CAPTA (Child Abuse Prevention and Treatment Act) 2003 From Washington to Harrisburg to Philadelphia
Substance Exposed Newborns: Collaborative Approaches to a Complex Issue June 24, 2010 Nick Claxton, CQSW Children with Special Health Care Needs, Program Coordinator Philadelphia Department of Public Health/ Division of Maternal, Child and Family Health
Learning Objectives: 1. The history of how the Philadelphia CAPTA program came about 2. How the current Philadelphia CAPTA program is designed 3. Some of the challenges encountered during planning and first two years of implementation and how they were addressed
Nick s background Social Work training in London To Philadelphia 1981 1981 1997: child welfare 1997 2002: hospital social work 2002 present: public health
How one city responded to new federal requirements The story so far: Washington, DC; 2003 Harrisburg, PA; 5/2007 Philadelphia Department of Human Services (DHS); 7/2007 Philadelphia Department of Public Health, Maternal, Child & Family Health (MCFH); 9/2007
Learning Objective 1: How the Philadelphia CAPTA program came about AIA conference; Substance Exposed Newborns: Weaving Together Effective Policy & Practice (October 6-7, 2005, Washington DC) Came back to MCFH inspired and asked what is Philadelphia doing? Met with DHS to discuss what was being done MCFH and DHS worked on developing a response social workers, attorneys, nurses, attorneys, administrators, attorneys
Learning Objective 1: How the Philadelphia CAPTA program came about Coincidental but significant timing of development of CAPTA program The response in Philadelphia to the new CAPTA requirements took place at a time of significant public scrutiny of the child welfare system We ll come back to this in more detail in the Challenges Encountered discussion
Learning Objective 2: Design of the local CAPTA program Staff makeup DHS CAPTA supervisor (MSW); social workers (bachelor s or master s level) MCFH CAPTA supervisor (M.Ed); social worker (MSW); substance abuse specialist (MPH); nurse (RN, BS) Role of MCFH/CAPTA team: to provide assessment, brief intervention, and referrals within a 90-day time frame
Learning Objective 2: Design of the MCFH CAPTA program Primary MCFH Social Worker Responsibilities part case management ; part clinical intervention contact person with DHS for all initial arrangements meet with mother; explain program specifics, answer questions complete psychosocial assessment
Learning Objective 2: Design of the MCFH CAPTA program Primary MCFH Social Worker Responsibilities cont. assure that requisite HIPAA and consent forms are understood and signed address needs, particularly as they apply to barriers that may keep client from participating in and successfully completing her treatment program conduct further home visits as needed
Learning Objective 2: Design of the MCFH CAPTA program Primary MCFH Nurse Responsibilities meet with mother and infant; complete assessment on both develop an action plan that addresses individual health and developmental issues provide education on range of issues (e.g., safe sleep, feeding, developmental milestones, when to call doctor v. go to ER, toddler behavior [in response to newborn], discipline) meet weekly with mother and infant until baby has reached 10 lbs or no health barriers are evident; switch to every other week
Learning Objective 2: Design of the MCFH CAPTA program Primary MCFH Substance Abuse Specialist Responsibilities meet with mother; explain program specifics, answer questions complete substance use assessment develop action plan based on client s needs and circumstances make referral to appropriate program (D&A, MH, dual diagnosis) follow-up with client and/or program as needed conduct home visits as appropriate to provide support and/or address problems
Learning Objective 2: Design of the MCFH CAPTA program Primary MCFH Supervisor Responsibilities provide programmatic management plan, coordinate, and evaluate the delivery of services to referred clients provide clinical and administrative supervision to MCFH team conduct weekly team meetings to assure quality of services to program participants work with DHS CAPTA supervisor to resolve issues as they arise generate clinical reports
Learning Objective 2: Design of the MCFH CAPTA program Primary MCFH Supervisor Responsibilities cont. specific position was created several months into the program didn t expect the number of referrals (51 in 1 st quarter) needed someone with clinical experience and no other responsibilities to oversee day-to-day aspects of program
Learning Objective 2: Design of the MCFH CAPTA program USUAL FLOW OF CAPTA REFERRALS receive referral from DHS visit with client is scheduled and conducted MCFH CAPTA program is explained to client, questions answered; psychosocial and substance use assessments are completed; consent and HIPAA forms are signed; information packet given to client; initial intake at appropriate treatment center is scheduled; nurse is called and initial visit scheduled
Learning Objective 2: Design of the MCFH CAPTA program USUAL FLOW OF CAPTA REFERRALS cont. RN sees mother and infant for assessment; schedules next appointment assessments are written up within 24 hours any needs brought up during initial joint visit are addressed follow-up is done to determine whether client kept her intake appointment, if no, client is contacted to determine why and to establish a time for rescheduling
Learning Objective 2: Design of the MCFH CAPTA program USUAL FLOW OF CAPTA REFERRALS cont. client is monitored by SW, RN, and BHS as needed whatever comes up gets dealt with appropriate referrals made DHS worker is kept apprised of anything that arises that impacts the client and/or infant and other children in the household
Learning Objective 2: Design of the MCFH CAPTA program USUAL FLOW OF CAPTA REFERRALS cont. client s current status is discussed by team at weekly meetings as 90-day limit is approached, recommendations for follow-up by DHS are addressed joint closing visit with DHS and one MCFH/CAPTA representative is arranged and client is discharged.
Case example more complex than most, but not unusual coordinated efforts amongst MCFH CAPTA staff coordinated efforts with others local County Assistance Office Social Security Administration Motor Vehicle Administration treatment providers family members
SSA CAO DMV HIP MCFH/ SW Hospital SW AZ s father D&A program BHSI MCFH/ BHS Beatrice AZ s nephew Addie Zen Natisha Zen AZ s mother FOC AZ s niece AZ s PCP NB s pediatrician NB s specialist MCFH/ RN HOUSEHOLD MCFH/ CAPTA DHS/ CAPTA
Learning Objective 3: Some of the challenges encountered during planning and the first two years of implementation and how they were addressed Planning DHS was in the middle of significant public scrutiny following major articles in Philadelphia Inquirer (2006) re: a number of deaths that had occurred on their caseload. Headlines included: DHS workers suspended in child s death ; DHS death reviews are kept confidential ; Firm (agency) with ties to DHS investigated.
Learning Objective 3: Some of the challenges encountered during planning and the first two years of implementation and how they were addressed a Grand Jury was convened and issued a blistering report, which led eventually to the firing of several DHS and private agency workers, and criminal prosecutions oversight of DHS by a Community Oversight Board with consequent changes in policy and practice
Learning Objective 3: Some of the challenges encountered during planning and the first two years of implementation and how they were addressed CAPTA planning took place in this context i.e. with the public CPS agency under probably its most intense scrutiny ever move toward a safety model, especially with young children (under 5) (e.g. -> DHS workers had to visit within 2 hours of referral) DHS therefore erred strongly on the side of caution. Monthly reports became weekly reports quite detailed reports have continued to change
Learning Objective 3: Some of the challenges encountered during planning and the first two years of implementation and how they were addressed Who is the client? Significant Questions Arising: What is a referral as opposed to a report? How voluntary is voluntary?
Learning Objective 3: Some of the challenges encountered during planning and the first two years of implementation and how they were addressed Significant Questions Arising: What about only marijuana? What about alcohol even though not included in CAPTA law? What about legal drugs used illegally?
Learning Objective 3: Some of the challenges encountered during planning and the first two years of implementation and how they were addressed Significant Questions Arising: What about only marijuana? What about alcohol even though not included in CAPTA law? What about legal drugs used illegally?
Learning Objective 3: Some of the challenges encountered during planning and the first two years of implementation and how they were addressed FYI Drugs of choice The MCFH experience has included only marijuana heroin PCP opiates benzodiazepines crack cocaine/powdered crack methadone and combinations of the above
Learning Objective 3: Some of the challenges encountered during planning and the first two years of implementation and how they were addressed Newborn (CAPTA) MCFH CAPTA Priority of Responsibilities Other children in the family (DHS) Mother (CAPTA) Other adults in the family (professional practice)
Comments from MCFH Team Members Strengths and Challenges Social Worker Flexibility. Housing Nurse Multidisciplinary approach, we are small enough to keep everyone on the same page and to allow for flexibility in meeting clients individual needs Getting mothers to accept drug & alcohol treatment
Comments from MCFH Team Members Substance Abuse Specialist Strengths and Challenges Multidisciplinary team approach used in the assessment and referral processes CAPTA services are short-term; drug addiction and recovery are on a continuum. Barriers and stressors often cause people to go in and out of treatment for many years.
Learning Objective 3: Some of the challenges encountered during planning and the first two years of implementation and how they were addressed clinical differences in assessment, both within the MCFH team and with other agencies. communication with other significant agencies e.g. drug and alcohol treatment agencies
Recent Changes Proposed to MCFH s Role What might the future hold? DHS has been discussing changes in its response to CAPTA referrals various changes to the MCFH role proposed using the MCFH CAPTA team solely for comprehensive assessments (14 days only) details yet to be confirmed uncertainty for the MCFH team
Lessons Learned? Interdepartmental collaboration can be very powerful Interdepartmental collaboration can be challenging How does pure policy translate into practice? It s always a dynamic process
Thank you! If you would like to discuss further anything related to this presentation, please feel free to contact Nick Claxton at: Nick.Claxton@phila.gov 215.685.5232