Nancy K. Young, Ph.D., Director

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Childrens Bureau Permanency Partnership Forum
VII May 19 to 21, 2003 Permanency Outcomes
for Children Affected by Substance Abuse
Nancy K. Young, Ph.D., Director National Center
on Substance Abuse and Child Welfare Children and
Family Futures 4940 Irvine Boulevard, Suite
202 Irvine, CA 92620 714.505.3525 Fax
714.505.3626 www.ncsacw.samhsa.gov
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Work Shop Overview

• NCSACW
• Scope of Issue
• Policy Tools for Solutions
• Models of Changed Practice
• Issues for Children
• Models of Family Drug Courts

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Developing Knowledge and Providing Technical
Assistance to Federal, State, Local Agencies and
Tribes to Better Serve Families with Substance
Use Disorders in the Child Welfare and Family
Court Systems
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• NCSACW's goal
• To promote effective practice, organizational,
  and system changes at the local, state, and
  national levels by
• Developing and implementing a comprehensive
  program of information gathering and
  dissemination
• Providing technical assistance

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• A Consortium Approach
• Children and Family Futures - implementing the
  NCSACW under contract with CSAT and ACYF
• CWLA Child Welfare League of America
• NASADAD National Association of State Alcohol
  and Drug Abuse Directors
• NCJFCJ National Council of Juvenile and
  Family Court Judges
• APHSA American Public Human Services
  Association
• NICWA National Indian Child Welfare Association

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• Tasks
• Conduct Marketing and Public Awareness
• Collection and Dissemination of Information
• Develop Materials
• Develop Web-based Access to Information and
  Tutorials
• Conduct Conferences and Meetings
• Provide Technical Assistance

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Believing is seeing
By inverting the cliché, it communicates that we
can only see what we are prepared to see
Child abuse was discovered when, doctors
added social workers to their teams Until
then, doctors didnt allow the possibility that
parents were hurting their kids because they
didnt know what to do next
Diane L. Coutu, Sense and reality A
conversation with celebrated psychologist Karl E.
Weick, Harvard Business Review. April 2003. pp.
84-90.
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The Power of Teams

• Social workers said, Sure, child abuse happens,
  and we know how to handle it by providing child
  protective services
• At that point the physician teams could afford
  to see child abuse, because then they knew how to
  deal with it.
• The greater the repertoire of responses
• you have on your team,
• the more things you can do.

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The Power of Teams

• Only when social workers really connect with
  substance abuse counselors do they know what to
  do next when alcohol and other drugs are a part
  of the problem
• Then they can, as Weick puts it, afford to see
  substance abuse, because they have a response to
  it

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The Power of Teams

• Only when substance abuse counselors connect with
  child development and family services workers do
  they have a sense of the full force of family
  dynamics in helping parents recover
• And only when family support staff connect with
  income support workers do they know what to do
  next when poverty is a part of the problem

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Paths of a Childs Exposure to Alcohol and Other
Drugs
PATHS OF EXPOSURE
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Impact of AOD on Children

• The Two Most Significant Risks to Children of
• Substance Users
• They Have Poorer Developmental Outcomes
• They Are at High Risk of Substance Abuse
  Themselves1
• Children of Substance Abusers Exhibit
• Depression and Anxiety More Often Than
• Children from Non-addicted Families2

1. Department of Health and Human Services,
Blending Perspectives and Building Common Ground,
April 1999 2. National Association for Children
of Alcoholics, Children of Addicted Parents
Important Facts, http//www.nacoa.org
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National Estimates of Children Living With At
Least One Substance Abusing Parent
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COSAs and Child Abuse/Neglect Victims
Millions
0 2 4 6 8
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Child Maltreatment 2001
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California Parents Entering Publicly-Funded
Substance Abuse Treatment

• Had a Child under age 18 59.0
• Had a Child Removed by CPS 24.5
• If a Child was Removed, Lost Parental
  Rights 36.9
• Treated in Outpatient 32.5
• Treated in Residential 44.7
• Treated with Methadone 73.6

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Key Barriers Between Substance Abuse, Child
Welfare and The Courts

• Beliefs and Values
• Competing Priorities
• Treatment Gap
• Information Systems
• Staff Knowledge and Skills
• Lack of Communication
• Different Mandates

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The Five Clocks

• TANF Welfare
• 24 Months 60 Months

• ASFA - Child Welfare
• Permanent Plan at 12 Months
• File for TPR if in Out-of-Home Care 15 out
• of 22 Months, Can File TPR if Abandoned

• Recovery - Lifetime Process, One Day at a Time

• Child Development

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How to Connect the AOD, CWS, Court Systems
Elements of System Linkages

• Underlying Values
• Daily Practice-Screening and Assessment
• Daily Practice-Client Engagement and Retention in
  Care
• Daily Practice-AOD Services to Children
• Joint Accountability
• and Shared Outcomes

• Information Sharing MIS
• Training/Staff Development
• Budgeting/Program Sustainability
• Building Community Supports
• Working with Related Agencies and Support Systems

From CSAT Technical Assistance Publication (TAP)
27 Navigating the Pathways Revised March 2003
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Policy Tools

• Development of Policy Tools to Facilitate
  Collaborative Work Across Systems
• Collaborative Values Inventory
• Collaborative Capacity Instrument
• Matrix of Progress in Linking Substance Abuse and
  Child Welfare Services

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Key CFSR Outcomes with Implicationsfor Substance
Abusing Families

• Families Have Enhanced Capacityto Provide for
  Their Childrens Needs
• Children Receive Appropriate Services to Meet
  Their Educational Needs
• Children Receive Adequate Services to Meet Their
  Physical and Mental Health Needs

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Families Have Enhanced Capacityto Provide for
Their Childrens Needs

• Improved Screening and Assessment Protocols and
  Effective Communication Paths Across Systems
• Standardized Screening Tools
• Partnering for AOD Expertise
• Standardized Monitoring Reporting Tool
• Joint Case Planning

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Families Have Enhanced Capacityto Provide for
Their Childrens Needs

• Engaging and Retaining Parents in Care
• Use of Motivational Interviewing and Stages of
  Change
• Use of Persons in Recovery as Members with Family
  Team
• Use of Substance Abuse Staff to Increase Recovery
  Management
• Increased Judicial Oversight
• Preserving Relationships with Birth Parents
  Regardless of Type of Permanency Outcome

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Models of Changed Practice

• Workers out-stationed in collaborative settings
• Increased case management and monitoring of
  recovery progress
• New methods and protocols on sharing information
• Increased judicial oversight and family drug
  treatment courts
• New priorities for treatment access for child
  welfare-involved families
• New safe and sober housing initiatives

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Children Receive Appropriate Services to Meet
Their Educational, Physical and Mental Health
Needs

• Services for Children and Families
• Based on Developmental Stages
• Prenatal and Birth Primary Health Care
• Infants Bonding and Attachment
• Toddlers Developmental Interventions
• School Readiness Language, LD and Behavior
• Latency COSA Group Interventions
• Pre-Adolescent Targeted Prevention
• Adolescence Intervention Treatment
• Transition to Adulthood COSA Coping and Life
  Skills

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Childrens Service Models

• Define At Risk Births
• Primary Care 4 Ps Parents, Partner, Past,
  Pregnancy
• Hawaii Healthy Start Risk Factors
• Developmental Screening
• Early Childhood Education
• Free to Grow RWJ Program
• Starting Early Starting Smart - SAMHSA
• Parent Training
• Nurturing Parents Institute for Health
  Recovery - Boston

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Childrens Service Models

• Children of Substance Abusers
• The 7 Cs NACOA.ORG
• I didnt Cause it
• I cant Cure it
• I cant Control it
• I can Care for myself by
• Communicating my feelings
• Making healthy Choices
• And by Celebrating myself

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Models of Family Treatment Courts

• Integrated Santa Clara
• Both dependency matters and recovery management
  conducted in the same court with the same
  judicial officer

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Models of Family Treatment Courts

• Dual Track San Diego
• Dependency matters and recovery management
  conducted in same court with same judicial
  officer during initial phase
• If parent is noncompliant with court orders,
  parent may be offered DDC participation and case
  may be transferred to a specialized judicial
  officer who increases monitoring of compliance
  and manages only the recovery aspects of the case

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Models of Family Treatment Courts

• Parallel - Sacramento
• Dependency matters are heard on a regular family
  court docket
• Specialized court services offered before
  noncompliance occurs
• Compliance reviews and recovery management heard
  by a specialized court officer

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Significantly Less Criminal CPS Recidivism
Among FDTC Parents in Five Sites
plt.05
Percent of Parents in 18 Months
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Average Days to PermanencySacramento County
Dependency Drug Court
n90
n146
plt.001
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Nancy Sids Top 10 List for Foster and
Adoptive Parents

• Keep a journal of everything
• Get on the wait list for the best services in
  town
• Live on the internet with other parents
• To ask can he understand after being told he
  can hear
• Be prepared to have a 3rd or 4th jobcase
  managementwe are their best advocates and know
  them better than any professional

Personal Experience not NCSACW
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Nancy Sids Top 10 List

1. Knowing the mental health diagnoses of birth
   parents is critical
2. Children of bi-polar parents with ADHD symptoms
   should be treated as bi-polar
3. Schools will usually first say No, hire an
   advocate for I.E.P.
4. Know that adopted kids have a hole in their
   heart
5. Take time for yourselvesdont mortgage your
   marriage

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The Most Important Clock

• The Clock that is Ticking on Us
• How long do we have to act if our families have
  24 months to work and 12 months to reunify?
• Taking this clock seriously means that we build
  the needed bridges between systems with a sense
  of urgency and a timetable that start now