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National Center on Substance Abuse and Child Welfareand Child Welfare

Bringing Systems Together for Family Recovery, Safety

and Stability

S t b 24 2009September 24, 2009Presented by:

Cathleen Otero, MSW, MPADeputy Director, NCSACW

DropoffDropoff PointsPoints

1,000 Children – 750 Parents

60% of Parents Need Assessment 60% of Parents Need Assessment 450

50% Go for Assessment 225

80% Need Treatment 180

50% Go to First Session 90

30% Complete 90 Days - 30

50% Reunify - 15

Differences in values and perceptions of primary clientTi i diff i i t

Frequently Cited Barriers

Timing differences in service systems Knowledge gaps among staff working in the

systems Lack of tools for effective engagement in services Intervention and prevention needs of children Lack of effective communication Data and information gaps Categorical and rigid funding streams as well

as services and treatment gaps3

Develop principles for working together Create on-going dialogues and efficient

Suggested StrategiesSuggested Strategies

communication Develop cross-training opportunities Improve screening, assessment and monitoring

practice and protocols Develop funding strategies to improve timely

treatment access Expand prevention services to children Develop improved cross-system data collection

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Developing knowledge andDeveloping knowledge and providing technical assistance to

federal, state, local agencies and tribes toimprove outcomes for families with

substance use disorders in thesubstance use disorders in thechild welfare and family court systems

A Program of the Substance Abuse and Mental Health

Services AdministrationCenter for Substance Abuse Treatment

and theAdministration on Children, Youth and Families

Children’s BureauOffice on Child Abuse and NeglectOffice on Child Abuse and Neglect

NCSACW Goals

To improve outcomes for families by promoting effective practice, and organizational and system changes at the local, state, and national levels

To develop and implement a comprehensive program of information gathering and dissemination

To provide technical assistance

Navigating the PathwaysPublished by CSAT

• A framework for defining elements of collaboration

To define linkage points across systems: where are the most important bridges we need to build?

• Methods to assess effectiveness of collaborative work

To assess differing values

To assist sites in measuring their implementation

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Collaborative Practice and Policy Tools

Ten Element Framework – A method to organize collaborative activities in specific practice and policy areas

Collaborative Values Inventory – An anonymous way to explore values and beliefs to facilitate the development of common principles using web‐based data collection

Collaborative Capacity Instrument – An anonymous way to assess the strengths and challenges in each of the areas of system linkages using web‐based data collection

TEXT PAGE

Matrix of Progress in System Linkages – A practice‐based approach that specifies characteristics of advance collaboration practice in the elements of system linkages

Screening and Assessment for Family Engagement, Retention and Recovery — SAFERR  ‐‐A guidebook to develop effective communication across systems while engaging families in services

Mission

1. Underlying Values and Priorities

Elements of System LinkagesThe Ten Key Bridges

System Elements

Children, Family, Tribal, and Community Services

2.  Screening and Assessment

3.  Engagement and Retention 4.   Services for Children  5.  Community and Family 

Support

Outcomes

10. Shared Outcomes and Systems Reforms

6. Information Systems 7. Training and System Tools

8. Budget and Sustainability

9. Working with Other Agencies 

Technical Assistance

Objectives

To share knowledge across systems the three systems: g y ysubstance abuse, child welfare, dependency court

To promote understanding of cross systems issues and to advance cross-system collaboration

To increase awareness and adoption of cross systems approaches

To facilitate communication across systems To improve outcomes for children and adults

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Collaboration practice and policy tools

Technical Assistance

Information and sharing of models Expert consultation and research Development of issue-specific products

Monographs, white papers, fact sheets

Training resources On line courses training materials On-line courses, training materials

Longer-term strategic planning and development of protocols and practice models

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Information and Sharing of Models

• Materials

Expert Consultation and Research

• Background research/data

Technical Assistance

• Materials• Publications• Referrals to experts• Peer to peer consultation• Involves identifying and using existing knowledge, materials, products, and resources

• Collecting and disseminating

• Background research/data analysis

• Conference calls with expert consultants

• Analyzing CCI/CVI scores• Annotated bibliography and custom literature searches

• Compiling resources and data on

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• Collecting and disseminating information from sites who have implemented practice and policy changes

Compiling resources and data on specific topics (e.g. peer mentors, methamphetamine)

Development of Issue‐Specific Products

Training and Facilitation

Technical Assistance

• Materials• Publications• Referrals• Involves identifying and using existing knowledge, materials, products, and resources

• Collecting and disseminating

• Group Facilitation• Conference Presentation• Legislative or commissioner hearings or meetings

• On‐site training• Web‐based training courses with CEUs

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• Collecting and disseminating information from sites

with CEUs• Training curricula and materials 

In‐Depth Technical Assistance

Technical Assistance

• Application and acceptance process• 15 month program facilitated by a Consultant Liaison• Sets priorities for practice and policy changes• Develops protocols and implementation plans

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In-Depth Technical AssistanceIn-Depth Technical AssistanceRegional Partnership Grants and In-Depth Technical Assistance Sites

Tribal Governments

County Government

Regional Partnership Grantee

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National Center on Substance Abuse and Child Welfareand Child Welfare

Technical Assistance Resources

Mission

1. Underlying Values and Priorities

Elements of System LinkagesThe Ten Key Bridges

System Elements

Children, Family, Tribal, and Community Services

2.  Screening and Assessment

3.  Engagement and Retention 4.   Services for Children  5.  Community and Family 

Support

Outcomes

10. Shared Outcomes and Systems Reforms

6. Information Systems 7. Training and System Tools

8. Budget and Sustainability

9. Working with Other Agencies 

Underlying Values and Principles of Collaboration 

• Collaborative Capacity Instrument

• Collaborative Values Inventory

• Synthesis of Cross System Values and Principles: A National Perspective

IDTA Memoranda of Understanding and• IDTA Memoranda of Understanding and statements of shared values and principles

Screening, Assessment, Engagement and Retention

• Screening and Assessment for Family E t R t ti d REngagement, Retention and Recovery (SAFERR)

• IDTA protocols & engagement resources• Substance Abuse Specialists in Child Welfare

Agencies and Dependency Courts: Considerations for Program Designers andConsiderations for Program Designers and Evaluators

• Utilizing Drug Testing in the Context of Child Welfare (in development)

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Screening and Assessment for Family Engagement, Retention and Recovery

Screening and Assessment for Family Engagement, Retention and Recovery (SAFERR)and Recovery (SAFERR)

– Provides screening and assessment tools

– Includes guidelines for communication and collaboration across the systems responsible for

TEXT PAGE

systems responsible for helping families

– Assists with developing cross-system communication protocols

Services to Children, Working with Related Agencies and Building 

Community Supports

• Substance Exposed Infants: State Responses• Substance Exposed Infants: State Responses

• SAFERR Appendix on screening and assessment tools for children and youth

• IDTA Parent Partner program materials

• Family Centered Treatment for Women with Substance Use Disorders

Services to Children

Multiple Opportunities for InterventionCommonly noted consequences for children

– Fetal Alcohol Syndrome (FAS)– Alcohol-related neuro-developmental disorders (ARND)

• Physical health consequences• Lack of secure attachment• Psychopathology• Behavioral problems• Poor social relations/skills• Deficits in motor skills• Cognition and learning disabilities

Policy and Practice Framework: Five Points of Intervention

Initiate enhanced2. Prenatal screening

1. Pre-pregnancy awareness of substance use effects

ParentChild

Initiate enhanced prenatal services

3. Identification at Birth

4. Ensure infant’s safety and d t i f t’ d

2. Prenatal screening and assessment

Respond to parents’ d

System Li k

TEXT PAGE

Identify and respond to parents’ needs

respond to infant’s needs

5. Identify and respond to the needs of

● Infant ● Preschooler● Child ● Adolescent

System Linkages

needsLinkages

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Training and Staff Development

• NCSACW online tutorials

• Participant workbooks and supervisor handbooks

• IDTA State examples of training initiatives

• The Child Welfare-Substance Abuse Connection: A Compendium of Training Curricula and Resources

Training and Staff Development

• Understanding Substance Abuse and Facilitating R A G id f Child W lf W kRecovery: A Guide for Child Welfare Workers

• Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals

• Understanding Substance Use Disorders, g ,Treatment and Family Recovery: A Guide for Legal Professionals – New!

• Participant workbooks and supervisor handbooks developed by the State of Utah

Online Training

TEXT PAGE

I have completed the tutorial training, and utilized the information to help educate new child protective service workers. The information is very useful, understandable, and very specific to the issues and concerns that child welfare workers will encounter, and how these should be handled.

-Direct Service Provider

Available at no charge at http://ncsacw.samhsa.gov

Implementing Online Tutorials

TEXT PAGEAvailable for free PDF download at http://ncsacw.samhsa.gov

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Training and Related Products

• On-Line Training

– Available at no cost

– Upon completion of the tutorial:– Upon completion of the tutorial:

• Certificate awarded

• CEUs and CLEs are available

• Visit http://ncsacw.samhsa.gov

– Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment ProfessionalsGuide for Substance Abuse Treatment Professionals

– Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Child Welfare Professionals

– Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Legal Professionals

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Training and Staff Development

• Substance Use Disorders, Mental Disorders and C O i Di d T i i P k (iCo-Occurring Disorders Training Package (in development)

• State Legislator information resources web-pages (in development)

Budgeting and Program Sustainability

• White Paper on Funding Comprehensive Services for Families with Substance Use Disorders in Child Welfare and Dependency Courtsand Dependency Courts

• Funding Family-Centered Treatment for Women With Substance Use Disorders– Detailed tables of Federal funding sources for comprehensive

services

• Sustainability discussion guide for Regional Partnership Grants

• IDTA State strategic plans for continued efforts

Joint Accountability, Shared Outcomesand Information Systems

• SAFERR communication protocols

• IDTA State communication protocols and examples of data system improvements

• A Review of Alcohol and Drug Issues in the States' Child and Family Service Reviews and Program Improvement PlansProgram Improvement Plans

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Joint Accountability, Shared Outcomes and Information Systems

• Guide to Cross-System Data Sources for State and Tribal Child Welfare Substance Abuseand Tribal Child Welfare, Substance Abuse Treatment, and Court Systems (In Development)

• May 16, 2008: Connecting the Dots: How States and Counties Have Used Existing Data Systems to Create Cross System Data Linkages

– http://www cffutures com/webinars shtml#May16http://www.cffutures.com/webinars.shtml#May16

• RPG report on cross-system indicators and data sources

How Do I Access Technical Assistance?

• Visit the NCSACW website for resources and products at http://ncsacw.samhsa.gov

• Email us at ncsacw@cffutures.org

Bringing Systems Together for Family Recovery, Safety, and StabilityWorking together. Whether you work in Child Welfare, Substance

Abuse Treatment, or the Courts, it takes everyone working together to improve

outcomes for families affected by substance use disorders.

Learning together. Understanding each system’s

practices and procedures and

learning to speak each other’s

languages will help everyone work

together more effectively for the

benefit of families.

We can help. The National Center on Substance

Abuse and Child Welfare offers

technical assistance, training, and

informational tools to support your

efforts to collaborate.

To find out more: Visit our Web site atwww.ncsacw.samhsa.gov

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESSubstance Abuse and Mental Health Services AdministrationAdministration for Children and Families

Look What NCSACW Has to Offeru Web Site with Information, Resources, and Materialsu Consultation on Building Collaboration among Substance Abuse Treatment, Child

Welfare Agencies, and the Court Systemsu Free Accredited Online Courses for Professionals l Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide

for Child Welfare Professionals l Understanding Child Welfare and the Dependency Court: A Guide for Substance

Abuse Treatment Professionals l Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide

for Legal Professionals

Collaboration in Action. Child welfare, substance abuse treatment and court professionals in States, Tribes, Counties, and communities across the country are coming together on behalf of families. They are: l Developing Memoranda of Understanding and shared values statements to guide

their collaboration l Putting screening and assessment protocols in place to enhance parent engagement

and retention in services l Identifying the special needs of children affected by substance abuse l Creating data systems and information sharing protocols that can support cross-

system case management l Finding creative ways to fund comprehensive family centered services.

Visit our Web site at www.ncsacw.samhsa.gov to review examples of these

and other available tools.

Framework and Policy Tools for Improving Linkages Between Alcohol and Drug Services, Child Welfare, and Dependency Courts

The ultimate goal of the professionals who work with children and families affected by substance use disorders and involved in the child welfare system is to facilitate positive outcomes for these families. Ideally, the parent will receive effective treatment for the substance use disorder so that the child can remain with the parent, while the well-being of the child is fully supported throughout the parent’s recovery process. Achieving this outcome requires intensive collaboration by multiple agencies working with the family. NCSACW helps child welfare agencies, substance abuse treatment providers, and dependency courts to establish cross-system collaboration that sets the stage for positive outcomes. To carry out this work, NCSACW has developed a ten-element framework for collaboration and a set of three policy tools that support the framework. The Framework: Ten Elements of System Linkages

For cross-system collaboration to be effective and sustainable, each system – child welfare, substance abuse treatment, and the courts – must be engaged in each of these ten areas:

• Underlying values and principles of collaborative relationships • Daily practice: client screening and assessment • Daily practice: client engagement and retention in care • Daily practice: services to children of substance abusers • Joint accountability and shared outcomes • Information sharing and data systems • Budgeting and program sustainability • Training and staff development • Working with related agencies • Working with the community and supporting families

Why Are these Ten Factors Important?

• Underlying values and principles of collaborative relationships

The partners in cross-system collaboration must create effective relationships with one another. The values held at the organizational level and by individual participants affect the likelihood of agreement on critical issues. The discussion of values is the cornerstone of a collaborative relationship.

• Daily practice in AOD screening and assessment

Each of the collaborating agencies must be aware of screening and assessment issues. Relevant agencies must determine whether the parent has a substance abuse problem, assess the nature of the problem and the most effective treatment, and determine what information should be communicated to the other agencies.

• Daily practice in engaging and retaining parents

Each of the collaborating agencies has the opportunity to encourage the parent to stay in the recovery process and meet the requirements imposed on them. Many obstacles confront parents who want to keep their families together while they deal with substance abuse. Judges can respond in a way that supports continued engagement in recovery and the court process; the parent’s attorney can make sure the parent knows the consequences of their actions.

• Daily practice in services to children A family systems approach is necessary when substance abuse services are provided to parents with children in the child welfare system. A parent’s substance use disorder has a tremendous impact on the children, who need continuing skilled support. When residential care is warranted, it must be a priority to

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keep parents and their children together, if appropriate. Without effective intervention, the children of substance abusers may repeat the parent’s pattern. The special needs of children of substance abusers must be addressed in prevention and intervention programs.

• Joint accountability and shared outcomes

The collaborative partners need to establish joint accountability and agree upon goals. The outcomes that they develop together guide the work of the collaborative; they demonstrate that the collaborative has achieved interagency agreement on desired results. Without agreement on shared outcomes, each of the partners is likely to measure its own progress as it did prior to collaboration, focused on its own perspective.

• Shared information systems Shared information is the prerequisite for joint accountability. Joint information systems form the basis of communicating across systems and are necessary to track progress toward shared goals. Effective communication and information sharing provide the guideposts that gauge the effectiveness of the collaborative’s programs.

• Budgeting and program sustainability The collaborative partners must tap the full range of funding resources available to the state or community so that it can develop stability over time for its innovative approaches.

• Training and staff development Cross-training at all levels – administrative, management, and line-level staff – is essential to ensuring cooperation between key players in the systems.

• Working with other agencies Many parents with alcohol and other drug problems also require the assistance of services other than substance abuse and child welfare to address the complex issues affecting their families. The primary partners must form relationships with mental health, domestic violence, primary health, housing, legal, and employment-related services.

• Working with the community and supporting families Community-based organizations have been shown to be great resources. They can mobilize community members and have a role in preventing child abuse and substance abuse, as well as providing on-going support after formal services have ended.

Policy Tools

• The Matrix of Progress in Building Linkages Among Alcohol and Drug Agencies, Child Welfare Services, and the Dependency Court is a tool for assessing collaboration across systems. The Matrix of Progress identifies benchmarks for improving the system linkages by specifying the fundamentals of improved practice, good practice, and best practice for each of the ten elements in the framework.

• The Collaborative Values Inventory (CVI) is a questionnaire that serves as a neutral, anonymous way of assessing how much a group shares the values that underlie its work. The CVI is designed to identify issues that may not be raised if the collaborative begins its work together without clarifying the underlying values of its members.

• The Collaborative Capacity Instrument (CCI) is a self-assessment tool designed to elicit intra- and interagency discussion about progress in addressing specific issues and about prioritizing programs and policy plans.

• Screening and Assessment for Family Engagement, Retention, and Recovery (SAFERR) provides guidance for using efficient screening and assessment tools and communication strategies that support sound and timely decisions about the safety of children and about the treatment and recovery of parents. It also includes methods for developing collaborative relationships between the systems to help improve outcomes for these families.

These tools are available on the Children and Family Futures website (http://www.cffutures.org) for use by States and communities. This Framework and Policy Tools was published in the SAMHSA Publication No.SMA-04-3930, Navigating the Pathways: Lessons and Promising Practices in Linking Alcohol and Drug Services With Child Welfare, Technical Assistance Publication (TAP) Series #27, April 2002.

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Understanding Substance Abuse and Facilitating Recovery:

A Guide for Child Welfare Workers • Discusses the relationship of alcohol and drugs to families in the child welfare

system • Provides information on the biological, psychological, and social processes of alcohol

and drug addiction to help staff recognize when substance abuse is a risk factor in their cases

• Describes strategies to facilitate and support alcohol and drug treatment and

recovery

National Center on Substance Abuse and Child Welfare

714.505.3525 • 714.505.3626 fax www.ncsacw.samhsa.gov • ncsacw@cffutures.org

A service of the Substance Abuse and Mental Health Services Administration (SAMHSA),

Center for Substance Abuse Treatment (CSAT) and the Administration on Children, Youth and Families (ACYF) Children's Bureau, Office on Child Abuse and Neglect (OCAN).

Available Online View or download Understanding Substance Abuse and Facilitating Recovery at the NCSACW website: www.ncsacw.samhsa.gov/files/UnderstandingSAGuide.pdf

PHD1092

Order Free Copies

You may order printed copies of Understanding Substance Abuse and Facilitating Recovery from:

• National Clearinghouse for Alcohol and Drug Information Call 800-729-6686, or online at http://ncadistore.samhsa.gov/catalog Select ‘Quick Find and Order,’ inventory number PHD1092 • Child Welfare Information Gateway Call 800-394-3366, or online at http://www.childwelfare.gov Click on ‘Online Catalog,’ select ‘Title Index,’ and click on ‘U’

Screening and Assessment for Family Engagement,

Retention and Recovery (SAFERR)

• Presents the SAFERR model for helping staff of public and private agencies respond to families affected by substance use disorders

• Provides screening and assessment tools to help caseworkers make sound, timely

decisions about the safety of children • Includes guidelines for communication and collaboration across the systems

responsible for helping families

National Center on Substance Abuse and Child Welfare 714.505.3525 • 714.505.3626 fax

www.ncsacw.samhsa.gov • ncsacw@cffutures.org

A service of the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT) and the Administration on Children, Youth and Families (ACYF)

Children's Bureau, Office on Child Abuse and Neglect (OCAN).

Download SAFERR or Order Free Copies Download a PDF copy from http://www.ncsacw.samhsa.gov/files/SAFERR.pdf Order printed copies from: • National Clearinghouse for Alcohol and Drug Information - Call 800-729-6686 and ask for SAFERR, SMA 07-4261, or - Order online at http://ncadistore.samhsa.gov/catalog - click on ‘Quick Find & Order’ and type ‘Screening’ in the ‘Title’ box • Child Welfare Information Gateway - Call 800-394-3366 and ask for SAFERR, SMA 07-4261, or - Order online at http://www.childwelfare.gov - click on ‘Online Catalog,’ select ‘Title Index,’ and click on ‘S’

Publication Number SMA 07-4261

ANNOUNCING TWO NEW ONLINE RESOURCES FROM THE CENTER FOR SUBSTANCE ABUSE TREATMENT

Family-Centered Treatment for Women with Substance Use Disorders—History, Key Elements and Challenges This monograph introduces the concepts and evolution of the field in providing a family-centered treatment approach for women and their families. It examines the role of family in the context of treatment for women and addresses the treatment needs of children and the inclusion of fathers, husbands, and other family members in treatment planning. The discussion includes key principles, components of service needs, modalities of treatment delivery, and challenges and solutions to establishing and operating family-centered treatment programs.

Funding Family-Centered Treatment for Women with Substance Use Disorders This resource paper is a companion to the Family-Centered Treatment monograph and assists treatment providers and State substance abuse agencies to identify and access potential sources of funding for comprehensive family-centered treatment. The paper includes definitions of funding terminology and current methods of advanced cross-system funding strategies. Highlights of the experiences and insights of one organization, SHIELDS for Families, in developing an effective comprehensive services financing strategy are provided. Finally, concrete steps on getting started and recommendations for treatment providers and State agencies are provided.

Both papers can be downloaded from the CSAT Treatment Improvement Exchange (TIE)

Website at http://womenandchildren.treatment.org