responding to families: timelines, clocks and the future nancy k. young, ph.d., director july 14,...
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Responding to Families:Responding to Families:Timelines, Clocks and the FutureTimelines, Clocks and the Future
Nancy K. Young, Ph.D., DirectorNancy K. Young, Ph.D., Director
July 14, 2004July 14, 2004Baltimore, MDBaltimore, MD
Responding to Families:Responding to Families:Timelines, Clocks and the FutureTimelines, Clocks and the Future
A Sense of SatisfactionA Sense of Satisfaction
A Sense of UrgencyA Sense of Urgency
We have much to feel good about in our efforts to We have much to feel good about in our efforts to combine forces to help children and families affected combine forces to help children and families affected by substance use disorders and child abuse or neglectby substance use disorders and child abuse or neglect
At the same time, we need a much greater sense of At the same time, we need a much greater sense of urgency in building on these victories to enter into the urgency in building on these victories to enter into the next phase of getting serious and getting to scalenext phase of getting serious and getting to scale
Two Opposing Ideas:Two Opposing Ideas:
1968 1973 1980s 1990s
2004
Timelines
Looking Back
TimelinesTimelines
1968 – Report of alcoholic mothers with babies 1968 – Report of alcoholic mothers with babies with a distinctive, unusual appearance in with a distinctive, unusual appearance in FranceFrance
1973 – Fetal Alcohol Syndrome named by a 1973 – Fetal Alcohol Syndrome named by a team of researchers in Seattleteam of researchers in Seattle
Mid 1970s Mid 1970s Estimate of the number of children of heroin addicts Estimate of the number of children of heroin addicts
and children of alcoholicsand children of alcoholics Fanshel reports substance abuse is common among Fanshel reports substance abuse is common among
families in child welfarefamilies in child welfare
BeginningsBeginnings
TimelinesTimelines
Impact of crack cocaine in urban centersImpact of crack cocaine in urban centers Chasnoff’s group begin to publish research on Chasnoff’s group begin to publish research on
prenatal effects of cocaine prenatal effects of cocaine 1983 National Institute on Drug Abuse (NIDA) 1983 National Institute on Drug Abuse (NIDA)
College on Problems of Drug Dependence College on Problems of Drug Dependence conference – First Poster Session on Children conference – First Poster Session on Children Prenatally-Exposed to CocainePrenatally-Exposed to Cocaine
Early and Mid 1980sEarly and Mid 1980s
Number of children in foster care escalatesNumber of children in foster care escalates
TimelinesTimelines
Mid to Late 1980sMid to Late 1980s
Foster Care PopulationFoster Care Population
0
100,000
200,000
300,000
400,000
500,000
600,000
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
0
1
2
3
4
5
6
7
8
Total Children Children per 1,000
52% Increase over 6 Years
Number of Children in Foster Care on Last Day of Federal Fiscal Year
Foster Care Population and Persons Foster Care Population and Persons who First Used Crack or Meth in Past Yearwho First Used Crack or Meth in Past Year
*All persons age 12 and over
0
100000
200000
300000
400000
500000
600000
19801981 1982 19831984 1985 1986 19871988 1989 19901991 1992 1993 19941995 1996 19971998 19992000 20012002
0
100,000
200,000
300,000
400,000
500,000
600,000
Children in Foster Care New Crack Users* New Methamphetamine Users*
TimelinesTimelines
Mid to Late 1980sMid to Late 1980s Child welfare agencies began responding to Child welfare agencies began responding to
an epidemic of kids coming into care and an epidemic of kids coming into care and cocainecocaine
Schools began their efforts to understand Schools began their efforts to understand prenatally-exposed children prenatally-exposed children 1987 Los Angeles Unified School District 1987 Los Angeles Unified School District
develops pilot program to understand develops pilot program to understand educational impact of prenatal cocaine educational impact of prenatal cocaine exposureexposure
Federal Grant Support BeganFederal Grant Support Began National Center on Child Abuse and Neglect National Center on Child Abuse and Neglect
94 programs, including Illinois, Connecticut, New Jersey 94 programs, including Illinois, Connecticut, New Jersey Piloted out-stationing substance abuse counselors in child Piloted out-stationing substance abuse counselors in child
welfare officeswelfare offices
NIDA research effortsNIDA research efforts SAMHSA Specialized women’s treatment programsSAMHSA Specialized women’s treatment programs
Between 1997 and 1999 Between 1997 and 1999 Five National Reports on Substance Abuse and Five National Reports on Substance Abuse and
Child WelfareChild Welfare
TimelinesTimelines
1990s1990s
Five National Reports on Substance Abuse and Five National Reports on Substance Abuse and Child WelfareChild Welfare Responding to Alcohol and Other Drug Problems in Child Responding to Alcohol and Other Drug Problems in Child
Welfare: Weaving Together Practice and Policy (1998)Welfare: Weaving Together Practice and Policy (1998)
Foster Care: Agencies Face Challenges Securing Stable Foster Care: Agencies Face Challenges Securing Stable Homes for Children of Substance Aubsers (1998)Homes for Children of Substance Aubsers (1998)
Healing the Whole Family: A Look at Family Care Programs Healing the Whole Family: A Look at Family Care Programs (1998)(1998)
No Safe Haven: Children of Substance-Abusing Parents (1999)No Safe Haven: Children of Substance-Abusing Parents (1999)
Blending Perspectives and Building Common Ground: A Report Blending Perspectives and Building Common Ground: A Report to Congress on Substance Abuse and Child Protection (1999)to Congress on Substance Abuse and Child Protection (1999)
TimelinesTimelines
1990s1990s
Many communities began program modelsMany communities began program models
TimelinesTimelines
1990s1990s
Family Treatment CourtsFamily Treatment Courts
Training and Curricula DevelopmentTraining and Curricula Development
Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents
Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning
Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office
Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker
TimelinesTimelines
1990s1990s Efforts by members of Congress and advocacy Efforts by members of Congress and advocacy
groups to ensure that substance abuse issues groups to ensure that substance abuse issues were addressed in the Adoption and Safe were addressed in the Adoption and Safe Families Act (ASFA)Families Act (ASFA)
TimelinesTimelines
Looking at our Achievements
1990s1980s
2004
1.1. Active working relationships and multiple Active working relationships and multiple models of connectionmodels of connection
Courts, Child Welfare Agencies and Treatment Courts, Child Welfare Agencies and Treatment ProvidersProviders
Leadership provided by NCSACW consortium Leadership provided by NCSACW consortium member organizations: member organizations: American Public Human Services Association - APHSAAmerican Public Human Services Association - APHSA Child Welfare League of America - CWLA Child Welfare League of America - CWLA National Association of State Alcohol and Drug Abuse National Association of State Alcohol and Drug Abuse
Directors - NASADADDirectors - NASADAD National Council of Juvenile and Family Court Judges - National Council of Juvenile and Family Court Judges -
NCJFCJ NCJFCJ National Indian Child Welfare Association - NICWANational Indian Child Welfare Association - NICWA
Our Biggest AchievementsOur Biggest Achievements
TimelinesTimelines
2. Leadership of the Federal Government2. Leadership of the Federal Government 1999 Blending Perspectives report, in 1999 Blending Perspectives report, in
response to ASFAresponse to ASFA 1999 Stakeholders forum called for a 1999 Stakeholders forum called for a
central focal point for these effortscentral focal point for these efforts 2000-2001 Regional forums held around 2000-2001 Regional forums held around
the nation the nation 2002 Funding of the National Center on 2002 Funding of the National Center on
Substance Abuse and Child WelfareSubstance Abuse and Child Welfare
Our Biggest AchievementsOur Biggest Achievements
TimelinesTimelines
3. Progress in the Dependency Courts3. Progress in the Dependency Courts Judge McGee in Reno and Judge Parham in Judge McGee in Reno and Judge Parham in
Pensacola Florida apply principles and strategies of Pensacola Florida apply principles and strategies of adult drug courts to dependency proceedings. adult drug courts to dependency proceedings.
Judge Milliken in San Diego initiated the first county-Judge Milliken in San Diego initiated the first county-wide approach to parental substance use disorderswide approach to parental substance use disorders
Our Biggest AchievementsOur Biggest Achievements
TimelinesTimelines
Courts increasingly document their effectivenessCourts increasingly document their effectiveness
The NCJFCJ and NADCP have provided strong The NCJFCJ and NADCP have provided strong foundations for expansion of model courts and foundations for expansion of model courts and development of family treatment courts development of family treatment courts
4. Advances in the accountability agenda4. Advances in the accountability agenda Children’s Bureau’s Child and Family Service Children’s Bureau’s Child and Family Service
Review (CFSR) process Review (CFSR) process
SAMHSA’s Plan to Transition the Substance SAMHSA’s Plan to Transition the Substance Abuse Prevention and Treatment Block Grant Abuse Prevention and Treatment Block Grant (SAPTBG) to a Performance Environment(SAPTBG) to a Performance Environment
TimelinesTimelines
Our Biggest AchievementsOur Biggest Achievements
Missing boxes versus data protocolsMissing boxes versus data protocols
5. Development of a Comprehensive 5. Development of a Comprehensive Framework and Policy ToolsFramework and Policy Tools
10 Element Framework10 Element Framework
Our Biggest AchievementsOur Biggest Achievements
TimelinesTimelines
Information Sharing & Information Sharing & Management Management
Training and Staff Training and Staff DevelopmentDevelopment
Budgeting and Program Budgeting and Program SustainabilitySustainability
Building Community Building Community SupportsSupports
Connecting AOD, CWS, Court Systems: Elements of System Linkages*
From CSAT Technical Assistance Publication (TAP) 27: Navigating the Pathways *Revised March 2003From CSAT Technical Assistance Publication (TAP) 27: Navigating the Pathways *Revised March 2003
Underlying ValuesUnderlying Values Screening and Screening and
AssessmentAssessment Client Engagement Client Engagement
and Retention in Careand Retention in Care AOD Services to AOD Services to
Children Children Joint Accountability Joint Accountability
and Shared Outcomesand Shared Outcomes Working with Related Working with Related Agencies and Support Agencies and Support SystemsSystems
Underlying ValuesUnderlying Values
Information Sharing & Information Sharing & Management Management
Training and Staff Training and Staff DevelopmentDevelopment
Budgeting and Program Budgeting and Program SustainabilitySustainability
Building Community Building Community SupportsSupports
Working with Related Working with Related Agencies and Support Agencies and Support SystemsSystems
Connecting AOD, CWS, Court Systems: Elements of System Linkages*
From CSAT Technical Assistance Publication (TAP) 27: Navigating the Pathways *Revised March 2003From CSAT Technical Assistance Publication (TAP) 27: Navigating the Pathways *Revised March 2003
Underlying ValuesUnderlying Values Screening and Screening and
AssessmentAssessment Client Engagement Client Engagement
and Retention in Careand Retention in Care AOD Services to AOD Services to
Children Children Joint Accountability Joint Accountability
and Shared Outcomesand Shared Outcomes
Underlying ValuesUnderlying Values
5. Development of a Comprehensive 5. Development of a Comprehensive Framework and Policy ToolsFramework and Policy Tools
10 Element Framework10 Element Framework
Our Biggest AchievementsOur Biggest Achievements
TimelinesTimelines
Collaborative Values InventoryCollaborative Values Inventory Collaborative Capacity InstrumentCollaborative Capacity Instrument Screening and Assessment for Family Screening and Assessment for Family
Engagement, Retention and Recovery -- Engagement, Retention and Recovery -- SAFERR SAFERR
Biggest Challenges:Biggest Challenges:
Clocks still runningClocks still running
The Four ClocksThe Four Clocks
CFSR’s have documented CFSR’s have documented Case reviews found parental substance use disorders Case reviews found parental substance use disorders
were a factor in 16% to 48% of caseswere a factor in 16% to 48% of cases Need for child welfare training in addictions Need for child welfare training in addictions Gaps in servicesGaps in services Inadequate assessment and follow up on the Inadequate assessment and follow up on the
underlying needs of families, including substance underlying needs of families, including substance abuseabuse
Substance use disorders in families with repeat casesSubstance use disorders in families with repeat cases
The First ClockThe First Clock
ASFA TimetableASFA Timetable
Timeliness of intervention versus “Call me Tuesday”Timeliness of intervention versus “Call me Tuesday”
National Study on Child and Adolescent Well-National Study on Child and Adolescent Well-Being: Child Welfare Workers’ (CWW) Being: Child Welfare Workers’ (CWW)
Identification of Substance AbuseIdentification of Substance Abuse
Of the caregivers who are alcohol dependent Of the caregivers who are alcohol dependent 71% are classified by the CWW as not having an alcohol 71% are classified by the CWW as not having an alcohol
problemproblem
Of the caregivers who are drug dependentOf the caregivers who are drug dependent 73% are classified by the CWW as not having a drug 73% are classified by the CWW as not having a drug
problemproblem
CWW’s misclassify caregivers who are CWW’s misclassify caregivers who are substance dependent most of the timesubstance dependent most of the time
Timeliness of InterventionsTimeliness of Interventions
Taking CFSR findings seriously and Taking CFSR findings seriously and including remediation strategies in Program including remediation strategies in Program Improvement PlansImprovement Plans
The First ClockThe First Clock
ASFA ChallengesASFA Challenges
The Second ClockThe Second Clock
Poverty and low-income work affect neglect, Poverty and low-income work affect neglect, which is the majority of all reportswhich is the majority of all reports
Neglect is often associated with both Neglect is often associated with both substance abuse and povertysubstance abuse and poverty
TANF resources have been used in innovative TANF resources have been used in innovative models for this populationmodels for this population
Treatment aftercare focus on jobs and housing Treatment aftercare focus on jobs and housing TANF reauthorization proposes treatment be TANF reauthorization proposes treatment be
counted as a work activitycounted as a work activity
TANF TimetableTANF Timetable
““A day at a time for the rest of your life” A day at a time for the rest of your life” Recovery is a lifelong process with a disease Recovery is a lifelong process with a disease management approach not emergency caremanagement approach not emergency care
Low-dosage, 4-hour a week outpatient Low-dosage, 4-hour a week outpatient programs do not build on what we know about programs do not build on what we know about effective treatment for this populationeffective treatment for this population
The Third ClockThe Third Clock
Recovery TimetableRecovery Timetable
The Third ClockThe Third Clock
Recovery ChallengesRecovery Challenges
Comprehensive services and longer-term supports Comprehensive services and longer-term supports are criticalare critical Clinical treatment, clinical support and community Clinical treatment, clinical support and community
supportssupports
Recognizing the needs of children of parents in Recognizing the needs of children of parents in treatmenttreatment
Findings from TOPPS II Findings from TOPPS II on Status of Childrenon Status of Children
61% of women coming into treatment live with a child less than 18 years old
Among women with children, 31% had a child removed from home due to a child protection court order
Among women who had children removed from home, 41% had parental rights terminated to 1 or more child
8 out of every 100 women had their parental rights terminated
Children of substance abusers need in-depth Children of substance abusers need in-depth assessments and interventions that respond to assessments and interventions that respond to their developmental status and the special needs their developmental status and the special needs created by substance use disorders in their family created by substance use disorders in their family grief, loss, separation, attachment grief, loss, separation, attachment
Adolescents who may have begun their own Adolescents who may have begun their own substance usesubstance use
The Fourth ClockThe Fourth Clock
Child Development TimetableChild Development Timetable
The Fourth ClockThe Fourth Clock
Every 70 seconds a baby is born in this country Every 70 seconds a baby is born in this country who was prenatally exposed to alcohol or illicit who was prenatally exposed to alcohol or illicit drugs drugs
Child Development TimetableChild Development Timetable
CommunicationCommunication – a critical factor in all four of – a critical factor in all four of the systems represented by the four clocks, the systems represented by the four clocks, and in several others that affect these children and in several others that affect these children and familiesand families Frontline workersFrontline workers Program managersProgram managers
Policy officialsPolicy officials
Putting the Four Clocks in SyncPutting the Four Clocks in SyncCommunication, Linkages and PrioritiesCommunication, Linkages and Priorities
Putting the Four Clocks in SyncPutting the Four Clocks in SyncCommunication, Linkages and PrioritiesCommunication, Linkages and Priorities
CommunicationCommunication: Who needs to know what when: Who needs to know what when Communication strategies, protocols, supports and Communication strategies, protocols, supports and
policy that clarifies communication pathwayspolicy that clarifies communication pathways
LinkageLinkage points across systems points across systems 10 elements of system linkages10 elements of system linkages
Confidentiality is usually not about legal barriers, but Confidentiality is usually not about legal barriers, but often more about trustoften more about trust
Encouraging the flow of informationEncouraging the flow of information
Collaboration takes timeCollaboration takes time
PriorityPriority – Community-wide agreement that – Community-wide agreement that these families receive the services they needthese families receive the services they need
Putting the Four Clocks in SyncPutting the Four Clocks in SyncCommunication, Linkages and PrioritiesCommunication, Linkages and Priorities
Real reform is more than a collaboration meeting Real reform is more than a collaboration meeting every monthevery month
Getting clocks connected to each other requires Getting clocks connected to each other requires genuine collaboration… which takes timegenuine collaboration… which takes time
Future TrendsFuture Trends
Four Trends: Pushing the Timeline Four Trends: Pushing the Timeline into the Futureinto the Future
1968 1973 1980s 1990s
2004
1. 1. Substance-Exposed BirthsSubstance-Exposed Births
We are learning more about the enormous costs of We are learning more about the enormous costs of letting most of these babies go home without helpletting most of these babies go home without help
We are learning how powerful early intervention We are learning how powerful early intervention can be in improving the life chances of these can be in improving the life chances of these childrenchildren
We are learning more about how to prevent We are learning more about how to prevent substance-exposed births substance-exposed births
CAPTA AmendmentsCAPTA Amendments
We need a national debate on both “upstream” We need a national debate on both “upstream” prenatal screening and universal screening at birthprenatal screening and universal screening at birth
Future TrendsFuture Trends
2.2. Growth of Family Drug Treatment CourtsGrowth of Family Drug Treatment Courts
Courts and their communities will need to decide Courts and their communities will need to decide how large-scale their interventions need to behow large-scale their interventions need to be
How timely their interventionHow timely their intervention
How to adapt family treatment court strategies to How to adapt family treatment court strategies to prevent child removal among families receiving child prevent child removal among families receiving child welfare serviceswelfare services
Future TrendsFuture Trends
3.3. The Pressures for AccountabilityThe Pressures for Accountability
Only child welfare agencies and treatment providers Only child welfare agencies and treatment providers that develop their capacity to measure their impact that develop their capacity to measure their impact will survive the continuing hard fiscal climate will survive the continuing hard fiscal climate
When resources are scarce, allocating them to When resources are scarce, allocating them to ineffective programs has moral implications and real ineffective programs has moral implications and real consequences for those children and familiesconsequences for those children and families
Redefining “reasonable efforts” based on CFSR Redefining “reasonable efforts” based on CFSR findings that substance abuse services are not findings that substance abuse services are not available for reunification efforts in many states may available for reunification efforts in many states may heighten the focus on the array of available servicesheighten the focus on the array of available services
Future TrendsFuture Trends
4. Family-Centered Policy and Practice4. Family-Centered Policy and Practice
Intervening with families before children need to be Intervening with families before children need to be removed is good economics and good practiceremoved is good economics and good practice
Pew Commission’s recommendations for changing the Pew Commission’s recommendations for changing the financing of the child welfare system to remove incentives financing of the child welfare system to remove incentives for foster care underscore the need for front-end reformsfor foster care underscore the need for front-end reforms
As child welfare links to reforms in home visiting, As child welfare links to reforms in home visiting, family support programs, and school-based family support programs, and school-based interventions, these need to be measured against interventions, these need to be measured against what they have done for the children living with what they have done for the children living with parents with substance use disorders parents with substance use disorders
Future TrendsFuture Trends
The fifth clock is the one that is ticking on The fifth clock is the one that is ticking on us…it measures how fast we get it…how us…it measures how fast we get it…how rapidly we respond to human needs that grow rapidly we respond to human needs that grow larger by the day larger by the day
We have to measure what we do against We have to measure what we do against what what needs doingneeds doing, not against what we did , not against what we did last yearlast year
The Fifth ClockThe Fifth Clock
UrgencyUrgency
Every 70 seconds a baby is born in this country Every 70 seconds a baby is born in this country who was prenatally exposed to alcohol or illicit who was prenatally exposed to alcohol or illicit drugs drugs
Every minute and a half, one of those babies goes Every minute and a half, one of those babies goes home without screening or any effort to begin early home without screening or any effort to begin early interventionintervention A baby and a family we already know are highly at riskA baby and a family we already know are highly at risk
The Fifth ClockThe Fifth Clock
UrgencyUrgency
Listening to the voice of a childListening to the voice of a child
““I Have a Dream”I Have a Dream”
Responding to Families:Responding to Families:Timelines, Clocks and the FutureTimelines, Clocks and the Future
This is the Fifth ClockThis is the Fifth Clock