Collaborative Community Court Teams: Implementing Plans of Safe Care - PowerPoint PPT Presentation

Collaborative Community Court Teams: Implementing Plans of Safe Care Ken DeCerchio, MSW | Program Director Gail Barber, MSW | Senior Associate

Acknowledgement National Quality Improvement Center for Collaborative Community Court Teams

Children and Family Futures National FDC National Center on Training and TA Substance Abuse and Program Child Welfare Quality Sobriety Prevention Improvement Children Affected by Treatment Methamphetamine and Family Center for and In-Depth Recovery Collaborative Recovery Statewide System Technical Assistance (IDTA) Program Community Improvement Program Teams Court Teams Regional Partnership Grants Rounds I-6 Substance-Exposed Infants Peer Learning Court Funding by IDTA Program Individual Funded by Funded by DDCF Funded by ACF/CB, SAMHSA Jurisdictions Funded by OJJDP ACF/ACYF, CB and TDE

Change our work’s focus CB’s Goals and Priorities • Preventing maltreatment • Preventing unnecessary placement Prioritize the importance of families 1 • Children must be kept in their communities and schools 2 • Foster parents must become resources to help support birth parents Focus our interventions on the well-being of 3 children and their parents • Address both parent and child trauma • Don’t cause additional trauma through unnecessary removal 4 Build the capacity of communities to support 5 children and families • Locally based resources and services Develop and support a healthy • Supports families need must be located where families live and stable child welfare workforce • Competent, skilled and informed • Capable and visionary leadership

Understanding the Challenge

Prevalence of Parental Alcohol or Other Drug Use as a Contributing Factor for Reason for Removal in the United States and Ohio, 2000 to 2018 45% 39.0% 40% 35% 32.2% 30.6% 28.5% 30% 24.7% 25% 26.5% 18.5% 20% 18.5% 15% 9.3% 10% 9.8% 5% 0% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 National Ohio Note: Estimates based on all children in out of home care at some point during Fiscal Year Source: AFCARS Data, 2000-2018

Percent of Children with Terminated Parental Rights by Reason for Removal in the United States and Ohio, 2018 Neglect 42.5% Parent Alcohol or Drug Use 28.8% Parent Unable to Cope Inadequate Housing Physical Abuse Parent Incarceration Abandonment Sexual Abuse Child Behavior Child Alcohol or Drug Use Child Disability Relinquishment Parent Death 0% 10% 20% 30% 40% 50% 60% 70% 80% National Ohio Note: Estimates based on all children in out of home care at some point during Fiscal Year Source: AFCARS Data, 2018 v1

Incidence of Parental Alcohol or Other Drug Use as a Reason for Removal in the United States and Ohio, 2000 to 2018 39.3% 40% 39.2% 35% 32.8% 30.1% 35.8% 30% 30.8% 25.1% 27.6% 25% 20% 20.6% 18.0% 15% 8.1% 10% 9.8% 5% 0% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 National Ohio Note: Estimates based on children who entered out of home care during Fiscal Year Source: AFCARS Data, 2000-2018

Incidence of Parental Alcohol or Other Drug Use as a Contributing Factor for Removal in the United States, 2000 to 2018 55% 52.1% 45% 43.6% 36.1% 40.1% 35% 36.3% 30.6% 23.1% 27.8% 28.1% 25% 15% 16.5% 5% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 -5% Under Age 1 Age 1 or Older Note: Estimates based on children who entered out of home care during Fiscal Year Source: AFCARS Data, 2000-2018

Percent of Children Under Age 1 with Parental Alcohol or Other Drug Use as a Reason for Removal in the United States and Ohio, 2000 to 2018 60% 52.1% 50% 43.6% 40.1% 46.1% 40% 36.1% 42.2% 30% 32.0% 27.8% 20% 13.0% 16.9% 10% 0% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 National Ohio Note: Estimates based on children under age 1 who entered out of home care during Fiscal Year Source: AFCARS Data, 2000-2018

Percent of Children Under Age 1 with Parental Alcohol or Other Drug Use as a Reason for Removal by Ethnicity/Race in the United States and Ohio, 2018 80% 69.6% 70% 59.8% 60% 55.6% 52.6% 50.0% 48.9% 48.6% 48.1% 50% 46.6% 44.9% 38.7% 40% 32.7% 29.9% 30% 20.0% 20% 10% 0.0% 0.0% 0% NH White NH Black NH AI NH AS NH Pac NH multi Hispanic Unknown National Ohio Note: Estimates based on children who entered out of home care during Fiscal Year Source: AFCARS Data, 2018 v1

Relationship of Substance Use and Child Welfare Indicators 15% 10% 10% 10% increase in the overdose death rate 4.5% 5% corresponds 2.6% 2.3% with… 0% Reports of Foster Care Substantiated Drug Deaths Placements Maltreatment Reports (Radel et al., 2018)

5 Points Of Family Intervention for Infants with Prenatal Substance Exposure and Their Families Pre-Pregnancy Awareness of substance use effects Prenatal Initiate enhanced prenatal services Screening and Assessment Parent/Caregiver Identification at Birth Child Neonatal, Infancy, and Postpartum Respond to Ensure infant’s safety and respond to infant’s needs parents’/caregivers’ needs Childhood and Adolescence Identify and respond to parents’/caregivers’ needs Identify and respond to the needs of the toddler, preschooler, child, and adolescent

Opportunities and Challenges For women with substance use disorders and their infants and families Beyond Prenatal Birth Prenatal Screening Ongoing Support Birth Protocols Substance Use and Services Disorder Treatment

Overview Comprehensive Addiction and Recovery Act (CARA) amendments to the Child Abuse Prevention and Treatment Act (CAPTA)

1974 Primary Child Abuse Prevention and Treatment Act (CAPTA ) Changes in 2003 The Keeping Children and Families Safe Act CAPTA Related to 2010 The CAPTA Reauthorization Act Infants with 2016 Prenatal Comprehensive Addiction and Recovery Act (CARA) Substance 2018 Substance Use-Disorder Prevention that Promotes Exposure Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act)

CARA’s Primary Changes to CAPTA 1. Further clarified population to infants “born with and affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure, or a Fetal Alcohol Spectrum Disorder,” specifically removing “illegal” 2. Specified data to be reported by States 3. Required Plan of Safe Care to include needs of both infant and family/caregiver 4. Specified increased monitoring and oversight by States to ensure that Plans of Safe Care are implemented and that families have access to appropriate services

PLANS OF SAFE CARE Lessons from the National Center on Substance Abuse and Child Welfare (NCSACW)

CWS SUD Hospital Safety Treatment Discharge Plan Plan Plan How is Pl Plan an of of Sa Safe fe Car are e Different?

Domains that might be in a Plan of Safe Care • Primary, Obstetric and Gynecological Care • Substance Use and Mental Health Disorder Prevention and Treatment • Parenting and Family Support • Infant Health and Safety • Infant and Child Development No one template fits the needs of all communities, settings or families

Who could do Plans of Safe Care? • Multi-agency • Well-trained • Shared trust and knowledge • Supportive hand-offs (Sloper, 2004)

Lead Agency/Provider Identification at Birth & Populations of Women Prenatal Period Infant Affected 1. Using legal or illegal drugs, on an opioid Maternal and Child Health Service medication for chronic pain or on medication Provider Prenatal Care Provider in concert with (e.g., benzodiazepines) that can result in a Home visiting, early childhood pain specialist or other physician withdrawal syndrome and does not have a intervention, new parent education, substance use disorder etc. Prenatal Care Provider 2. Receiving medication assisted treatment for Therapeutic Substance Use or in concert with Opioid Treatment an opioid use disorder (Buprenorphine or Opioid Use Disorder Treatment Provider or waivered prescriber Methadone) or is actively engaged in Provider with support from Maternal and/or therapeutic treatment treatment for a substance use disorder and Child Health or Child Welfare provider 3. Misusing prescription drugs, or is using legal Prenatal Care Provider or High Risk or illegal drugs, meets criteria for a substance Pregnancy Clinic in concert with Child Welfare Services use disorder, not actively engaged in a substance use disorder treatment treatment program agency

Child welfare will generally not be involved with a family in the prenatal period unless there is another child with an open case. Partners are important for early engagement of pregnant women in treatment and prenatal care to improve the health and well-being outcomes for mother and the infant.

POSC is a unique opportunity for cross- system collaboration No single agency can do it alone

Innovations: Quality Improvement Center Collaborative Community Court Teams