Running the MarathonRunning the MarathonSacramento County’s Ten Year Journey Sacramento County’s Ten Year Journey Enhancing Alcohol and Other Drug and Enhancing Alcohol and Other Drug and

Child Welfare Services to FamiliesChild Welfare Services to Families

Toni J Moore Alcohol and Drug Administrator

Carol Chrisman Juvenile Court Referee

Geri WilsonChild Protective Services Division Manager

Steve NelsonParents’ Attorney

AODTI – Mid 1990sAODTI – Mid 1990s

Cross Training EffortsCross Training Efforts

AOD System of CareAOD System of Care

Early Intervention Early Intervention SpecialistsSpecialists

STARS ServicesSTARS Services

CWS Changes and CWS Changes and BenefitsBenefits

Presentation OverviewPresentation OverviewPresentation OverviewPresentation Overview

Dependency Drug Dependency Drug Court OverviewCourt Overview

Goals and Critical Goals and Critical ComponentsComponents

Success MeasuresSuccess Measures

Court System Changes Court System Changes and Resultsand Results

To incorporate alcohol and other drug treatment services as an integral part of the health and human services delivery system DHHS - Child Welfare, Mental Health, Public Health,

Adult Protective Services, and Primary Health Care

Alcohol and Other Drug Treatment Initiative (1994)

Alcohol and Other Drug Treatment Initiative (1994)PROGRAM VISIONPROGRAM VISIONPROGRAM VISIONPROGRAM VISION

To build and expand service capacity To transform the department into a primary provider of

AOD services To achieve treatment on demand

Alcohol and Other Drug Treatment Initiative

PremisesAlcohol and Other Drug Treatment Initiative

Premises

Health, social service and criminal justice caseloads are driven by AOD abuse

Current treatment capacity can meet less than 25% of demand

Agency staff can serve as the first line of defense

Both the client and the system need to be held accountable

Addressing AOD issues is essential to competent practice

Risk Assessment for the child is incomplete without an AOD Assessment of the parent

Developing practical applications of harm reduction vs. a zero tolerance approach

CWS social workers serve as AOD group co-facilitators to help bridge service gaps

Changes in Child Welfare PracticeChanges in Child Welfare PracticeChanges in Child Welfare PracticeChanges in Child Welfare Practice

Ensure CWS Clients receive treatment priority

Expand interim and group services to help achieve treatment on demand

Promote treatment services that are responsive to other system involvement

Changes in AOD PracticeChanges in AOD PracticeChanges in AOD PracticeChanges in AOD Practice

Training to Build Service CapacityTraining to Build Service Capacity

Level OneLevel One overview of chemical dependency beginning to intermediate AOD information introduction to assessment and treatment

Level TwoLevel Two advanced AOD information assessment and treatment skill building SASSI Certification training

Level ThreeLevel Three group treatment service skills special treatment topics

Additional Training ComponentsAdditional Training Components

Strategies for Family ChangeStrategies for Family Change

Resiliency TrainingResiliency Training

Motivational InterviewingMotivational Interviewing

Adolescent Treatment TrainingAdolescent Treatment Training

CWS TopicsCWS Topics

Service System Overview

Dependency System Overview

Mandated Reporting Responsibilities

Risk Assessment

Decision-making

Critical Time Frames

AOD Treatment Provider TrainingAOD Treatment Provider TrainingAOD Treatment Provider TrainingAOD Treatment Provider Training

Best Use of ResourcesBest Use of Resources

Ensure CWS and other multi-Ensure CWS and other multi-service users get service priorityservice users get service priority

Reduce the number of clients that Reduce the number of clients that “fall through the cracks”“fall through the cracks”

Alcohol and Other Drug Alcohol and Other Drug System of CareSystem of Care

Alcohol and Other Drug Alcohol and Other Drug System of CareSystem of Care

Alcohol and Drug Priority ClientsAlcohol and Drug Priority ClientsFor Publicly Funded SlotsFor Publicly Funded Slots

Alcohol and Drug Priority ClientsAlcohol and Drug Priority ClientsFor Publicly Funded SlotsFor Publicly Funded Slots

Federal Priorities Pregnant

HIV

Injection Drug Users

Children’s Protective Services Clients Multi-County Service Users

Criminal Justice Involved (Pregnant and Juvenile Offenders)

Public Assistance Recipients (CalWorks and Others)

System ToolsSystem Tools Screening and Service ReferralScreening and Service Referral Preliminary AssessmentPreliminary Assessment Treatment AuthorizationTreatment Authorization

System of Care ToolsSystem of Care ToolsSystem of Care ToolsSystem of Care Tools

Provider Partner’s ToolsProvider Partner’s Tools Addiction Severity Index Addiction Severity Index (ASI)(ASI) ASAM Patient Placement CriteriaASAM Patient Placement Criteria

Three CWS-AOD Specialist Social Workers Three CWS-AOD Specialist Social Workers stationed at the Juvenile Courtstationed at the Juvenile Court

Offer immediate AOD assessment and treatment Offer immediate AOD assessment and treatment authorizationauthorization

Educate parents about the Dependency and Educate parents about the Dependency and Family Reunification ProcessFamily Reunification Process

Early Intervention SpecialistEarly Intervention Specialist

Program ComponentsProgram ComponentsProgram ComponentsProgram Components

Have an Alcohol and Other Drug Assessment Have an Alcohol and Other Drug Assessment

Begin Your Alcohol and Other Drug TreatmentBegin Your Alcohol and Other Drug Treatment

Begin Drug TestingBegin Drug Testing

Stay Clean and SoberStay Clean and Sober

EIS Tips for ParentsEIS Tips for Parents

How to Get StartedHow to Get StartedHow to Get StartedHow to Get Started

Attend all Court hearings Attend all Court hearings

Cooperate with your Court InvestigatorCooperate with your Court Investigator

Participate in services and follow all Court ordersParticipate in services and follow all Court orders

Visit your children as often as possibleVisit your children as often as possible

Meet with your Reunification Social Worker monthly and always Meet with your Reunification Social Worker monthly and always keep them informed of your address, phone and message numberkeep them informed of your address, phone and message number

Services are offered for a short time only, failure to participate may Services are offered for a short time only, failure to participate may result in losing your rights and your children being placed for result in losing your rights and your children being placed for adoptionadoption

EIS Tips for ParentsEIS Tips for Parents

Steps you can take to reunify with your childrenSteps you can take to reunify with your childrenSteps you can take to reunify with your childrenSteps you can take to reunify with your children

CPS Division (38%)

SOC – Number and Percent of Substances Reported on SOC – Number and Percent of Substances Reported on

CWS Assessments as Most Frequently UsedCWS Assessments as Most Frequently Used (2002-03)(2002-03)

SOC – Number and Percent of Substances Reported on SOC – Number and Percent of Substances Reported on

CWS Assessments as Most Frequently UsedCWS Assessments as Most Frequently Used (2002-03)(2002-03)

111

391

196

473

669

1,352

1,391

1,502

1,647

0 500 1000 1500 2000

Alcohol (21% )

Marijuana (19% )

Tobacco (18% )

Methamphetamines (17% )

Cocaine/Crack (9% )

Others (6% )

Opiates (3% )

Hallucinogens (5% )

PCP (1% )

Clients = 1,827Substances Reported = 7,732Average per client = 4.2

Staff Assessment of AOD Involvement Among Staff Assessment of AOD Involvement Among Child Welfare ClientsChild Welfare Clients 2002/03 2002/03

Staff Assessment of AOD Involvement Among Staff Assessment of AOD Involvement Among Child Welfare ClientsChild Welfare Clients 2002/03 2002/03

AOD Abuser26%

Chemically Dependent In

Recovery15%

AOD User21%

No AOD Use

8%Chemically

Dependent Not in Recovery

30%

No AOD Use

AOD User

AOD Abuser

In Recovery

Not inRecovery

Client Level of Functioning Client Level of Functioning by Severity of AOD Problems by Severity of AOD Problems 2002/032002/03

Client Level of Functioning Client Level of Functioning by Severity of AOD Problems by Severity of AOD Problems 2002/032002/03

7

8

5

14

10

34

59

55

65

73

67

59

34

38

30

13

22

7

0 10 20 30 40 50 60 70 80 90 100

No AOD Use

Occasonal User

Regular User

Substance Abuser

Dependent in Recovery

Dependent Not inRecovery

Low Moderate High

Number of Referrals of CWS Clients by Type of Number of Referrals of CWS Clients by Type of AOD Service AOD Service 2002/032002/03

Number of Referrals of CWS Clients by Type of Number of Referrals of CWS Clients by Type of AOD Service AOD Service 2002/032002/03

270

248

161

107

119

287

159

124

509

251

1

0 100 200 300 400 500 600

Methadone

Options/Perinatal

Intensive Outpatient

Day Treatment

Add. Assesment

Other

Pre-treatment Grp.

Detox

Outpatient

Residential

Self-help

Tier 1Residential = 248 (11%)Detox = 107 (5%)Total = 355

Tier 2Outpatient = 412 (18%)Intensive Outpatient = 509 (22%)Day Treatment = 124 (5%)Total = 1,045

Total Referrals 2,291

Offers early engagement and interventionOffers early engagement and intervention

Ensures timely assessment and treatment Ensures timely assessment and treatment authorizationauthorization

Reinforces CWS and Court complianceReinforces CWS and Court compliance

Expedites linkages to other service needsExpedites linkages to other service needs

Promotes system accountabilityPromotes system accountability

Provides workload relief for Social WorkersProvides workload relief for Social Workers

Benefits of EIS ComponentBenefits of EIS Component

16 Recovery Specialists16 Recovery Specialists

Offer support and monitoring of AOD related Offer support and monitoring of AOD related case activitiescase activities

Liaisons among clients, CWS AOD, treatment Liaisons among clients, CWS AOD, treatment providers and the Courtproviders and the Court

Twice monthly reports for the Dependency Drug Twice monthly reports for the Dependency Drug CourtCourt

Specialized Treatment and Recovery ServicesSpecialized Treatment and Recovery Services

STARSSTARSSTARSSTARS

Provides support and advocacy for AOD impacted Provides support and advocacy for AOD impacted parentsparents

Bridges treatment programs and CWSBridges treatment programs and CWS

Reduces trauma to family through effective coordinationReduces trauma to family through effective coordination

Places emphasis on engagement and retention in Places emphasis on engagement and retention in treatmenttreatment

Promotes system (reasonable efforts) and client Promotes system (reasonable efforts) and client accountabilityaccountability

Provides workload relief for Social WorkersProvides workload relief for Social Workers

Benefits of STARS ComponentBenefits of STARS Component

Complimentary Practice -Complimentary Practice - should work with both should work with both the child welfare and CalWORKs time clocksthe child welfare and CalWORKs time clocks (particularly AOD perinatal services)(particularly AOD perinatal services)

Complimentary Practice -Complimentary Practice - should have a family should have a family focus, and not work with only the child or parentfocus, and not work with only the child or parent

Complimentary Practice - Complimentary Practice - should use case should use case management services to bridge the gap between management services to bridge the gap between AOD treatment and child welfare servicesAOD treatment and child welfare services

Key Elements of Complimentary PracticeKey Elements of Complimentary Practice

Complimentary Practice - Complimentary Practice - should utilize case and should utilize case and family conferencing to ensure inclusion in family conferencing to ensure inclusion in treatment planning and implementationtreatment planning and implementation

Complimentary Practice - Complimentary Practice - should work to resolve should work to resolve confidentialityconfidentiality issues between systems to reduce issues between systems to reduce barriers to successful treatmentbarriers to successful treatment

Complimentary Practice - Complimentary Practice - should work to should work to develop reasonable approaches to relapsedevelop reasonable approaches to relapse

reassess and re-motivate the parentreassess and re-motivate the parent reassess the risk to the childreassess the risk to the child

Key Elements of Complimentary PracticeKey Elements of Complimentary Practice

Drug Court HistoryDrug Court History

1992 – Criminal Justice Cabinet Formation1992 – Criminal Justice Cabinet Formation

1996 – Adult Criminal Drug Court Established1996 – Adult Criminal Drug Court Established

Mid-1990s – Enhanced AOD/CWS LinkagesMid-1990s – Enhanced AOD/CWS Linkages

1999 – Began DDC Planning Efforts1999 – Began DDC Planning Efforts

2001 – DDC Started2001 – DDC Started

2002 – Began Juvenile Drug Court Planning Efforts2002 – Began Juvenile Drug Court Planning Efforts

Drug Court Planning/Coordinating CommitteeDrug Court Planning/Coordinating Committee Court Attorneys (parent, child, Department) Alcohol and Drug Services Division Recovery Specialist Case Manager: Specialized

Treatment and Recovery Services (STARS) Treatment providers

Formation of Drug CourtFormation of Drug Court

Increase collaboration between agencies Ensure reasonable efforts

Decrease time to assess and treat Increase compliance with treatment Increase 12 month permanent

placements Increase family reunification rates Decrease time in foster care

Goals of Drug CourtGoals of Drug Court

Prompt assessment (1 day)

Prompt treatment (2-5 days)

Intensive case management Track I - twice weekly Track II - weekly Track III - twice monthly

Critical Components: TreatmentCritical Components: Treatment

Parallel Track Court vs. Integrated Track (Santa Clara; Reno) vs.Dual Track (San Diego)

Frequent court hearings and progress reports Level I: 30-60-90 days Level II (failures): Bi-weekly (90 days) Level III (aftercare): Monthly (90 days)

Timely sanctions and incentives

Critical Components: CourtCritical Components: Court

Contacts with Recovery Specialist Case Managers (STARS)

Attendance in treatment

Attendance in support groups (e.g. 12-Step)

Test results for presence of drug/alcohol

Reports to Drug CourtReports to Drug Court

Verbal reinforcement by judicial officer

Certificates of acknowledgement

Gift certificates to clothes closets

Tokens of acknowledgement

“recovery rocks”

Drug Court IncentivesDrug Court Incentives

1st: Reprimand from judicial officer

2nd: 2 days in jail

3rd: 4 days in jail

Drug Court SanctionsDrug Court Sanctions

Parent CharacteristicsParent Characteristics

Evaluation Data Year 1 Year 2

Average age 32 32

Women 69% 69%

Ethnic/racial diversity

Caucasian:

African-American:

Hispanic:Other:

51%

25%

14%

10%

60%

18%

16%

6%

Parent CharacteristicsParent Characteristics

Evaluation Data Year 1 Year 2

Unemployed

< High School Grad

82%

46%

83%

44%Homeless

Pregnant

44%

20%

53%

11%Chronic Mental Illness

Methamphetamine

26%

46%

31%

55%

During the first two years of the program (Oct. 1, 2001 – September 30, 2003) 535 parents have participated in the Drug Court Program.

As of January 31, 2004

311 parents have received 90 day certificates fro continuous compliance

133 parents have graduated with 180 days of continuous compliance

Outcomes to DateOutcomes to Date

Random tests 2-3 per week: all negative

Individual and group treatment: no absence

Recovery Specialist meetings: no absence

Support group/12-step: 3 or more per week

Drug Court appearances: no misses

Comply with court orders: all

180 Day Graduation180 Day Graduation

85% of parents with DDC involvement entered substance abuse treatment vs. 23% of the comparison group

66% of parents with DDC involvement successfully completed their treatment within 12 months

Parental OutcomesParental Outcomes

33% (144) of DDC children reunified vs. 19% of the comparison group, creating a cost savings of $2,141,056

DDC children reunified in 5.6 months vs. 7 months for the comparison group a foster care savings of $413,712

The average length of stay for DDC children was 10.3 months vs. 22.8 months for the comparison group

Child OutcomesChild Outcomes

Improved alcohol and drug services

Immediate access to services

Increased client contact

Less legal/factual issues regarding reasonable services addressing alcohol and drug issues

Accountability for all

Better information on client’s progress

Empowerment of the client in their case

Benefits from the Parents’ Attorney PerspectiveBenefits from the Parents’ Attorney Perspective

Improved Judicial Decision-making

Good quality evidence of reasonable efforts

Good quality evidence regarding parental participation and progress in services

Improved success in meeting statutory timelines

Improved outcomes for children through reunification, reduced placement moves and permanence

Less litigation over reasonableness of efforts

Benefits from the Court’s PerspectiveBenefits from the Court’s Perspective

CWS RedesignCWS Redesign

Building on community partnerships

Family Resource Centers

Enhancing services to children

Child Welfare Next StepsChild Welfare Next Steps