The Family Wellness Court The Family Wellness Court for Infants and Toddlersfor Infants and Toddlers

Judge Erica YewJudge Erica YewSanta Clara County Superior CourtSanta Clara County Superior CourtIn partnership with Cynthia Ambar, MPA, Project DirectorIn partnership with Cynthia Ambar, MPA, Project Director

Santa Clara County Social Services AgencySanta Clara County Social Services AgencyAnd First 5 of Santa Clara CountyAnd First 5 of Santa Clara County

FWC Overview

An expansion and enhancement of An expansion and enhancement of existing child welfare dependency drug existing child welfare dependency drug court with a child focuscourt with a child focus

Target population: Pregnant women and Target population: Pregnant women and parents, with children 0 to 3, whose parents, with children 0 to 3, whose abuse of methamphetamine and other abuse of methamphetamine and other substances have placed their children in substances have placed their children in or at risk of out-of-home placement.or at risk of out-of-home placement.

FWC Primary PartnersFWC Primary Partners

Social Services Agency (SSA), SSA’s Department of Social Services Agency (SSA), SSA’s Department of Family and Children’s Services and SSA’s County Family and Children’s Services and SSA’s County CounselCounsel

Superior CourtSuperior Court LACY (children’s attorneys)LACY (children’s attorneys) Dependency Advocacy Center (parent ‘s attorneys)Dependency Advocacy Center (parent ‘s attorneys) Department of Drug and Alcohol ServicesDepartment of Drug and Alcohol Services County Mental HealthCounty Mental Health FIRST 5 Santa Clara CountyFIRST 5 Santa Clara County

Primary FWC Goals (1)

Early identification of and intervention Early identification of and intervention for the needs of pregnant women and for the needs of pregnant women and parents with substance use disorders.parents with substance use disorders.

Rapid engagement and successful Rapid engagement and successful retention in treatment and careretention in treatment and care

Reduction in subsequent positive tox Reduction in subsequent positive tox births births

Primary FWC Goals (2)

Early identification and intervention for developmental delays, disabilities and concerns for children 0-3 whose parents come before the FWC

Creation of a comprehensive System of Care across all systems serving children in or at risk of out-of-home placement as a result of parents’ methamphetamine and other substance abuse

FWC Eligibility Criteria

The parent has given birth to an infant that has been exposed to methamphetamine or other substance abuse during the pregnancy; OR

The parent has a child under the age of three that was either born drug exposed or has been raised in a substance abuse afflicted environment with documented abuse and/or neglect; AND

The parent does not demonstrate intractable mental health issues as presented in the filed petition; AND

The parent is not likely to face long term incarceration

RationaleRationale for Child Focusfor Child Focus

Substance exposed high risk for Substance exposed high risk for developmental and behavioral concernsdevelopmental and behavioral concerns

Effectiveness of early interventionEffectiveness of early intervention Improvements in overall family functioning and Improvements in overall family functioning and

relationshipsrelationships CAPTA requirements for early intervention CAPTA requirements for early intervention

services, such as screening for substance services, such as screening for substance abuseabuse

FWC Customer Characteristics

“Fast-track” cases History of child welfare system involvement as

children Prior cases in CWS, many with prior termination

of parental rights Extensive trauma history Extremely low income Homeless or living in substandard housing Methamphetamine primary drug of choice

FWC Services (1)

Therapeutic court environment, with regular reviews Case management Legal representation Early drug and alcohol assessment and treatment Residential inpatient-treatment for women; and for

women with their children Mentor Parent support Domestic violence advocacy and services Transportation assistance (bus tokens, bus passes for

their children, bicycles, cab vouchers, gas money, out of county bus passes, car seats)

Linkages to shelter and housing

FWC Services (2)

Limited funding to assist with barriers to case plan completion

Linkages to employment and benefits services, record clearance

Coordination with Criminal Court partners Therapeutic services, dyadic and PCIT

included Pregnancy prevention education Comprehensive developmental and

behavioral screening, assessment and interventions for all children

Child appointed special advocates (CASA’s) for many children

FWC Services (3)

Linkage to health coverage and primary care physicians

Access to a wide array of parenting workshops

Home visitation and Public Health Nurses Early care and education services GED assistance Language assistance Oral health care for children and some

limited dental services for adults Tattoo removal and MORE….

Children’s Services OverviewChildren’s Services Overview

Funded by FIRST 5 Santa Clara CountyFunded by FIRST 5 Santa Clara County Medi-Cal/EPSDT is leveragedMedi-Cal/EPSDT is leveraged MHSA (Prop 63), County General Fund and MHSA (Prop 63), County General Fund and

reimbursement via public children’s insurance reimbursement via public children’s insurance programs are also utilized for Mental Health programs are also utilized for Mental Health servicesservices

System of Care: Tiered system based on level of System of Care: Tiered system based on level of need as determined by screening and need as determined by screening and assessments utilizing standardized tools and assessments utilizing standardized tools and evidence-based practicesevidence-based practices

Assessing For and Addressing Assessing For and Addressing Developmental and Behavioral ConcernsDevelopmental and Behavioral Concerns

ASQ/ASQ-SE ASQ/ASQ-SE ((Social Emotional)Social Emotional) screeningscreening Level 1 assessment Level 1 assessment (based on concerns identified by (based on concerns identified by

ASQ/ASQ-SE)ASQ/ASQ-SE)

Level 2 assessment Level 2 assessment (based on concerns identified by (based on concerns identified by ASQ/ASQ-SE)ASQ/ASQ-SE)

MDT MDT ((Multi-Disciplinary Team) Multi-Disciplinary Team) meeting to discuss meeting to discuss results, make recommendationsresults, make recommendations

Referrals for community interventions as Referrals for community interventions as indicatedindicated

Promoting Bonding and Promoting Bonding and AttachmentAttachment

Parenting curriculums that include Parenting curriculums that include children and parent/child interactionschildren and parent/child interactions

Home visitationHome visitation Supervised visitationSupervised visitation Dr. T. Berry Brazelton’s TouchpointsDr. T. Berry Brazelton’s Touchpoints Child Appointed Special Advocates in a Child Appointed Special Advocates in a

new rolenew role

Addressing Mental HealthAddressing Mental Health Needs Needs

Early Childhood Mental Health Specialist on FWC Early Childhood Mental Health Specialist on FWC court team court team

Therapeutic services that include:Therapeutic services that include: Parent-Child Interactive Therapy (PCIT) Parent-Child Interactive Therapy (PCIT) Cognitive Behavioral Therapy (CBT) Cognitive Behavioral Therapy (CBT) Trauma-focused cognitive behavioral therapy (TF Trauma-focused cognitive behavioral therapy (TF

CBT) CBT) Trauma-Focused Play Therapy Trauma-Focused Play Therapy Dyadic (Child/Parent Psychotherapy) Dyadic (Child/Parent Psychotherapy) The Incredible YearsThe Incredible Years

Duration of Services

Services initiated at dependency hearing Services continue until child welfare case closed Aftercare program in development, continued

mentor involvement, recovery mentors, stepped down recovery support, alumni events, continuation of CASA services, continued mental health counseling for parent and child, in-home support services, parenting classes

Customized aftercare packet upon dismissal ceremony with Solidarity bracelet, phone card, FWC Team and community resources, photo with team in engraved frame, motivational card

FWC Hearings (1)

Hearings may occur daily, weekly, twice a month or once monthly depending on parent progress

Staffings are held with the court team prior to the hearing to discuss case progress, concerns and develop joint recommendations

Incentives or Sanctions may be given

FWC Hearings (2)

Strength-based therapeutic court environment

Parents are given positive feedback on progress and areas of non-compliance are addressed

Providers problem solve with client to identify and address needs

FWC Hearings (3)

“When I went to court, I always had a voice. I didn’t just sit and get talked about, I wasn’t just talked about from different views. I actually was given a choice, ‘Do you have any concerns? Anything that you need?’ I was given a chance, so I should to speak up and not be over looked and talked about among everybody.”

Family Team Meetings

Purpose is to develop the child welfare case plan in a strength-based environment with input from family and friends, SW and FWC Team

Scheduled between jurisdiction and disposition hearings

Ultimate goals are to enable children to remain at home with extra support and to give the family an active role in developing their case plan

Engaging Fathers

Equal focus on parents Court environment Men’s treatment counselors Mentor Father Male THU in which fathers and their

children can remain together

Working with Trauma

FWC values statement includes trauma-informed system

Commitments by Partner Agencies Provider education Continual system assessment and

modification Trauma specific services-DADS seeking

safety, Mental Health trauma based cognitive behavioral therapy

FWC Funding (1)

Awarded $3.7 million over five years $6.3 million total with First 5 match Grant funds Project Director, mentors, AOD

assessor and counselor, mental health child specialist, court coordinator and training, onsite drug monitoring, short-term strategic planning and evaluation

Evaluation >10% of project budget

FWC Funding (2)

Enhanced model required an additional annual contribution of more than $500,000 for direct client services, many provided by one-time funding

Additional positions include parent therapist, mentor father, part-time psychiatrist, men’s treatment counselors and eligibility worker

Implementation

March 14, 2008March 14, 2008 105 Families, 141 parents (with 90 being actively 105 Families, 141 parents (with 90 being actively

engaged) and 179 children served as of August 2009.engaged) and 179 children served as of August 2009. 14 cases dismissed, 11 reunifications and three TPR 14 cases dismissed, 11 reunifications and three TPR

(78%) successful. Two of the three TPR’s had open (78%) successful. Two of the three TPR’s had open cases prior to FWC enrollment. (State 37%, County cases prior to FWC enrollment. (State 37%, County 44%, DDTC 76% with non-fast track cases)44%, DDTC 76% with non-fast track cases)

Target population expanded to include fathers, Target population expanded to include fathers, regardless of maternal involvementregardless of maternal involvement

No subsequent pos-tox births (despite many births)No subsequent pos-tox births (despite many births)

Sustainability (1)

Inventory existing funding streams Identify gaps in funding or capacity issues in

the service array Identifying opportunities for systems

integration/coordination, maximization of current leverage funding streams, and identification of funding steams that could be easily accessed to maintain the existing program

Implementation of governance structure that provides for top-down/bottom-up information exchange and decision-making

Sustainability (2)

Identifying potential long term means to fund the program such as legislative initiatives, grant applications and seeking philanthropic support

Ensuring families are linked to all benefits for which they qualify, in particular CalWORKS

Cost analysis to demonstrate long-term cost savings

Sustainability (3)Sustainability (3)

Making children in care a local funding priorityMaking children in care a local funding priority Reprioritization of drug treatment slotsReprioritization of drug treatment slots Judicial advocacy for restoration of treatment Judicial advocacy for restoration of treatment

servicesservices Sharing resources among County deptsSharing resources among County depts Convening and partnering with service providers Convening and partnering with service providers

with needed resourceswith needed resources

Primary Keys to Success

Commitment at highest agency administrative levels

Shared values Passion and commitment of involved staff Comprehensive service model Service model that evolves as additional client

needs are identified Incorporation of the parents’ voices (through

mentors and the actual parents before the court)

Promoting the parent-baby bond

Primary Challenges

Sustainability of enhanced model in an environment of budget cuts

Multiple and complex needs of clients, in particular housing and self-sufficiency, such as employment

Information sharing and data collection without a centralized database

Assessor funding years 3-5

Why Problem Solving Courts Work

“What was beneficial for me was the encouragement that they [FWC] give you. They give you so much encouragement and acknowledge every good thing you do. I got teary eyed every time they would acknowledge me for all the good that I’ve done, you know, the hard work. I overcame the hard stuff in my life. Now it’s getting easier and easier. They acknowledge every single thing, too. And that’s what makes me want to go on more. It encouraged me to do good things, because I’m getting acknowledged by these people in the court.”

Why Problem Solving Courts Work

People want to do better, but don’t believe they can

The human spirit is strong Genuine, constant positive regard penetrates

pain and builds trust Don’t discount “bribery” or the power of

incentives People love their children

QUESTIONS?

Please contact Melanie Daraio, Community Progam Manager, FIRST 5 of Santa Clara County

Email address: melanie@first5kids.org Website: www.first5kids.org