Substance Abuse Services for Youth in Florida: A Guide for Families

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1 Substance Abuse Services for Youth in Florida: A Guide for Families March 2009 Florida Certification Board/Southern Coast ATTC Monograph Series #4 Substance Abuse Services for Youth in Florida: A Guide for Families 1


3 Table of Contents Chapter One: Introduction...7 Purpose of this Publication...7 Chapter Two: Know Your Child...11 Talking to Your Child...11 Tips for Talking...11 What if My Child Doesn t Want Help?...12 Chapter Three: Taking the First Step...15 Getting Advice from Others...15 Getting an Assessment...15 Types of Assessments...16 Mental Health Problems...16 Where to Get an Assessment...18 Chapter Four: When Emergencies Happen...21 If your Child is Arrested...21 What if a Judge says Your Child Has a Problem?...22 What if the School says Your Child had Drugs?...22 Hospitalization...23 Chapter Five: Privacy of Information...25 Protecting Your Privacy...25 Mandated Reporting Requirements...25 Special Rules for Youth Seeking Alcohol/Drug Treatment...25 Protected Health Information...25 Chapter Six: Understanding Treatment...29 Types of Services...29 Finding Quality Care...30 What to Expect During Treatment...31 Signs that Treatment is Working...32 Maintaining Treatment Successes...33 Chapter Seven: Paying for Services...35 Payment Terminology...35 Paying for Services...38 Co-Payments...39 Locating Payment Assistance...39 Publicly-Funded Services...40 Documenting Eligibility...40 Chapter Eight: Your Rights and Responsibilities...43 Concerns about the Care Your Child is Receiving...44 Grievance Procedures...44 References...45 Appendices...47 Appendix A: Web Resources...48 Appendix B: Common Mental Health Disorders Among Children...50 Appendix C: Florida Department of Children and Families, Substance Abuse and Mental Health Program Offices...52 Appendix D: Florida Medicaid Area Offices...55

4 4 Substance Abuse Services for Youth in Florida: A Guide for Families Disclaimer: Please note that many people have reviewed this guide for accuracy at the time of publication. Remember, though, contact information, laws and agency policies can change at any time. It is always a good idea to request copies of current policies and rules from the agencies with whom you are working.

5 The system for children s substance abuse services can be complex and confusing. Navigating through it can be difficult, time consuming, and stressful. This guide can help. Dear Parent, If you learn your child is abusing drugs, you must act. Finding someone to treat your child s substance abuse problem is just as important taking care of his or her physical well-being. If your child has a broken bone, you go to an emergency room. But what if he or she is using or abusing alcohol or other drugs? Where do you go? A common complaint from parents is that they are frustrated in trying to obtain services from the systems that treat both substance abuse and mental health problems. This can be very complicated and confusing. This guidebook has been created to assist you in accessing substance abuse services for your child in Florida. The guidebook is a one-stop resource for parents. It is written for parents, but it is our hope that family members, community organizations, schools, and healthcare providers will also use the information. This guidebook maps all the different parts of the system (both public and private) and how they connect. We have included warning signs and symptoms of substance use; assessment and treatment options for substance abuse problems; and descriptions of different types of services providers and services that can help parents. Remember, you are providing important support for your child. Take care of yourself mentally and physically. Do not become frustrated; seek help. The resources in this guidebook have proven effective. Substance Abuse Services for Youth in Florida: A Guide for Families 5

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7 1 Chapter One: Introduction Rarely can we turn on the TV or read the headlines today without hearing about someone in trouble with alcohol or other drugs. Young people are particularly at risk for experimenting with them. Yet we know that alcohol and drug use interferes with important learning and growth that take place during the teenage years. Alcohol and drug abuse can affect a youth s ability to make good decisions. It can lead to health, school, developmental, legal, and family problems. The reasons youth use drugs are as different as the kids themselves. Some try alcohol and/or drugs to feel good, i.e., to be part of a group, to feel happier or be more at ease. Others may use drugs to cope with bad feelings, such as boredom, loneliness or sadness. They may be exposed to drugs by friends and may be curious about their effects. Sometimes drug use is happening in the family with an older brother or sister, or perhaps a parent. Drugs are more widely available to youth than most adults realize. For instance, the 2008 Florida Youth Substance Abuse Survey (of 91,471 Florida students in grades 6-12) showed 53.2% reported that they have used alcohol in their lifetime and 29.8% reported using it in the last 30 days. More than one in five (21.5%) Florida high school students reported one or more occasions of binge drinking (defined as the consumption of five or more drinks in a row) in the last two weeks. Marijuana use within the last thirty days was reported by 11.1%. Youth who use alcohol and other drugs often have a mental or emotional problem as well, which sometimes appears even before the drug use begins. Despite the widespread use of alcohol and other drugs by youth, most parents think not my kid. What would you do if you thought your child might be involved? Where would you go? What could you expect? Purpose of this Publication This guidebook is written to help you answer these questions. While there are no immediate, guaranteed solutions, there is much that you as a parent can do. Study after study has shown that parents are the most important influence in a teen s decision to use or not use drugs. Please note that whenever drugs are mentioned throughout this guidebook, it is important to remember that this includes alcohol, the most frequently used drug by teens. The time to act is now if you suspect or know that your child is using drugs. This guidebook will help you to: Identify some signs and symptoms of alcohol and drug use Learn tips for talking to your child Become familiar with places to go for help Understand what types of help is available Learn how you can be part of your child s care Understand you and your child s rights and responsibilities Review the most common payment methods The flow chart on the following pages will assist you in thinking through some of the action steps you will take in seeking help for your child and where to go in this publication to answer some of these important questions. Substance Abuse Services for Youth in Florida: A Guide for Families 7

8 A Quick Guide to Making Decisions Is Treatment Needed? Are you concerned that your child may be abusing alcohol or other drugs? YES Talk to your child. Ask questions that may help you to determine if you should be concerned. Are you still worried? YES Talk to others who know your child such as teachers, coaches, doctors, clergy and other parents. Do they agree that there may be a problem? NO Continue the positive things that you are doing. Remain watchful for signs or symptoms of a problem. Help your child to make healthy choices. NO Does the assessment recommend services other than substance abuse treatment, such as family counseling or mental health services? YES YES YES Get a professional assessment of your child s situation. (See page 18). Use the DCF Adolescent Substance Abuse Treatment Directory as a resource. Does the assessment recommend substance abuse treatment? NO If no services are recommended, continue positive parenting, seek healthy social support for yourself and your child and re-assess if negative changes create new concerns. YES Review the treatment recommendation as a family. Decide if you will seek treatment at this time. Decide as a family if you will enroll in these services. If the assessment agency has not provided specific information, call 211 to find services. Do you want to enroll your child in substance abuse treatment? (See page 29). YES 8 Substance Abuse Services for Youth in Florida: A Guide for Families

9 A Quick Guide to Making Decisions When Treatment is Necessary Do you know if your child is eligible to receive services at the agency you have identified treatment? YES If your child is eligible for services, do you know how much services cost and how you will pay for services? YES NO YES NO If you want to enroll your child in treatment, do you know where to find it? NO Call the agency or agencies you have selected and ask about your child s eligibility. Be prepared to answer questions about the treatment recommendation, where you live and your income. See the chart on pages for ways to pay for treatment. YES YES Use the Adolescent Treatment Directory to find an agency in your area or call 211 to help you find appropriate services. treatment, do you know where to find it? YES If you know your child is eligible and you have a way to pay for services, call to see if a treatment slot is available. See the boxes below for what to do next. NO YES If a treatment slot is not available at this time, ask to be put on a wait list. Find out if there are services available to wait list clients. If so, enroll in those services. If the wait will be long, ask for a referral to an alternative appropriate agency or service. Continue to seek community and social support for your child and family. If a treatment slot is available, set up an appointment for an intake visit. Make sure you know what documentation and records you need to bring with you to this appointment. Substance Abuse Services for Youth in Florida: A Guide for Families 9

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11 2 Chapter Two: Know Your Child How will you know if your child is using alcohol or drugs? It may not be easy to tell, since changes in youth are expected as they approach the teen years. Knowing your child and the kinds of things that may indicate drug use will help. While none of these confirm your child is using, you may want to know what s causing them. Talking to Your Child The first step is often the hardest. Admitting to yourself that your child may be using alcohol or drugs can be frightening. The thought of talking to your child about potential drug use can be even scarier. Parents may also feel guilty or responsible. What s important to remember now is that there are many reasons why kids use drugs. It is never too early or too late to take action. Parents are the most important part of a child s life and your actions from this point on can make a difference. Always consider seeking professional advice for yourself. There is no need for you to confront this alone. Before you engage your child in a conversation, you ll need to prepare yourself. Go for a walk, sit where you can t be disturbed, and think. Reflect on the facts of the situation. Try to avoid negative feelings of anger and betrayal - as they won t be useful to you in this conversation and may result in your child tuning out. Organize your thoughts. Decide what you want to say. Tips for Talking First, learn what you can about alcohol and drugs. Many of the resources in Appendix A of this guidebook will direct you to places where this information is available for parents. Signs and Symptoms There may be sudden changes in the way your child acts, such as: Increased secrecy about activities Unusual outbursts of temper Withdrawal from the family Lying or stealing There may be changes in the way your child sounds or looks, such as: Slurred speech or lack of coordination Major weight loss or gain Different clothing, particularly those with drug messages There may be changes in your child s social or school activities, such as: Skipping school Drop in grades Loss of interest in previous activities Change in friends You may find things that may be related to alcohol or drug use, such as: Rolling papers, pipes, clips, etc. Lighter fluid, gasoline cans, etc., sometimes with paper bags or rags Bottles of eye drops (may be used to cover up blood shot eyes) Missing bottles of alcohol or prescription drugs from the home Find a time to talk with your child when you are calm and know what you want to say. Arrange for some privacy. Ensure there is enough uninterrupted time for the discussion. Tell your child what you have seen and how you feel about it. Be specific about what you have noticed that makes you think he or she may be using alcohol or other drugs. Explain why this concerns you. Try to find out what is going on and encourage your child to talk about alcohol or drugs. Convey your love and ensure your child that you will get help for him/ her and the family if needed. Substance Abuse Services for Youth in Florida: A Guide for Families 11

12 After presenting the facts as you see them, ask your child for his/her response to the information you ve presented. Listen. Hear what your child is saying. You can show your attentiveness by simply repeating or reflecting what your child has said or by saying it back in your own words. This will make sure that you truly understand what s/he is trying to tell you. Listen! Be prepared for your child to deny using alcohol or drugs. Even if your child admits it, s/he may not think there is a problem. Discuss what the rules are in your family about drug or alcohol use and that you will enforce these. You can also share that there will be a continuing conversation about this and that you may want to talk to a professional. Leave the door open for the child to talk to you at any time in the future. The resources in Appendix A also include websites that have information about teenage drug use and give additional tips about how to talk to your child. What if My Child Doesn t Want Help? Chances are your child will not think or admit s/he needs help. The question for you as a parent becomes: How can you get your child the help once you believe s/he needs it? You must be firm about the importance of an assessment and/or recommended treatment. Substance abuse professionals who work with youth are prepared to counsel kids who may not yet recognize a problem. You may want to contact a substance abuse program and get some advice on what you can say and do before you speak with your child. Sometimes a young person may continue to refuse to attend or participate in substance abuse services. Under a Florida law called the Marchman Act (Chapter 397, Florida Statutes) there are some special circumstances when a youth can be taken involuntarily for assessment and/or treatment. The special circumstances include the requirements that the youth is substance impaired as evidenced by: 1. has lost the power of self-control with respect to substance use; and either 2. (a) has harmed, threatened to or attempted to harm him or herself or others, o r (b) needs substance abuse services but is so impaired by the use of substances that he/she cannot recognize the need or make a rational decision to get services; however, refusal to get services does not necessarily show evidence of a lack of judgment. The process used to enforce the Marchman Act varies in each county. In some counties, the family contacts an agency that provides substance abuse services for assistance in filing a Petition for Involuntary Assessment and Stabilization with the court. In the other counties, the probate office at the courthouse is the first point of contact. Once a petition for assessment has been filed, the Court will determine if your child needs to be immediately picked up for assessment without a hearing (an Ex Parte order), or will set a hearing date and time. If a hearing is conducted, all parties will have the opportunity to advise the judge of the need for the assessment and the resources available to complete it. 12 Substance Abuse Services for Youth in Florida: A Guide for Families

13 If the judge finds that there is enough evidence to meet the requirements for involuntary assessment, your child will be ordered to attend an appointment with a substance abuse counselor in an outpatient office-type setting. The judge could also direct your child to be placed into a secure facility such as a Juvenile Addictions Receiving Facility (if one is available in your area). During your child s stay in this safe and secure environment, s/he will receive a physical exam, in detailed substance abuse assessment, and supportive counseling every day. The assessment is usually completed within seventy-two (72) hours. The goal of the assessment is to provide you and your child a recommendation for treatment and a referral for followup care. In most cases, the counselor can make an appointment with a treatment provider during the assessment, and can answer questions regarding his or her recommendations. The counselor s duty is to ensure that your child is placed in the least-restrictive setting to receive care. This may be an outpatient program, daytreatment setting, or a residential facility. Finally, the counselor will determine if the youth is willing to enter the program on a voluntary basis, or if another Marchman Act court hearing will be necessary to ensure your child follows through with the recommended treatment. Based upon the results of the assessment and the determination that the youth will not voluntarily enter treatment, a Marchman Act Petition for Involuntary Treatment can be filed by the parent or a designated representative of the treatment facility (or the counselor) who completed the assessment. A court hearing will be held, and everyone involved in the case will have a chance to discuss the findings of the assessment and the appropriate treatment program. The judge will then make a determination whether your child should be court ordered to attend treatment. Key Terms Assessment: A professional review of a child s and family s needs that is done when they first seek services from a provider. The assessment of the child includes a review of physical and mental health, substance use history, developmental history, school history and performance, family situation, and behavior in the community. Diagnosis: The identification and labeling of a disorder or disease based on its signs and symptoms. Treatment: A set of activities carried out by properly trained and certified professionals that can help to reduce or eliminate the abusive use of alcohol and drugs. Marchman Act: A law under the Florida Statutes (Chapter 397) that enables family members to obtain help for a loved one who is unwilling to seek substance abuse services voluntarily. The Marchman Act court process is not a criminal proceeding but is designed to ensure your child understands the seriousness of his or her need for treatment and complies with the court order. If your child fails to obey the Order for Treatment, an Order to Show Cause as to why he or she has not followed the court order is filed with the court and s/he can be held responsible under the law. The court s order can be reviewed and renewed within sixty (60) days in order to make certain your child completes the program. Substance Abuse Services for Youth in Florida: A Guide for Families 13

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15 3 Chapter Three: Taking the First Step Getting Advice from Others You may want to talk to other people who can offer support and information on where to get help. There are various resources available to you at this point. Sometimes it is helpful to talk to other families who have had the same experience. This may be someone you know. Knowing that you are not alone and how others have sought help can be very encouraging. Many communities have self help groups for families such as Alanon and Narcanon. You can check your phone book for listings of these or Alcoholics Anonymous or Narcotic Anonymous hotlines for meeting locations and times. You may want to talk to your child s doctor. A doctor can also examine your child and perhaps order a drug test that can screen for the recent presence of certain drugs in the urine. The doctor may also be able to recommend a substance abuse professional or program where you can take your child for an assessment. Consider talking to your child s school counselor. School counselors often know if there are specialists in the school system that can help decide if a referral for a substance abuse or mental health assessment is needed. School counselors also often know where you can take your child for assessment and treatment within the community. Some schools have services that take place in the school for youth who may have a substance or mental health problem. You can ask your child s school counselor if there are services like this in your child s school. You may want to call your local office of the Florida Department of Children and Families (DCF) Substance Abuse Office. They will be able to tell you about publicly funded facilities or how to access private care. Getting an Assessment When you or others decide that your child may need help, the next step is getting your child an assessment. The assessment provides explanations of your child s problems as well as recommendations for strategies to treat them. During an assessment, the substance abuse professional will talk with your child and the family, and sometimes others (i.e., probation officers or teachers) in order to collect current and background information. This should include asking if your child has any specific cultural or physical needs that should be considered. The substance abuse professional doing the assessment may want your child to complete other tests or questionnaires. All information will be used to determine if your child is having any problems that need treatment. The initial assessment usually takes from one to two hours. The substance abuse professional will make recommendations to you and your child once the assessment is completed. These recommendations may include the need for further assessment and/ or treatment and the places where treatment may be available. Substance Abuse Services for Youth in Florida: A Guide for Families 15

16 Types of Assessments Some of the most common types of assessments for a substance abuse and/or co-existing mental health problem, and the type of professional who typically provides them are described in the following table. Type of Assessment Psychosocial Medical Psychiatric Who Does It Substance Abuse Professional (Bachelor or Master degree) Mental Health Professional (Bachelor, Master or Doctoral degree) Social Worker (Bachelor of Social Work, Master of Social Work or Licensed Clinical Social Worker) Physician (Medical Doctor-MD) Physician Assistant (PA) Advanced Registered Nurse Practitioner (ARNP) Psychiatrist (MD) Purpose Collects current information and background information in order to determine the need for substance abuse and mental health treatment Determines the need for medical assistance to withdraw from alcohol or drugs; conducts a routine medical exam Assesses mental and emotional problems; provides a diagnosis and treatment recommendations, including any medications Sometimes an assessment will include a urine drug screen. A urine sample can be tested to detect if certain drugs are present in the urine. Not all drugs can be detected in urine and each drug can only be detected for a certain period of time. Urine drug testing does not tell how often the drug has been used. Blood testing for alcohol and other drugs is rarely performed. It occurs most often in cases of arrests for driving under the influence or in hospitals in emergency situations. Mental Health Problems Young people can have mental, emotional, and behavioral problems. Mental health disorders, sometimes called emotional disorders, are medical conditions that can disrupt a child s mood, thinking, feelings, and ability to interact with and relate to others in his or her life. For the majority of children, a change in mood, feelings, and behavior is a natural part of child development. However, when these changes begin to impact a child s ability to function on a daily basis, a mental health disorder may be the cause of these changes. If this is the case, the child may need mental healthcare. If you suspect that your child has a mental health issue, it may be hard to know when to seek help. If you observe some of the following symptoms, it may be time to talk to your child s doctor about your child s symptoms: Extreme anxiety or worry Constant hyperactivity 16 Substance Abuse Services for Youth in Florida: A Guide for Families

17 Appearing distracted when others try to interact with him or her Constant nightmares Frequent anger, aggression, or disobedience Constant temper tantrums that cannot be explained Significant changes in eating or sleeping habits Significant change in performance at school Inability to handle daily stresses or problems Constant complaining about physical problems (for example, stomachaches or headaches) Acting withdrawn or depressed Self-injurious behaviors Drug or alcohol use may also be a sign of other mental health issues. Some children use substances as a way to control mental health symptoms a form of self-medicating without the use of (and sometimes the stigma of) prescription medications. If you think that your child may have a problem with drugs or alcohol, you may need to think about other mental health issues as well. Trying to figure out if a mental health problem is affecting your child is not easy and requires the expertise of a doctor, such as a psychiatrist or a pediatrician, or a mental health professional. These professionals can evaluate the child and determine if he or she has a mental health issue. Specially designed interview and assessment tools are used to evaluate a person for mental health disorders. The person conducting the assessment bases the diagnosis on the person s report of symptoms, and his or her observation of the person s attitudes and behavior. The physician or mental health professional then determines if the person s symptoms and degree of disability point to a diagnosis of a specific disorder. If a mental health problem is identified, it too should be treated. Experts agree that both substance abuse and mental health should be addressed at the same time. Not doing so is likely to result in treatment failure. The substance abuse professional may refer your child to a psychiatrist for evaluation. Parental permission is required TIP If your child s behavior concerns you, write down how he or she acts each day specific signs or symptoms, how often they happen, in what context they happen, when you first noticed them, and any other concerns you have. This will be a big help when you talk to your child s doctor or mental health specialist. It is also a good habit to get into for the future. If your child is diagnosed with a mental health disorder, your records can be very helpful in charting his or her symptoms and response to treatment over time. Substance Abuse Services for Youth in Florida: A Guide for Families 17

18 in most cases in order for your child to receive medication for mental or behavior problems. A description of common mental disorders among children and adolescents can be found in Appendix B. Where to Get an Assessment Substance abuse assessment and treatment services are offered primarily in two types of systems: publicly funded services, which families must qualify for, and services covered by a family s private insurance. There are programs that are mostly funded by state and public dollars. Because these programs receive public funding, they cannot deny services to individuals solely based on a person s inability to pay. You may want to contact your local publicly funded substance abuse program or community mental health center if you have limited income or financial resources. There are several ways you can access information about where to go for an assessment. Dial 211 for information and referral provided by Florida Alliance of Information and Referral Services which provides assistance to approximately 75% of Florida s population. Look in the Yellow Pages of your local telephone book which will list alcohol and drug treatment programs. Call the Florida Department of Children and Families Substance Abuse and Mental Health Office that serves your county. See listing in Appendix C. Obtain a copy of Florida s best source of information for publicly funded adolescent substance abuse programs - the Directory of DCF Funded Adolescent Substance Abuse Treatment Programs in Florida This Directory was developed to assist parents, families, Access the directory at: professionals, and individuals in locating services for Florida youth. Any of the providers listed in this directory, by county, will be happy to answer your questions about the various services they provide. Privately funded services can be obtained from both agencies and individuals, with families paying a fee. Since privately funded services do not receive public funding, they are more costly to the people who receive them. If you have insurance, it may pay for some of the costs, depending upon your policy. For details about payment options, please see Chapter Seven, Paying for Services. 18 Substance Abuse Services for Youth in Florida: A Guide for Families

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21 4 Chapter Four: When Emergencies Happen Emergencies and crisis situations happen and sometimes cannot be avoided. Crisis situations are filled with high levels of stress, anxiety, and fear. Your best bet is to remain calm and realize your child needs your help and support. Your Child s Situation Your child is showing severe, out of control behavior. Your child may be a threat to self or others. You are frightened. There has been a major change in your child s behavior. Your child seems unable to function without help. You feel unable to cope with the situation or help your child. There has been a mild to moderate change in your child s behavior. You are worried, but not alarmed. When to Get Help Immediately (emergency) hours (urgent) Soon (a routine evaluation) Where to Get Help Call 911 Hospital Emergency Room Mental Health Crisis Stabilization Units 1 Police Call 211 Pediatrician or other physician Substance Abuse or Mental Health provider or agency Community Organization (call your local DCF office as shown in Appendix C for the number) Pediatrician or other physician Substance Abuse or Mental Health provider or agency School Family or friend Community Organization (call your local DCF office as shown in Appendix C for the number) 1 Crisis Stabilization Services These services are residential acute care services that are provided on a 24-hour, 7-day a week basis. The services involve brief, intensive residential treatment to meet the needs of individuals who are experiencing acute crises and who, in the absence of a suitable, alternative, would need inpatient psychiatric hospitalization. Each county in Florida either has such a facility, usually called a Crisis Stabilization Unit (CSU), or contracts with a facility to serve people from that respective county. Several counties may contract with a facility to provide this service. If your Child is Arrested Many youth who are involved with alcohol or drugs come to the attention of the juvenile justice system since the use of these substances are illegal. The juvenile justice system includes a range of services provided under the Florida Department of Juvenile Justice to youth who break the law. There are different points of contact a youth may have within the juvenile justice system where a potential substance abuse or mental health problem may be identified. When a minor is taken into custody by a police officer for a law violation, the officer will determine whether the child can be released to the family pending further action on the charges or if the child needs to be screened for Substance Abuse Services for Youth in Florida: A Guide for Families 21