Expanding Services to Children and Families in Family Drug Courts: Lessons Learned from the. Grant Program. Acknowledgement.

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1 Expanding Services to Children and Families in Family Drug Courts: Lessons Learned from the Children Affected by Methamphetamine Grant Program Acknowledgement Introductions This presentation is supported by: Department of Health and Human Services Substance Abuse & Mental Health Services Administration Grants to Expand Services to Children Affected by Methamphetamine in Families Participating in Family Treatment Drug Court (RFA No. TI CFDA No.: ) A Substance Abuse and Mental Health Services Administration (SAMHSA) funded grant program focused on expanding and/or enhancing services to children and their families who are affected by their methamphetamine use and abuse 3 Presenters Sharon Amatetti, SAMHSA Phil Breitenbucher, NCSACW Chad Rodi, NCSACW Erin Hall, NCSACW Audience CAM Grantees? FDC Team members? 1

2 CAM Grant - Background Grants to Expand Services to Children Affected by Methamphetamine in Families Participating in Family Treatment Drug Court (CAM) Why Focus on Children? Although FDCs are about families, children s service needs are not typically part of FDC programs. We know a lot about how to support children of parents with substance abuse and addiction. It s the right thing to do. The Core Messages CAM Grant - Background Family Drug Courts Expectations of CAM Grantees Enhance or expand services to families and children Add to existing family drug court and addiction treatment services Prevention for Children occurs in the context of Family 7 Designated Services Coordinator Evidence Based Practices 2

3 Federal Support for Family Drug Courts WA 2010 Grantees NE CA AZ CO MO OK CAM CSAT FDC Grants Regional Partnership Grants FDC Grants * 12 Grantee Sites Children Affected by Methamphetamines 10 Number of Families Served Total Numbers Served as of September 30, 2012 Target Actual Served Children (155%) Adults (151%) Why Should FDCs Focus on the Needs of Children? 3

4 Statements of the Problem Statements of the Problem How many children in the US have a parent in need of substance abuse treatment? Over 8.3 million under % of all children 14% of those under 5 Office of Applied Studies (2009). The NSDUH report: Children living with substance-dependent or substance-abusing parents: Rockville, MD: Substance Abuse and Mental Health Services Administration. 13 How many children in the child welfare system have a parent in need of treatment? t t? Between 1/3 and 2/3 (according to US DHHS reports, 1999). 61% of infants, 41% of older children who are in out of home care (Wulczyn, Ernst and Fisher, 2011). 87% of families in foster care with one parent in need; 67% with two (Smith, Johnson, Pears, Fisher, DeGarmo (2007). 14 FDC Practice Improvements Approaches to child well-being in FDCs have changed. Challenges Being Addressed by CAM Grantees Parents need understanding and skill to meet children s needs. Children need comprehensive assessments and services. In the context of the parent s recovery Family Centered Treatment Child-focused assessments and services Parents and children need assessments and services to address trauma and relationship issues. Families need access to supportive services following reunification

5 Challenges Being Addressed by CAM Grantees Prenatal exposure to substances Bonding and Attachment issues Trauma exposure Childhood Trauma Disrupts all aspects of normal development Brain development, cognitive growth and learning Emotional self-regulation Attachment and social-emotional development Mental health 18 Potential Challenges of Living with a Parent with a Substance Use Disorder Severe, inconsistent or inappropriate discipline Neglect of basic needs Jeopardized safety and health Disruption of parent/child relationship Exposure to Trauma Addict Spouse: Chief Enabler Children: Enabler in Training Hero Comic Scapegoat Lost Child Roles and Family Dynamics 19 5

6 Who are the CAM Grantees? CAM Program Strategies All 12 sites had established FDCs Who are the CAM Grantees? CAM FDC Strategies Very Big and Very Small Number of Children Served (as of September 30, 2012) Population of County served by FDC Biggest Smallest ,189,641 31,953 Different FDC models Parallel Integrated Hybrid 6

7 Who are the CAM Grantees? CAM Strategies Different Target Populations Each grantee is serving a unique target population. Some examples include: Very young children (0-5) Voluntary/pre-filing Concurrent felony criminal case Outreach, Engagement & Retention Parenting Education Developmental & Behavioral Trauma-Focused - Adults Trauma-Focused - Children CAM Child Interventions & Strategies Across Age Spectrum Intervention Nurturing ring Parenting Celebrating Families Evidence-Based Parenting Neuro-develop. Screening ASQ NCFAS PCIT Parent-Child Therapy Celebrating Families 16 week program focusing on recovery. Parenting Education Nurturing Parenting group and in-home components focusing on prevention and treatment of child abuse. Strengthening Families 14 session program focusing on increasing resilience and reducing risk factors. Parents as Teachers home visiting program focusing on early childhood. SafeCare home visiting program focusing on safety, healthcare and parent-child interaction. 7

8 Parenting Education Therapeutic Based Parent/ Child Interventions Nurturing Families 12 week program focusing on family members learning together. Incredible Years training series focused on decreasing behavior problems and increasing social skills in children. Positive Parenting Program strategies for parents focusing on managing child behavior and promoting healthy relationships. Great Beginnings home visiting and early childhood mental health to promote well-being, health, social-emotional and cognitive development. Child Parent Psychotherapy trauma-focused intervention for very young children focusing on attachment and relationships. Promoting First Relationships Prevention intervention for very young children focused on attachment and positive relationships. Therapeutic Based Parent/ Child Interventions Therapeutic Based Parent/ Child Interventions Parent-Child Interactive Therapy - intervention for 2-7 year olds and parents focusing on relationships and behavior management. TheraPlay trauma-informed therapy modality focused on attachment, self-esteem and trust. COACHES neuro-cognitive behavioral intervention focused on recovery for children. Circles of Security - relationship based early intervention i program designed to enhance attachment. Marriage and Family Therapist comprehensive assessment, short term counseling and referral for children and parents focusing on trauma, mental health and child development. Circles of Security - relationship based early intervention program designed to enhance attachment 8

9 Outreach, Engagement and Retention Activities Peer Mentors previous FDC graduates support participants throughout the program. Outreach Workers staff members working off-site to locate and encourage clients to engage or re-engage in treatment. Recovery Resource Specialists paid staff members who are in recovery provide peer support, aggressive outreach and connection to community services. Court Appointed Special Advocates volunteer mentors/advocates for children. ADULTS Trauma-Focused Helping Women Recover integrated treatment model for women with addiction and history of trauma. Helping Men Recover - integrated treatment model for men with addiction and history of trauma. Trauma Focused Assessments and Therapy mental health counseling focused on identification and treatment of trauma. Seeking Safety cognitive behavior therapy for people with cooccurring PTSD and addiction. CHILDREN Trauma-Focused TheraPlay - trauma-informed therapy modality focused on attachment, self-esteem and trust. Trauma Focused Assessments and Therapy - mental health counseling focused on identification and treatment of trauma. DEVELOPMENTAL CHILD DEVELOPMENTAL/BEHAVIORAL Ages and Stages Questionnaire 3 assessment of developmental delays for children 0-5. BEHAVIORAL Ages and Stages Questionnaire SE - assessment of social emotional delays for children 0-5. Child Behavior Checklist assessment of behavior problems in children up to age 18. 9

10 CAM Program Performance Indicators CAM Program Performance Indicators Child/Youth C1. Children remain at home C2. Occurrence of child maltreatment C3. Average length of stay in foster care C4. Re entries to foster care placement C5. Timeliness of reunification C6. Timeliness of permanency C7. Prevention of substance exposed newborns C8. Children connected to supportive services C9. Improved child well being Adult A1. Access to substance abuse treatment A2. Retention in substance abuse treatment A3. Reduced substance use A4. Parents/caregivers connected to supportive services A5. Employment A6. Criminal behavior Family/Relationship F1. Improved parenting F2. Family relationships and functioning F3. Risk/protective factors Preliminary Findings- Number Served Preliminary Findings-Safety Between September 2010 and September 2012 grantees have served: 1,240 Families 1,623 Adults 2,701 Children Approximately 1/3 of the participants are still participating in the CAM program. No substance exposed births after CAM entry Loweroccurrence occurrence of maltreatmentwithin six months compared to the average among the 6 states where CAM grantees are located 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% Percentage of Children who had Substantiated/Indicated Maltreatment within 6 Months after CAM Program Enrollment 3.2% 6.4% CAM Participant Comparative State Data 10

11 Preliminary Findings-Permanency Preliminary Findings-Permanency Nearly all children in home at CAM entry remained in the home Those who were out of home were reunified more quickly 80.0% 75.0% 70.0% 65.0% 60.0% Percentage of Children Reunified in Less than 12 Months 75.7% 67.0% CAM Participant Comparative State Data Children Remain at Home 8.2% Remained In-Home 90.8% Removed from Home More children achieved finalized adoption (39%) compared to the 6 state median (35%) Re entry into foster care within 12 months was substantially lower than the comparative 6 state median 15.0% 10.0% 5.0% 0.0% Percentage of Children that Re-entered Foster Care in Less than 12 Months 5.0% 14.0% CAM Participant i t Comparative State Data Preliminary Findings-Recovery Participants had timely access to care most often the same day of enrollment for those not already in care (mean=13.7 7d days) Full or part time employment increased by 21% from admission to discharge compared with an average of 17% for the 6 states in which grant programs are located 25% 20% 15% 10% 5% Increase in Employment 21% 17% CAM Participant Comparative State Data Preliminary Findings-Recovery There was a substantial decrease in drug and alcohol use from intake to discharge Percent of adults reporting a reduction in use by drug type 62.9% (n=197) - Methamphetamine 70.4% (n=81) - Marijuana 62.8% (n=78) - Alcohol 68.0% (n=25) - Heroin/other opiates 28.6% (n=14) - Cocaine 0% 11

12 Preliminary Findings-Well Being Overall Mean NCFAS Scores for Each Domain (lower is better) CAM Program Emerging Lessons Learned Intake Closure Significant improvement from intake to closure was demonstrated across all 10 domains of family functioning assessed by the NCFAS G+R CAM FDC Strategies Emerging Lessons New Strategies Required New Collaborations Integrating children s services v. adding on children s services. Some of the biggest challenges were related to operation of the FDCs (unrelated to CAM services). A question of timing, when should parenting groups be started? Implementation of some evidence based practices was more expensive than expected. 12

13 Emerging Lessons Emerging Lessons For sites with success in increasing the emphasis on children, they can t imagine going back to the way it was before. Increased emphasis on children has increased buy-in from stakeholders. Increased emphasis on children brings new players to the table and communication protocols need to be established. The CAM Grant has changed the whole atmosphere of this court. It is much more professional and is seen as a credible, valuable program by the whole community. People who used to be against the program are now adamant supporters. I think this comes from the Judge and his incredible way with the court team and participants and the increased focus on children as a result of this grant. ~ CAM Grantee FDC Coordinator Tools for Practice Improvement Defining your Target Population Tools For Practice Improvement Identifying the needs of your target population Identifying existing services and service gaps 13

14 Serving Children Scope of Services Serving the Needs of Children FDCs do not have to do this alone, but should be Substance Abuse T t Treatment t Child Developmental Educational Youth Services Primary Health and Dental connected to those who are serving children Parent-child relationships Trauma & Mental Health That s what collaborative means The challenge is not to divert resources from 53 treating parents to help their children But to mobilize and link to new resources from other agencies that already serve children 54 Discussion and Questions 55 14

15 Contact Information Sharon Amatetti, MPH CAM Grant Federal Project Officer SAMHSA Phil Breitenbucher, MSW CAM Program Contract Support Project Director Children and Family Futures RESOURCES Please visit: projects/ family-drugcourts GENERAL INQUIRES: VISIT:

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