10.7 Undertake the substance testing of parents

Transcription

1 10.7 Undertake the substance testing of parents Purpose This procedure outlines the process for facilitating the substance testing of parents in cases where there are indicators that parents are engaging in serious and persistent substance misuse or abuse, and confirmation of the substance misuse or abuse is required to inform the investigation and assessment or ongoing intervention with the family. Key steps 1. Overview of substance testing 2. Substance test results 3. Implement substance testing 4. Implement concurrent assessment, monitoring and intervention strategies Standards 1. The substance testing of a parent will occur in order to assess, respond to and monitor the protection and care needs of a child, where it is probable that this misuse or abuse is having, or will have, a significant impact on the child s physical or emotional well-being. 2. The substance testing of a parent will always occur in conjunction with additional strategies for assessing and monitoring the child s protection and care needs, and where possible, in conjunction with other intervention strategies aimed at assisting parents to achieve reduced or controlled use, or abstinence. 3. The substance testing of a parent will only occur if a parent provides informed written consent. Authority Child Protection Act 1999, section 5, 6, 7, 51A-51Y, 61(a), 73, 78, 82, 95, 159A-159H and 159M-159N Communities Policy: Recordkeeping Policy No. 408: Information privacy Chapter 10.7 Undertake the substance testing of parents July 2013 Page 1

2 Key steps - Undertake the substance testing of parents 1. Overview of substance testing 1.1 Consider the substance testing of a parent 1.2 Consider the testing schedule 2. Substance test results 2.1 Interpret substance test results 2.2 Substance test results as evidence in court proceedings 3. Implement substance testing 3.1 Obtain consent 3.2 Facilitate the substance testing of a parent 3.3 Respond to non-negative test results 3.4 Respond to non-compliance by a parent 4. Implement concurrent assessment, monitoring and intervention strategies Chapter 10.7 Undertake the substance testing of parents July 2013 Page 2

3 1. Overview of substance testing Substance misuse is the use of a substance not consistent with legal or medical guidelines. Substance abuse is a maladaptive pattern of substance use that has an effect on the brain, which leads to social, psychological, physical or legal problems. In some cases, the substance testing of parents may be considered a necessary and important part of an investigation and assessment or ongoing intervention by the department, based on the extent and nature of the parents substance misuse or abuse history and the level and nature of harm, or unacceptable risk of harm, to the child. When it is considered necessary or important that parents participate in substance testing, do not rely on substance testing as the only strategy for assessing or monitoring the child s protection and care needs, or as the only strategy for parents to address their substance misuse or abuse. The substance testing of parents is not always an accurate or reliable means of monitoring parental substance misuse or abuse - urine samples may be tampered with, certain drugs will only be detected if the frequency of testing is adequate. In addition, it cannot be assumed that once parents resolve their substance misuse issues, they will be able to meet the child s protection and care needs - particularly if other risk factors, for example, mental health issues are contributing to the child being in need of protection. Note: Any reference to Alcohol, Tobacco and Other Drugs Services (ATODS) or an ATODS treatment plan in this procedure will include any other related service and the treatment plan with that service. Information about the test Substance testing is a process which incorporates two steps: the screening test provides a quick process for establishing whether a substance, or class of substance, is likely to be present in a given sample, and the confirmation test is a second test on the same sample in circumstances where the screening test provides a non-reassuring result. Where applicable, substance testing will occur by urinalysis (urine testing), unless another method of testing is already being undertaken as part of a parents ATODS treatment plan, or otherwise recommended by ATODS. The collection of a urine sample may be observed by a medical practitioner or paramedical staff under the direction of a medical practitioner, to reduce possibility of contamination or substitution. Under no circumstances is a departmental officer to observe the provision of a urine sample. There are three levels of supervised collection (Level 1, 2 or 3) which are consistent with the Australian and New Zealand standards. Level 1 requires direct visualisation of the urine stream from the urethra to the container at all times. Level 2 requires the supervisor to stand within the cubicle or collection room alongside the person while the sample is being passed. Level 3 requires the person to remove outer heavy Chapter 10.7 Undertake the substance testing of parents July 2013 Page 3

4 clothing and empty pockets prior to entering the collection cubicle and the supervisor waits outside while the urine is being passed. Level 3 is the minimum acceptable level of supervision, with levels 1 and 2 going beyond this standard. Level 1 and 2 are generally reserved for situations where there is a high likelihood of the parent attempting to tamper with, or substitute, the urine prior to the container being sealed. A confirmation test is used to confirm the results of the screening test which eliminates false positive findings. The confirmation test will also characterise the type of substance, differentiating over-the-counter and prescription substances from illicit drugs. The test will provide an indication of the amount of substance present in the sample which will inform whether the parent s stated use is consistent with the confirmation test results. The team leader is responsible for approving requests for confirmation testing. Alcohol, Tobacco and Other Drugs Services Alcohol, Tobacco and Other Drugs Services (ATODS) provides information, clinical assessment, counselling, treatment and referral with a range of alcohol and other drug related problems. ATODS offer a range of activities about health promotion and the training of professionals on the management of substance misuse, abuse and dependence. ATODS will provide the departmental officer with general advice, information on current treatment plans with a parent and consult with the Drugs of Dependence Unit (DDU) at the request of the senior practitioner, if necessary. Drugs of Dependence Unit The DDU minimises the harm to the public from inappropriate use of controlled drugs by providing a monitoring, investigative, enquiry and research service. The DDU monitors the prescription of methadone and buprenorphine within the Queensland Opioid Treatment Program. If during the course of intervention by the department, it becomes apparent that the DDU may hold information in relation to a parent, contact the local ATODS to discuss the circumstances, including possible information held by the DDU in relation to the parent. Following this discussion, decide whether to proceed with a request to ATODS for ATODS to contact the DDU for information about the parent. 1.1 Consider the substance testing of a parent If it has been determined that substance use by the parent will have a detrimental impact on the child s emotional or physical well-being, substance testing may be used to confirm or dispute allegations of parental substance misuse or abuse. Consider the substance testing of a parent: when there are indicators that a parent is engaging in serious and persistent substance misuse or abuse and substance testing is required to inform an assessment about whether a child is in need of protection or continues to be in need of protection - this may be demonstrated by regular or heavy patterns of substance misuse or abuse, binge use or dependency Chapter 10.7 Undertake the substance testing of parents July 2013 Page 4

5 following the reunification of a child for a specified period, where serious and persistent substance misuse or abuse by a parent has contributed to a child being in need of protection. If a parent is admitting to substance misuse or abuse, consideration should be given to the benefits of continuing with substance testing. A substance test can only evidence the presence, type and quantity of a substance. It cannot inform how the substance impacts on the parent s ability to function. Further assessment is required in relation to the parent s ability to meet the protection and care needs of their child. For information about the indicators and risks associated with parental substance misuse or abuse, refer to the practice paper Parental substance misuse and child protection: overview, indicators, impacts, risk and protective factors. For information about substance misuse treatment and intervention options, including the effectiveness of specific options and practices for enhancing intervention outcomes, refer to the practice paper Parental substance misuse and child protection: intervention strategies. Where substance testing is requested of a parent, primarily for assessing, responding to and monitoring the protection and care needs of a child, the department is able to meet the associated costs. Obtain approval from the financial delegate for any anticipated expenditure involved in the implementation of substance testing, prior to requesting a parent s participation in substance testing. 1.2 Consider the testing schedule When considering the substance testing schedule (how frequently substance testing should occur), take into consideration the substance misuse or abuse history of the parent, any current treatment plan and the protection and care needs of the child. In particular, consider the following when determining the substance testing schedule: the purpose of substance testing the parent and how continued misuse or abuse impacts on their ability to parent the child any current engagement with ATODS or other related service, to assist with reduced or controlled use or abstinence previous treatment or intervention provided to the parent, including intervention outcomes where a parent has not engaged with a treatment program, whether there would be any benefit is requesting ongoing substance testing when results will likely be positive how test results will be used to inform assessment, intervention or case planning with the family and whether significant decisions about a child would be altered if a positive test result was received whether further information gathering and observation is sufficient to negate the need for substance testing. Where the parent is engaged with ATODS or other related service, the development of the testing schedule will occur in consultation with that service. Chapter 10.7 Undertake the substance testing of parents July 2013 Page 5

6 Additional information to be considered when determining the testing schedule includes: the detection period for most substances is two to three days - most illicit substances have a half life (the time taken for 50% of the substance to leave the body) the duration of substance testing is dependent on the history of the substance misuse or abuse - for a less dependent parent, short-term testing of approximately two to six months may be adequate long-term substance testing is appropriate for a parent who is engaging in chronic substance use or a parent with dependency where there is a likelihood of relapse. Where substance testing will occur, or is occurring at the request of the department, document the testing schedule in a case note in the investigation and assessment or ongoing intervention event in ICMS. If the parent is already participating in substance testing as part of a treatment plan with ATODS or other related service, and the testing schedule is documented within that treatment plan, attach the treatment plan to the relevant event in ICMS. 2. Substance test results 2.1 Interpret substance test results Initial test (screening test) results will either provide a negative result or a non-negative result. The term non-negative is used to signify a result which requires further testing. A non-negative initial test result will not stand up to legal scrutiny. If the finding is potentially significant and further action is considered, the sample must undergo confirmation testing. Tests which have been confirmed are generally accepted without challenge in courts. The pathology which undertook the substance testing of the parent will provide advice and assistance with interpreting test results where required. 2.2 Substance test results as evidence in court proceedings Courts only accept and recognise results of tests where tests are conducted in accordance with the 'Australian/New Zealand Standard, Procedures for the collection, detection and quantification of drugs of abuse in urine' (the standard). Where possible, the parent is to attend Queensland Medical Laboratories (QML) Pathology or Sullivan Nicolaides Pathology (SNP) collection centres, both of which are certified to conduct substance testing in accordance with the standard. Where the parent does not have access to a QML or SNP collection centre, consult with the team leader. If necessary, contact the Commercial Accounts Liaison, QML by telephone on (07) to discuss whether alternative accredited collection centres are available, for example, in rural and remote areas. Queensland Health is unable to comply with the standard for the collection or analysis of samples. Chapter 10.7 Undertake the substance testing of parents July 2013 Page 6

7 Director of Forensic Medicine The Director of Forensic Medicine provides clinical forensic medical services including the examination of victims of crime and alleged offenders, toxicological advice to the Coroner and courts in relation to suspicious deaths and appears in court to give expert advice. Where the outcomes of court proceedings are reliant on substance test results, confer with the senior practitioner about whether consultation should occur with the Director of Forensic Medicine, Queensland Health by telephone on (07) Implement substance testing 3.1 Obtain consent The substance testing of a parent can only be undertaken when a parent provides written consent. Where a parent is requested to undertake an initial screening test, advise the parent about the proposed urine substance test and talk through the Consent form - Initial screening test with the parent. If the parent consents to the initial screening test, ask the parent to sign two copies of the consent form. Provide the parent with one copy of the signed consent form and attach the other copy to the relevant event in ICMS. Where the parent is requested to participate in an ongoing testing schedule, discuss the testing schedule with the parent. If the parent consents to participate in the ongoing testing schedule, ask the parent to sign two copies of the consent form Consent form - Ongoing testing schedule. Provide the parent with one copy of the signed consent form and attach the other copy to the relevant event in ICMS and document the testing schedule into a case note. 3.2 Facilitate the substance testing of a parent Where the parent consents to substance testing at the request of the department: discuss with the parent their history of substance use - which substances, frequency and quantity (where the parent admits recent substance use, consider whether it is necessary to continue with an initial screening test) advise the parent that the urine substance test is for the purpose of determining whether there are substances in their system or monitoring the level of substances in their system request that the parent undertake a urine test and talk through the Consent form - Initial screening test or Consent form - Ongoing testing schedule provide the parent with a QML or SNP pathology request form for the relevant collection centre who will undertake the substance test (collection centres can be contacted for copies of their pathology request form when required) ask the parent to take the QML or SNP pathology request form and photo identification when attending the collection centre for the substance test provide a copy of the QML or SNP screening test results to the parent who undertook the test and discuss the results with them Chapter 10.7 Undertake the substance testing of parents July 2013 Page 7

8 in consultation with the team leader, consider whether a subsequent safety assessment or review of the case plan is required, where a test has a non-negative result in consultation with the team leader, decide whether confirmation testing will be undertaken on the non-negative result where the confirmation test has a positive result, discuss the results with the team leader and consider any further action required provide a copy of the QML or SNP confirmation test results to the parent and discuss the results with them. Depending on the frequency of testing and the substances previously identified, consideration may be given to whether confirmation testing is required for each non-negative test result where the parent is participating in an ongoing testing schedule. 3.3 Responding to non-negative test results In some circumstances, it may be considered necessary to undertake confirmation testing prior to any immediate action being taken. However, where non-negative results from the initial screening test, whether in isolation from, or in combination with, parental stressors indicate significant risk to the child, the decision to take immediate action prior to confirmation testing will be considered, as outlined below, in accordance with the principle that the well-being and best interests of a child are paramount (Child Protection Act 1999, section 5). Any decision made in response to a non-negative test result needs to be made in the best interests of the child. Long-term abstinence from substance use has many positive benefits for the parent, however, the risk of relapse is high and consideration needs to be given to the safety of the child where a parent returns a non-negative test result. A non-negative test result must be considered in assessing the immediate and long-term needs of the child and progress towards the case plan goal. Where the substance testing of a parent returns a non-negative result, this needs to be considered within the broader context of: any treatment plans the parent is currently participating in and the goals of the treatment (reduced or controlled use or abstinence) any recent change in circumstances which may place additional stressors on the family and parental symptoms or behaviours associated with the detected substance the nature of substances detected, taking into consideration the history of misuse or abuse by the parent and the impact on the child the protection and care needs of the child. In addition, on receipt of a non-negative test result the departmental officer will: discuss the test results with the parent and where possible, discuss the reasons for the non-negative result and whether the parent would be willing to engage with an ATODS treatment program, or other related service consider whether a subsequent safety assessment is required where the child is in the family home consider whether immediate action is required to ensure the safety of the child Chapter 10.7 Undertake the substance testing of parents July 2013 Page 8

9 consider whether a review of the case plan is required consult with the senior practitioner, where required. 3.4 Responding to non-compliance by a parent A parent may refuse to attend, or cease attending, substance testing, ATODS or other related service, at any time. Where the child's case plan incorporates substance testing or other treatment options and the parent subsequently decides to cease attending, determine whether: a case plan review is required and if so, the urgency of the review an out-of-home care placement is necessary to ensure the child's protection, until the case plan review is undertaken. When a parent refuses to consent to substance testing or is not attending ATODS treatment programs, and general, non-identifying advice is required to assist departmental officers in making assessments and decisions about the protection and care needs of a child, contact the local ATODS and obtain the necessary advice or information. 4. Implement concurrent assessment, monitoring and intervention strategies The substance testing of parents is not generally considered an intervention in isolation from other substance misuse or abuse treatment options. Where parents participate in substance testing, it is necessary that other, complementary methods for establishing, monitoring and addressing parental substance misuse are clearly incorporated as part of departmental intervention. For further information, refer to the practice paper Parental substance misuse and child protection: intervention strategies. In addition to the substance testing of parents, ensure that consideration is given to: assessment and/or treatment by ATODS, for the purpose of: determining the parent s level and nature of the substance misuse or abuse and associated health and intervention needs obtaining advice about the most effective and appropriate substance misuse or abuse intervention options available to parents practical strategies parents can use to manage the stressors in their lives relapse prevention planning, including practical strategies for implementation assessment and intervention strategies in relation to other risk factors, where applicable, identified as contributing to the child s protection and care needs, for example, mental health issues, knowledge of child development and parenting and behaviour management skills. For information about available substance misuse or abuse interventions, contact the nearest Alcohol, Tobacco and Other Drug service. Note: Should parents request ATODS assessment or treatment, regardless of whether substance testing is occurring or whether test results are non-negative or positive, always: refer the parent to an appropriate service record the referral outcome. Chapter 10.7 Undertake the substance testing of parents July 2013 Page 9

10 Resources Forms and templates Consent form - Initial screening test Consent form - Ongoing testing schedule Departmental resources Practice paper: Parental substance misuse and child protection: intervention strategies Practice paper: Parental substance misuse and child protection: overview, indicators, impacts, risk and protective factors External resources Alcohol, Tobacco and Other Drugs Chapter 10.7 Undertake the substance testing of parents July 2013 Page 10