Chemical Dependency in Child Welfare

Presented by:MeLinda Trujillo, DBHR

Amy Martin, DBHR

Introductions

• Trainers

MeLinda Trujillo – Treatment ManagerDivision of Behavioral Health and

Recovery

Amy Martin – Youth Treatment ManagerDivision of Behavioral Health and

Recovery

• Training Ground Rules and Personal Reactions

Training Agenda Introduction The Basics of Alcohol and Other Drugs

Collaborative work with other Professionals & Families

Trauma in Substance Abusing Families

GAIN SS Screening Tool

Introduction to Alcohol and Other

Drugs

A Basic Understanding

Why Do People Use Alcohol and Other Drugs?

BiologicalPsychologicalSocialCultural, and Environmental factorsResearch notes that men and women

often experience different progressions from substance use to abuse and dependence.

Levels of Substance Use and Risk of Child Abuse and Neglect General categorization of substance

use is as follows:◦Substance use◦Abuse◦Dependence.

Any level of substance use by a parent can place a child in imminent harm, create present danger or create impending danger of physical abuse and/or neglect.

It is important to determine if substance use is a factor in an unsafe situation for a child. HANDOUT

Impact of Drugs onthe Brain

Causes significant changes in brain chemistry

Disrupts normal communication between neurons.

Continued use can impact the ability to experience pleasure.

Engaging in a compulsive behavior, even in the face of negative consequences.

Inability to limit intake of the addictive substance

Long lasting or permanent changes to the brain

Brain Scan

Treatment WorksPeriods of abstinence, or reduced substance

use are a result of effective intervention and treatment

Treatment outcomes show a decrease in negative outcomes for addicts

Relapse is part of recovery. Increased and/or continued support and interventions assist in regaining abstinence.

Types of Treatment Continuum of Care in Washington State

Acute detoxSub-acute detoxIntensive InpatientRecovery HouseLong TermIntensive OutpatientOutpatientAftercare

HANDOUT

Opiate Substitution Treatment

Client receives medication :◦ To assist in stabilizing brain chemistry◦ In conjunction with outpatient counseling.

Effective ONLY with opiate class drugs

Pregnant mothers generally are prescribed this modality as a way of remaining free from illegal substances and maintaining their pregnancy Infant will likely need to detox after its birth as a result of this

method of treatment

Of a number of treatment options methadone is the most commonly used modality.

Referral Issues/Options

Treatment accessObtaining FundingKnowing the Resources

Certified Chemical Dependency Provider Directory

A directory that includes chemical dependency service providers certified by the Division of Behavioral Health and Recovery (DBHR).  Certified agencies are listed alphabetically within each county.

http://www.dshs.wa.gov/dbhr/dadirectory.shtml

Tools for Working with Substance Abusing Individuals

in the Child Welfare System UAs are a tool to be used in monitoring levels of a

substance (decreasing/increasing levels) in a person’s system

UA Best Practice will be discussed in more depth during 2 day training

Random, observed UA’s are the most accurate type of testing

UAs are a tool and can be augmented by the client.

UAs should not be the basis in deciding permanency – such as reunification

Other methods for collecting information on a person’s level of usage are hair follicle testing, oral swabs and blood tests – these tend to be less utilized due to increased cost of testing

Need for Collaboration Expected family outcomes may differ based on

perspective◦ CA looks at safely reunifying children with

parents.◦ CDPs are working with the client to address

addiction CA concerns about the family need to be shared

with the CDPs It is critical the CDP and CA Social Worker

understand the very different roles each have with the family.

CDP confidentiality guidelines are based on 42 CFR Part 2. CA Social Workers guidelines are based on Health Insurance Portability and Accountability Act of 1996 (HIPPA).

Redisclosure of information received from a chemical dependency program are subject to 42 CFR Part 2. HANDOUT

Keep in mind that… One person can’t collaborate.

Child SafetyCDPs are not trained to the policies &

procedures of CA in great depth. CDP risk factors mean something very

different. They can provide information related to treatment progress that can help the social worker to better understand potential risks of abuse and/or neglect of children involved.

Parents diagnosed as chemically dependent may not be as responsive to skill development training (anger management classes, parenting classes, etc.) if their recovery program has not been established.

Zero to Three

Months

Poor Progress/

Precontemplation

Some Progress/Contempl

ation/Prep

Moderate Progress/Prep/

Action

Substantial Progress/Action/Maintenance

Chemical Dependency Treatment

Parent remains in denial of substance abuse/chemical dependency and has not completed substance abuse screen.

o Reduction of initial resistance and defensiveness

o Parent has completed chemical dependency assessment and entered into chemical dependency treatment

o Attendance in chemical dependency treatment becomes more consistent

o Regular attendance in chemical dependency treatment

o Parent has recognized and accepted the negative consequences of own substance abuse

If applicable, parent has participated in collaborative service planning meeting with child welfare worker and chemical dependency treatment worker

HANDOUT

INDICATORS FOR PROGRESS IN THE SUBSTANCE ABUSE RECOVERY PROCESS: ZERO TO THREE MONTHS

Trauma in Substance Abusing Families

Working Definition of Trauma

Trauma is the unique individual experience of an event or enduring conditions in which-

The individual’s ability to integrate his or her emotional experience is overwhelmed; or

The individual experiences a threat to life, bodily integrity or sanity.

Exercise Questions What originally brought you into the field?

Which clients do you most enjoy working with? What is it about them that you enjoy?

Which clients do you least enjoy working with? What is it about them that you do not enjoy?

What was your role in your family growing up?

Do you see any relationship between your role and the clients you enjoy or don’t enjoy?

Group Discussion

What did you notice your discussions?

How was this activity for you personally?

What if any emotions came up?

Some Consequences of Trauma

Alcohol, tobacco and other drug abuse to manage intense emotional states

Other self destructive behaviorsEither numb or over-reactive

emotional statesAttention problems

Over/Under ResponsibilityA reframe of co-dependency as a concept - is

taking responsibility for myself legal?Does each spouse take on responsibilities

that make sense to the situation?Do the children take on parenting roles?Children placed in this role may have

difficulty accepting and recognizing help and support. They may feel they have to be strong for parent or parents.

Focus on others to avoid focus on self.Maintain known dysfunctional family

dynamics better than unknown family dynamics.

Self Care for Practitioners

Often secondary trauma is experienced while working with clients.

As professionals, we are sometimes triggered on a very deep level by experiences that we had long thought were dealt with.

It’s crucial to ensure that you have ways of caring for yourself and working through these experiences.

Issues of transference and counter-transference arise with clients most often when we haven’t cared for ourselves.

Victimization and Connection to Substance Abuse

90% of public behavioral health clients have been exposed to trauma (Muesser et al., 2004)

Most have multiple experiences of trauma

34 to 53% report childhood sexual or physical abuse (Kessler et al., 1995)

43 – 81% report some type of victimization

Resiliency Factors

Intelligence Determination Quality of relationships Creativity Caring for self Accepting help from others

Introduction to Global Appraisal of Individual Needs – Short Screen

(GAIN-SS)

Global Appraisal of Individual Needs – Short

Screener (GAIN-SS)•A validated screening tool used with adults and youth (ages 13 years and older).

•The GAIN-SS identifies a need for a chemical dependency, mental health or co-occurring assessment. The identified needed assessment would be referred to and completed by a community professional.

•This tool does not identify service needs, only the need for further assessment.

HANDOUT

When to administer the GAIN-SS screen:

During the first 45 days of an open CPS investigation◦If a case is not going to be transferred and is a high standard referral, a GAIN-SS screen must be completed

•FVS or CFWS social workers will complete a GAIN-SS screen if one has not yet been completed during the CPS investigation

•CHET Screeners will administer the GAIN-SS to youth 13 years and older if one was not administered during the investigation

Results of Mental Health Component of GAIN-SSIf an adult or youth answers “YES” to the suicide question, regardless of any other answers, the social worker/CHET screener will:

o Refer the client to the local crisis line, or

o Notify a Designated Mental Health Professional (DMHP) to the positive suicide response on the screen

Mental Health and/or Substance Abuse Assessment

- Referral Process If the screen results produce two or more

“YES” responses, the social worker will:◦ Make a referral to a community mental health

provider or substance abuse professional for further assessment

◦ If there are substance abuse indicators and mental health indicators, the social worker will make a referral to a community professional for a co-occurring disorder assessment

• A referral can be made even if there are no questions with a “YES” answer on the screen

If a client is already involved in substance abuse or mental health services, a new referral is not needed.

  Reflecting…

What, if anything, did you find out/discover about yourself and your work during this session?

  What would you like to be sure to take with you and

hold onto from this session?

  What, if anything, would you like to get rid of or

eliminate from your regarding your work with clients or in their behalf?

What, if anything, moved you during this session?

Thank YouQuestions?

MeLinda Trujillo melinda.trujillo@dshs.wa.gov

Amy Martin amy.martin2@dshs.wa.gov