creating change through collaboration: substance abuse and ... · policy and practice innovations...
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Creating Change through Collaboration:
Substance Abuse and Child Welfare Policy and Practice Innovationsy
Nancy K. Young
Denise Churchill
Sam Gillespie
Peter Panzarella
SAMHSA Women’s Conference
4 9 4 0 I r v i n e B l v d . , S u i t e 2 0 24 9 4 0 I r v i n e B l v d . , S u i t e 2 0 2I r v i n e , C A 9 2 6 2 0I r v i n e , C A 9 2 6 2 0
7 1 47 1 4 -- 5 0 55 0 5 -- 3 5 2 53 5 2 5n c s a c w @ c f f u t u r e s . o r g n c s a c w @ c f f u t u r e s . o r g
w w w . n c s a c w . s a m h s a . g o vw w w . n c s a c w . s a m h s a . g o v
SAMHSA Women s Conference
July 28-28, 2010
Chicago, Illinois
Topics for Discussion
• Making the Case for Collaboration
• The “How To” of Collaboration
• What’s Being Done
• Technical Assistance Resources
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2
A Program of the
Substance Abuse and Mental Health Services AdministrationCenter for Substance Abuse Treatment
and the
Administration on Children, Youth and FamiliesChild ’ BChildren’s Bureau
Office on Child Abuse and Neglect
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Making the CaseMaking the Case for Collaboration
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Children Living with One or More Substance-Dependent Parent
10.6
6.2
7.5
8.3
8.4
4.5
2.8
0 5 10 15Numbers indicate millions
5Blending Perspectives and Building Common Ground: A Report to Congress on Substance Abuse and Child Protection Washington, DC: Department of Health and Human Services. 1999.
Parental Substance Use Cited as Factor in Child Welfare Case
Parental or Alcohol Drug Abuse as Factor in Cases of Child Removal
Substance Abuse as Primary Reason for Case Opening
2007 AFCARS Data2007 AFCARS DataParental Alcohol or Drug Abuse as Factor
in Cases of Child Removal(N=190,900 Cases)
CFSR Round 1 Review2001-2004
(N=50 Cases)
CFSR Round 2 Review2007-2010
(N=65 Cases)
State Percent Percent Percent
A 4.4 16 20B 5.8 16C 9.2 2D** 10.0 8
TEXT PAGE*In Round 1, these data were not included in the first cohorts of States reviewed, it was an added item in subsequent States.
E 11.8 4 14F 42.6 2G 46.4 18H 51.0 8 31I 58.0 8 8J** 63.6 27
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Data Summary
United States
N b P tNumber Percent
Total Treatment Admissions 1,817,577* 100%
Alcohol 732,925 40.3%
All Other Drugs 1,084,652 59.7%
Child Maltreatment Victims 758,289 20.9%
TEXT PAGE
Child Victimization Rate 10.3
1) U.S. Department of Health and Human Services, Administration on Children, Youth and Families. Child Maltreatment 2008 (Washington, DC: U.S. Government Printing Office, 2009). Tables 3.1, 3.32) Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Treatment Episode Data Set (TEDS) Highlights ‐ ‐ 2009 National Admissions to Substance Abuse Treatment Services. Tables 2a, 6a. OAS Series #S‐40, DHHS Publication No. (SMA) 08‐4313, Rockville, MD, 2009.
* Includes those with disposition of substantiated, indicated or alternative response victim. Percentage is number of maltreatment cases out of total number of children who received a CPS investigation.
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The Reunification Gap: A State-level Example
Case Study:
• 62% of reunifications occur within 12 months62% of reunifications occur within 12 months
(11,500 of 18,500 reunifications)
• Per the National target of 75.2%, this state’s 12 month reunification goal should be 13,900.
• Therefore, the gap between the current and target reunification rate is 2 400 childrentarget reunification rate is 2,400 children.
• 2,400 children 1,701 parents– Child-parent ratio conversion = .72
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• 1,701 parents need to complete treatment to meet the National Target reunification rate.
The Reunification Gap: A State-level Example
• To have 1,701 parents complete treatment, an additional 4,700 treatment spaces are necessary.– Assume 36% of parents who enter treatment
successfully complete the treatment episode
• 4,700 new treatment spaces represents 2.4% of the state’s total treatment admissions (assuming no overlap).– State has almost 200,000 annual treatment
admissions
The Threshold Issues
• Is substance abuse more than “just one more thing”—does it have a major impact on child welfare outcomes?
How can outcomes for families be improved through• How can outcomes for families be improved through partnership between the child welfare and substance abuse treatment systems?
• What is the role of timely access to effective treatment to resolve the substance abuse disorders affecting children and families involved in the child welfare system?
Wh t ibilit d t t t i h t
TEXT PAGE
• What responsibility do treatment agencies have to address child welfare outcomes?
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The “How To” of CollaborationThe “How To” of Collaboration
The 10 Elements of System Linkages The 10 Elements of System Linkages
and Models of Collaborationand Models of Collaboration
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Identified barriers1. Differences in values and perceptions of primary
li t
Summary of the Five National Reports
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 communication6. Lack of effective communication
7. Data and information gaps
8. Categorical and rigid funding streams as well as treatment gaps
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Suggested strategiesSuggested strategies1. Develop principles for working together
Summary of the Five National Reports
p p p g g
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 timely5. Develop funding strategies to improve timely treatment access
6. Expand prevention services to children
7. Develop improved cross-system data collection
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ChangingThe System
Getting Better at Getting Along:
Four Stages of Collaboration
ChangingThe Rules
The System
Existing Funding
External Funding
InformationExchange
JointProjects
Sid Gardner, 1996Beyond Collaboration to Results
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Navigating the PathwaysPublished by CSAT
• A framework for defining elements of collaboration
To define linkage points across systems: where are the most important bridges we need to build?
• Methods to assess effectiveness of collaborative work
To assess differing values
To assist sites in measuring their implementation
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Mission
1. Underlying Values and Priorities
Elements of System LinkagesThe Ten Key Bridges
System Elements
Children, Family, Tribal, and Community Services
2. Screening and Assessment
3. Engagement and Retention
4. Services for Children 5. Community and Family
Support
Outcomes
10. Shared Outcomes and Systems Reforms
6. Information Systems 7. Training and System Tools 8. Budget and Sustainability9. Working with Other
Agencies
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Collaborative Practice and Policy Tools
Ten Element Framework – A method to organize collaborative activities in specific practice and policy areas
Collaborative Values Inventory – An anonymous way to explore values and beliefs to facilitate the development of common principles using web‐based data collection
Collaborative Capacity Instrument – An anonymous way to assess the strengths and challenges in each of the areas of system linkages using web‐based data collection
Matrix of Progress in System Linkages – A practice‐based approach that specifies characteristics of advance collaboration practice in the elements of system linkages
Screening and Assessment for Family Engagement, Retention and Recovery — SAFERR ‐‐A guidebook to develop effective communication across systems while engaging families in services
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Mission
1. Underlying Values and Priorities
Elements of System LinkagesThe Ten Key Bridges
System Elements
Children, Family, Tribal, and Community Services
2. Screening and Assessment
3. Engagement and Retention
4. Services for Children 5. Community and Family
Support
Outcomes
10. Shared Outcomes and Systems Reforms
6. Information Systems7. Training and System
Tools8. Budget and Sustainability
9. Working with Other Agencies
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Underlying Values and Principles of Collaboration
Tools and Resources
• Collaborative Values Inventory
• Synthesis of Cross System Values and Principles: A National Perspective
ModelsModels
• IDTA Memoranda of Understanding and statements of shared values and principles
Mission
1. Underlying Values and Priorities
Elements of System LinkagesThe Ten Key Bridges
System Elements
Children, Family, Tribal, and Community Services
2. Screening and Assessment
3. Engagement and Retention
4. Services for Children 5. Community and Family
Support
Missing Boxes
Outcomes
10. Shared Outcomes and Systems Reforms
6. Information Systems7. Training and System
Tools8. Budget and Sustainability
9. Working with Other Agencies
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Dropoff Points
50,000 Children with Substantiated Abuse/Neglect 33,000 Parents
60% of Parents Need Assessment 60% of Parents Need Assessment
19,800
50% Go for Assessment
9,900
80% Need Treatment
7,920
50% Go to First Session 3,960
30% Complete 90 Days – 1,188
2150% Reunify or Stay with Parents 594
Spectrum of Substance Use Disorders
Experiment Experiment ppand and UseUse
AbuseAbuse
DependenceDependence22
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Screening and Assessment
Tools and Resources• SAFERR- Screening and
Assessment for Family Engagement, Retention and Recovery
Models • Arizona Families• Arizona – Families
F.I.R.S.T. Model• Washington – GAIN-SS
and CDPs statewide• Maine- U.N.C.O.P.E.
Mission
1. Underlying Values and Priorities
Elements of System LinkagesThe Ten Key Bridges
System Elements
Children, Family, Tribal, and Community Services
2. Screening and Assessment
3. Engagement and Retention
4. Services for Children 5. Community and Family
Support
Call Me Tuesday
Outcomes
10. Shared Outcomes and Systems Reforms
6. Information Systems7. Training and System
Tools8. Budget and Sustainability
9. Working with Other Agencies
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Engagement and Retention
Tools and ResourcesSAFERR S i d A t f F il• SAFERR- Screening and Assessment for Family Engagement, Retention and Recovery
• SAS- Substance Abuse Specialist Paper
Models • Arizona – Families F.I.R.S.T. Model
S t STARS• Sacramento- STARS• Cuyahoga County- START
Mission
1. Underlying Values and Priorities
Elements of System LinkagesThe Ten Key Bridges
System Elements
Children, Family, Tribal, and Community Services
2. Screening and Assessment
3. Engagement and Retention
4. Services for Children 5. Community and Family
Support
Outcomes
10. Shared Outcomes and Systems Reforms
6. Information Systems7. Training and System
Tools8. Budget and Sustainability
9. Working with Other Agencies
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10 Element FrameworkServices to Children
• Complex interchange of biological, psychological and sociological events
• Screening is complicated by:– 1. There is no absolute profile of
developmental outcomes
– 2. Other issues in parental behavior, competence and disorders interactcompetence, and disorders interact which may lead to multiple co-occurring problems for children
Daily Practice – Services to ChildrenMultiple Opportunities for Intervention
• Commonly noted consequences for children– Fetal Alcohol Syndrome (FAS)– Alcohol-related neuro-developmental disorders
(ARND)• Physical health consequences• Lack of secure attachment• Psychopathology• Behavioral problemsBehavioral problems• Poor social relations/skills• Deficits in motor skills• Cognition and learning disabilities
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Services to Children
Tools and Resources• Substance-Exposed
I f t St t RInfants: State Responses to the Problem
Models • Washington State• Research Triangle InstituteResearch Triangle Institute• RPG Children's Cluster• Miami Zero to Two Court• Strengthening Families• Celebrating Families
Mission
1. Underlying Values and Priorities
Elements of System LinkagesThe Ten Key Bridges
System Elements
Children, Family, Tribal, and Community Services
2. Screening and Assessment
3. Engagement and Retention
4. Services for Children 5. Community and Family
Support
What is the role of the RecoveryCommunity in Child Welfare Practice?
Outcomes
10. Shared Outcomes and Systems Reforms
6. Information Systems7. Training and System
Tools8. Budget and Sustainability
9. Working with Other Agencies
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Mission
1. Underlying Values and Priorities
Elements of System LinkagesThe Ten Key Bridges
System Elements
Children, Family, Tribal, and Community Services
2. Screening and Assessment
3. Engagement and Retention
4. Services for Children 5. Community and Family
Support
Outcomes
10. Shared Outcomes and Systems Reforms
6. Information Systems7. Training and System
Tools8. Budget and Sustainability
9. Working with Other Agencies
Joint Accountability, Shared Outcomes and Information Systems
Tools and Resources• RPG Data codebookRPG Data codebook• Webinars on linkages
Models • Michigan revised SACWIS to prioritize families with
substance use disorders• CFSR and NOMS processes• California CalOMS now tracks 7500 CW parents inCalifornia CalOMS now tracks 7500 CW parents in
treatment and knows which had positive outcomes [36%]
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Mission
1. Underlying Values and Priorities
Elements of System LinkagesThe Ten Key Bridges
System Elements
Children, Family, Tribal, and Community Services
2. Screening and Assessment
3. Engagement and Retention
4. Services for Children 5. Community and Family
Support
Outcomes
10. Shared Outcomes and Systems Reforms
6. Information Systems7. Training and System
Tools8. Budget and Sustainability
9. Working with Other Agencies
Training and Staff Development
Tools and Resources• NCSACW online tutorials• NCSACW online tutorials
• Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers
• Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals
U d t di S b t U Di d T t t• Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Legal Professionals
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Online Training
Available at no charge at http://ncsacw.samhsa.gov
Implementing Online Tutorials
Available at no charge at http://ncsacw.samhsa.gov
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NEW! Child Welfare Training Toolkit
6 modules, each containing a:
•Trainer Script•PowerPoint Presentation•Handouts
•Case Vignettes
A il bl t NOAvailable at NO CHARGE!
http://www.ncsacw.samhsa.gov/training/def
ault.aspx
Training and Related Products
• On-Line Training
– Available at no cost
– Upon completion of the tutorial:
• Certificate awarded
• CEUs and CLEs are available
• Child Welfare Training Toolkit: Helping Child Welfare Workers Support Families with Substance Use, Mental,
d C O i Di dand Co-Occurring Disorders http://www.ncsacw.samhsa.gov/training/toolkit/
• State Legislator information resources web-pages (in development)
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Mission
1. Underlying Values and Priorities
Elements of System LinkagesThe Ten Key Bridges
System Elements
Children, Family, Tribal, and Community Services
2. Screening and Assessment
3. Engagement and Retention
4. Services for Children 5. Community and Family
Support
Outcomes
10. Shared Outcomes and Systems Reforms
6. Information Systems7. Training and System
Tools8. Budget and Sustainability
9. Working with Other Agencies
Budget and Sustainability
Tools and Resources
• White Paper on Funding Comprehensive Services for Families with Substance Use Disorders in Child Welfare and Dependency Courts
• Funding Family-Centered Treatment for Women With Substance Use Disorders– Detailed tables of Federal funding sources for comprehensive
services
• Sustainability discussion guide for Regional Partnership Grants and webinars
• IDTA State strategic plans for continued efforts
Models
• Milwaukee Courts Integrated Funding System
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Mission
1. Underlying Values and Priorities
Elements of System LinkagesThe Ten Key Bridges
System Elements
Children, Family, Tribal, and Community Services
2. Screening and Assessment
3. Engagement and Retention
4. Services for Children 5. Community and Family
Support
Outcomes
10. Shared Outcomes and Systems Reforms
6. Information Systems7. Training and System
Tools8. Budget and Sustainability
9. Working with Other Agencies
Working with Other Agencies
Partnership most frequently cited as necessary:
• Mental health services for adults.
• Mental health services for children.
• Domestic Violence
• Housing
• Income Support (TANF, Vocational Training, Employment)Employment)
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Working with Other Agencies
Tools and ResourcesF il C t d T t t f W• Family Centered Treatment for Women
• A Review of Alcohol and Drug Issues in the States’ Child and Family Service Reviews and Program Improvement Plans
Models • Shields for Families, PROTOTYPES, Meta House • Other multiservice agencies
Mission
1. Underlying Values and Priorities
Elements of System LinkagesThe Ten Key Bridges
System Elements
Children, Family, Tribal, and Community Services
2. Screening and Assessment
3. Engagement and Retention
4. Services for Children 5. Community and Family
Support
Outcomes
10. Shared Outcomes and Systems Reforms
6. Information Systems7. Training and System
Tools8. Budget and Sustainability
9. Working with Other Agencies
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Shared Outcomes System Reforms
Tools and Resources• SAFERR communication protocols• IDTA State communication protocols and examples of data• IDTA State communication protocols and examples of data
system improvements• A Review of Alcohol and Drug Issues in the States' Child and
Family Service Reviews and Program Improvement Plans
Models • Guide to Cross-System Data Sources for State and Tribal
Child Welfare, Substance Abuse Treatment, and Court Systems (In Development)
• May 16, 2008: Connecting the Dots: How States and Counties Have Used Existing Data Systems to Create Cross System Data Linkages
– http://www.cffutures.com/webinars.shtml#May16
NCSACW In‐Depth Technical Assistance Sites Children’s Bureau Regional Partnership Grants
OJJDP Family Drug Courts
US DEPARTMENT OF HEALTH AND HUMAN SERVICESSubstance Abuse and Mental Health Services AdministrationAdministration for Children and Familieswww.samhsa.gov
NCSACW IDTA Sites = 20 Sites
16 States
3 Tribal Communities
1 County
14 OJJDP Sites
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So what is being done and what
can we do?can we do?
Denise Churchill
Sam Gillespie
Peter Panzarella
Denise Churchill, LMFTDenise Churchill, LMFTOrange Orange County Social Services AgencyCounty Social Services Agency
Child & F ilChild & F il S iS iChildren & Family Children & Family ServicesServices
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Orange County DemographicsOrange County Demographics Orange County covers nearly 800 square miles Orange County covers nearly 800 square miles
and is located between Los Angeles and Sanand is located between Los Angeles and Sanand is located between Los Angeles and San and is located between Los Angeles and San Diego counties in Southern California Diego counties in Southern California
The county is densely populated by 3 million The county is densely populated by 3 million residents, with 3,910 persons per square mileresidents, with 3,910 persons per square mile
47% Caucasian, 33% Hispanic, and 15% Asian47% Caucasian, 33% Hispanic, and 15% Asian 885,353 children ages 0885,353 children ages 0--1818gg
2,973 Dependents of the Court (March 2010 data)2,973 Dependents of the Court (March 2010 data)
Data source: Report on the Conditions of Children in Orange County, 2009 Data source: Report on the Conditions of Children in Orange County, 2009
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Current Fiscal EnvironmentCurrent Fiscal Environment January 2009 January 2009 –– Present:Present:
Budgetary impactsBudgetary impacts Budgetary impactsBudgetary impacts Staff furloughs & layoffsStaff furloughs & layoffs ↓Resources↓Resources Client needClient need
Lowest # of child welfare dependent children in Lowest # of child welfare dependent children in past 10 yearspast 10 yearspast 10 yearspast 10 years
Improved Federal Child Welfare Outcomes for Improved Federal Child Welfare Outcomes for Safety, Permanence, Stability & WellSafety, Permanence, Stability & Well--Being Being
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InIn--Depth Technical AssistanceDepth Technical Assistance Orange County, California: 2008Orange County, California: 2008--2010 2010 –– first county sitefirst county site Partners: Child Welfare AOD Treatment CourtsPartners: Child Welfare AOD Treatment Courts Partners: Child Welfare, AOD Treatment, CourtsPartners: Child Welfare, AOD Treatment, Courts Target Population: Target Population: Families with coFamilies with co--occurring child occurring child
welfare and substance use disorders that are in the welfare and substance use disorders that are in the jurisdiction of the Juvenile Court.jurisdiction of the Juvenile Court.
Focus on “front end” system processesFocus on “front end” system processes Goals & Priorities:Goals & Priorities:
Needs Analysis on range of services and available supportsNeeds Analysis on range of services and available supports Streamline referral process, communication and service accessStreamline referral process, communication and service access Inventory & analyze existing data & develop sharing protocolsInventory & analyze existing data & develop sharing protocols Develop a crossDevelop a cross--system training plan to support shared learningsystem training plan to support shared learning
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Virtual WalkthroughVirtual Walkthrough
NIATx Process Improvement ModelNIATx Process Improvement ModelFlowcharting the WalkthroughFlowcharting the Walkthrough Flowcharting the WalkthroughFlowcharting the Walkthrough
Nominal Group Process to identify Nominal Group Process to identify challenges/solutionschallenges/solutions
Roles & Responsibilities of ParticipantsRoles & Responsibilities of Participants Focus on the systems & processes, not the individual Focus on the systems & processes, not the individual
staffstaff Timeframes, decision points, handTimeframes, decision points, hand--offs, information offs, information , p ,, p , ,,
sharingsharing Who, What, Where, How, When?Who, What, Where, How, When? Consider the client’s perspectiveConsider the client’s perspective Note observations & ideasNote observations & ideas
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May 2009 & February 2010May 2009 & February 2010
Nearly 80 Orange County participantsNearly 80 Orange County participants Nearly 80 Orange County participants Nearly 80 Orange County participants Identified opportunities to achieve better Identified opportunities to achieve better
outcomesoutcomes Improved “front end” system processesImproved “front end” system processes Interesting considerationsInteresting considerations Key challenges identifiedKey challenges identifiedKey challenges identifiedKey challenges identified Key solutions generatedKey solutions generated
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Infant identified as drug exposed at birth
Emergency Response SSW (ERSSW) assigned
ERSSW visits hospital, meets with nurse
ERSSW reviews mother and infant charts
Flow Chart: Services for Orange County Parents Whose Children are Identified as Drug Exposed at BirthFlow Chart: Services for Orange County Parents Whose Children are Identified as Drug Exposed at Birth
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ERSSW interviews mother
ERSSW leaves mother and calls supervisor (SSSS) to discuss case and decide using SDM assessment
whether to hold child
If yes
ERSSW calls law enforcement of patient's
home jurisdiction and speak to watch commander to
obtain authorization for hold
If yes (always is)
ERSSW completes hold form in infant's medical chart
ERSSW completes Blue Form (Petition for Removal
Application with time of completion which starts the
ERSSW explains hold to mother and together with the nurse provides information
on treatment services
ERSSW completes paperwork at office: File blue
paperwork at Orangewood Children's Home, completes
referral in computer system to
Intake SSW should be assigned
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premoval process timeline) on treatment services p y
get on detention hearing schedule
Same day
Team Decisionmaking (TDM) Scheduler schedules room
and invites appropriate people: parents, ERSSW,
CalWORKS if available
W/in 1 day
TDM held in person or by telephone if parent still in hospital, identify potential
family members for placement
Timing of 3 days
disputed by
parents
Parent recieives TDM summary, court hearing date,
time and location,familymembers under consideration
(we didn't discuss how this gets done and how the parent
gets it in time)
Hand off to Dependency Intake SSW (DISSW)
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Detention Hearing Day: Parent orientation (voluntary)
Parent goes through security, at reception is told which court
room, sits for a long time outside court room w/various people approaching for info, parent assigned attorney at
court
Parent hears finding and placement decision
Parent ordered to drug test
Orders for services, pre-trial hearing and trial scheduled
Assign FSW?
Yes
Att b ll i f
5544
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Family Service Worker (FSW) follow-up with placement,
completes checklist case with parent, goes over finding
Attorney verbally informs parent of the court order and
parent to call SW, encourages parent to get involved in
services
Assign Drug Court?
No
Hand-off to Dependency Investigation SSW/FSW w/in 3
days
W/in 2 weeks
First interview of FSW with parents to discuss case
planning including treatment
Treatment access depends on services. Drug Court services
accessed faster, outpatient (OP) services accessed faster, wait lists vary but currently no
wait for OP
Jursidiction Hearing Day: Parent goes through security. At reception, told which court
room
Parent receives case plan in writing
FSW reviews court minutes and works with parent on
orders
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wait for OP
DISSW goes through the case with parent
Parent may become involved with educational specialist,
CalWORKS or perinatalprogram
Parent may be assigned a Parent Mentor
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Initial Walkthrough OutcomesInitial Walkthrough Outcomes
2 Plan/Do/Study/Act (PDSA) Cycles to pair2 Plan/Do/Study/Act (PDSA) Cycles to pair2 Plan/Do/Study/Act (PDSA) Cycles to pair 2 Plan/Do/Study/Act (PDSA) Cycles to pair Parent Mentors with ParentsParent Mentors with Parents
Parent Surveys & Focus GroupsParent Surveys & Focus Groups Staff &Community Partner Focus GroupsStaff &Community Partner Focus Groups Orange County Training MatrixOrange County Training Matrix
R i li d R A li tiR i li d R A li ti Regionalized Resource ApplicationRegionalized Resource Application Data Exchange Protocol Data Exchange Protocol –– SSA & HCASSA & HCA
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Parent Engagement EffortsParent Engagement Efforts Earlier access to treatment for child welfare parentsEarlier access to treatment for child welfare parents Development of Recovery Specialist Model Development of Recovery Specialist Model p y pp y p
Family Services WorkersFamily Services Workers Assigned upon child entering foster care to assess Assigned upon child entering foster care to assess
parent’s needs, facilitate early access to treatment parent’s needs, facilitate early access to treatment and child visitationand child visitation
Development of Parent Partner ModelDevelopment of Parent Partner Model Contract with Family Support NetworkContract with Family Support Network Provides parent partners at the initial Team Decision Provides parent partners at the initial Team Decision
Making meeting, prior to the first court hearing, Making meeting, prior to the first court hearing, leading to increased rates o service plan engagementleading to increased rates o service plan engagement
Operation of Family Dependency Drug Court ModelOperation of Family Dependency Drug Court Model
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Ongoing Oversight & SupportOngoing Oversight & Support Child Welfare Redesign Planning CouncilChild Welfare Redesign Planning Council
Efforts to redesign Child Welfare Contracted ServicesEfforts to redesign Child Welfare Contracted Services Efforts to redesign Child Welfare Contracted ServicesEfforts to redesign Child Welfare Contracted Services Efforts to prioritize court ordered case plan activitiesEfforts to prioritize court ordered case plan activities
Blue Ribbon CommissionBlue Ribbon Commission Efforts to build Volunteer Parent Mentor poolEfforts to build Volunteer Parent Mentor pool Efforts to increase Recovery Specialist Model (FSW)Efforts to increase Recovery Specialist Model (FSW)
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Sam GillespieIllinois Department of Children and
Family Services, Service Intervention Division
Statewide Alcohol and Other Drug Abuse Services Administrator
Setting the Stage
1998 GAO study in Chicago and Louisiana 74% of Cook County (Chicago) foster care
h d 1 i d b hcases had 1 or more parents required by the child welfare service plan to receive treatment
Less than 20% of parents were in treatment or had completed treatment at the time of the study
Average time in foster care for substance abuse involved families: 46 months
Most child welfare agencies has limited f ili it ith il bl b tfamiliarity with available substance resources
Judges reported that permanency decisions were consistently delayed due to a lack of information on parent’s treatment progress
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Setting the Stage
DCFS Inspector General reports cite substance abuse in child death andsubstance abuse in child death and injury cases involving intact families
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Child Welfare Needs from the Substance Abuse System
Outreach and Engagement with the client early and often in the processclient early and often in the process
Streamlined referral process for the caseworker (as paperless as possible)
Expedited assessment and entry into treatment
Collaboration with caseworker to Collaboration with caseworker to eliminate barriers to treatment
Child care, transportation, fees
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Child Welfare Needs from the Substance Abuse System
Joint staffings, family meetings, substance abuse treatment planningsubstance abuse treatment planning
Re-engagement in services when necessary
Standardized regular reporting to the worker and the courts
Treatment progress, drug test results, observations of parent-child interaction
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Child Welfare Needs from the Substance Abuse System
Assistance with other identified barriers to recovery and reunificationto recovery and reunification
Mental health, domestic violence, housing needs
Substance abuse providers can help child welfare workers to understand the an entire family needs treatment and the family needs to recover from a parent’s substance abuse
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Illinois’ Responses
On site substance abuse assessments and same day referrals at Cook Countyand same day referrals at Cook County Juvenile Court
Recovery Coaches to work with parents, caseworkers, treatment providers and the courts
Intact Family Recovery program to pair Intact Family Recovery program to pair child welfare workers and substance abuse case managers to jointly work substance exposed infants (SEI) cases
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Illinois’ Responses
Drug free, recovery oriented housing programs for recovering moms andprograms for recovering moms and children
Targeted funding to substance abuse providers to serve referrals from child welfare and collaborate with caseworkers and the courts
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Lessons Learned from Cross-Systems Collaboration
Judges need consistent timely information over the course of treatment and the childover the course of treatment and the child welfare case
Reports from substance abuse providers have to clearly show progress in a case and movement toward recovery and the ability to parentWh th t th ll When the courts see the overall progress of a case they can become more comfortable and accepting of relapses and lack of progress at points during treatment
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Lessons Learned from Cross-Systems Collaboration
Judges are the key component in the court system but not the onlycourt system, but not the only components
Prosecutors, defense attorneys, guardians, courtroom staff must all buy in to the collaborative model for success
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ConnecticutConnecticut Re-Directed Funding:
RSVP and Ensuring Cost Savings
P t P llPeter Panzarella,
Director of Substance Abuse at DCF
Connecticut Overview
Population - 3,409,549 Approximately 750,000 under age 18
N C t G t (169 T G t No County Government (169 Town Government and Home Rule)
CT Department of Children and Family is a consolidated Children’s Agency with mandates
CT Department of Mental Health and Addiction Services (Adults)
Unified Judicial Branch
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Development of Recovery Specialist Voluntary Program
CORE Team
Policies and Practice
Staff DevelopmentInformation Sharing Staff Development
Resources
Information Sharing
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RSVP ProgramThree Pilots; Bridgeport, Willimantic and New Britain
Recovery Specialists positions re-allocated from existing staff.
Based on STARS Model
No Family Drug Courts in CT
Conducts reliable random drug screens
Assist parents in engaging in SA treatment
Support parents in increasing their recovery capital Support parents in increasing their recovery capital through recovery coaching
Provide regular documentation to DCF, courts, and attorneys
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RSVP Program Outcomes
Increase inter-agency coordination and collaboration Increase coordinated case management and planning across
agencies Increase the number of OTC substance-abusing
parents/guardians receiving treatment and support services Increase length of time in substance abuse treatment; Increase treatment completion rates Shorten time to family permanency Increase family re-unification rates y Decrease rates of repeated child maltreatment and re-entry to
DCF; and Reduce costs associated with TPR cases
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DCF and DMHASProject SAFE Joint Contract
$3,680,863 FY2009 budgeted (DCF 70% and DMHAS 30%) 30% Drug Testing (Over Budget $160,000 in FY 2009) 9% on SA Evaluations 61% Treatment and Recovery
Contract Advanced Behavioral Health Central intake - # 800 Access to drug screens, substance abuse evaluations & a
variety of outpatient substance abuse treatment services Provider network 51 providers Centralized data reports & electronic billing
http://www.abhct.com/resources_Downloads.asp
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38
Connecticut Project SAFE Screening & Utilization Data
22,50025,000
Urine Testing
5 0007,500
10,00012,50015,00017,50020,000
CPS Caseload
Evaluations
02,5005,000
FY06 FY07 FY08* FY09
GAIN Short Screen
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Connecticut Substance Abuse Screening GAIN Short
Screen Data for Protective Services
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Project SAFE Drug Testing Data
2917 2913
Urine Tox ScreensFY 09 by Quarter - Statewide
2917
2307
2781
2327
2913
2645
2860
2217
1000
1500
2000
2500
3000
0
500
Quarter I Quarter II Quarter III Quarter IV
Random Utox TX UtoxFigure 1
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Cost Savings in Screening and Drug Testing
RSVP program, the urine toxicology screens occur ith i t t d t t kitwith an instant read test kit.
The client is asked if he/she has used any substances in the period since last tested
Client can challenge a positive test results the sample is sent to a lab for MG/CS confirmatory analysis.
The client signs that the results are accurate. No positive confirmatory testing is required.
Significant decrease in confirmation testing costs
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Projected Savings Shifting from Drug Testing to Recovery Supports
Priority to Clients with High Need Direct to TreatmentTreatment
Projected Decrease of 15% for FY 2010
Decrease of 7.7% of Average Number of Urine Tests Per Unduplicated Clients (Third Quarter Comparison)
35% Projected Cost Savings for FY 2011
Redirect to RSVP and Recovery Supports
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Together we embrace safety, permanency, g y, p y,substance abuse treatment and recovery.
Our ultimate goal is to achieve results for a family
th t ill l t lif ti ”that will last a lifetime.”
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Technical Assistance Technical Assistance ResourcesResourcesResourcesResources
81
Levels of Technical Assistance
Level One:
Information and Sharing of Models
Level Two:
Expert Consultation and
Research
Level Three:
Development of Issue‐ Specific
Products
Level Four:
Strategic Planning, Training Resources and Facilitation
16 States3 Tribes1 County
53 Grantees10 Pre‐IDTA
247 requests 366 requests 1077 requests
September 2001 through June 2009 82
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Types of TA Products
• Collaborative practice and policy tools
• Information and sharing of models• Information and sharing of models
• Expert consultation and research
• Development of issue-specific products
Monographs, white papers, fact sheets
• Training resources and collaborative facilitationg
On-line courses, training materials
• Longer-term strategic planning and development of protocols and practice models
83
Types of TA Products
• Collaborative practice and policy tools
• Information and sharing of modelsInformation and sharing of models
• Expert consultation and research
• Development of issue-specific products
Monographs, white papers, fact sheets
• Training resources and collaborative facilitationfacilitation
On-line courses, training materials
• Longer-term strategic planning and development
of protocols and practice models84
43
National Center on Substance Abuse and Child Welfare
How do I access technical assistance?
• Visit our NCSACW Exhibit Booth!
• Visit our Website: http://ncsacw.samhsa.gov
• E-mail Us: [email protected]
C ( 1 ) 0 3 2• Call Us: (714) 505-3525
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Denise Churchill, LMFTOrange County Social Services Agency, CFS
Nancy K. Young, MSW, PhDNational Center on Substance Abuse and Child Welfare
Contact Information
Specialized Family Services (SFS) ProgramAdministrative Manager IIPhone: (714) 704-8500 E-mail: [email protected]
DirectorPhone: (714) 505-3525Email: [email protected]
Sam GillespieIllinois Department of Children and Family Services Service Intervention
Peter Panzarella, MA, MSConnecticut Department ofDirector of Substance Abuse Services
TEXT PAGE
Family Services, Service InterventionDivisionStatewide Alcohol and Other Drug Abuse Services AdministratorPhone: (312) 814-5483E-mail: [email protected]
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Director of Substance Abuse ServicesPhone: (860) 642-3947E-mail: [email protected]