Florida An Analysis of Preferred Practice Approaches in Substance Abuse and Child Welfare - Comparative Practice Elements An Analysis of Preferred Practice Approaches in Substance Abuse and Child Welfare, 3/11/04 Values or Principles? Preferred Substance Preferred Child Welfare Abuse Approach Approach Practice Element: Practice Element: Prevention Practice Element: Prevention of Substance Use/Abuse Prevention of Child Abuse and Neglect Prevention interventions Prevention works! There and programs should be Education and support are many interventions now tailored to address risks programs need to be available to widely used that have been specific to population or parents of all age groups. They verified scientifically to cultural characteristics, such need to be tailored to address produce positive outcomes as age, gender, and ethnicity, cultural differences.2 in a wide range of field to improve program environments. effectiveness. Lacking a support network in times of crises puts families at Understanding the Prevention interventions significantly greater risk for underlying factors should be based upon the abuse or neglect. To provide (including risk and latest scientific evidence of immediate assistance to parents protective factors) that success – ones that have in times of stress, crisis care increase or decrease the risk consistently demonstrated programs should be available on for substance abuse and/or successful outcomes over a 24-hour basis and should child abuse within a target time, in a variety of settings include the following services: population is a pre-requisite and with multiple target telephone hot line, crisis for change. Risk and populations. caretakers, crisis baby-sitters, protective factors can affect crisis nurseries, and crisis children at different stages Risk and protective factors counseling. of their lives. At each stage, should be the primary targets risks occur that can be of effective prevention In terms of providing changed through prevention programs used in family, prevention services to at-risk interventions. school, and community families, home visitation settings. The goals of these programs have thus far proven Intervening with families programs is to build new and to be the most effective method is critical as a child’s earliest strengthen existing protective for educating and assisting interactions occur in the factors and reverse or reduce families. Comprehensive home family, and sometimes risk factors.1 visiting programs provide an 1 NIDA, Preventing Drug Use among Children and Adolescents, A Research-Based Guide for Parents, Educators, and Community Leaders, Second Edition, National Institute on Drug Abuse, 2003. 2 Cohn Donnelly, A. (1997) An Approach to Preventing Child Abuse, Chicago, IL: National Committee to Prevent Child Abuse. Values or Principles? Preferred Substance Preferred Child Welfare Abuse Approach Approach family situations heighten a array of services, including child’s risk for later drug Prevention programs nurse visitation to monitor the abuse when there is: should address all forms of health of an infant and mother, • a lack of attachment drug abuse, alone or in in-home parenting education and nurturing by combination, including the and mentoring. Home visitation parents or caregivers; underage use of legal drugs programs strive to create social • ineffective parenting; (e.g., tobacco or alcohol); the networks for new parents. and use of illegal drugs (e.g., Social isolation is a proven risk • a caregiver who marijuana or heroin); and the factor for child abuse (see abuses drugs. inappropriate use of legally footnote 2). obtained substances (e.g., Prevention is the first line inhalants), prescription of defense. Identification of medications, or over-the- persons at risk for abusing counter drugs.1 alcohol and other drugs should be an important Prevention programs component of pre-natal care. should be designed to intervene as early as Children of substance preschool to address risk abusers are at increased risk factors for drug abuse, such of abusing alcohol and other as aggressive behavior, poor drugs as they get older. social skills, and academic Once a parent is identified as difficulties. 1 a substance abuser, appropriate prevention Prevention programs should services for the child should be designed to enhance family be initiated. protective factors for children by teaching parents better Abusive behavior is family communication skills, known to be passed on from appropriate discipline styles, generation to generation. firm and consistent rule Child maltreatment may enforcement, and other family result in, or be more likely to management approaches. occur, when children have Family-based prevention health or developmental programs should also enhance problems. It is important to family bonding and identify any behavioral, relationships. 1 educational, and/or psycho- emotional problems in Prevention programs children who have should be long-term with maltreated. Early detection repeated interventions (i.e., of such problems should booster programs) to Values or Principles? Preferred Substance Preferred Child Welfare Abuse Approach Approach occur and lead to reinforce the original appropriate health, mental prevention goals. health, or other services that will best protect these children from becoming abusive parents. Older children who have been victims of maltreatment should have every opportunity to receive life skills training that will be valuable in adulthood. Such life skills training should include information about the parenting role, as well as the skills needed to protect themselves from abuse (adult domestic violence). Values Preferred Substance Preferred Child Welfare Abuse Approach Approach Practice Element: Practice Element: Screening Practice Element: Screening Screening for Substance for Substance Use/Abuse for Substance Use/Abuse Use/Abuse The identification of a Screening should be substance abuse issue that is Substance abuse conducted for the evaluation impairing a caregiver’s ability to screening should be of a possible presence of care for their children should be available in health care substance abuse and other determined during the child settings, mental health particular problems, and to protection investigation/intake programs and other portals determine if a more detailed process. There are many repeat of entry into the service assessment is warranted. investigations of maltreatment system. resulting from insufficient Screening should be identification of underlying Treatment needs to be conducted using a brief, substance abuse problems. The readily available once inexpensive and standardized identification of family dynamics needs are identified.3 screening tool. There are a that might indicate an underlying Families in crisis must number of standardized substance abuse problem should have quick access to screening tools available for result from further information appropriate treatment, not use by persons not gathering from the person who a spot on a waiting list. specifically trained in made the report and collateral addictions assessment and contacts with persons who are Relationships and counseling. likely to know the caregivers. collaboration between systems are what will Screening for substance The investigator should share ensure that the appropriate abuse typically includes substance use/abuse concerns with information is gathered gathering data about: current the caregiver, and seek a voluntary and shared in order to and lifetime use, risk-related substance abuse evaluation from a benefit families. behaviors, the immediacy of substance abuse professional. If intervention needed for the caregiver is unwilling to substance toxicity, voluntarily seek an assessment, a intoxication and withdrawal court order should be obtained. In symptoms; aggression or all cases, all information gathered danger to others; potential for by the protective investigator self-inflicted harm or suicide; should be fully shared with the and co-existing mental health substance abuse professional problems. conducting the assessment. Persons conducting screenings should be aware 65-12.006 requires investigators 3 Principles of Drug Addiction Treatment, National Institute on Drug Abuse, 2000. Values Preferred Substance Preferred Child Welfare Abuse Approach Approach that some screens that and service counselors to screen perform well for one all children and their families for population might not be as substance abuse problems. optimal in others. The focus should be on identification of problematic use of alcohol and other drugs before use interferes with child safety. Workers in these arenas should receive training in signs and symptoms of substance abuse and in use of basic screening instruments. For pregnant women, screens need to be conducted for “risky drinking” and other types of substance misuse or abuse that may harm the fetus. Safety screening should be conducted for both women and children. Care should be taken when using urinalysis as a screening tool. A thorough history to identify possible legal prescription use that can affect urinalysis should be completed. Values Preferred Substance Preferred Child Welfare Abuse Approach Approach Practice Element: Practice Element: Screening Practice Element: Screening for Screening for Child for Child Maltreatment that Child Maltreatment that requires Maltreatment that requires state intervention state intervention requires state intervention Substance abuse The child abuse counselors are mandated to investigation/intake’s primary Child safety and report suspected child abuse responsibility is to determine whether protection is an or neglect. This should be or not a child’s caregiver is protecting exception to general clearly communicated to their child from risks of harm which confidentiality clients receiving treatment. are created by acts or omissions on the protections. Prompt reporting of part of the caretaker, and what suspected abuse or neglect interventions are needed. Each state Many of the risk should take place, even statute defines harm to children. factors associated with when such reporting may Florida’s statutory definitions are risk for child damage the therapeutic provided in F.S. 39.01. Systems maltreatment are alliance between counselor should respond promptly to reports of common to those and client. abuse/neglect.5 dependent on alcohol or other drugs: poor Screening for child The response to reports of abuse impulse control; maltreatment risk factors to and neglect and requests for impaired judgment; detect possible problem assistance should be met with an offer poorly developed areas should be a part of the of help. The intake assessment must interpersonal skills; substance abuse screening include a determination as to when a behaviors that place and assessment protocol child is in need of the protection and children at risk (such as after informing the client of supervision of the court, and when drug dealing and leaving regulations concerning immediate safety plans must be made children unattended to mandatory reporting. to ensure child safety as well as acquire or use caregiver safety when domestic substances); social Treatment plans for violence is occurring isolation; and lack of substance abuse clients interpersonal supports.4 who are parents should The investigation/intake must include provisions for determine the protective, treatment, monitoring client safety. and ameliorative services necessary to safeguard and ensure the child’s safety and well being and SAFERR: 4 Hoffman, N., Shulman, G., and Young, N. Addition and Child Welfare Professionals: The Makings of a Healthy Partnership, Addiction Professional, NAADAC, Vol. 2. No. 2,, March 2004 5 All italicized text in the Child Welfare column is from “Framework for Individualized, Needs Based Child Welfare Practice” produced by Child Welfare Policy and Practice Group, Inc. Values Preferred Substance Preferred Child Welfare Abuse Approach Approach Ensure that data are development. In the absence of consistently collected egregious abuse or neglect, there must regarding the number and be efforts to provide the caregivers status of children, both in with the support, treatment and and out of their care assistance needed to be able to provide their children with adequate Be aware of children’s care and safety. There must be a needs and make determination of whether the child can connections to experts to remain with his caregivers, with or assess and address those without special in-home services and needs assistance. Link children of substance abusing parents to SAFERR: supportive services as Train staff to consistently make necessary, to improve well- observations and ask key questions being of children regarding the substance use of all Ensure that supervisors persons living in the household, have consistently monitor cases the knowledge of what to do with this for clinical implications for information, and engage/motivate children individuals—this includes males in mother’s life, extended family members, foster parents and kinship Routinely share with CWS arrangements and court staff the information collected Routinely record the results of regarding children observations and questions in the case record Ensure that supervisor staff consistently monitor case records for substance use notations Know the current status of each child’s biological/psychological/social needs and connect to appropriate services Routinely share with ADS and court staff the information collected regarding children and potential parental substance use disorders Values Preferred Substance Preferred Child Welfare Abuse Approach Approach Practice Element: Practice Element: Engaging Practice Element: Engaging Engaging clients, clients and significant others parents, children and other significant others, parents, caregivers (foster parents, children and other relative caregivers) caregivers (foster parents, The client and significant relative caregivers) others in the client’s life should The child and family should be actively involved in feel a sense of personal Promoting client/family examining their options for ownership in the plan and the readiness to change treatment, understanding their decision process. Children and increases the likelihood of rights, and selecting treatment families are more likely to enter successful outcomes. strategies based on needs and into a helping relationship when preferences (where possible). the worker or supporter has Engagement of The level of the client’s interestdeveloped a trusting client/family/ in making specific changes relationship with them. The significant others means should be explored. quality of this relationship is the acknowledging and single most important practicing acceptance of Continual facilitation of the foundation for engaging the (though not acquiescence client’s participation in the child and family in a process of to) a broad range of treatment and recovery process change. Children and families concerns, opinions, should be achieved through: the are more likely to pursue a plan preferences, beliefs, establishment of a helping or course of action that they emotions, styles, and relationship characterized by have a key role in designing. motivations. warmth, respect, genuineness, concreteness and empathy; the The assessment and Families, children and use of counseling strategies that planning process should engage clients must be viewed value individual differences the caregivers in an ongoing within the context of the including culturally team process. The team should support systems that can be appropriateness; the promotion include persons in the extended brought to bear upon the of client knowledge, skills and family and/or friends of the success of the case. attitudes that contribute to a caregivers, with the agreement positive change in substance of the caregivers. Based on the use behaviors.6 family’s goals and the Family engagement is challenges that need to be recognized as a critical element addressed in order to meet those in successful substance abuse goals, involved professionals treatment. Family dynamics and other key support persons 6 US Department of Health and Human Services, SAMHSA, Center for Substance Abuse Treatment. Addiction Counseling Competencies: The Knowledge, Skills and Attitudes of Professional Practice. Technical Assistance Publication Series, #21(2002) Values Preferred Substance Preferred Child Welfare Abuse Approach Approach and history are often need to be members of the team. contributing or precipitating When children are placed in factors that complicate alternative living arrangements, substance abuse treatment. including foster care, the substitute The substance abusing caregivers also need to be parent is generally the members of the team. identified client whose problems are targeted in the treatment plan. It is unlikely that the affected child will make significant contributions to treatment decisions, but the child welfare worker should be a part of the treatment team when appropriate so that expectations for behavioral change that affect child custody and placement are clear to all parties. Values Preferred Substance Preferred Child Welfare Abuse Approach Approach Practice Element: Practice Element: Strength- Practice Element: Strength- Strength- based based intervention. based intervention. intervention. Motivation to change is a When children and families Focusing on client critical element of substance see that their strengths are strengths is a primary goal abuse treatment. Identifying recognized, respected and of treatment. strengths can assist the client in affirmed, they are more likely maintaining motivation by to rely on them as a foundation Treatment plans should establishing a track record of for taking the risks of change. be individualized, behavior- success in early treatment focused, outcome-oriented engagement. For caregivers, and formulated with interventions are primarily mutually agreed upon (by Resistance and denial are oriented to assist them in client/family/staff) recognized as part of the making difficult changes. The actions/outcomes. addictive process. Strategies for stages of change that persons overcoming experience are predictable and Respect must be given resistance/ambivalence and normal. Most adults have gone for the family/client’s breaking through denial are through difficult times and individual pace toward routinely incorporated into have developed their own change, allowing for substance abuse treatment. successful strategies for incremental achievements Focusing on strengths rather surviving and coping. The toward goals than problems can be an identification of a person’s important strategy for past successful coping overcoming resistance and strategies is an important way increasing motivation. to assist them in planning for the new challenges they face. For children, interventions are oriented to helping them overcome the emotional and developmental problems that have resulted from past maltreatment, including the trauma of separation from their caregivers and other family members who may be important to them. The special interests and talents of children need to be identified and cultivated. Values Preferred Substance Preferred Child Welfare Abuse Approach Approach Children need developmentally appropriate information to understand what is happening in their lives and why, and what to expect. For caregivers and children, the ongoing feedback and praise for progress made and achievements, however small, needs to be ample and continuous. Adequate support from the family’s team requires ongoing positive reinforcement and encouragement, as well as honest feedback about expectations not yet fulfilled Values Preferred Substance Abuse Preferred Child Welfare Approach Approach Practice Element: Practice Element: Functional Practice Element: Functional Functional assessment assessment assessment The caregiver who Assessment is an ongoing “Do we know what we need to abuses substances is part process through which the know about this family in of a larger family system counselor collaborates with the order to do what we need to that is impacted by the client and other to gather and do?” At a minimum, this substance abuse in many interpret information necessary for includes: ways. The impact on planning treatment and evaluating • The child’s immediate family members of the client progress. safety, and whether in- substance abuse as well as home interventions will the impact of the caregiver A number of valid and reliable assure safety. entering treatment needs quantitative instruments, such as • An understanding of the to understood and the Addiction Severity Index, may situations that surround addressed. Other unmet be used. However, in general the caregiver’s substance special needs of children practice, standardized instruments abuse, including need to be addressed in are supplemented with a clinical motivators and barriers to order to assist the family interview. change. This will serve as achieve success over the a roadmap of a caregiver’s long term. Assessment may also include interpersonal, review of clinical records from intrapersonal and Treatment prior treatment or service episodes environmental triggers. recommendations must be or interviews with collateral • An understanding of the based on an accurate information sources (with caregiver’s level of assessment and the needs appropriate releases). motivation to enter of the specific individual. treatment (Stage 1) and A comprehensive assessment whether motivational process must be sensitive to age, interventions are needed. gender, cultural issues and • The impact of the disabilities and include, at a substance abuse on other minimum, the following domains: family members, • History of alcohol and other providing a foundation for drug use understanding their needs • Physical health history and as the caregiver enters 7 US Department of Health and Human Services, SAMHSA, Center for Substance Abuse Treatment. Addiction Counseling Competencies: The Knowledge, Skills and Attitudes of Professional Practice. Technical Assistance Publication Series, #21(2002) 8 National Center on Substance Abuse and Child Welfare (2002), Screening and Assessment for Family Engagement, Retention and Recovery (SAFERR), Prepublication Draft. Values Preferred Substance Abuse Preferred Child Welfare Approach Approach current status treatment. For children, • Mental Health history and an understanding of their current status strengths and opportunities • Addiction and mental health for building their treatment history resiliency. • Family Issues • Who are persons (family, • Work and career history friends) that are important • Physical, emotional and world to the child and family and view concerns are they safe individuals • History of criminality for the child and family to • Spirituality interact with? Are there other persons who can • Education and functional serve on the family’s literacy team? • Socio-economic status • Whether other important • Current legal status issues are present, such as • Living situation / Housing domestic violence, mental status illness, and/or other • Support networks special needs of the • Connection to community caregivers. resources.7 The Comprehensive SAFERR Fundamentals8: Behavioral Assessment that is In determining the nature of an required for all children issue, share diagnostic information entering care should provide with CWS within 7 days of much of the above assessment, using a standardized information. The child and form to make information sharing family team should review all uniform—Was the screen available assessment validated by assessment information and agree upon determination of substance abuse the implications for planning. or dependency? In determining the extent of an SAFERR Fundamentals: issue, conduct a multi- In determining the nature of dimensional assessment within 30 an issue, share the nature of days and share results with CWS the case with ADS agency within 7 days. The written report upon referral using is delivered to CWS and standardized forms information is shared using Signed consents for standardized forms that include: disclosure are executed in compliance with 42 CFR, Frequency of use Values Preferred Substance Abuse Preferred Child Welfare Approach Approach Impact of drug toxicity Part II Precipitating incidents in How does alcohol and drug the CWS case use affect parent (e.g. blackouts) Results of CWS observations and screens Level of impairment—is parent functioning in a way Directly refer individuals that impairs his/her ability to with positive results on meet child’s basic needs alcohol and drug screens Family connections, strengths, and/or observation of extended family substance abuse for Employment/education status assessment In determining the extent of Parent’s trauma history an issue, Family Assessment Assessment of motivation and information is shared with engagement level ADS agency within 30 days Who is caring for child during using standardized forms that parental alcohol/drug use or include: substance seeking behavior Criminal and civil court What is child witnessing or history being exposed to during Prior child abuse/neglect parental alcohol/drug use or cases substance seeking behavior Use by significant others and other adults in home Statement of parent’s perception of relationship Information about home between their substance environment—including abuse/dependency problem past and/or present and their parenting abilities violence in the home Was parent a CWS Treatment recommendation— dependent level of care, length of time in treatment, can children be with Does parent have a history parents and/or visit in of mental illness (results treatment of psych evaluation) Does the Indian Child Other family events going on Welfare Act (ICWA) (marriages, deaths, moves, and/or Inter-state Compact etc.) on Placement of Children Does Inter-state compact (ICPC) apply apply? CWS drug testing Any additional service needs requirements Values Preferred Substance Abuse Preferred Child Welfare Approach Approach Re-assessment information is shared with CWS agency as warranted Parents perception of issue SAFERR Model Practice: Extended Family, Family ADS, CWS and court staff and family meet to Strengths, Connections to discuss assessment results and to develop case Community and Resources plans; meetings should conducted in a manner that is comfortable for families in regards to Assessment of How language, culture, etc. Children are Doing Multi-disciplinary team should complete Results of alternative assessment, level of care determination and diagnosis within 30 days or soon after the dispute resolution preliminary protective hearing in court involved cases Conduct on-going assessment at each decision making point in case and share re- assessment information with ADS agency as warranted updated at least 30 days SAFERR Model Practice: ADS, CWS and court staff and family meet to discuss assessment results and to develop case plans; meetings should conducted in a manner that is comfortable for families in regards to language, culture, etc. Multi-disciplinary team should complete assessment, level of care determination and diagnosis within 30 days or soon after the preliminary protective hearing in court involved cases Values Preferred Substance Preferred Child Welfare Abuse Approach Approach Practice Element: Child and family service Practice Element: Service Practice Element: Child planning process planning process and family service planning process An individual’s The client is an active treatment and services pan participant in treatment planning Children and their families must be assessed and outcome monitoring. This should receive individualized continually and modified as is a collaborative process in services based on their unique necessary to ensure that the which the counselor and the strengths and needs. Children plan meets the person’s client identify desired treatment and parents should be changing needs.9 outcomes and identify the encouraged and assisted to strategies for achieving them. articulate their own strengths Understanding and and needs, the goals they are recognizing the stages of Client-identified goals are as seeking for themselves and change and other signs of important as legal requirements what services they think are progress toward in achieving treatment success. required to meet these goals. case/treatment goals are The mix of services provided critical elements that Because substance abuse should be responsive to the should be used to reinforce incorporates denial, objective strengths and needs of the child positive change and measures such as urinalysis can and his/her family. demonstrate therapeutic be used to help clients Conceptualizing the needs optimism. realistically and honestly view based plan should not be their situation. Feedback from constrained by the availability For women, many significant others should also be of services. Where needed clinical, developmental, incorporated into the treatment services are unavailable, and economic issues are process. appropriate services should be intertwined and impact created. service planning and The data derived from the outcomes: screening and assessment Services to children and • Psychological stressors processes form the basis of a their families should be for women, including treatment plan. At a minimum planned and delivered through sexual and physical the treatment plan addresses the an individualized service plan abuse, violence, and identified substance use crafted by the child victimization; disorder(s), as well as issues and family team. Children, • Social and cultural role related to treatment progress, their parents, the family’s issues for women, including relationships with informal support network, which pertain to stigma, family and significant others, caregivers and foster parents self-esteem, under- employment, education, should be full participants in 9 Principles of Drug Addiction Treatment, National Institute on Drug Abuse, 2000. Values Preferred Substance Preferred Child Welfare Abuse Approach Approach education, and spirituality, health concerns, and this team. The family’s economic deficits; legal needs.10 informal helping system and • Centrality of women’s natural allies are central to relationships as an Parenting issues should be supporting the family’s organizing principle in addressed as part of the capacity to change. Their their lives, particularly treatment plan and access to involvement in the planning their relationships with appropriate parenting training process provides sustaining children and families; should be available, either supports over time. • Loss of image and within the treatment program or Involvement should include personal empowerment; by referral. regular participation in family and team meetings as a point for • Vulnerability in health SAFERR Fundamentals: engagement, assessment, and high risk behaviors, Develop an individualized planning intervention and with frequent medical treatment plan with the assessment of progress. problems and a high participant, incorporating rate of HIV/AIDS and objectives related to child safety, Children, parents and foster sexually transmitted permanency, and well-being parents should be accurately diseases. and timely informed, in Integrate treatment plan language understandable to activities and objectives with the them of their rights, the goal activities and goals in the CWS for the child/family and case plan individualized service plans. Develop treatment plans that incorporate awareness of the SAFERR Fundamentals: family’s CWS case plan and other timetables and prioritize Develop a case plan that activities as possible incorporates objectives related Jointly review treatment plan to parents treatment and with CWS staff and the family recovery Share treatment plan activities Incorporate needed treatment and goals with CWS staff interventions for children’s issues in case plans Monitor treatment compliance by frequently sharing of Ensure that case plan activities, information about: objectives, and service strategies do not conflict with Number of drug tests the alcohol and drug treatment required and results of drug plan as possible tests 10 US Department of Health and Human Services, SAMHSA, Center for Substance Abuse Treatment. Addiction Counseling Competencies: The Knowledge, Skills and Attitudes of Professional Practice. Technical Assistance Publication Series, #21(2002) Values Preferred Substance Preferred Child Welfare Abuse Approach Approach Progress in Jointly review case plan with obtaining/maintaining ADS staff and the family abstinence Share case plan activities, Number of group and objectives, and service individual sessions required strategies with ADS staff and attended Share qualitative and Treatment goals and quantitative information about progress toward treatment meeting case plan objectives goals ADS agency at standardized intervals and at the time of Continually assess movement critical incidents through stages of change Provide progress reports to Share qualitative and ADS workers and the courts in quantitative information about a timely fashion compliance with court orders, meeting treatment plan Share new information with objectives, and parenting ADS when: responsibilities with CWS and Visitation schedules are court at standardized intervals being changed and at critical incidents Changes in service plans Provide progress reports to CWS are being considered staff and courts at agreed upon There is a case transfer to a intervals new CWS worker or unit Ensure that aftercare When the child is moved to incorporates child welfare goals a new placement and supports optimal long-term Include indicators of capacity family connections of families with substance use Include changes in family disorders to meet the needs of functioning and children’s status their children regarding safety, in outcome measures permanency, and well-being in Routinely monitor and share outcome measure outcome data with CWS and Routinely monitor and share court staff outcome data with ADS services SAFERR Model Practice: SAFERR Model Practice: Team development of family driven case plans with shared Team development of family objectives driven case plans with shared Court interventions are used objectives Values Preferred Substance Preferred Child Welfare Abuse Approach Approach therapeutically with families Court interventions are used therapeutically with families Outcome results are used for Outcome results are used for community-wide planning and community-wide planning and prevention efforts prevention efforts Cross agency and community- Cross agency and community- wide funding strategies are wide funding strategies are employed to sustain programs employed to sustain programs Values Preferred Child Welfare Preferred Substance Approach Abuse Approach Practice Element: Effective Practice Element: Effective Practice Element: Effective teamwork and coordination teamwork and coordination teamwork and coordination Effective treatment Substance-abusing clients Decisions about child and attends to multiple needs of may have significant life family interventions are more the individual, not just his management issues beyond relevant, comprehensive and or her drug use.11 their substance abuse and the effective when the family’s team treatment plan should take makes them. Families should Interdisciplinary and these issues into consideration. always be core member of the interagency coordination Active case management and team. Coordination of the should be provided within service linkage should be activities of case contributors is the parameters of federal incorporated into the treatment essential and works most confidentiality guidelines. process. These services effectively and efficiently when should be coordinated with the it occurs in regular face-to-face Service coordination, child welfare worker and other meetings of the family team. which includes case systems’ representatives to Generally, all children over the management and client avoid duplication and age of 10 years should advocacy, establishes a confusion. participate on their family team. framework of action for the family/client to achieve Exchange of relevant Family team meetings specified goals.12 information for effective provide important opportunities service coordination is made for families to discuss what Minimizing the number of in a manner consistent with interventions are working or not system points of contact for confidentiality regulations and working to help them achieve multiple health and social generally accepted their goals. Other team members services needed by clients is professional standards of care. have the same opportunity to optimal. provide feedback. Timely and Attendance at treatment relevant changes to the team reviews by the child individual case plan can be welfare worker can assist in developed and agreed upon by assuring that goals of the two all team members. All persons systems are aligned. on the team should know the current plan goals, action steps, persons responsible, and time frames. 11 Principles of Drug Addiction Treatment, National Institute on Drug Abuse, 2000. 12 US Department of Health and Human Services, SAMHSA, Center for Substance Abuse Treatment. Addiction Counseling Competencies: The Knowledge, Skills and Attitudes of Professional Practice. Technical Assistance Publication Series, #21(2002) Values Preferred Child Welfare Preferred Substance Approach Abuse Approach The involvement of other service systems is often required. Communication and interaction with the court should reflect timeliness, preparation, knowledge, respect and accuracy. The system should take an active role in seeking to ensure that local education agencies recognize children’s education rights and provide children with educational services in accord with those rights. The system should include probation or parole officers on the family team when they are involved with any family members. Values Preferred Substance Preferred Child Welfare Abuse Approach Approach Practice Element: Out-of- Practice Element: Out-of-home home placement of Practice Element: Out- placement of children children of-home placement of children Removal of children from Parents do better in their homes causes additional treatment when they are trauma. Every effort should be able to remain with their Whenever possible, parents made, when safety can be children or have frequent in residential treatment should assured, to plan out-of-home contact and visitation. be allowed to bring their care with the parents, including children with them into their involvement in the child’s Children experience treatment. transition. trauma when they are separated from their The treatment program may When children cannot live families. When children provide a safe place to discuss safely with their families, the must be removed to be family placement issues. first considerations for protected, their trauma is placement should be with lessened when they can Substance abuse treatment kinship connections capable of remain in their own should be offered in the least offering and demonstrating the neighborhoods and restrictive setting appropriate resources for a safe, stable and maintain existing to the severity of the substance appropriate home. Siblings connections with families, abuse problem. should be placed together. schools, friends and other informal supports Placements should be made in the least restrictive, most normalized setting responsive to the child’s needs. Temporary, interim placements should be avoided. Children should be placed in settings that could reasonable be expected to deliver long term care if necessary. To this end, the use of congregate shelter placements should be avoided in favor of family based settings. Children younger than six should not be placed in congregate settings unless it is necessary to maintain connections with siblings placed in the same setting. When Values Preferred Substance Preferred Child Welfare Abuse Approach Approach shelter is used, the placement should be short terms. The system should forbid summary discharges of children from placement. The system should develop a policy that describes steps that should be taken prior to a child’s discharge from a placement. The system should be based on the philosophy that the disruption of a placement is a failure of the system, not a failure of the child. AFSA Timeframes: When children have been removed from their homes, federal law now requires that a permanency plan be established no later than twelve months after the child’s entry into care. This means that a parent must be making reasonable progress toward recovery and reunification within 12 months. Values Preferred Substance Preferred Child Welfare Abuse Approach Approach Practice Element: Special Practice Element: Special Supports to Supports to Clients in Care Practice Element: Children/Clients in Care Special Supports to To promote healing and Children in Care The special needs of the support for clients receiving child need to be addressed substance abuse services, in order to ensure that they especially women, a healing Children should receive able to interact with their environment should include prompt and appropriate attention peers and family in age- attention to the physical, to their health care needs. Mental appropriate and safe ways, emotional, spiritual and safety health needs should be addressed and to succeed in school. needs of individuals. as developmentally appropriate. Children should have freedom Findings from enhanced Support to clients in from excessive medication, versus standard women’s treatment must also attend to unnecessary seclusion and substance abuse treatment practical issues such as child restraint. contrasts suggest that care, housing support and enriching women’s transportation. The system should treatment with additional vigorously seek to assure that components specifically Addicted or drug-abusing children, when in foster care or oriented toward meeting individuals with co-existing custody, are integrated to the women’s needs adds value mental disorders should have maximum extent feasible into above and beyond the both disorders treated in an normalized school settings and expected effects of standard integrated way. activities and achieve success in programs.13 school. Medications should be viewed as a potential Visitation between children extension of treatment for in care and their parents and patients, especially when among siblings should be combined with counseling and addressed in each child’s other behavioral therapies. individualized service plan. The Treatment medications offer frequency and circumstances of help in suppressing the visiting should depend on age withdrawal syndrome and and need. Visiting should be drug craving and in blocking viewed as an essential ingredient the effects of drugs. of family reunification services. Hence, when the goal is for the 13 National Evaluation Data Services (NEDS). Effectiveness of Women’s Substance Abuse Treatment Programs: A Meta-Analysis. Batelle Centers for Public Health, Arlington, VA. May 2001. 14 Principles of Drug Addiction Treatment, National Institute on Drug Abuse, 2000 (for all 3 substance abuse practice elements on this page) Values Preferred Substance Preferred Child Welfare Abuse Approach Approach child to return home or live with For women who are a family member, visiting should pregnant, services need to be be actively encouraged. Visiting focused on helping the woman plans that require agency have safer pregnancies and oversight or participation should healthier babies, with take into account the work, appropriate support to infants. education Links between Medicaid, and other obligations on the part substance abuse, and health of the parents. After hours and agencies at the state level, and weekend visits should be options between prenatal care and to permit parents to meet substance abuse treatment necessary obligations. Visiting agencies at the local level may be arranged by the child, the need to be cultivated and child’s parents or family, or the maximized. foster parents, as well as by staff and the staff of residential Treatment programs facilities in accordance with the should provide assessment for individualized service plan. HIV/AIDS, Hepatitis B and C, tuberculosis and other Supervision of visiting infectious diseases and should be required only when counseling to help patients there is a danger that the parent modify or change behaviors or family member with whom that place themselves or the child is visiting will harm the others at risk of infection.14 child unless the visit is supervised. Values Preferred Substance Preferred Child Welfare Abuse Approach Approach Practice Element: Formal Services Practice Element: Practice Element: Formal Services Formal Services Alcohol and other drug addiction is a treatable Culturally competent AFSA Timeframes: disorder. programming needs to be When children have been factored into the design and removed from their homes, Support for an delivery of addiction services federal law now requires that a individual’s or a family’s (addressing such issues as race, permanency plan be established physical, mental emotional ethnicity, culture, sexual no later than twelve months after and spiritual needs should orientation, age, criminal the child’s entry into care. This be incorporated into justice status, disability status). means that a parent must be treatment. making reasonable progress Treatment services are toward recovery and Individuals have the based upon the client’s needs, reunification within 12 months. right and the responsibility in accordance with the to fully participate in all appropriate level of care, and The system should be decisions related to their with the active participation of sensitive to cultural differences health care, including the client in determining the and the special needs of minority addiction treatment. course of care. ethnic and racial groups. Services should be provided in a Health differs by gender Treatment services should be manner that respects these as well as by race and provided in the most effective differences and attends to these ethnicity requiring dosage and intensity levels to special needs. These differences specialized care. Among achieve success (i.e. at least 3 and special needs should not be women, however, alcohol months for outpatient and used as an excuse for failing to and drug abuse may residential services). provide services. progress differently, and may require different A variety of treatment The service array should be treatment approaches. services need to be available, sufficiently flexible to be adapted such as individual, group and to the unique needs of each child Recovery from the family counseling, as well as and family. Services and disease of alcohol and drug alternative therapies based on supports best meet child and addiction is often a long- client needs and desires. family needs when they are term process, involving Therapeutic approaches need provided in the family’s natural multiple relapses before a to be based on the latest setting or for children in patient achieves prolonged 15 Principles of Drug Addiction Treatment, National Institute on Drug Abuse, 2000 16 Covington, S. S. Helping Women Recover: A Program for Treating Addiction. San Francisco: Jossey-Bass, 1999. Values Preferred Substance Preferred Child Welfare Abuse Approach Approach abstinence. scientific evidence of custody, the child’s current effectiveness and delivered by Combining prison- and counselors who are skilled in Children and their families community-based delivering specific therapeutic should have access to a treatment for drug-addicted protocols. comprehensive array of services, offenders reduces the risk including intensive home-based of both recidivism to drug- For women in treatment, services, designed to enable related criminal behavior providers of services need to children to live with their and relapse to drug use.15 provide comprehensive, families or to achieve timely trauma-informed services that permanency address women’s multiple placement. If services are roles, complex psychological limited to delivery in a identity, and the cultural and particular place, children often social realities in which they have to move to receive them. live and work.16 Services should be flexible enough to be delivered where Self-help groups (AA, NA, the child and family reside. etc) can be used to complement Children and families should and extend the effects of not be expected to adapt to professional treatment. ineffective services. Relapse prevention strategies need to be incorporated into all therapeutic protocols to facilitate abstinence as well as provide help for individuals who experience relapse. Substance abuse treatment programs should have staff members who are knowledgeable about local resources that can be used to augment services they do not provide. Case management and referral to appropriate services, both during treatment and after discharge, should be incorporated into the treatment Values Preferred Substance Preferred Child Welfare Abuse Approach Approach process. Addiction treatment programs should be available to incarcerated persons to help them succeed in preventing a return to criminal and drug abusing behaviors. Linkages need to be made with to community-based programs that continue treatment when the individual leaves prison. Values Preferred Substance Preferred Child Welfare Abuse Approach Approach Practice Element: Practice Element: Informal Practice Element: Informal Informal Supports Supports Supports One of the keys to Programs should be Through a family team process, helping persons with sensitive to the relational every family should be assisted substance abuse disorders issues that an individual with including/developing their during the recovery brings into treatment, taking own informal support system of process is to encourage full advantage of those that family members and/or friends. healthy connections and provide positive connections The team process is a way to relationships. and support. develop the capacity of the family’s informal support system Neighborhood and in terms of understanding the community resources and family’s challenges, goals, and institutions should be needs for support and assistance. identified as assets in the The team process provides an client’s treatment planning. important means for mobilizing the resources of the family’s informal Linking clients with support system. community-based, self-help groups during treatment and Neighborhood and community after discharge should occur resources and institutions should to create a network that can be treated as key partners in support the services provided serving children and families, both by professional counselors. in planning for individual families and as a partner in system design and operations. Many of the services and resources that children and families find most accessible and responsive are those found in their own community, provided within their own neighborhoods and culture. Relative and foster caregivers should be provided with the formal and informal supports they need to successfully care for the children placed with them. Values Preferred Substance Preferred Child Welfare Abuse Approach Approach Practice Element: Practice Element: Practice Element: Tracking and Tracking and Tracking and Adaptation Adaptation Adaptation An individual’s treatment The treatment team The status of children and and services plan must be meeting provides an their families is routinely assessed continually and appropriate forum for review checked as well as the results of modified as necessary to of the client’s and children’s services and supports that are ensure that the plan meets status. being provided. Evaluating the the person’s changing efficacy of services and supports needs.17 Progress toward identified should occur primarily at family goals is documented and team meetings, with the family discussed with the client. assisted in providing honest feedback to the team as to what is working or not working to move them successfully toward their goals. The family team meeting is also the forum for other team members to provide reinforcement to the family about progress being made as well as any potential opportunities for improving intervention. The team, with the family’s input, should develop consensus as to needed changes in the child/family’s plan and the steps needed to effect those changes. 17 Principles of Drug Addiction Treatment, National Institute on Drug Abuse, 2000. Values Preferred Child Welfare Preferred Substance Approach Abuse Approach Practice Element: Long-term Practice Element: Long- Practice Element: Long-term View term View View (Recovery) (Recovery) (Recovery) The system is responsible There needs to be a The family’s case plan should for ensuring that caregivers are system of monitoring and include an explicit plan for the able to transition successfully aftercare that assures child and family that enables from formal services provided sustained disease them to live safely and and sustain the progress they management. Post- independently from the child have made over the long term. treatment support services welfare system. The plan When a long-term view has not need to be of sufficient scope should provide direction and been adequately envisioned and duration to assist in support for making smooth and planned for, the likelihood sustaining recovery. transitions across settings, of relapse and re-abuse of providers and levels of service. children remains high. Relapse prevention plans Recognizing craving and need to be in place for all relapse as an integral part of clients leaving primary addiction has tremendous treatment services. importance for developing strategies, which must encompass ways to enable the client to deal with continued exposure to the cues that are associated with drug abuse long after formal treatment is completed. Values Preferred Child Welfare Preferred Substance Approach Abuse Approach Practice Element: Practice Element: Effective Effective Results Results Practice Element: Effective Results The system is Substance use is reduced or responsible for producing eliminated. Children are protected from effective results. When abuse and neglect. parents are not yet Client refrains from criminal motivated to enter involvement. Children are provided with treatment, the system is stability and permanency in their responsible for making Social functioning and lives within timeframes every effort to motivate and relationships are improved. appropriate to their encourage parents to obtain developmental needs. treatment. Stable, gainful employment or educational enrollment is Where possible, children remain The ultimate goal of all maintained. with their families or are addiction treatment is to reunified through the provision enable the individual to of services that strengthen the achieve lasting abstinence, capacity and skills of their but the achievement of caregivers. immediate goals (to reduce drug use, improve the Children achieve success in patient's ability to function, school and become stable, and minimize the medical gainfully employed adults. and social complications of drug abuse) are also very Families are engaged and important. satisfied with the services and supports they receive.