creating change through collaboration: substance abuse and ... · policy and practice innovations...

1

Creating Change through Collaboration:

Substance Abuse and Child Welfare Policy and Practice Innovationsy

Nancy K. Young

Denise Churchill

Sam Gillespie

Peter Panzarella

SAMHSA Women’s Conference

4 9 4 0 I r v i n e B l v d . , S u i t e 2 0 24 9 4 0 I r v i n e B l v d . , S u i t e 2 0 2I r v i n e , C A 9 2 6 2 0I r v i n e , C A 9 2 6 2 0

7 1 47 1 4 -- 5 0 55 0 5 -- 3 5 2 53 5 2 5n c s a c w @ c f f u t u r e s . o r g n c s a c w @ c f f u t u r e s . o r g

w w w . n c s a c w . s a m h s a . g o vw w w . n c s a c w . s a m h s a . g o v

SAMHSA Women s Conference

July 28-28, 2010

Chicago, Illinois

Topics for Discussion

• Making the Case for Collaboration

• The “How To” of Collaboration

• What’s Being Done

• Technical Assistance Resources

2

2

A Program of the

Substance Abuse and Mental Health Services AdministrationCenter for Substance Abuse Treatment

and the

Administration on Children, Youth and FamiliesChild ’ BChildren’s Bureau

Office on Child Abuse and Neglect

3

Making the CaseMaking the Case for Collaboration

3

Children Living with One or More Substance-Dependent Parent

10.6

6.2

7.5

8.3

8.4

4.5

2.8

0 5 10 15Numbers indicate millions

5Blending Perspectives and Building Common Ground: A Report to Congress on Substance Abuse and Child Protection Washington, DC: Department of Health and Human Services. 1999.

Parental Substance Use Cited as Factor in Child Welfare Case

Parental or Alcohol Drug Abuse as Factor in Cases of Child Removal

Substance Abuse as Primary Reason for Case Opening

2007 AFCARS Data2007 AFCARS DataParental Alcohol or Drug Abuse as Factor

in Cases of Child Removal(N=190,900 Cases)

CFSR Round 1 Review2001-2004

(N=50 Cases)

CFSR Round 2 Review2007-2010

(N=65 Cases)

State Percent Percent Percent

A 4.4 16 20B 5.8 16C 9.2 2D** 10.0 8

TEXT PAGE*In Round 1, these data were not included in the first cohorts of States reviewed, it was an added item in subsequent States.

E 11.8 4 14F 42.6 2G 46.4 18H 51.0 8 31I 58.0 8 8J** 63.6 27

4

Data Summary

United States

N b P tNumber Percent

Total Treatment Admissions 1,817,577* 100%

Alcohol 732,925 40.3%

All Other Drugs 1,084,652 59.7%

Child Maltreatment Victims 758,289 20.9%

TEXT PAGE

Child Victimization Rate 10.3

1) U.S. Department of Health and Human Services, Administration on Children, Youth and Families. Child Maltreatment 2008 (Washington, DC: U.S. Government Printing Office, 2009). Tables 3.1, 3.32) Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Treatment Episode Data Set (TEDS) Highlights ‐ ‐ 2009 National Admissions to Substance Abuse Treatment Services. Tables 2a, 6a. OAS Series #S‐40, DHHS Publication No. (SMA) 08‐4313, Rockville, MD, 2009.

* Includes those with disposition of substantiated, indicated or alternative response victim. Percentage is number of maltreatment cases out of total number of children who received a CPS investigation.

7

The Reunification Gap: A State-level Example

Case Study:

• 62% of reunifications occur within 12 months62% of reunifications occur within 12 months

(11,500 of 18,500 reunifications)

• Per the National target of 75.2%, this state’s 12 month reunification goal should be 13,900.

• Therefore, the gap between the current and target reunification rate is 2 400 childrentarget reunification rate is 2,400 children.

• 2,400 children 1,701 parents– Child-parent ratio conversion = .72

5

• 1,701 parents need to complete treatment to meet the National Target reunification rate.

The Reunification Gap: A State-level Example

• To have 1,701 parents complete treatment, an additional 4,700 treatment spaces are necessary.– Assume 36% of parents who enter treatment

successfully complete the treatment episode

• 4,700 new treatment spaces represents 2.4% of the state’s total treatment admissions (assuming no overlap).– State has almost 200,000 annual treatment

admissions

The Threshold Issues

• Is substance abuse more than “just one more thing”—does it have a major impact on child welfare outcomes?

How can outcomes for families be improved through• How can outcomes for families be improved through partnership between the child welfare and substance abuse treatment systems?

• What is the role of timely access to effective treatment to resolve the substance abuse disorders affecting children and families involved in the child welfare system?

Wh t ibilit d t t t i h t

TEXT PAGE

• What responsibility do treatment agencies have to address child welfare outcomes?

6

The “How To” of CollaborationThe “How To” of Collaboration

The 10 Elements of System Linkages The 10 Elements of System Linkages

and Models of Collaborationand Models of Collaboration

11

Identified barriers1. Differences in values and perceptions of primary

li t

Summary of the Five National Reports

client

2. Timing differences in service systems

3. Knowledge gaps

4. Lack of tools for effective engagement in services

5. Intervention and prevention needs of children

6 Lack of effective communication6. Lack of effective communication

7. Data and information gaps

8. Categorical and rigid funding streams as well as treatment gaps

12

7

Suggested strategiesSuggested strategies1. Develop principles for working together

Summary of the Five National Reports

p p p g g

2. Create on-going dialogues and efficient communication

3. Develop cross-training opportunities

4. Improve screening, assessment and monitoring practice and protocols

5 Develop funding strategies to improve timely5. Develop funding strategies to improve timely treatment access

6. Expand prevention services to children

7. Develop improved cross-system data collection

13

ChangingThe System

Getting Better at Getting Along:

Four Stages of Collaboration

ChangingThe Rules

The System

Existing Funding

External Funding

InformationExchange

JointProjects

Sid Gardner, 1996Beyond Collaboration to Results

14

8

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

15

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 Sustainability9. Working with Other

Agencies

16

9

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

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

17

Mission



System Elements





Support

Outcomes


6. Information Systems7. Training and System

Tools8. Budget and Sustainability

9. Working with Other Agencies

10

Underlying Values and Principles of Collaboration

Tools and Resources

• Collaborative Values Inventory

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

ModelsModels

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

Mission



System Elements





Support

Missing Boxes

Outcomes





11

Dropoff Points

50,000 Children with Substantiated Abuse/Neglect 33,000 Parents

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

19,800

50% Go for Assessment

9,900

80% Need Treatment

7,920

50% Go to First Session 3,960

30% Complete 90 Days – 1,188

2150% Reunify or Stay with Parents 594

Spectrum of Substance Use Disorders

Experiment Experiment ppand and UseUse

AbuseAbuse

DependenceDependence22

12

Screening and Assessment

Tools and Resources• SAFERR- Screening and

Assessment for Family Engagement, Retention and Recovery

Models • Arizona Families• Arizona – Families

F.I.R.S.T. Model• Washington – GAIN-SS

and CDPs statewide• Maine- U.N.C.O.P.E.

Mission



System Elements





Support

Call Me Tuesday

Outcomes





13

Engagement and Retention

Tools and ResourcesSAFERR S i d A t f F il• SAFERR- Screening and Assessment for Family Engagement, Retention and Recovery

• SAS- Substance Abuse Specialist Paper

Models • Arizona – Families F.I.R.S.T. Model

S t STARS• Sacramento- STARS• Cuyahoga County- START

Mission



System Elements





Support

Outcomes





14

10 Element FrameworkServices to Children

• Complex interchange of biological, psychological and sociological events

• Screening is complicated by:– 1. There is no absolute profile of

developmental outcomes

– 2. Other issues in parental behavior, competence and disorders interactcompetence, and disorders interact which may lead to multiple co-occurring problems for children

Daily Practice – Services to ChildrenMultiple Opportunities for Intervention

• Commonly noted consequences for children– Fetal Alcohol Syndrome (FAS)– Alcohol-related neuro-developmental disorders

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

15

Services to Children

Tools and Resources• Substance-Exposed

I f t St t RInfants: State Responses to the Problem

Models • Washington State• Research Triangle InstituteResearch Triangle Institute• RPG Children's Cluster• Miami Zero to Two Court• Strengthening Families• Celebrating Families

Mission



System Elements





Support

What is the role of the RecoveryCommunity in Child Welfare Practice?

Outcomes





16

Mission



System Elements





Support

Outcomes





Joint Accountability, Shared Outcomes and Information Systems

Tools and Resources• RPG Data codebookRPG Data codebook• Webinars on linkages

Models • Michigan revised SACWIS to prioritize families with

substance use disorders• CFSR and NOMS processes• California CalOMS now tracks 7500 CW parents inCalifornia CalOMS now tracks 7500 CW parents in

treatment and knows which had positive outcomes [36%]

17

Mission



System Elements





Support

Outcomes





Training and Staff Development

Tools and Resources• NCSACW online tutorials• NCSACW online tutorials

• Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers

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

U d t di S b t U Di d T t t• Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Legal Professionals

18

Online Training

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

Implementing Online Tutorials

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

19

NEW! Child Welfare Training Toolkit

6 modules, each containing a:

•Trainer Script•PowerPoint Presentation•Handouts

•Case Vignettes

A il bl t NOAvailable at NO CHARGE!

http://www.ncsacw.samhsa.gov/training/def

ault.aspx

Training and Related Products

• On-Line Training

– Available at no cost

– Upon completion of the tutorial:

• Certificate awarded

• CEUs and CLEs are available

• Child Welfare Training Toolkit: Helping Child Welfare Workers Support Families with Substance Use, Mental,

d C O i Di dand Co-Occurring Disorders http://www.ncsacw.samhsa.gov/training/toolkit/

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

20

Mission



System Elements





Support

Outcomes





Budget and Sustainability

Tools and Resources

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

• IDTA State strategic plans for continued efforts

Models

• Milwaukee Courts Integrated Funding System

21

Mission



System Elements





Support

Outcomes





Working with Other Agencies

Partnership most frequently cited as necessary:

• Mental health services for adults.

• Mental health services for children.

• Domestic Violence

• Housing

• Income Support (TANF, Vocational Training, Employment)Employment)

22

Working with Other Agencies

Tools and ResourcesF il C t d T t t f W• Family Centered Treatment for Women

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

Models • Shields for Families, PROTOTYPES, Meta House • Other multiservice agencies

Mission



System Elements





Support

Outcomes





23

Shared Outcomes System Reforms

Tools and Resources• SAFERR communication protocols• IDTA State communication protocols and examples of data• 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 Plans

Models • Guide to Cross-System Data Sources for State and 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#May16

NCSACW In‐Depth Technical Assistance Sites Children’s Bureau Regional Partnership Grants

OJJDP Family Drug Courts

US DEPARTMENT OF HEALTH AND HUMAN SERVICESSubstance Abuse and Mental Health Services AdministrationAdministration for Children and Familieswww.samhsa.gov

NCSACW IDTA Sites = 20 Sites

16 States

3 Tribal Communities

1 County

14 OJJDP Sites

24

So what is being done and what

can we do?can we do?

Denise Churchill

Sam Gillespie

Peter Panzarella

Denise Churchill, LMFTDenise Churchill, LMFTOrange Orange County Social Services AgencyCounty Social Services Agency

Child & F ilChild & F il S iS iChildren & Family Children & Family ServicesServices

25

Orange County DemographicsOrange County Demographics Orange County covers nearly 800 square miles Orange County covers nearly 800 square miles

and is located between Los Angeles and Sanand is located between Los Angeles and Sanand is located between Los Angeles and San and is located between Los Angeles and San Diego counties in Southern California Diego counties in Southern California

The county is densely populated by 3 million The county is densely populated by 3 million residents, with 3,910 persons per square mileresidents, with 3,910 persons per square mile

47% Caucasian, 33% Hispanic, and 15% Asian47% Caucasian, 33% Hispanic, and 15% Asian 885,353 children ages 0885,353 children ages 0--1818gg

2,973 Dependents of the Court (March 2010 data)2,973 Dependents of the Court (March 2010 data)

Data source: Report on the Conditions of Children in Orange County, 2009 Data source: Report on the Conditions of Children in Orange County, 2009

49

Current Fiscal EnvironmentCurrent Fiscal Environment January 2009 January 2009 –– Present:Present:

Budgetary impactsBudgetary impacts Budgetary impactsBudgetary impacts Staff furloughs & layoffsStaff furloughs & layoffs ↓Resources↓Resources Client needClient need

Lowest # of child welfare dependent children in Lowest # of child welfare dependent children in past 10 yearspast 10 yearspast 10 yearspast 10 years

Improved Federal Child Welfare Outcomes for Improved Federal Child Welfare Outcomes for Safety, Permanence, Stability & WellSafety, Permanence, Stability & Well--Being Being

50

26

InIn--Depth Technical AssistanceDepth Technical Assistance Orange County, California: 2008Orange County, California: 2008--2010 2010 –– first county sitefirst county site Partners: Child Welfare AOD Treatment CourtsPartners: Child Welfare AOD Treatment Courts Partners: Child Welfare, AOD Treatment, CourtsPartners: Child Welfare, AOD Treatment, Courts Target Population: Target Population: Families with coFamilies with co--occurring child occurring child

welfare and substance use disorders that are in the welfare and substance use disorders that are in the jurisdiction of the Juvenile Court.jurisdiction of the Juvenile Court.

Focus on “front end” system processesFocus on “front end” system processes Goals & Priorities:Goals & Priorities:

Needs Analysis on range of services and available supportsNeeds Analysis on range of services and available supports Streamline referral process, communication and service accessStreamline referral process, communication and service access Inventory & analyze existing data & develop sharing protocolsInventory & analyze existing data & develop sharing protocols Develop a crossDevelop a cross--system training plan to support shared learningsystem training plan to support shared learning

51

Virtual WalkthroughVirtual Walkthrough

NIATx Process Improvement ModelNIATx Process Improvement ModelFlowcharting the WalkthroughFlowcharting the Walkthrough Flowcharting the WalkthroughFlowcharting the Walkthrough

Nominal Group Process to identify Nominal Group Process to identify challenges/solutionschallenges/solutions

Roles & Responsibilities of ParticipantsRoles & Responsibilities of Participants Focus on the systems & processes, not the individual Focus on the systems & processes, not the individual

staffstaff Timeframes, decision points, handTimeframes, decision points, hand--offs, information offs, information , p ,, p , ,,

sharingsharing Who, What, Where, How, When?Who, What, Where, How, When? Consider the client’s perspectiveConsider the client’s perspective Note observations & ideasNote observations & ideas

52

27

May 2009 & February 2010May 2009 & February 2010

Nearly 80 Orange County participantsNearly 80 Orange County participants Nearly 80 Orange County participants Nearly 80 Orange County participants Identified opportunities to achieve better Identified opportunities to achieve better

outcomesoutcomes Improved “front end” system processesImproved “front end” system processes Interesting considerationsInteresting considerations Key challenges identifiedKey challenges identifiedKey challenges identifiedKey challenges identified Key solutions generatedKey solutions generated

53

Infant identified as drug exposed at birth

Emergency Response SSW (ERSSW) assigned

ERSSW visits hospital, meets with nurse

ERSSW reviews mother and infant charts

Flow Chart: Services for Orange County Parents Whose Children are Identified as Drug Exposed at BirthFlow Chart: Services for Orange County Parents Whose Children are Identified as Drug Exposed at Birth

11

ERSSW interviews mother

ERSSW leaves mother and calls supervisor (SSSS) to discuss case and decide using SDM assessment

whether to hold child

If yes

ERSSW calls law enforcement of patient's

home jurisdiction and speak to watch commander to

obtain authorization for hold

If yes (always is)

ERSSW completes hold form in infant's medical chart

ERSSW completes Blue Form (Petition for Removal

Application with time of completion which starts the

ERSSW explains hold to mother and together with the nurse provides information

on treatment services

ERSSW completes paperwork at office: File blue

paperwork at Orangewood Children's Home, completes

referral in computer system to

Intake SSW should be assigned

22

premoval process timeline) on treatment services p y

get on detention hearing schedule

Same day

Team Decisionmaking (TDM) Scheduler schedules room

and invites appropriate people: parents, ERSSW,

CalWORKS if available

W/in 1 day

TDM held in person or by telephone if parent still in hospital, identify potential

family members for placement

Timing of 3 days

disputed by

parents

Parent recieives TDM summary, court hearing date,

time and location,familymembers under consideration

(we didn't discuss how this gets done and how the parent

gets it in time)

Hand off to Dependency Intake SSW (DISSW)

33

54

28

Detention Hearing Day: Parent orientation (voluntary)

Parent goes through security, at reception is told which court

room, sits for a long time outside court room w/various people approaching for info, parent assigned attorney at

court

Parent hears finding and placement decision

Parent ordered to drug test

Orders for services, pre-trial hearing and trial scheduled

Assign FSW?

Yes

Att b ll i f

5544

66

Family Service Worker (FSW) follow-up with placement,

completes checklist case with parent, goes over finding

Attorney verbally informs parent of the court order and

parent to call SW, encourages parent to get involved in

services

Assign Drug Court?

No

Hand-off to Dependency Investigation SSW/FSW w/in 3

days

W/in 2 weeks

First interview of FSW with parents to discuss case

planning including treatment

Treatment access depends on services. Drug Court services

accessed faster, outpatient (OP) services accessed faster, wait lists vary but currently no

wait for OP

Jursidiction Hearing Day: Parent goes through security. At reception, told which court

room

Parent receives case plan in writing

FSW reviews court minutes and works with parent on

orders

77

wait for OP

DISSW goes through the case with parent

Parent may become involved with educational specialist,

CalWORKS or perinatalprogram

Parent may be assigned a Parent Mentor

88

55

Initial Walkthrough OutcomesInitial Walkthrough Outcomes

2 Plan/Do/Study/Act (PDSA) Cycles to pair2 Plan/Do/Study/Act (PDSA) Cycles to pair2 Plan/Do/Study/Act (PDSA) Cycles to pair 2 Plan/Do/Study/Act (PDSA) Cycles to pair Parent Mentors with ParentsParent Mentors with Parents

Parent Surveys & Focus GroupsParent Surveys & Focus Groups Staff &Community Partner Focus GroupsStaff &Community Partner Focus Groups Orange County Training MatrixOrange County Training Matrix

R i li d R A li tiR i li d R A li ti Regionalized Resource ApplicationRegionalized Resource Application Data Exchange Protocol Data Exchange Protocol –– SSA & HCASSA & HCA

56

29

Parent Engagement EffortsParent Engagement Efforts Earlier access to treatment for child welfare parentsEarlier access to treatment for child welfare parents Development of Recovery Specialist Model Development of Recovery Specialist Model p y pp y p

Family Services WorkersFamily Services Workers Assigned upon child entering foster care to assess Assigned upon child entering foster care to assess

parent’s needs, facilitate early access to treatment parent’s needs, facilitate early access to treatment and child visitationand child visitation

Development of Parent Partner ModelDevelopment of Parent Partner Model Contract with Family Support NetworkContract with Family Support Network Provides parent partners at the initial Team Decision Provides parent partners at the initial Team Decision

Making meeting, prior to the first court hearing, Making meeting, prior to the first court hearing, leading to increased rates o service plan engagementleading to increased rates o service plan engagement

Operation of Family Dependency Drug Court ModelOperation of Family Dependency Drug Court Model

57

Ongoing Oversight & SupportOngoing Oversight & Support Child Welfare Redesign Planning CouncilChild Welfare Redesign Planning Council

Efforts to redesign Child Welfare Contracted ServicesEfforts to redesign Child Welfare Contracted Services Efforts to redesign Child Welfare Contracted ServicesEfforts to redesign Child Welfare Contracted Services Efforts to prioritize court ordered case plan activitiesEfforts to prioritize court ordered case plan activities

Blue Ribbon CommissionBlue Ribbon Commission Efforts to build Volunteer Parent Mentor poolEfforts to build Volunteer Parent Mentor pool Efforts to increase Recovery Specialist Model (FSW)Efforts to increase Recovery Specialist Model (FSW)

58

30

Sam GillespieIllinois Department of Children and

Family Services, Service Intervention Division

Statewide Alcohol and Other Drug Abuse Services Administrator

Setting the Stage

1998 GAO study in Chicago and Louisiana 74% of Cook County (Chicago) foster care

h d 1 i d b hcases had 1 or more parents required by the child welfare service plan to receive treatment

Less than 20% of parents were in treatment or had completed treatment at the time of the study

Average time in foster care for substance abuse involved families: 46 months

Most child welfare agencies has limited f ili it ith il bl b tfamiliarity with available substance resources

Judges reported that permanency decisions were consistently delayed due to a lack of information on parent’s treatment progress

60

31

Setting the Stage

DCFS Inspector General reports cite substance abuse in child death andsubstance abuse in child death and injury cases involving intact families

61

Child Welfare Needs from the Substance Abuse System

Outreach and Engagement with the client early and often in the processclient early and often in the process

Streamlined referral process for the caseworker (as paperless as possible)

Expedited assessment and entry into treatment

Collaboration with caseworker to Collaboration with caseworker to eliminate barriers to treatment

Child care, transportation, fees

62

32


Joint staffings, family meetings, substance abuse treatment planningsubstance abuse treatment planning

Re-engagement in services when necessary

Standardized regular reporting to the worker and the courts

Treatment progress, drug test results, observations of parent-child interaction

63


Assistance with other identified barriers to recovery and reunificationto recovery and reunification

Mental health, domestic violence, housing needs

Substance abuse providers can help child welfare workers to understand the an entire family needs treatment and the family needs to recover from a parent’s substance abuse

64

33

Illinois’ Responses

On site substance abuse assessments and same day referrals at Cook Countyand same day referrals at Cook County Juvenile Court

Recovery Coaches to work with parents, caseworkers, treatment providers and the courts

Intact Family Recovery program to pair Intact Family Recovery program to pair child welfare workers and substance abuse case managers to jointly work substance exposed infants (SEI) cases

65

Illinois’ Responses

Drug free, recovery oriented housing programs for recovering moms andprograms for recovering moms and children

Targeted funding to substance abuse providers to serve referrals from child welfare and collaborate with caseworkers and the courts

66

34

Lessons Learned from Cross-Systems Collaboration

Judges need consistent timely information over the course of treatment and the childover the course of treatment and the child welfare case

Reports from substance abuse providers have to clearly show progress in a case and movement toward recovery and the ability to parentWh th t th ll When the courts see the overall progress of a case they can become more comfortable and accepting of relapses and lack of progress at points during treatment

67

Lessons Learned from Cross-Systems Collaboration

Judges are the key component in the court system but not the onlycourt system, but not the only components

Prosecutors, defense attorneys, guardians, courtroom staff must all buy in to the collaborative model for success

68

35

ConnecticutConnecticut Re-Directed Funding:

RSVP and Ensuring Cost Savings

P t P llPeter Panzarella,

Director of Substance Abuse at DCF

Connecticut Overview

Population - 3,409,549 Approximately 750,000 under age 18

N C t G t (169 T G t No County Government (169 Town Government and Home Rule)

CT Department of Children and Family is a consolidated Children’s Agency with mandates

CT Department of Mental Health and Addiction Services (Adults)

Unified Judicial Branch

70

36

Development of Recovery Specialist Voluntary Program

CORE Team

Policies and Practice

Staff DevelopmentInformation Sharing Staff Development

Resources

Information Sharing

71

RSVP ProgramThree Pilots; Bridgeport, Willimantic and New Britain

Recovery Specialists positions re-allocated from existing staff.

Based on STARS Model

No Family Drug Courts in CT

Conducts reliable random drug screens

Assist parents in engaging in SA treatment

Support parents in increasing their recovery capital Support parents in increasing their recovery capital through recovery coaching

Provide regular documentation to DCF, courts, and attorneys

72

37

RSVP Program Outcomes

Increase inter-agency coordination and collaboration Increase coordinated case management and planning across

agencies Increase the number of OTC substance-abusing

parents/guardians receiving treatment and support services Increase length of time in substance abuse treatment; Increase treatment completion rates Shorten time to family permanency Increase family re-unification rates y Decrease rates of repeated child maltreatment and re-entry to

DCF; and Reduce costs associated with TPR cases

73

DCF and DMHASProject SAFE Joint Contract

$3,680,863 FY2009 budgeted (DCF 70% and DMHAS 30%) 30% Drug Testing (Over Budget $160,000 in FY 2009) 9% on SA Evaluations 61% Treatment and Recovery

Contract Advanced Behavioral Health Central intake - # 800 Access to drug screens, substance abuse evaluations & a

variety of outpatient substance abuse treatment services Provider network 51 providers Centralized data reports & electronic billing

http://www.abhct.com/resources_Downloads.asp

74

38

Connecticut Project SAFE Screening & Utilization Data

22,50025,000

Urine Testing

5 0007,500

10,00012,50015,00017,50020,000

CPS Caseload

Evaluations

02,5005,000

FY06 FY07 FY08* FY09

GAIN Short Screen

75

Connecticut Substance Abuse Screening GAIN Short

Screen Data for Protective Services

76

39

Project SAFE Drug Testing Data

2917 2913

Urine Tox ScreensFY 09 by Quarter - Statewide

2917

2307

2781

2327

2913

2645

2860

2217

1000

1500

2000

2500

3000

0

500

Quarter I Quarter II Quarter III Quarter IV

Random Utox TX UtoxFigure 1

77

Cost Savings in Screening and Drug Testing

RSVP program, the urine toxicology screens occur ith i t t d t t kitwith an instant read test kit.

The client is asked if he/she has used any substances in the period since last tested

Client can challenge a positive test results the sample is sent to a lab for MG/CS confirmatory analysis.

The client signs that the results are accurate. No positive confirmatory testing is required.

Significant decrease in confirmation testing costs

78

40

Projected Savings Shifting from Drug Testing to Recovery Supports

Priority to Clients with High Need Direct to TreatmentTreatment

Projected Decrease of 15% for FY 2010

Decrease of 7.7% of Average Number of Urine Tests Per Unduplicated Clients (Third Quarter Comparison)

35% Projected Cost Savings for FY 2011

Redirect to RSVP and Recovery Supports

79

Together we embrace safety, permanency, g y, p y,substance abuse treatment and recovery.

Our ultimate goal is to achieve results for a family

th t ill l t lif ti ”that will last a lifetime.”

80

41

Technical Assistance Technical Assistance ResourcesResourcesResourcesResources

81

Levels of Technical Assistance

Level One:

Information and Sharing of Models

Level Two:

Expert Consultation and

Research

Level Three:

Development of Issue‐ Specific

Products

Level Four:

Strategic Planning, Training Resources and Facilitation

16 States3 Tribes1 County

53 Grantees10 Pre‐IDTA

247 requests 366 requests 1077 requests

September 2001 through June 2009 82

42

Types of TA Products

• Collaborative practice and policy tools

• Information and sharing of models• Information and sharing of models

• Expert consultation and research

• Development of issue-specific products

Monographs, white papers, fact sheets

• Training resources and collaborative facilitationg

On-line courses, training materials

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

83

Types of TA Products

• Collaborative practice and policy tools

• Information and sharing of modelsInformation and sharing of models

• Expert consultation and research

• Development of issue-specific products

Monographs, white papers, fact sheets

• Training resources and collaborative facilitationfacilitation

On-line courses, training materials

• Longer-term strategic planning and development

of protocols and practice models84

43

National Center on Substance Abuse and Child Welfare

How do I access technical assistance?

• Visit our NCSACW Exhibit Booth!

• Visit our Website: http://ncsacw.samhsa.gov

• E-mail Us: [email protected]

C ( 1 ) 0 3 2• Call Us: (714) 505-3525

85

Denise Churchill, LMFTOrange County Social Services Agency, CFS

Nancy K. Young, MSW, PhDNational Center on Substance Abuse and Child Welfare

Contact Information

Specialized Family Services (SFS) ProgramAdministrative Manager IIPhone: (714) 704-8500 E-mail: [email protected]

DirectorPhone: (714) 505-3525Email: [email protected]

Sam GillespieIllinois Department of Children and Family Services Service Intervention

Peter Panzarella, MA, MSConnecticut Department ofDirector of Substance Abuse Services

TEXT PAGE

Family Services, Service InterventionDivisionStatewide Alcohol and Other Drug Abuse Services AdministratorPhone: (312) 814-5483E-mail: [email protected]

86

Director of Substance Abuse ServicesPhone: (860) 642-3947E-mail: [email protected]

creating change through collaboration: substance abuse and ... · policy and practice innovations...

Documents