Remember this! Key Concepts 1/5/2016. Substance Abuse and Child Welfare Practice

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1 Substance Abuse and Child Welfare Practice Lissette Jackson-Shepherd, MSW JD Remember this! Substance abuse is NOT child abuse you must establish a link between substance use/abuse and harm or danger to the child! Key Concepts Substance abuse and addiction affects all of us: Community, families, and the work place. Substance abuse and addiction are not character flaws. How we view people who use substances is based upon a societal/cultural frame of reference. Most individuals who use and abuse substances do so for an underlying reason that may be hidden from view. Motivational Interviewing is an evidence-based tool for engaging parents with substance abuse problems in the process of change. 1

2 Key Concepts, cont. Sustained change in addictive behavior involves predictable stages that include the necessary stage of relapse. Planning for these stages is a key skill in Child Welfare Services intervention. Statutory timeframes for reunification can be challenged by the duration of the recovery process. Use of methamphetamine results in fundamental changes in the brain that impair sustained recovery. Child Welfare Services intervention requires engaging in a balance between accountability and engagement and close examination of the codependent relationship. Substance Abuse and Child Welfare Practice Is there a difference between substance use and substance abuse? Can parents use or abuse substances and NOT abuse/neglect their children? What is the difference between cause and correlation? What is the Child Welfare focus? Substance Abuse and Child Welfare Practice Substance abuse is one of the overriding characteristics of families served in the system. Children of substance abusing parents are more likely to experience abuse or neglect than children in non-substance abusing households. Parents who abuse substances are less likely to be able to function effectively in a parental role. Of children who died from abuse/neglect in a 2000 study, 25% had a chemically dependent mother. Between 1/3 to 2/3 of child maltreatment cases involve substance abuse. 2

3 To protect the child s current and future safety, wellbeing and stability and When possible and not in conflict with the first mission, to strengthen and preserve the family unit Child Protection Mandates Four Clocks Guiding Work with Chemically Dependent Families Drug Recovery time frames ASFA TANF Child Development Clock Impact of Parental Substance Abuse on Children Environmental, physical, emotional impact Parenting issues Correlations between child maltreatment and substance use Characteristics of parents at risk to abuse substances 3

4 What do you think? How do you think the Child Welfare practice should adjust to address the increasing occurrence of caregivers who have a medical marijuana card or who are abusing prescription medication rather than illegal drugs? How does our intervention change when the drug of abuse is alcohol? Do you consider methadone treatment a legitimate treatment option? Disproportionality issues in working with families with substance abuse problems Gender differences Alcohol and Substance Abuse is an equal opportunity disease Historic trauma Rates of illegal drug use Prevalence and correlations between substance abuse and child maltreatment QUIZ Pages {

5 The nexus between substance abuse and child maltreatment WARM-UP ACTIVITY Each group is assigned an abuse category Appoint a recorder and presenter(s) Discuss a real life case example illustrating the impact of caregiver substance use for abuse category Report out: Brief case summary and answers to questions on the handout Human History of Substance Use Humans have long history of using mind-altering substances Alcohol dates back to 9400 BC Marijuana dates back to 3000 BC Substances used in medical, religious/ceremonial and warfare settings What is our human pattern? The Controlled Substances Act of 1970 Federal legislation to control manufacture, importation, use and distribution Five Schedules based upon potential for abuse, accepted medical use and potential for dependence Alcohol is not on the schedule Marijuana is a Schedule I substance 5

6 Drug Abuse Chart The Cycle of Addiction Early Stages -- Use Middle Stages - Abuse Late Stage -- Dependence Experimentation, social use, relief of pain and stress Loss of predictable outcomes, use in isolation, lifestyle changes Escaping responsibilities of life, legal problems, debilitation DSM-V Diagnostic Criteria Substance-Related and Addictive Disorders Substance Use Disorders Addictive Disorders Other Disorders of Interest 6

7 Commonly Abused Drugs ACTIVITY Each group is assigned one of several drug classifications Report Out: Physiological indicators/effects of use Environmental indicators of use/common paraphernalia Social and psychological indicators of abuse Time period of testing/detection (pgs 25-31) Methamphetamine Abuse 7

8 What is it? Meth and the Threat to Children and Families What does it look like? Short-term effects of use? Long-term effects of use? Meth and the Threat to Children and Families Physical Symptoms Behavioral Symptoms Mental Symptoms Paraphernalia Meth Labs Meth and the Risk to Children Fast Facts Annual Use 72% increase in last decade In areas of high use, 5% of babies exposed to meth in utero Higher rates of use in Hawaiian and Native American communities African Americans using meth at lowest rate Women disproportionately impacted Best Practice Implications Screening & assessment Gender differences Comprehensive approaches Integrate contingency planning Multiple treatment practices 8

9 Use Abuse Dependency Typical experiences of child with primary caregiver who abuses substances Implications for Risk to Children at Various Stages Children and Substance Abuse: Safety & Risk Emotional and behavioral responses Talking to children about substance abuse Risks to child safety & wellbeing 3 key responsibilities for Child Welfare worker Exposed children and possible symptoms Children and Substance Abuse: Safety & Risk, cont. Worker Safety Law Enforcement s role Prompts for medical assessment Indicators of present danger (removal) Indicators of impending danger (safety planning) 9

10 Four Critical Analysis Questions How are safety threats manifested? Is there a non-using protective adult? Is a CWS managed safety plan appropriate? What are the best interventions? What are your local policies related to responding to Drug- Endangered Children referrals? Is it a safety threat or a risk? Table Team Scenario Game 10

11 Characteristics of a chemicallydependent family Homeostasis Purpose of family Elements of family functioning Co-Dependent Partner (and the Child Welfare worker) Protector Controller Blamer Loner Enabler Co-dependency Roles Child Roles Parentification Family Hero Scapegoat Lost Child Mascot 11

12 The Family Continuum of Alcohol and Drug Dependence Children COA Roles Neglect and abuse Biologic vulnerability Fetus/Infant Intrauterine toxicity Neonatal toxicity / withdrawal Increased muscle tone Neglect/abuse Grandma/Exten ded Family Drug/alcohol dependence and codependence Father Drug/alcohol dependence Mother Drug/alcohol dependence and codependence COA issues Pregnancy complications Familial, environmental and cultural milieus define what is normative or deviant Developmental Stages of Risk Taking: Experimentation as a Task of Adolescence Genetics Interpersonal Factors (Life Experiences) Environmental Issues/Exposures How Dependence Develops Progression of Family Dynamics Learning Phase: as disease process impacts family, members experience stress, tension, strained relationships, crises, emotional pain Seeking Phase: members have flashes of awareness that a serious problem exists and attempt to find solutions for it Harmful phase: members defensive and reactive behaviors become automatic & predictable; rigid & habitual roles created Escape phase: members can no longer tolerate the established dysfunctional system & search for ways to escape 12

13 Cultural Considerations Attitudes, values and behaviors about drug and alcohol use Consideration of subgroup memberships Context of immigration Degree of acculturation Risk factors Let s try it out Let s meet Lisa and her children! Case Study #1 Issues of Drug-Exposed Infants Outcomes depend on intersection between exposure effect and care giving Three common manifestations: Hypersensitivity to stimuli Problems with muscle tone Gastrointestinal problems 13

14 Developmental Impacts Motor Cognitive Language Skills Behavior Attachment Physical Growth Effects of Different Substances on Infants Alcohol Cocaine Marijuana Heroin Methamphetamine Nicotine Fetal Alcohol Syndrome 14

15 Tips for preparing caregivers for newborns in withdrawal Control stimuli Be alert to cues Be proactive Gradually add new things Create and use respite care What is recovery? Transition Stabilization Early Recovery Middle Recovery Late Recovery Maintenance Recovery happens one day at a time for the rest of your life, Alcoholics Anonymous Brain biochemistry New research has changed our frame of understanding and treatment Two neurotransmitters: Dopamine and Serotonin Synaptic chemical factory 15

16 Brain Chemistry and Addiction Neurotransmitter production is turned off, receptor sites are desensitized, (neuro-adaptation occurs) and in some drugs, reuptake system is damaged Client is chemically depressed External chemical supply needed to address depression and stave off withdrawal Environmental cues triggers need to use At next use (relapse), the brain responds differently Cognitive functioning impaired during early recovery Brain recovery take a minimum of months Dopamine Pathway Functions: Reward Pleasure, euphoria Motor function Compulsion Basic Needs Reward Pathways: Nucleus acumens Hippocampus VTA Serotonin Pathway Basic Functions: Mood Memory processing Sleep regulation Cognition Motivation and Readiness for Change Dual Diagnosis Motivational Interviewing Solution-focused Questions 16

17 Stages of Change Pre-contemplation Contemplation Determination and Preparation Action Maintenance and Relapse Let s take another look at Lisa s situation { Croup Activity Models of Treatment Moral/Social Learning Medical/Disease Bio-psycho-social 17

18 Methods of Intervention 12-Step Outpatient Day Treatment Detoxification Methadone Clinical In-patient Residential Treatment Mix and Match: Understanding the { terms of formal substance abuse assessments (70-72) What does your county s FDTC look like? 18

19 Assessment and Services Planning ASAM TWEAK Instrument Strengths Available as check lists, Provide structure, Can be used as prompts Standardized Field Friendly CAGE Short Screen Instrument Limitations Perceived as impersonal & intrusive Leading questions foster greater tendency to lie/become defensive ***Culturally-specific supports Group Activity Read Case Study #2 Write a SMART objective Describe two services: one formal and one informal What challenges do you face in accessing and working with your local treatment partners? 19

20 Collaborating Cross-System Differences in mission and means Confidentiality and Information Sharing Roles and limits of authority Evidence Based and Promising Practices Motivational Interviewing Community Reinforcement + Vouchers Approach Alcoholics Anonymous Community Reinforcement Approach SAMHSA/CSAT Resources Treatment Improvement Protocols Free! 20

21 Know and use ALL of your resources! Please complete evaluations before you leave!!! 21