Expanding Services to Children and Their Families in FDC

Transcription

1 Expanding Services to Children and Families in FDCs: Lessons Learned from the Children Affected By Methamphetamine Grant Program Phil Breitenbucher, MSW Erin Hall, MS Children and Family Futures October 13, 2013

2 Acknowledgement 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 Children and Family Futures The Mission To improve safety, permanency, well-being and recovery outcomes for children, parents and families affected by trauma, substance use and mental health disorders. Consults with government agencies and service providers to ensure that effective services are provided to families Advises Federal, State, and local government and community-based agencies, and conducts research on best ways to prevent and address the problem Provides comprehensive and innovative solutions to policy makers and practitioners

4 Children and Family Futures Research and Evaluation In-depth Technical Assistance Regional Partnership Grants I Office of Juvenile Justice and Delinquency Prevention National Center for Substance Abuse and Child Welfare Children Affected by Meth Regional Partnership Grants II

5 What is the impact of parental substance use disorders on the child?

6 Impact on the Child Prenatal exposure Postnatal environment: - Living with a parent with a substance use disorder - Separation and attachment - Neglect of basic needs, including safety and health - Exposure to trauma

7 1,640 babies were born with prenatal substance exposure 1,200 children were the victims of substantiated abuse/neglect associated with substance abuse; 3 of these children died 205 child maltreatment victims were removed from their homes associated with parental substance abuse 75 parents with a substance use disorder had their parental rights terminated Source: Children s Bureau Maltreatment Report (2009)

8 Statements of the Problem How many children in the child welfare system have a parent in need of treatment? 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)

9 Parental AOD as Reason for Removal Percentage of child removals Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Source: AFCARS Data, 2011

10 70 PARENTAL AOD AS REASON FOR REMOVAL IN THE UNITED STATES PERCENT Source: AFCARS Data Files

11 Percent and Number of Children with Terminated Parental Rights by Reason for Removal Neglect (n=75,915) Parent Alcohol or Drug Abuse (n=46,478) Parent Unable to Cope (n=25,254) Physical Abuse (n=19,501) Inadequate Housing (n=17,852) Sexual Abuse (n=6,345) Abandonment (n=7,897) Child Behavior (n=7,444) Parent Incarceration (n=8,324) Child Alcohol or Drug Abuse (n=3,805) Child Disability (n=5,513) Reliquishment (n=2,225) Parent Death (n=1,171) 6% 7% 6% 7% 3% 5% 2% 1% 22% 17% 15% 40% 65% 0% 10% 20% 30% 40% 50% 60% 70% Adoption and Foster Care Reporting System (2011) [Data file]. Ithica, NY: National Data Archive on Child Abuse and Neglect.

12 Substance Use and Child Maltreatment Substance use and child maltreatment are often multigenerational problems that can only be addressed through a coordinated approach across multiple systems to address needs of both parents and children.

13 The Birth of the FDC Movement First FDCs convened in Reno, Nevada and Pensacola, Florida in

14 Common Vision Extraordinary Effort Court Drug Treatment Child Welfare 3 Systems with multiple: Mandates Training Values Timing Methods

15 What Is a Family Drug Court? Devoted to cases of child abuse and neglect that involve substance abuse by the child s parents and/or other caregivers; Focused on safety and welfare of the child while giving parents tools needed to become sober, responsible caregivers; Utilizes a multidisciplinary team approach to assess the family s situation, devising comprehensive case plans that address the needs of the children and the parents. Family Dependency Treatment Courts: Addressing Child Abuse and Neglect Cases Using a Drug Court Model: Bureau of Justice Assistance, December 2004

16 Family Drug Court Goals To provide a continuum of family-based treatment and ancillary services for children and parents To provide continuing care and information that families need to access the services they may require to function responsibly To integrate the needs of both children and parents, encompassing the entire family as the client Family Dependency Treatment Courts: Addressing Child Abuse and Neglect Cases Using a Drug Court Model: Bureau of Justice Assistance, December 2004

17 Number of FDCs FDC Movement

18 Federal Support for Family Drug Courts Direct Funding (FY2012) - $19 million

19 Common Ingredients of FDCs Increased Responses to management of participant recovery behaviors services and (sanctions & Earlier access compliance incentives) to assessment and treatment Increased judicial services oversight System of identifying families 2002 Process Evaluation

20 What is Success in FDC? Key Outcomes Safety (CWS) Reduce re-entry into foster care Decrease recurrence of abuse/neglect Permanency (Court) Reduce time to reunification Reduce time to permanency Reduce days in care Recovery (AOD) Increase engagement and retention in treatment Increase number of clean UA s Increase number of graduates Decrease Recidivism

21 Research Update on Family Drug Courts Douglas B. Marlowe, J.D., Ph.D. and Shannon Carey, Ph.D. Publication Date: May 2012 To download, visit: eed-know-briefs

22 HIGHER TREATMENT COMPLETION RATES SHORTER TIME IN FOSTER CARE HIGHER FAMILY REUNIFICATION RATES LOWER TERMINATION OF PARENTAL RIGHTS FEWER NEW CPS PETITIONS AFTER REUNIFICATION COST SAVINGS PER FAMILY

23 100 Reunification Rates FR Rates Up to 20-40% higher # of Days FDC vs Comparison Days in Foster Care Several Fewer Months 0 New Petition (Source: Marlowe and Carey, May 2012) New CPS Petition after FR Infrequent, In all conditions

24 Cost Savings Per Family $ 5,022 Baltimore, MD $ 5,593 Jackson County, OR $ 13,104 Marion County, OR Burrus, et al, 2011 Carey, et al, 2010 Carey, et al, 2010

25 Holistic approach, addresses family well-being FDCs are Serving Families FDCs hold parents responsible for their recovery and parenting Family stress and trauma can greatly contribute to relapse; family stability can greatly contribute to recovery

26 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.

27 FDC Practice Improvements Approaches to child well-being in FDCs have changed. In the context of the parent s recovery Family- Centered Treatment Childfocused assessments and services

28 Core Messages Family Drug Courts Child Well-Being occurs in the context of Family

29 Children Affected by Meth Grants (CAM) Funded by SAMHSA to focus on expanding and/or enhancing services to improve the well-being, permanency, and safety outcomes of children 12 Grantees awarded; $1.4 million over 4 years Wide range of program designs and program strategies Designated Services Coordinator Evidence Based Practices

30 Challenges Being Addressed by CAM Grantees Parents need understanding and skill to meet children s needs Children need comprehensive assessments and services Parents and children need assessments and services to address trauma and relationship issues Families need access to supportive services following reunification

31 CAM Grantees Clarke County, WA Butte County, CA Sacramento, CA Santa Cruz, CA San Luis Obispo, CA Santa Barbara, CA Colorado Nebraska (6 FDCs) Dunklin County, MO Oklahoma Riverside, CA Pima County, AZ

32 CAM Grantees Clarke County, WA Sacramento, CA Santa Cruz, CA San Luis Obispo, CA Santa Barbara, CA Butte County, CA Colorado Riverside, CA Pima County, AZ Nebraska (6 FDCs) Oklahoma Dunklin County, MO

33 CAM Year 2 Data Upload September 2010 June ,213 Children 1,972 Adults 1,496 Families

34 Who are the CAM Grantees? 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

35 Selected CAM Program Strategies Parenting Education Therapuetic Based Parent- Child Engagement & Outreach Trauma-Focused - Adults Trauma-Focused - Children Developmental & Behavioral

36 Intervention Nurturing Parenting Celebrating Families Evidence-Based Parenting Neuro-Developmental Screening ASQ NCFAS PCIT Parent-Child Therapy CAM Child Interventions & Strategies Across Age Spectrum

37 Child/Youth (9) Children remain at home Occurrence of child maltreatment Average length of stay in FC Re-entries to FC placement Timeliness of reunification Timeliness of permanency Prevention of substance-exposed newborn Connected to supportive services Improved child well-being CAM Performance Indicators Adults (6) Access to treatment Retention in treatment Reduced substance use Connected to supportive services Employment Criminal behavior Family/Relationship (3) Improved parenting Family Relationships and functioning Risk/protective factors

38 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 Six Months after CAM Program Enrollment 2.5% CAM Participant 6.4% Comparative State Data Preliminary Findings Safety No substance-exposed births after CAM entry Lower occurrence of maltreatment within six months compared to the average among the six states where CAM grantees are located

39 75.0% 70.0% 65.0% 60.0% Percentage of Children Reunified in Less than 12 Months 72.2% CAM Participant 67.0% 9.5% 90.5% Comparative State Data Children Remain At Home Preliminary Findings Permanency Remained In-Home Removed from Home Nearly all children in-home at CAM entry remained in the home Those who were out of home were reunified more quickly

40 15.0% 10.0% 5.0% 0.0% Percentage of Children that Re-entered Foster Care in Less than 12 Months 4.6% CAM Participant [VALUE] Comparative State Data Preliminary Findings Permanency 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

41 25 Increase in Employment Preliminary Findings Recovery % CAM Participant 17% Comparative State Data Participants had timely access to care- most often the same day of enrollment for those not already in care (mean=13.7 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

42 Preliminary Findings Recovery Percent of adults reporting a reduction in use by drug type 66.4% (n=271) - Methamphetamine 67.7% (n=130) - Marijuana 57.1% (n=133) - Alcohol 58.7% (n=46) - Heroin/other opiates 28.6% (n=24) - Cocaine

43 Preliminary Findings Well-Being Overall Mean NCFAS Scores for Each Domain (lower is better) Intake Closure

44 Emerging Lessons Learned New strategies required new collaborative partnerships Increased emphasis on children brings new players to the table and communication protocols need to be established 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 For sites with success in increasing the emphasis on children, they can t imagine going back to the way it was before a new way of doing business

45 Tools for Practice Improvement Defining your target population Identifying the needs of your target population Identifying existing services and service gaps

46 Serving Children Scope of Services Educational Youth Services Child Developmental Substance Abuse Treatment Primary Health and Dental Parent-child relationships Trauma & Mental Health

47 Serving the Needs of Children FDCs do not have to do this alone, but should be connected to those who are serving children That s what collaborative means The challenge is not to divert resources from treating parents to help their children But to mobilize and link to new resources from other agencies that already serve children

48 Today programs are working to improve the lives of children and families Source: Children s Bureau Maltreatment Report (2009) 168,000 children with special needs, including effects of prenatal substance exposure, will attend highquality early childhood education programs 3,000 parents will enter substance abuse treatment 478 children will exit foster care to safe and stable permanent placements 340 children will be reunified 33 parents will graduate from FDC

49 Resources

50 Just released! To download, please visit:

51 National Center on Substance Abuse and Child Welfare Resources Conference presentations Workshop trainings Online tutorials Toolkits Publications Video Please visit:

52 National Center for Substance Abuse and Child Welfare 1. Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers 2. Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals 3. Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Legal Professionals Please visit: NCSACW Online Tutorials

53 Phil Breitenbucher, MSW Erin Hall, MS Commercentre Drive, Suite 140 Lake Forest, CA (714) Contact Information