
1.56 |
1.752 |
1.77 |
| Site 2 |
1.49 |
1.63 |
1.77 |
1.38 |
1.27 |
1.43 |
1.5 |
1.62 |
1.52 |
1.67 |
| Site 3 |
1.72 |
2.09 |
1.76 |
1.52 |
1.45 |
1.48 |
1.49 |
1.62 |
1.58 |
2.29 |
| Site 4 |
1.88 |
1.83 |
2.17 |
1.47 |
1.47 |
1.85 |
1.5 |
1.71 |
1.88 |
1.98 |
CCI SUMMARY SCORES: Post-IDTA
| |
COMMUNITY/
FAMILY |
RELATED
AGENCIES |
BUDGETING |
STAFF
DEVELOP |
INFO
SHARING |
OUTCOMES |
CHILDREN |
ENGAGE/
RETAIN |
SCREEN/
ASSESS |
VALUES |
| Site 1 |
1.72 |
1.82 |
2.16 |
2.11 |
1.5 |
1.86 |
1.55 |
1.79 |
1.93 |
2.52 |
| Site 2 |
1.94 |
1.92 |
2 |
1.82 |
1.48 |
1.58 |
1.53 |
1.67 |
1.59 |
2.14 |
| Site 3 |
1.89 |
2.05 |
2.03 |
1.95 |
1.65 |
1.72 |
1.76 |
1.78 |
1.93 |
2.55 |
| Site 4 |
2.11 |
1.99 |
2.18 |
1.93 |
2.05 |
2.1 |
1.93 |
1.98 |
2.26 |
1.56 |
Massachusetts – pre/post CCI
| |
COMMUNITY/
FAMILY |
RELATED
AGENCIES |
BUDGETING |
STAFF
DEVELOP |
INFO
SHARING |
OUTCOMES |
CHILDREN |
ENGAGE/
RETAIN |
SCREEN/
ASSESS |
VALUES |
| Post-IDTA |
1.8 |
1.89 |
1.68 |
1.59 |
1.57 |
1.69 |
1.51 |
1.53 |
1.66 |
2.21 |
| Pre-IDTA |
1.68 |
1.7 |
1.8 |
1.34 |
1.28 |
1.34 |
1.3 |
1.48 |
1.48 |
1.99 |
Massachusetts Family Recovery Collaborative Accomplishments
- State level Memorandum of Understanding between agency partners and tribe
- Statement of Shared Values and Guiding Principles
- Draft Protocol on Screening, Assessment, and Communication
- Family Engagement Program Concept Paper and Proposal