who is eligible for sense? - pcaaz
TRANSCRIPT
1
Substance
Exposed
Newborn
Safe
Environment
Families with substance exposed newborns agree to participate in the SENSE program offered by DCS after a report was made.
SENSE is a multidisciplinary approach to ensuring children’s safety and needs are met while making behavioral changes with parents.
A coordinated service delivery in which there are up to 5 visits in the home weekly made by service providers and DCS.
2
Who is Eligible for SENSE? • Any newborn exposed to substances
prenatally.
• The SEN was reported to DCS as a report, with or without dependency.
• The baby is going home with parents and parents agree to services, can be safe or unsafe w/safety plan.
3
2
Mandated reporters including OB/GYN staff, hospitals, midwives and relatives with concerns report prenatal substance abuse
Once the newborn and/or parent test positive, the parent reports drug use or a positive drug test during prenatal visits results in a report generated at the DCS hotline.
A.R.S.13-3620e the requirement that health care professionals report substance exposure in infants to DCS.
A.R.S.13-3401 lists 150+ possible substances.
SFY 2015 the Child Abuse Hotline received 3,594 reports with a tracking characteristic of substance exposed newborn and SFY 2016 reports were up to 4,059 received w/SEN tracking characteristic
3
Impaired fetal growth
Prematurity
Neurobehavioral impairment
Regulatory impairment
Behavioral changes
Developmental delays
SIDS
Child abuse
For use with parents who have addictions to Opiods
Medications to reduce problem addiction behavior and cravings
Medications include methadone, suboxone, vivitrol
Can use MAT as long as needed to assist the person to reframe from abuse of drugs
Breast feeding should be encouraged with mom’s that are not using any other drugs
Has the parent signed an ROI for coordination
Is parent participating in drug testing and counseling?
Is parent missing doses?
Are there any questionable behaviors of the parent your or someone observed?
Is the parent showing any other substances on the PDMD?
Can you please send a monthly progress report for the parent’s participation in MAT?
4
Parent should be engaged and/or completed formal substance abuse treatment
Ask MAT provider what is the level of treatment provided to parent
Parents actively engaged in MAT are 70% more likely to be reunited w/children
Good Clinics can be found by going to Arizona Opiate Treatment Coalition (AOTC)
HOSPITAL
HOTLINE
DCS INVESTIGATIONS
Global Assessment
of present and
impending danger
and risk
Child Safety and
Risk Assessment
(CSRA)
C-CSRA and Case
Plan
1. Extent of maltreatment2. Circumstances surrounding maltreatment and prior history3. Parents functioning4. Children’s functioning5. Parenting Practices6. Disciplinary Practices
5
Is the child/ren safe? The first priority is to ensure safety and keep families together whenever possible.
Substantiate/unsubstantiate allegation
Based on assessments, what services are needed and could the family benefit from?
What type of intervention is warranted?
Is court oversight needed?
Voluntary
PlacementHome with Parents
OR
With Safety
Monitor.
Without
Safety
Monitor.OR
Out of home
90 days.
Out of Home
Dependency
Not a SENSE case
OR
OR
In
Home
Intervention
In
Home
Dependency
OR SENSE SERVICE
ONLY
JFCS SWHD HRT/PSP
DCS SENSE PROGRAM MARICOPA COUNTY
Families FIRST& Drug testing
Intensive In Home Service
ProviderHV Nurse
Healthy Families or Parents as
Teachers where available
DCS In-homeSpecialist
Recovery Coaches
15
6
Complete a substance abuse assessment to determine the level of treatment
Notify client of Families First treatment recommendations and set appointments
Notify team members of the assessment results and treatment recommendations
Communicate with team client’s progress or relapses.
Vision Statement and Guiding Principles
The vision of the Substance Abuse Treatment Fund is to build a family centered service delivery system, which promotes family independence, stability, self-sufficiency, and recovery from substance abuse, assures child safety and supports permanency for children.
TERROS Substance Abuse Treatment Philosophy
Uses the strengths-based, best practice Recovery Model
Number of sessions are not counted
Based on treatment/recovery/case plans/behavioral changes
Stages of change model
Motivational interviewing
Involvement in community supports
SENSE cases will utilize all providers to engage client into treatment services
7
Substance Abuse Treatment
ASSESSMENT
The AFF assessment is a comprehensive substance abuse assessment that is also provided by the RBHA and is designed to determine the level of care that is most beneficial to the client.
The referred client will need to meet the DSM-5 diagnostic criteria for a recommendation of substance abuse treatment services
Levels of Care
Substance Abuse Awareness: contemplative stage
Standard Outpatient: least restrictive outpatient treatment, minimum 3 hours of group therapy a week
Intensive Outpatient: most intensive outpatient treatment, minimum 8 hours group therapy a week
Residential: 24 hour care treatment
Recovery Maintenance: aftercare services and community resource involvement
(Treatment is a combination of individual, group, and family components)
Drug Testing
AFF uses a best practice model for Drug Testing frequency:
– 2X per week for the first 60 days
– 2X per month from 61-120 days
– 1X per month after 120 days
Testing results from other entities are included in the above requirements to ensure services are not duplicated
8
Supportive Services
Case Management Services: to eliminate any barriers to treatment including child care, transportation, utilities, housing assistance, etc.
Concreate Support Services: financial assistance
Recovery Coaches• Engage clients into treatment
• Encourage clients to remain in treatment
• Help clients navigate the child welfare system
• Guide clients through the process of recovery
• Recovery Coaches are assigned to all SENSE clients
• May attend the 10, 45, 90 day SENSE staff meetings
Make contact with client within 12 hours
Assist in coordinated case plan development with family and all team members.
Ensures infant is assessed by pediatric nurse within 30 days of case assignment
Make the referral to Healthy Families/PAT/Home visitor program
Set up email for all team members. Set up10, 45 and 90 day staffings with family and all providers
Infant Physical
Weight, length, head circumference
Allergies, medications
Nutrition, feedings
Respiratory/cardiovascular
Immunizations, car seats
Vision, hearing
Elimination, sleep patterns
ER—Urgent care visits
PCP well child visits
24
9
Infant Developmental
Denver II Developmental screen
Ages and Stages Questionnaire (ASQ) developmental screen
Maternal Health
Postpartum visit and inter-conception information
Edinburgh Postnatal Depression Scale (EPDS)
Smoking
Brief Medical HX
25
Families voluntarily participate in the program from pregnancy up to the child turning 5 years old
Families must enroll prior to baby turning 90 days old
Visits are weekly w/SENSE families
Developmental screenings, parenting skills and family self sufficiency are goals of the program.
All families are eligible for PAT regardless of income, needs and includes ALL family members
Participation is voluntary and families can enter the program with chn any age under 5
Families can enter the program prenatally and can participate in the program until kindergarten
Visits weekly w/SENSE families and does a baseline developmental screening
10
With SENSE cases
communication is the Key.
The parents sign a Release of Information to ALL involved providers so all providers can communicate with each other and the family.
TASC/ PSI
FAMILY
Families FIRST
Completes intake
and reports results
Healthy Families for
Infant assessment &
Long Term Services
where available or PAT
Family Preservation
Team engages family
in behavioral changes
In-Home case
manager
conducts
weekly home
visit .
Court
The earlier in a case we communicate, the better the outcome for the family...and the infant.
Communication starts with attending training, the 10, 45 and 90 day meetings and weekly emails.
30
11
In Home Unit case managers see family within 2 days.
If Release of Information was not signed at TDM, CM has family sign, giving permission for all parties to communicate with one another.
In Home CM makes referral to AZ Families FIRST if this was not done at TDM
Refers for Family Preservation/Intensive In Home Team
Ensures drug testing has been requested and who will be monitoring weekly results
Set up 10, 45 and 90 day staffing with family and all providers
Once teams are identified by agencies:
In Home CM creates and adds to email list of all team members
In Home CM arranges team meeting with family within 10 days
At this time the family’s case plan is developed.
12
Mid-point meeting will be held with family in their home and all team providers in 6-8 weeks to discuss behavioral changes made, barriers to goals and progress of the family
Comprehensive case plan will be reviewed by all parties along with Infant Care Plan
Closure staffing will be held with family and all team members.
Development or review of after-care plan with family.
Family Preservation services conclude at this time.
Healthy Families/PAT/Home Visitor Program and Families First should be encouraged with the family to continue services.
DCS In Home case manager will continue contact with AFF and Healthy Families/PAT as long as the DCS case is open.
DCS will monitor the family until the DCS case is closed and review infant care plan
It is a goal of SENSE the home visitor program such as HF or PAT services and AFF continue after DCS case closure.
13
When all members of the SENSE team communicate with one another, it looks like this:
Safe Children, Healthy Families
Without coordination and communication we can not support parents and children effectively.
14
We can make a difference…
…that’s what makes SENSE.
SFY 2014 and 2015 SFY 2014 and 2015
Signed into law August 2016 to address SEN’s
Plans for safe care for infants identified as being affected by substance abuse or withdrawal symptoms
States report number of infants affected, number of infants with safe care plans and number of infants for whom service referrals were made including services to parents and caregivers.
15
DCS Specialists must Create an Infant Care Plan for ALL newborns prenatally exposed to alcohol or other substances
ALL SEN cases remaining open or closing at investigations
Create plan with parents, caretakers, providers
Have plan signed by parents or out of home caregivers
Plan should address substance abuse treatment for parents, medical care for infant, safe sleep, knowledge of parenting and infant development, living arrangements, child care and social connections.
Plan should be reviewed and reassessed during staffings, CFT and other meetings
Develop Aftercare plan prior to case closure
QUESTIONS?