Child Welfare and Substance Abuse: Current Issues and Innovations National Association of State...

Child Welfare and Substance Abuse:Current Issues and Innovations

National Association of State Alcohol and Drug National Association of State Alcohol and Drug Abuse Directors Annual MeetingAbuse Directors Annual Meeting

Miami, FloridaMiami, Florida

June 2005June 2005

Nancy K. Young, M.S.W., Ph.D.

A Sense of Satisfaction

A Sense of Urgency

We have much to feel good about in our efforts to We have much to feel good about in our efforts to combine forces to help children and families combine forces to help children and families affected by substance use disorders and child affected by substance use disorders and child abuse or neglectabuse or neglect

At the same time, we need a much greater sense At the same time, we need a much greater sense of urgency in building on these victories to enter of urgency in building on these victories to enter into the next phase of getting serious and getting into the next phase of getting serious and getting to scaleto scale

Two Contrasting Ideas:

Topics

NCSACW

Children with Prenatal Substance Exposure

Children of Substance Abusers who are also Victims of Child Abuse and/or Neglect

Children in the Child Welfare System with their own Substance Use Disorder

Future Trends

A Program of the Substance Abuse and Mental Health

Services AdministrationCenter for Substance Abuse Treatment

and theAdministration on Children, Youth and Families

Children’s BureauOffice on Child Abuse and Neglect

MISSION To improve outcomes for families by promoting

effective practice, organizational, and system changes at the local, state, and national levels Developing and implementing a comprehensive

program of information gathering and dissemination

Providing technical assistance

PRODUCTS Free On-Line Training with CEUs

Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals – Now Available

Understanding Addiction and Recovery: A Guide for Child Welfare Workers

Understanding Families with Substance Use Disorders: A Guide for Judges and Attorneys working with Families in Family/Juvenile Court

PRODUCTS Program of In-Depth Technical Assistance

Round 1 – Summer 2003 to Fall 2004 Colorado – Licensing/certification of providers who specialize

in child welfare population and protocol for improving services Florida – Regional contracts to ensure local-level system

linkages and preferred practice model Michigan – Revised SACWIS to prioritize SUDs Virginia – Comprehensive 5-year plan

Round 2 – Winter 2005 to Spring 2006 Arkansas, Massachusetts, Minnesota and Squaxin Island

Tribe at Puget Sound

Information Sharing & Management

Training and Staff Development

Budgeting and Program Sustainability

Building Community Supports

Connecting AOD, CWS, Court Systems: Elements of System Linkages*

From CSAT Technical Assistance Publication (TAP) 27: Navigating the Pathways *Revised March 2003From CSAT Technical Assistance Publication (TAP) 27: Navigating the Pathways *Revised March 2003

Underlying Values Screening and

Assessment Client Engagement and

Retention in Care AOD Services to

Children Joint Accountability and

Shared Outcomes Working with Related Agencies and Support Systems

Policy Framework and Tools

10 Element Framework Collaborative Values Inventory Collaborative Capacity Instrument Matrix of Progress in Linkages Screening and Assessment for Family

Engagement, Retention and Recovery -- SAFERR

PRODUCTS Materials

Compendium of Training Curricula Understanding Substance Abuse: A Guide for

Child Welfare Practitioners Draft White Paper on Funding Substance Abuse

and Child Welfare Services Draft White Paper on Implementing the 2004

Substance Abuse Amendment in the Child Abuse Prevention and Treatment Act (CAPTA)

PRODUCTS we’re working on… State Policies regarding Substance Exposed

Infants Guidance to States and Communities on:

Screening and Assessment for Family Engagement, Retention and Recovery (SAFERR)

Methamphetamine and child risk and safety assessments

The use of drug testing in child welfare practice Medication assisted treatment for opiate

dependence and implications for child welfare

Foster Care Population

0

100,000

200,000

300,000

400,000

500,000

600,000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

0

1

2

3

4

5

6

7

8

Total Children Children per 1,000

52% Increase over 6 Years

Number of Children in Foster Care on Last Day of Federal Fiscal Year

Foster Care Population and Persons who First Used Crack or Meth in Past Year

*All persons age 12 and over

0

100000

200000

300000

400000

500000

600000

1980 1981 1982 19831984 19851986 1987 19881989 1990 1991 19921993 19941995 1996 19971998 19992000 20012002

0

100,000

200,000

300,000

400,000

500,000

600,000

Children in Foster Care New Crack Users* New Methamphetamine Users*

Children with Prenatal Substance Exposure

Number of Children Prenatally Exposed to Substances

Substance Used (Past Month)

3rd Trimester

Any Illicit Drug 2.3% women 94,139 infants

Alcohol Use 4.7% women 192,371 infants

Binge Alcohol Use

0.7% women 28,651 infants

SAMHSA, OAS, National Survey on Drug Use SAMHSA, OAS, National Survey on Drug Use and Health, 2002 and 2003 reported:and Health, 2002 and 2003 reported:



2nd Trimester 3rd Trimester





Binge Alcohol Use





State and local prevalence studies report 10-12% of infants or mothers test positive for alcohol or illicit drugs at birth5,6


1st Trimester 2nd Trimester 3rd Trimester







Binge Alcohol Use





Infants with pre-natal substance ~410,000 exposure

Where did they all go?


Total child victims under 1 year old ~86,000

Total children under 1 year old ~41,000 entering out-of-home-care

Most Go Home

90%+ are undetected and go home without assessment and needed services. Many doctors and hospitals do not test, or may have

inconsistent implementation of state policies

Tests detect only very recent use

Inconsistent follow-up for woman identified as AOD using or at-risk, but with no positive test at birth

Child Abuse Prevention and Treatment Act (CAPTA) Amendments of 2003 raises issues of identifying infants and reporting to Child Protective Services

Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments

Policies and procedures (including appropriate referrals to child protection service systems and for other appropriate services) to address the needs of infants born and identified as affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure, including a requirement that health care providers involved in the delivery or care of such infants notify the child protective services system of the occurrence of such condition in such infants, except that such notification shall not be construed to (I) establish a definition under Federal law of what constitutes child abuse; or (II) require prosecution for any illegal action (section 106(b)(2)(A)(ii));

The development of a plan of safe care for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms (section 106(b)(2)(A)(iii))

Prenatal substance exposure Fetal alcohol syndrome, fetal alcohol spectrum

disorder, neuro-developmental disorders

Postnatal environment factors Violence or traumatic events Drug and/or alcohol seeking behaviors Illicit drug sales or manufacturing Lack of adult interpersonal support systems Community effects such as living in poverty Lack of proper health care Inconsistent caregivers

Potential Consequences for Children

Areas of Child Development Affected by Parental Substance Use Disorders

Physical health consequences Lack of secure attachment Language delays and communication disorders Psychopathology Behavioral problems Poor social relations and skills Deficits in motor skills Cognition and learning disabilities

Research has shown that these effects can manifest themselves in multiple areas, including:

Children of Substance Abusers who are also Victims of Child Abuse

and/or Neglect

Children Living With One or More Substance Abusing Parent

4.5

2.8

6.2

7.5

6

8.3

8.4

10.6

0 2 4 6 8 10 12

Need Treatment for Illicit Drug Abuse

Dependent on Illicit Drugs

Dependent on Alcohol

Dependent on AOD

Abused or Dependent on Alcohol or Illicit Drug in Past Month

Dependent on Alcohol and/or NeedsTreatment for Illicit Drugs

Used Illicit Drug in Past Month

Used Illicit Drug in Past Year

In Millions

71% of caregivers who are alcohol dependent are classified by the CWW as not having an alcohol problem

73% of caregivers who are drug dependent are classified by the CWW as not having a drug problem

CWW’s misclassify caregivers who are substance dependent most of the time

Documenting Substance Use Disorders in Child Welfare

Children and Family Service Reviews (CFSRs) Parental substance use disorders were a factor in

16% to 48% of cases

Children in the Child Welfare System with their

own Substance Use Disorder

Children of substance abusers need in-depth assessments and interventions that respond to their developmental status and the special needs created by substance use disorders in their family grief, loss, separation, attachment

Adolescents who may have begun their own substance use – Few Independent Living Programs under Chafee Bill include prevention or intervention for children of substance abusers aging out of foster care

Children in the Child Welfare System with their own SUD

Youths who have ever been in foster care had higher rates of any illicit drug use than youths who have never been in foster care (33.6 vs. 21.7 percent)

Youths aged 12 to 17 who were in need of substance abuse treatment in the past year were more likely to have received treatment if they have ever been in foster care

Children in the Child Welfare System with their own SUD

Future Trends

TANF Opportunities

Treatment aftercare focus on jobs and housing

TANF reauthorization proposes treatment be counted as a work activity

Does your state define the child welfare population as a “needy family” under TANF

Can use TANF to pay for treatment

Models of Cross-system funding for joint initiatives Title IV-E Waiver projects

Funding Opportunities

Taking CFSR findings seriously and including remediation strategies in Program Improvement Plans

New round of CFSRs begin this summer – contact your state’s child welfare lead to get involved

Child and Family Service Reviews

Early recognition of Substance Use Disorders

Timeliness of Interventions

“Call me Tuesday”

“Your life has just begun”


ASFA Challenges

Four Components of System Reform

Comprehensive cross-system joint training AOD basics for all staff – 4 days required AOD screening, brief intervention, motivational

enhancement and AOD treatment – 4 days required of all case carrying workers

Group intervention skills – 4 days required of all ADS staff and voluntary for any CPS division staff

Early Intervention Specialists Immediate access to intervention and assessment at

the court hearings

Recovery Management Specialists Motivational enhancement Immediate access to recovery management and

treatment services Compliance monitoring

Dependency Drug Court 30, 60 and 90-day compliance hearings Structured incentives for compliance and sanctions

for non-compliance Voluntary participation in on-going services

Four Components of System Reform

Early recognition of Substance Use Disorders


“Call me Tuesday”

“Your life has just begun”


ASFA Challenges

A timely message of hope

The Voice of a Child

Nothing But Silence

By Ashley G.Age 12

January 2005

People all around meCalling out my name

But no I cannot hear themFor my heart is filled with shame

Nothing but silence

But only till the break of dawnWill I be feeling sad

For wandering out on the streetsAre my birth mom and dad

Why’d she do this to her and meWith this we’ll have to cope

But while she’s clean you never knowThere still could be hope

But in the perfect world I knowThere’s no harmful stuff

But now I’ve come to realizeIt’s just a bunch of bluff

Nothing but silence

Sitting by the widow sillA tear rolls down my cheek

Although it hurts I can’t expressMy heart is just too weak

Nothing but ache

It’s funny what one pill can doTo a mother or a kid

And now I know that for a factI won’t do what she did

Nothing but ache

Now I live a better lifeAnd drugs…I wouldn’t dare

Away from all the harmful thingsWith a family who cares

Nothing but love

I know it hurts, it sure hurt meAnd that’s why I’ll remain drug free

Nothing… but hope

Nothing But Silence

The fifth clock is the one that is ticking on us…it measures how fast we get it…how rapidly we respond to human needs that grow larger by the day

We have to measure what we do against what needs doing, not against what we did last year

The Fifth Clock

UrgencyUrgency

http://www.arium.org/anthology/kvanbeer/kvbafas.html Chasnoff, I. Cocaine Use in Pregnancy, New England Journal of Medicine, 1985 Barth, R. (2003). Substance Abuse Findings from the NSCAW Presented at NCSACW

Researchers’ Forum. December. Office of Applied Studies. (2004). Results from the 2003 National Survey on Drug Use and

Health: National findings (DHHS Publication No. SMA 04–3964, NSDUH Series H–25). Rockville, MD: Substance Abuse and Mental Health Services Administration. http://oas.samhsa.gov/2k5/FosterCare/FosterCare.htm

Office of Applied Studies. (2003). Results from the 2002 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 03–3836, NHSDA Series H–22). Rockville, MD: Substance Abuse and Mental Health Services Administration at http://oas.samhsa.gov/2k3/pregnancy/pregnancy.htm

Office of Applied Studies. (2002). Results from the 2001 National Household Survey on Drug Abuse: Volume I. Summary of national findings (DHHS Publication No. SMA 02-3758, NHSDA Series H-17). Rockville, MD: Substance Abuse and Mental Health Services Administration. http://www.drugabusestatistics.samhsa.gov/2k3/children/children.htm

Hamilton BE, Martin JA, Sutton PD. (2003) Births: Preliminary data for 2002. National vital statistics reports, 51 (11), Hyattsville, Maryland: National Center for Health Statistics at http://www.cdc.gov/nchs/data/nvsr/nvsr51/nvsr51_11.pdf

Child Welfare and Substance Abuse: Current Issues and Innovations

Vega, W., Noble, A., Kolody, B., Porter, P., Hwang, J. and Bole, A. (1993). Profile of Alcohol and Drug Use During Pregnancy in California, 1992: Perinatal Substance Exposure Study General Report. Sacramento, CA: CA Dept of Alcohol and Drug Programs

National Institute on Alcoholism and Alcohol Abuse. (2000). Tenth Special Report to Congress on Alcohol and Health. Washington, DC: Department of Health and Human Services at http://www.niaaa.nih.gov/publications/10report/intro.pdf

National Institute of Drug Abuse. (1998). Prenatal Exposure to Drugs of Abuse May Affect Later Behavior and Learning. NIDA Notes, 13 (4) at http://www.drugabuse.gov/NIDA_Notes/NNVol13N4/Prenatal.html

4940 Irvine Blvd, #202 714-505-3525 Irvine, CA 92620 www.ncsacw.samhsa.gov

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