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					  “A Proposed Curriculum: A Child Welfare Model for Keeping
Children Safe in Families Affected by a Substance Use Disorder ”

                    Milton R. Ayala, LMSW

        Title IV-E National Roundtable Conference
                      Galveston, Texas
                        May 27, 2011

                 Milton.Ayala@dfps.state.tx.us




                                                                   1
Overview
   Introduction
   Unit 1: Child Welfare
   Unit 2: Substance Use Disorders
   Unit 3: Casework
   Conclusion




                                      2
Objective


 Participants will be able to develop a
  curriculum for an elective course on
  child welfare and substance use
  disorders.



                                           3
                                   Background
 National Data
  In 2005, it was estimated that 9.2 million children in the
    United States lived in a household where a parent or other
    adult used illicit drugs [1]

       In 2005, it was estimated that alcohol and drug abuse were
        caregiver factors for more than 75 % of children who entered
        foster care [1]
       In 2006, it was estimated that 10-11% of newborns were
        exposed to or born addicted to alcohol or a controlled
        substance (400-440,000 infants) [2]

       In 2011, prenatal screening studies documented 15-20% of
        newborns were exposed to alcohol, tobacco, or illegal drugs
        prior to birth [3]


[1] National Center on Addiction and Substance Abuse at Columbia University, March 2005
[2] Young, Nancy K.(2006).Substance-Exposed Infants: Policy and Practice (PowerPoint slides). Retrieved from    4
www.ncsacw.samhsa.gov[3] Carpenter, L., Chasnoff, I., Yew, E. (2011). Family Drug Court: Services to Children
[PowerPoint Slides]. Retrieved from http://www.nationaldec.org/
Background:                                                     Texas Data

CPS Data
   In 2010, the number of families served (Investigation, Family
    Based Safety Services, and Substitute Care) = 194,058 [1]
   In 2010, the number of families with substance abuse involvement
    served = 85,819 (44.2%) [1]
   In 2010, of the 15,067 families served whose children were in
    substitute care, the % of familial caregivers with a substance
    abuse person characteristic = 66.3% [1]

Texas State Child Fatality Review Team Committee
 Fatality Reviews: In 2009 in Texas, there were 900 deaths
   resulting from alcohol-related accidents. Of the 900 deaths, 13 %
   (117) were children. [2]

   In 2011, substance abuse among caregivers has been identified as
    one of several major risk factors involved in child maltreatment
    deaths. [2]


      [1] DFPS Information Management Protecting Adults and Children in Texas (IMPACT) data Warehouse   5
      (November, 2010)
      [2] Texas State Child Fatality Review Team Committee. Position Statement. (April 2011).
                                                                                                                          6

Maxwell, Jane C. ATTC (2010). Update on Latest Drug Trends. (Power Point slides) Retrieved from website: www.utattc.net
               7

Source: DSHS
Federal Child Abuse Prevention and
Treatment Act-2003 (CAPTA)
Key Provisions
 States need to enact “…provisions or procedures for the
  reporting of known and suspected instances of child
  abuse and neglect…” [1]

 Health care providers involved in the delivery or care of
  a substance exposed newborn need to notify the Child
  Protective Services System (CPS) [1]

 Referrals of children involved in the CPS system from
  birth to age three are to be made to Early Childhood
  Intervention Services (ECI) [1]


        [1] Office of Child Abuse and Neglect. (2003). The Child Abuse and   8

        Prevention and Treatment Act.
Timelines
    Federal Adoption and Safe Families Act (ASFA)-
      1997
 Promote adoption of children in foster care

    Texas Timelines
 Investigation = 60 days
 Family Based Safety Services = 270 days (regular FBSS
  case)
 DFPS as Temporary Managing Conservarorship up to:
  365 days with an extension of 180 days
 Recovery = Years
     Recovery is a process of change in beliefs, values, skills, and the
      establishment of an environment that leads to a substance free
      lifestyle.

[
                                                                           9
SUD Defined
Substance use disorder (SUD) – includes the spectrums of substance abuse
    and dependence as defined by the diagnostic criteria of the American
    Psychological Association, Diagnostic and Statistical Manual of Mental
    Disorders, 4th Edition (DSM-IV): [1]

   Substance use – the consumption of legal or illegal, (or both),
    psychoactive substances.

   Substance abuse – a pattern of substance use that results in at least one
    of four consequences: (1)failure to fulfill role obligations, (2) use places one
    in danger (e.g., driving under the influence), (3)legal consequences occur,
    or (4) interpersonal/social problems result

   Substance dependence – a pattern of use resulting in at least three of
    seven dependence criteria as specified in the DSM-IV: (1) tolerance, (2)
    withdrawal, (3) unplanned use, (4) persistent desire or failure to reduce
    use, (5) spending a great deal of time using, (6) sacrificing activities to use,
    or (7)physical/psychological problems related to use.




         [1] Young, N. K., Nakashian, M., Yeh, S., & Amatetti, S. Screening and Assessment for
         Family Engagement, Retention, and Recovery (SAFERR), p.H-7. DHHS Pub. No. 0000. 10
         Rockville, MD: Substance Abuse and Mental Health Services Administration, 2006.
Unit 1: Child Welfare
 Chapter: Knowing the Family from the Perspective of
  a Child Protective Services (CPS) Caseworker
 In Texas, in an Investigation, caseworkers use the
   6 Questions from the Child Safety: A Guide for
     Judges and Attorneys (intended for information
     gathering purposes)
     Q1-What is the nature and extent of the
     maltreatment?
     Q2-What are the circumstances that accompany the
     maltreatment?
     Q3-How do the children in the family function?
     Q4-How does the parent discipline the children?
     Q5-What are the overall parenting practices?
     Q6-How does the parent manage his/her life?
                                                                                         11
   Lund, T.R., & Renne, J. (2009). Child Safety: A Guide for Judges and Attorneys,p.3.
Q6-How does the parent manage
his/her life?
 Areas that could be addressed in the subtitle are:
   SUDs
   Mental Health
   Communications and social skills
   Coping and stress management
   Problem solving
   Decision making
   Budget management
   Health and wellness
   Cultural norms
   Relationships
   Domestic violence
   Employment
   Familial expectations
                                                       12
Unit 1: Child Welfare continued
 Chapter: Introduction to the Enhanced
  Family-Centered Safety- Decision Making
  (EFCSDM) CPS Practice Model [1]
   Articulate difference between safety and risk
   Elaborate on differences between safe child
    versus unsafe child
   Explain the concepts of:
     Safety threats
     Child vulnerability
     Protective capacities


     [1] Lund, T.R., & Renne, J. (2009). Child Safety.   13
Unit 2: SUD
   Chapter: Understanding Addiction
       Subtitle: The Science of Addiction: A Brain Disease
   Chapter: Treatment
       Subtitle: Effectiveness of Treatment and Recovery
           Detoxification
           Inpatient Rehabilitation
           Outpatient Treatment
           Subtitle: Psycho-pharmacologic Management
       Subtitle: Faith-Based Interventions
   Chapter: Drug Testing
       Subtitle: Instant versus Laboratory Tests
       Subtitle: Substances and Detection Periods
       Subtitle: False Positive Results
   Chapter: Health Insurance Portability and Accountability Act
    (HIPAA)


                                                              14
Unit 3: CPS Casework with
SUD Caregivers
 Chapter: Family Engagement Strategies
   Subtitle: Motivational Interviewing
 Chapter: Information Gathering Tools
     direct and open questions
     active listening
     observation
     collateral contacts
     case reading
     drug test


                                          15
Unit 3 : CPS Casework with SUD
Caregivers continued
 Chapter: Protective Measures Specific to SUD
  Caregivers:
        home free of alcohol and drugs (part of a safety plan)
        referral for screening, treatment (part of a family plan)
        psycho-pharmacological management, if appropriate (part of a
         family plan)
        parenting education (part of a family plan)
        Submit to immediate drug test (part of a safety plan); (total
         abstinence for a “user” or “abuser” of a substance; pattern of
         negative readings for an addicted individual (part of a family
         plan)
        relapse prevention plan to include child safety measures (part
         of a family plan)
        identification of an abstinent-sober caregiver or monitor (part
         of a safety plan and can be included in the family plan)
        mechanism for daily reporting and tracking of urges and
         relapses in place (part of a family plan)


                                                                      16
Unit 3 : CPS Casework with SUD
Caregivers continued
      (if appropriate) safety plan
    (if appropriate) parental-child safety placement
    (if appropriate) removal


  Teaching point: a safety plan deals with
   immediate threats to child safety; the
   plan will state the" how”
   interventions/measures to keep the
   child safe
  A family plan keeps the child safe while
   working to reduce risk factors
  Subtitle: Family Drug Treatment Court
                                                        17
Unit 3: CPS Casework with SUD
Caregivers continued
 Chapter: CPS Caseworker’s
  Expectations of Treatment
   Increase caregiver’s protective capacities
    and decrease safety threats
   Treatment focus:
     cognitive
     behavioral
     emotional




                                                 18
Unit 3: CPS Casework with SUD
Caregivers continued
 Chapter: Arriving at Case Closure: “Factors Controlled”
   home free of drugs and alcohol
   no new concerns or allegations involving new safety
     threats
   children’s basic needs are being met
   caregiver is abstinent or has established a pattern of
     negative drug readings
   addicted caregiver is involved in treatment or
     recovery support groups
   relapse child safety plan in place
   psycho-pharmacological management, if appropriate


                                                         19
Unit 3: CPS Casework with SUD
Caregivers continued
    positive reports from providers, children and collaterals and
     the parent
    final drug test is negative and no new “hit” on a final criminal
     check
    support network in place
    existence of a abstinent-sober caregiver or monitor other than
     the SUD caregiver
    mechanism for daily self monitoring and reporting in place
    completion of parenting education that focused on parenting
     skills in the absence of illicit drugs and/or alcohol
    CPS family plan has mitigated safety threats and the caregiver
     has increased or enhanced his/her protective capacities; and
     the caregiver is willing and capable of protecting the child
     against safety threats




                                                                   20
Take Away Messages


 A SUD caregiver could pose threats to child
  safety. Undergraduate and graduate social
  work and human services/ health care
  departments should consider the
  importance of offering an elective course or
  training on child welfare and substance use
  disorders.
 It takes all of us to keep children safe.
                                             21
“Happy trails to you…”




                     22
Questions




            23
Handout: Resources and Additional
Information
    Adoption and Safe Families Act of 1997. Retrieved from:
http://www.acf.hhs.gov/programs/cb/laws_policies/cblaws/public_law/pl1
     05_89/pl105_89.htm

   Breshears, E.M., Yeh, S. & Young, N.K. Understanding Substance Abuse
    and Facilitating Recovery: A Guide for Child Welfare Workers. U.S.
    Department of Health and Human Services. Rockville, MD: Substance
    Abuse and Mental Health Services Administration, 2009.

   Center for Substance Abuse Treatment. Substance Abuse Specialists in Child
    Welfare Agencies and Dependency Courts Considerations for Program Designers
    and Evaluators. HHS Pub. No. (SMA) 10-4557 Rockville, MD: Substance Abuse
    and Mental Health Services Administration, 2010

   Lund, T.R., & Renne, J. Child Safety: Guide for Judges and Attorneys.
    American Bar Association, 2009.

   National Institute of Drug Abuse (NIDA). Principles of Drug Addiction Treatment.
    NIH Pub. No. 09-4180, 2009
   NIDA. The Science of Addiction. NIH Pub. No. 07-5605, 2007.



                                                                                  24
Handout: Resources and Additional
Information
   National Institute of Drug Abuse (NIDA). Principles of Drug Addiction Treatment.
    NIH Pub. No. 09-4180, 2009

   NIDA. The Science of Addiction. NIH Pub. No. 07-5605, 2007.

   Office of Child Abuse and Neglect. The Child Abuse and Prevention and
    Treatment Act, 2003.

   Young, N. K., Nakashian, M., Yeh, S., & Amatetti, S. Screening and
    Assessment for Family Engagement, Retention, and Recovery
    (SAFERR), p.H-7. DHHS Pub. No. 0000. Rockville, MD: Substance
    Abuse and Mental Health Services Administration, 2006.

   Young, N. K., Gardner, S., Otero, C., Dennis, K., Chang, R., Earle, K.,
    & Amatetti, S. Substance‐Exposed Infants: State Responses to the
    Problem. HHS Pub. No. (SMA) 09‐4369. Rockville, MD: Substance
    Abuse and Mental Health Services Administration, 2009.



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