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2	Overview of Presentation Policy and Practice Issues regarding Families with Substance Use Disorders Introduction of a Framework and Policy Tools for Interventions Models of Practice and Policies Family Treatment Court Findings Future Activities of NCSACW
3	Children Living With One or More Substance Abusing Parent
4	THE FIVE CLOCKS Temporary Assistance for Needy Families (TANF) 1996 24 Months Work Participation 60 Month Lifetime
5	Where have we been?
6	Five National Reports Child Welfare League of America General Accounting Office Children’s Defense Fund The National Center on Addiction and Substance Abuse at Columbia University The Department of Health and Human Services
7	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
8	CSAT Commissioned TAP The State of Connecticut The State of New Jersey Sacramento County, California Cuyahoga County, Ohio Jacksonville, Florida The Miami Dependency Court The San Diego Dependency Court
9	Introduction of a Framework and Policy Tools for Interventions
10	Framework for Systems Change To define linkage points across systems To describe the components of the initiative To assess the progress in implementation To assist sites in measuring their implementation
11	"Underlying Values" 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
12	1. Values and Common Principles Issues to Address Who is the Client -- Parent, Child, Family? Can AOD Users/Abusers/ Addicts/Alcoholics be Effective Parents? What is the Goal -- Recovery, Child Safety, Family Preservation, Economic Self-sufficiency?
13	How to Begin: Use Tools Such As the Collaborative Values Inventory to Identify and Resolve Differences That Exist Across System Ensure Conversation Happens at Policy, Supervisory and Front-line Levels
14	2. Daily Practice -- Client Intake, Screening and Assessment Issues to Address Roles and Responsibilities Across Systems Communication Paths Across Systems Incentives for Prioritization Missing Box Problem
15	Too Often We Practice… “Don’t Ask, Don’t Tell” Nationally, we have “missing box” problems
16	"Clarify Intake Procedures and AOD/Child..." Clarify Intake Procedures and AOD/Child Safety Screening Protocols Decide on Team, Tool, Method, Roles and Responsibilities to Provide AOD Expertise to Child Welfare Workers in Investigative/Assessment Phases Ensure Parents Seeking Treatment Receive Needed Supports for Child Safety
17	3. Daily Practice -- Client Engagement and Retention in Treatment Issues to Address Outreach and Engagement Strategies Addressing Motivation to Change Cross-system Agreement on Approaches to Relapse Responding to Clients’ Progress in Treatment
18	How to Begin: Implement Assessment and Interventions based on Readiness to Change Develop Mechanism to Re-engage Clients in Care Ensure AOD Treatment and CPS Practice is Responsive to Clients’ Individualized Needs
19	4. Daily Practice -- Services to Children Issues to Address Prevention, Early Intervention, and Treatment Services for Children in Contact with CPS Content of Independent Living Programs on Parental Substance Abuse Pediatrics (1999) v.103:1083 – 1155, Special Topics on Children and Adolescents in Families Affected by Substance Abuse http://www.pediatrics.org/cgi/content/full/103/5/SI/1083
20	How to Begin: Develop Partnerships to Respond to Potential Neuro-Developmental Effects of Prenatal Substance Exposure Provide Prevention and Intervention Services to Children and Adolescents Ensure that Youth Receive Appropriate Youth Development Intervention and Activities Ensure that ILP Teens Receive Appropriate Information Related to Risks of Substance Abuse
21	5. Information Sharing and Data Systems 6. Training and Staff Development
22	We Know AOD Treatment Pays 100 Women Average cost $6,800 $680,000 150 Children Average 2.5 years in out-of-home care @ $18,000 per year $45,000 each; $6.75 Million
23	Models of Changed Practice Workers outstationed in collaborative settings Increased case management and monitoring of recovery progress New protocols for sharing information Increased judicial oversight and family drug treatment courts New priorities for treatment access for child welfare-involved families [CA: 34% women; Sacramento 52%] New safe and sober housing initiatives AOD-DV-MH collaboration models
24	10. Working with Related Agencies Primary Health Care Domestic Violence Trauma Mental Health Dental Health Transportation Child Care Medicaid Housing Economic Security Education for Mother and Children
25	Policy Tools Collaborative Values Inventory Collaborative Capacity Instrument Matrix of Progress in Linking Substance Abuse and Child Welfare
26	Findings from the Retrospective Phase Family Drug Treatment Court National Cross-Site Evaluation Nancy K. Young, Ph.D. Mamie Wong, Ph.D. Tina Adkins, M.A. Shaila Simpson, M.S.W. Children and Family Futures 4940 Irvine Boulevard, Suite 202 Irvine, CA 92620 714.505.3525 Fax 714.505.3626 www.cffutures.com
27	Jointly Funded Department of Health and Human Services Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Services Administration on Children, Youth & Families, Children’s Bureau, Office on Child Abuse and Neglect Assistant Secretary for Planning and Evaluation Department of Justice National Institute on Justice Drug Court Program Office
28	Retrospective Phase Purpose Evaluation included Documenting the program models and processes for substance abuse treatment, child welfare services and the court Evaluating FDTC participants’ outcomes relative to a comparison group receiving standard services for substance abuse treatment engagement, retention and completion, child safety and permanency and the timeliness of court interventions Prospective phase is being implemented by NPC Research
29	Retrospective Phase Design Quasi Experimental - Comparison cases selected from either cases not offered FDTC services for administrative reasons or cases that entered CWS just prior to FDTC implementation Each FDTC Site Approximately 50 FDTC intakes and comparisons planned San Diego included 50 additional cases that participated in SARMS only Sample size allows use of simple statistical procedures to determine if there are significant intra- and inter-site differences in outcome
30	The Study Sites and Comparisons Selection criteria included length of FDTC operation and adequate sample size Jackson County, Missouri & similar cases not offered FDTC Washoe County, Nevada & similar cases not offered FDTC San Diego, California & similar cases entering CWS prior to FDTC implementation Santa Clara, California & similar cases entering CWS prior to FDTC implementation Suffolk County, New York & another court in the same county with standard services
31	Two Distinct Models Implemented Integrated – Jefferson, Reno, Santa Clara, Suffolk Both dependency matters and recovery management conducted in the same court with the same judicial officer Two Tier – San Diego Every parent with substance abuse allegations in court petition is offered services from a Substance Abuse Recovery Management Specialist (SARMS) – Parents are court ordered to participate at Jurisdictional Hearing 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 Dependency Drug Court 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
32	Findings
33	Significantly More FDTC Parents Entered Treatment within 18 Months of CPS Case
34	FDTC Parents Entered Treatment in Significantly Fewer Days Average Days from CWS Case Opening to 394 802 Treatment Entry* Average Days from FDTC Entry to Treatment Entry 59 Median Days from FDTC Entry to Treatment Entry 19
35	Significantly More FDTC Parents Participated in More Intensive Levels of Treatment
36	On Average, FDTC Parents Stayed in Treatment Longer than Comparison Parents
37	FDTC Parents Successfully Completed 59% of 919 Treatment Episodes Comparison Group Parents Successfully Completed 52% of 467 Treatment Episodes
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39	On Average, FDTC Children Have Less Time in Out of Home Care and Reunify Significantly Faster than Comparisons Average Number of Days in Out of Home Care 588 667 Average Number of Days to Reunification* 322 377
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42	Summary - Treatment Outcomes Significantly more FDTC parents enter treatment They enter treatment in significantly fewer days They participate in significantly more treatment episodes They receive more intensive levels of treatment On Average, they stay in treatment longer They complete nearly 60% of episodes
43	Summary - Child Safety FDTC parents have significantly less criminal recidivism FDTC parents have significantly less CPS recidivism
44	Summary – Timeliness of Case Resolution There were no differences in the type of child permanency achieved – Reunification, Adoption, Guardianship or Planned Long-Term Care FDTC Children reached permanency faster FDTC Children who reunified, did so in significantly less time
45	NCSACW Activities On-Line Curricula Primer for Child Welfare Workers White Paper on Funding Guidance to States on CAPTA Guidance on SAFERR National Conference – July 2004 In Depth Technical Assistance
46	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 take aggressive action to reconcile the clocks on children and their families