Improving Family Outcomes Using Treatment Engagement Strategies

Transcription

1 Improving Family Outcomes Using Treatment Engagement Strategies Nancy K. Young, Ph.D. Julia Maestas, M.S. Presented at The 5th National CONFERence on Behavioral Health for Women and Girls Health, Empowerment, Resilience and Recovery San Diego, CA July 2012

2 A Program of the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment and the Administration on Children, Youth and Families Children s Bureau Office on Child Abuse and Neglect 2

3 Welcome 1. Describe key aspects of Substance Abuse Specialists in Child Welfare Agencies and Dependency Courts - Considerations for Program Designers and Evaluators 2. Present information of lessons from Santa Clara s Dependency Advocacy Center Mentor Parent Program 3. Discuss resources available on this topic 4. Open Discussion on experience and lessons TEXT PAGE

4 Substance Abuse Specialists in Child Welfare Agencies and Dependency Courts - Considerations for Program Designers and Evaluators: Nancy K. Young, Ph.D. National Center on Substance Abuse and Child Welfare

5 Models of Collaborative Practice Paired Counselor and Child Welfare Worker Counselor Out-stationed at Child Welfare Office or Court Parent Mentors Substance Abuse Specialists Multidisciplinary Teams for Joint Case Planning Family Drug Treatment Courts

6 Substance Abuse Specialists in Child Welfare Agencies and Dependency Courts Conducted interviews with 7 sites with various models to extract common themes and lessons: Connecticut Delaware* Illinois* Massachusetts New Hampshire* Sacramento, CA Washington *Title IV-E Waivers

7 Purpose Improve the capacity of the child welfare system to serve parents with substance use disorders Improve collaboration between systems 7

8 Roles and Responsibilities Case management Screening, assessment, referral, and engagement into treatment Support to parents while in treatment Conduct home visits (CT, DE, IL, Sacramento) Drug testing (CT, DE, IL, Sacramento, San Diego) Consultation and Information sharing with child welfare and/or courts Training to child welfare and potentially the court Develop and implement substance abuse capacity building plans for child welfare (MA) 8

9 Location and Settings Employed by: State, county child welfare agency Community-based substance abuse treatment agency Contracted service provider or Self-employed and contracted by child welfare Area/regional/county/district child welfare offices (CT, DE, MA, NH, WA) Contracted service provider s office, near to juvenile court (IL, Sacramento, San Diego) 9

10 Underlying Values and Agreements Memorandum of Understanding (MOU) or other agreement formally outlines joint values and principles for the program (Sacramento, WA) MOU or other agreement outlining joint values influences the implementation of program, but was not developed for the program, specifically (Sacramento, MA) MOU or other agreement outlines systems and or other programs roles in program implementation (CT, DE, IL, San Diego) 10

11 Funding State funds CT, DE, MA Federal funds (i.e., Title IV-E, IV-B) IL and NH Multiple sources (i.e., partial state funding, tobacco settlement, agency budget reallocation) Sacramento, San Diego and Washington 11

12 Training and Supervision Licensed/certified addiction counselor Licensed clinical social worker with addiction certification (CT) Supervised by child welfare (CT, NH, WA) Supervised by contracted service provider (IL, Sacramento, San Diego) Receives child welfare New Worker Training (DE, MA, NH) Regular meetings to maintain program purpose and/or foster collaborative relationships Dual supervision (DE, MA) Participates in cross training 12

13 Regularly collects data (CT, DE, IL, NH, Sacramento, San Diego) Collects standardized data (IL, NH, Sacramento, San Diego) Regularly analyzes data (IL, Sacramento, San Diego) Outcomes and Evaluation

14 Sacramento Outcomes Child Placement Outcomes at 60 months Reunification Adoption Guardianship PP-Dependency FR-Dependency 60 Months TEXT PAGE

15 Critical Factors for Success Training: understanding how to use the specialist Training: cross-training multisystem staff Specialists background and expertise Support of leadership across systems Collaborative relationships

16 Critical Factors for Success Space and location of the specialist Communication and information-sharing protocols Sustainable and flexible funding sources Evaluation Access to treatment services

17 Tips and Techniques: Treatment Engagement Primary Purpose: Facilitate entry into treatment 1. Upon assessment, assist parent in making phone call to treatment for initial appointment 2. Provide treatment documents such as brochure or program rules 3. If known, provide parent with written treatment schedule (e.g.: pocket calendar) 4. If needed, provide number, documentation etc. of public transportation 5. Supply map to treatment facility (Best Practice: Bring parent to treatment facility for first appt.) 17

18 Lessons from the Field: Julia Maestas, M.S. Mentor Parent/After Care Program at Dependency Advocacy Center (DAC) in San Jose, CA

19 Dependency Advocacy Center Mentor Parent Program

20 History 75-80% of dependency cases involved a substance abusing parent Dependency Drug Treatment Court (DDTC) established in 1998 Need to increase and engage participants Barbara Bond, First DDTC Graduate, Hits the Waiting Room 2000

21 Model Overview California parent attorney representation structure Agent of the attorney/attorney-client privilege and confidentiality 8 mentor parents: 5 women and 3 men 2 alumni parent coordinators Funded by county and Federal dollars via county contracts: 1. Department of Alcohol and Drug Services (DADS) 2. Department of Mental Health (DMH) 3. Social Services (SSA; administrators of Department of Family and Children Services (DFCS) 4. Superior Court of Santa Clara County

22 Santa Clara County Family Drug Court Overview-DDTC and FWC DDTC (1998) 1. Voluntary 2. Parent w/children over three years 3. Post jurisdiction/disposition FWC (2008; 1 st in the Nation) 1. Automatic qualification 2. Parent w/children below three years 3. Detention 4. System changes (family team meeting, trauma informed, increased services and community connections)

23 Roles and Responsibilities Familiarize and assist parents with understanding and navigation of the dependency system Introduce and encourage participation in recovery concepts: AA/NA, 12 Steps, Sponsorship, Testing and Treatment Increase engagement with case plan and successful completion of family drug treatment courts DDTC and FWC Increase positive and productive communication with social workers and the attorneys Reliable access via phone and face-to-face contact at court and throughout the community Seeking and access to community resources, emphasizing life skills building and self-sufficiency

24 Building Trust and Advocacy Agent of the attorney-confidentiality and trust Not a part of the system; helping you get through the system Talk the talk and walk the walk real life examples Honesty with oneself, attorneys, court, systems and reaching recovery Speaking up and sharing thoughts, feelings and needs as a path to success

25 Case Walk-Through Step 1: Detention Packets are sent to Program Manager day before detention; reviewed for substance abuse allegations and Mentor Parent is assigned and tracked for DDTC or FWC Step 2: Mentor Parent updates with attorney and approaches client at detention hearing about their past experience, navigating dependency court, support, and getting a head start on recovery (Assessment, AA/NA Meetings, Sponsor etc.) Step 3: If time and situation allows, Mentor Parent shares about the benefits of DDTC or FWC and encourages the client to participate. Contact information is exchanged.

26 Case Walk-Through Step 4: If client is being tracked for DDTC, the Mentor Parent will support client through disposition and complete a DDTC application. If the client is being tracked for FWC, the Mentor Parent will support the client up to postdisposition and highly encourage participation in FWC. Step 5: Mentor Parent will guide and support client through the legal process (communication with attorney and support at all legal hearings), specialty court (reviews and resources via court coordinators) and recovery (visits at treatment, meeting support and finding sponsors). Mentor Program Manager provides support and case oversight for Mentor Parents. Step 6: Assist client to complete specialty court phases and participate in graduation from DDTC or FWC. Link the client with the Alumni Parent Coordinators (APCs) and After Care. Client is highly encouraged to work with the APC and participate in both the one-on-one and group settings and avoid re-entry into the dependency system.

27 Females vs. Males Females 1. Respond to face-to-face and verbal interactions 2. Quick engagement and participation 3. Require more of a buyin through the process 4. Require longer and more frequent contact 5. Establish emotional connections and bonds Males 1. Respond to directions and next-steps interactions 2. Delayed engagement and participation 3. Require more buy-in at the start of the process 4. Require shorter and less frequent contact 5. Establish practical connections and bonds

28 Administration and Supervision Oversight from upper management team of Executive Director, Chief Financial Officer, Mentor Program Manager and Supervising Attorneys Service Agreement/Scope of Service that is aligned with recovery support, dependency engagement and increasing the reunification of parents with children Mentor Program Manager Direct supervision, hiring and daily operation/administration of program Flexible schedules and family friendly work environment Encouragement of clean and sober living, raising healthy and stable families

29 Training and Development Trainings provided by agency partners, such as DADS, Mental Health and First Five. Family Development Credentials and Domestic Violence Specialists Emphasis on education, career development and community engagement Leadership and Empowerment From Client to Expert Trainings for DFCS social workers Father Engagement and Report Writing

30 Policy and System Changes Membership in the dependency court oversight, systems and implementation committees Assisting in the development of specialty court policies and procedures Requests from judicial officers for input Development of partner agencies awareness digital stories, focus groups and clients services development Sharing program and encouraging peer-to-peer models in recovery

31 Documentation Mentor Parent Program- Client Contact Form o o o o Time spent with the client Location of the contact Topic areas addressed in the interaction Notes are ed and confidential between mentor parent and attorney Monthly Data Collection- Mentor Monthly Contact o o Summary of time, attorney interaction and location with all clients Percentage of time mentor parent is spending on topic areas with all clients TEXT PAGE

32 Outcomes and Evaluation Mentor Program Evaluation 1. FWC Health and Human Services grant reporting evaluation Overall measure of success of FWC 2. San José State University-Social Work and Justice Studies-Specific to Mentor Parent Program

33 Outcomes and Evaluation: San José State University-Social Work and Justice Studies Purpose: Identify and measure specific components of the program that contribute to positive client outcomes Questions: 1. How does the Mentor Parent Program impact and contribute to FWC from the perspective of different stakeholders, including clients and professional? What are the specific elements that make a difference? 2. What are difference in needs and concerns of fathers and monolingual Spanish-speaking clients? 3. Are there differences in frequency and duration of contact with Mentor Parent between parents who reunify and those who do not? Findings: 1. Equally valued by professionals for their capacity to create bridges between providers and clients, provide insights in case planning, and help educate system partners. Valued for their shared experience, ability to assist parents in navigation through the system and capacity for creating hope. 2. Women had a greater number of contacts related to parenting, housing and healthcare, while men had more related to employment. In addition, women had a significantly greater number of contacts than men. 3. Monolingual Spanish speakers felt that the language barrier would have been detrimental without the mentor parent. 4. Pilot study: Total time spent in contact with Mentor Parents was significantly greater among clients who reunified with their children than with non-reunifying parents

34 After Care Encourage successful community engagement and avoid re-entry into the child welfare system Funded by the Bureau of Justice Assistance(BJA) and SAMHSA Joint effort from Dependency Advocacy Center (DAC) and Department of Alcohol and Drug Services (DADS) via the treatment Continuous Recovery Monitoring (CRM) Assist successful graduates from DDTC and FWC with: 1. Continued recovery 2. Identifying strengths and areas of improvement 3. Goals and needs assessment 4. Identifying, accessing and acquiring resources 5. Life skills support and self-sufficiency 6. Group support and positive interaction via social events 7. Opportunities for sharing and leading others

35 Important Lessons Females and Males are different in engagement and need gender specific strategies Mentor Parents should never serve in a role of formal assessor or a broker of resources Do not work harder than the client; Guiding vs. Enabling Agent of the attorney not the attorney; life/professional experience not legal advice Strategically plan for structural and budget changes This worked for me, but it may not work for you

36 Resources on Conference USB Today s presentation Substance Abuse Specialist Paper MPP Program Description, Policies and Procedures MPP Client Contact Form MPP Sample Monthly Data Collection Form MPP Evaluation Project Research Brief NCSACW TA resources handout

37 Discussion 37

38 Presenter Contact Information Nancy K. Young, Ph.D. National Center on Substance Abuse and Child Welfare Director Toll-Free: (866) Julia Maestas, M.S. Dependency Advocacy Center (DAC) Program Manager Website: