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8/2/2010 Family Drug Court Thank you for joining us today! Learning Academy Planning Community If you havent dialed into the audio (telephone) portion, please do so now: Module 3: Module 3: 1-866-516-5393 Access Code: 33403311

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8/2/2010 1

Thank you for joining us today!

If you haven’t dialed into the audio (telephone) portion, please do so now: 1-866-516-5393 Access Code: 33403311 If you are experiencing technical problems with the GoToWebinar program (visual portion), contact the help desk: 1-800-263-6317 Reference Webinar ID: https://www1 gotomeeting com/register/351561161 https://www1.gotomeeting.com/register/351561161 Today’s presentation and handouts are available for download at: http://www.cffutures.com/webinars

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The webinar will begin shortly.

Family Drug Court Learning Academy Planning Community Module 3: Module 3: Screening and Assessment

Children and Family Futures Office of Juvenile Justice and

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Office of Juvenile Justice and Delinquency Prevention Family Drug Court Technical Assistance Program 4940 Irvine Blvd, Suite 202 Irvine, CA 92620 714.505.3525 www.cffutures.org

This project is supported by Award No. 2009-DC-BX-K069 awarded by the Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs

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8/2/2010 2

Welcome!

AGENDA

  • Opening Remarks
  • Opening Remarks
  • Understanding Screening and Assessment in the

Larger Context: Project vs. System

  • Drug Testing
  • Introduction to Family Drug Court Screening and

Assessment

  • Family Drug Court: Core Screening Elements
  • Family Drug Court: Core Assessment Elements
  • Next Steps
  • Questions and Discussion

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Introductions

  • Phil Breitenbucher, MSW

Program Director Children and Family Futures Program Director, Children and Family Futures

  • Sid Gardner, MPA

President, Children and Family Futures

  • Theresa Lemus, RN, MBA, LADC

Program Associate, Children and Family Futures

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8/2/2010 3

Overview of Learning Academy Module Format

  • Polling Questions
  • Live Questions & Discussion
  • Webinar Evaluations

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How do I ask questions?

For your convenience, there are two ways to ask questions during this ways to ask questions during this webinar presentation:

  • 1. Type and send your questions

through the Question and Answer log located on the bottom half on your panel/dashboard. 2 There will also be time at the end

  • 2. There will also be time at the end
  • f the webinar for you to ask

questions via the conference line.

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8/2/2010 4

Planning Community

Mission and Underlying Values Early Implementation Community Joint & Shared Outcomes Enhanced Community Moving Towards System-wide Change Module 1 Principles of Collaborative Practice Screening & Assessment Running a FDC Program Services to Children Engaging the Community Pre-filing or Alternative Response Programs Module 2 Module 3

What is the FDC Online Learning Academy?

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Engagement & Retention Information Sharing & Data Systems Training & Staff Development Budget & Sustainability Module 4 Module 5 Special Topics

  • Engaging Defense Attorneys
  • Engaging Fathers
  • Understanding

Disproportionality & Disparity

  • Understanding Trauma
  • Marketing to Stakeholders
  • Cost Benefits Analysis

Planning Community

Mission and Underlying Values Early Implementation Community Joint & Shared Outcomes Enhanced Community Moving Towards System-wide Change Module 1 Principles of Collaborative Practice Screening & Assessment Running a FDC Program Services to Children Engaging the Community Pre-filing or Alternative Response Programs Module 2 Module 3

Where we’ve been thus far…

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Engagement & Retention Information Sharing & Data Systems Training & Staff Development Budget & Sustainability Module 4 Module 5 Special Topics

  • Engaging Defense Attorneys
  • Engaging Fathers
  • Understanding

Disproportionality & Disparity

  • Understanding Trauma
  • Marketing to Stakeholders
  • Cost Benefits Analysis
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8/2/2010 5

Polling Question #1

Which best describes your position? Att J d

  • Attorney or Judge
  • Drug Court Coordinator
  • Social Worker
  • Substance Abuse Treatment Provider
  • Other

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Understanding Screening and Assessment in the Larger Context: Project vs. System

Sid Gardner, MPA

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8/2/2010 6

Screening and Assessment Screening and assessment differ across t systems.

  • Screening: Determines eligibility and

appropriateness for participation in drug court.

  • Assessment: Helps to identify specific
  • Assessment: Helps to identify specific

types of services and determine the intensity of treatment needed.

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Re-visiting Module 1: Mission and Underlying Values How does your mission impact screening d t? and assessment?

  • Whom do you serve?
  • Difference in perception of the

primary client: the parent, the child, the family the family.

  • Difference in perception of the target

population

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8/2/2010 7 What is the intent of your screening and assessment protocol?

Who is your target population? Scope

  • Scope

– Universality vs. Specific Segments of the Population – Screening In vs. Screening Out – Does your program address other issues that families are experiencing? families are experiencing?

  • Scale

– Are you experiencing difficulty filling slots? – Do you need more slots?

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50,000 Children with Substantiated Abuse/Neglect 33,000 Parents

Drop-off Analysis

60% of Parents Need Assessment 19,800 50% Go for Assessment 9,900 80% Need Treatment 7,920 50% Go to First Session 3,960 30% Complete 90 Days – 1,188

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50% Reunify or Stay with Parents 594

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8/2/2010 8

Current Screening Practices

  • No state currently has universal

i f hild lf screening for child welfare cases

  • Some states and localities report much

higher rates of substance abuse based

  • n

– Worker training Worker training – Agreement on the tool to be used – Interagency agreements on what will happen as a result of a positive screen

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Polling Question #2

In your jurisdiction, what is the percentage of child welfare cases affected by parental child welfare cases affected by parental substance use?

  • 0-20%
  • 20-40%
  • 40-60%
  • 60-80%
  • 80-100%

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8/2/2010 9

Parental or Alcohol Drug Abuse as Factor in Cases of Child Removal Substance Abuse as Primary Reason for Case Opening

2007 AFCARS Data CFSR R d 1 R i CFSR R d 2 R i

Parental Substance Use Cited as Factor in Child Welfare Case*

2007 AFCARS Data Parental Alcohol or Drug Abuse as Factor in Cases of Child Removal (N=190,900 Cases) CFSR Round 1 Review 2001-2004 (N=50 Cases) CFSR Round 2 Review 2007-2010 (N=65 Cases)

State

Percent Percent Percent

A

4.4 16 20

B

5.8 16

C

9.2 2

D**

10.0 8

E

11 8 4 14

E

11.8 4 14

F

42.6 2

G

46.4 18

H

51.0 8 31

I

58.0 8 8

J**

63.6 27

*This chart depicts 10 of 52 states. **In Round 1, these data were not included in the first cohorts of States reviewed, it was an added item in subsequent States.

Use During Pregnancy

SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007-2008 Annual Average Total U.S. Births 2007: 4,317,000

Substance Used (Past 1st Trimester 2nd Trimester 3rd Trimester Month) Any Illicit Drug 7.2% 56,000 women 5.0% 46,000 women 2.8% 24,000 women Alcohol Use 20.7% 160,000 women 7.8% 71,000 women 3.5% 30,000 women Binge Alcohol Use 10.3% 79,000 women 1.9% 17,000 women 1.3% 11,000 women Cigarettes 23.7% 12.9% 13.7%

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8/2/2010 10 Drug Testing

Theresa Lemus, MBA, RN, LADC

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Drug Testing

Why are we addressing this?

  • Drug testing is the most frequently used indicator for

g g q y substance use in child welfare practice

  • Test results may influence decisions on child removal,

reunification and Termination of Parental Rights

  • Courts often order drug testing as a standard protocol for

g g p parents in the child welfare system

  • Lack of standardized recommendations for drug testing in

child welfare practice

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8/2/2010 11

Polling Question #3 A person that uses substances (drugs d/ l h l) t b “ d” and/or alcohol) cannot be a “good” parent.

  • True
  • False

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SPECTRUM OF ADDICTION

A Problem for Child Welfare and Court Officers: The most frequently used marker of substance abuse problems in child welfare and family court does not tell you anything about the individual’s place on the spectrum

EXPERIMENT AND USE

ABUSE DEPENDENCE

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8/2/2010 12

What Questions Can Drug Testing Answer?

  • Whether an individual has used a tested

substance within a detectable time frame

What Questions Can Drug Testing Not Answer?

  • A drug test alone cannot determine the existence or

absence of a substance use disorder absence of a substance use disorder

  • The severity of an individual’s substance use disorder
  • Whether a child is safe
  • The parenting capacity and skills of the caregiver
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8/2/2010 13

Drug Testing

  • For a more in-depth presentation on

D T ti l i it Drug Testing, please visit: http://www.cffutures.org/files/presentatio ns/DrugTestingPresentation_05202010. pdf

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Introduction to Family Drug Court Screening and Assessment

Phil Breitenbucher, MSW

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8/2/2010 14 What Are the Differences Between Screening and Assessment?

Screening and Assessment are part of an i d i i ki

  • ngoing decision-making process
  • Screening determines eligibility and

appropriateness for participation in drug court.

  • Assessment helps to identify specific

types of services and determine the intensity of treatment needed.

Types of Screening

Family Drug Court screening typically consists of two steps: 1. Justice System/Program Screening 1. Justice System/Program Screening

  • Does the client meet the pre-determined eligibility

criteria?

  • Eligibility criteria can include child welfare case

history, age of children, criminal history, etc. 2. Clinical Screening

  • Does the client have a substance abuse disorder?

Does the client have a substance abuse disorder?

  • Can current treatment services meet the client’s

substance abuse needs?

  • Are there other clinical features (e.g.: mental

health disorders)?

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8/2/2010 15

Goals of Screening: Program Eligibility

Determine:

  • Are legal and statutory eligibility
  • Are legal and statutory eligibility

requirements met?

Goals of Screening: Program Suitability

Identify and Assess:

  • Individuals with a history of violent

Individuals with a history of violent

  • ffenses/behavior
  • Environmental factors (e.g., employment, residential

stability, domestic violence history) or other disorders (e.g., mental health, cognitive deficits) to assure appropriate services are available to treat the participant the participant

  • Client’s motivation, including perception of benefits

and disadvantages of program participation.

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8/2/2010 16

Goals of Screening: Programmatic Considerations

  • Define major areas of client strengths and

Define major areas of client strengths and needs

  • Orient the potential client to program

requirements

  • Obtain consents for records and access to

collateral contacts collateral contacts

Goals of Assessment

Examine the scope and nature of substance abuse history abuse history

  • Understand the impact substance abuse

has had on the individual, including its influence on the child welfare case

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8/2/2010 17

Goals of Assessment

Identify:

  • The specific psychosocial problems to be
  • The specific psychosocial problems to be

addressed in treatment, including mental health disorders.

  • Specific needs to be addressed in treatment

planning and the appropriate level of care.

  • The full range of service needs, pursuant to

treatment planning treatment planning.

  • Specific employment, housing, child care,

educational and other needs.

Goals of Assessment

  • Match participants to appropriate types of

drug court services drug court services

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8/2/2010 18 Characteristics of Screening and Assessment

Purpose Key Components By Whom

FDC Screening Determine FDC Eligibility

  • Substance Abuse

Allegations

  • Child Welfare History and
  • FDC Case Manager
  • Attorney
  • Child Welfare Social

Child Welfare History and Status of CW Case

  • Explain Program
  • Releases Signed

Child Welfare Social Worker Clinical Screening Determine: 1) Appropriateness of treatment 2) Individual’s willingness and readiness for

  • Brief assessment of

substance use, social history, other disorders

  • Motivation/willingness to

participate

  • Releases Signed
  • Substance Abuse

Specialists (SAS)

  • FDC Case Manager

readiness for treatment

  • Releases Signed

Clinical Assessment Diagnosis Admission Treatment Planning

  • Examine scope and

nature of substance abuse issue

  • Identify full range of

service needs, pursuant to treatment planning

  • Match client to

appropriate services

  • Clinically trained and

qualified substance abuse counselor, psychologist, psychiatrist, social worker or nurse

What Factors Help to Shape the Drug Court Screening and Assessment Process?

  • What treatment options are available to the

d t ? drug court program?

  • Number of program referrals
  • Background, expertise and training of

screening staff

  • Eligibility criteria
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8/2/2010 19

Importance of Comprehensive Screening and Assessment in Drug Court

  • Candidates for drug court programs typically have a

wide range of co-occurring issues and disorders. wide range of co occurring issues and disorders.

  • Failure to detect these issues could lead to:

– Misdiagnosis – Neglect of appropriate interventions – Inappropriate treatment planning and referral – Over- or under-treatment of mental health symptoms with medications – Disruption of treatment services and demoralization of other participants – Poor treatment outcomes Components of a Comprehensive Family Drug Court Screening and Assessment Protocol

  • Eligibility screening is based on established written

criteria.

  • Child Welfare Social Workers, Substance Abuse

Specialist and/or FDC Case Managers are designated to screen cases and identify potential participants.

  • Eligible participants for family drug court are promptly

advised about program requirements and the benefits

  • f participating.
  • f participating.
  • Initial appearance before the family drug court judge
  • ccurs immediately after FDC intake, to ensure

program participation.

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8/2/2010 20

Components of a Comprehensive Family Drug Court Screening and Assessment Protocol

  • The court requires that eligible participants enroll in AOD

services immediately.

  • Individuals are initially screened and later periodically

assessed by both the FDC and treatment personnel to ensure that treatment services and individuals are suitably matched: – Ongoing assessment is necessary to monitor progress, to change the treatment plan as necessary, and to identify relapse cues identify relapse cues. – Participants are matched to treatment programs according to their specific needs. Guidelines for placement in various levels of treatment should be developed.

Motivational Interviewing

  • MI identifies a client’s motivation, including perceived benefits and

disadvantages of participation in the family drug court program and is a best practice approach that incorporates the following is a best practice approach that incorporates the following

  • bjectives:

– Seeks to understand the person's frame of reference, particularly via reflective listening; – Expressing acceptance and affirmation; – Eliciting and selectively reinforcing the client's own self motivational statements expressions of problem recognition, concern, desire and intention to change, and ability to change; – Monitoring the client's degree of readiness to change, and ensuring that resistance is not generated by jumping ahead of the client; – Affirming the client's freedom of choice and self-direction.

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8/2/2010 21

Family Drug Court: Core Screening Elements

Theresa Lemus, MBA, RN, LADC

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Background and Demographic Information

  • Name, address, age, race/ethnicity, and gender,

number and age of children number and age of children

  • Identifying contact numbers used by the court, child

welfare and/or the treatment provider

  • Status of Child Welfare Case
  • Child Welfare History (prior cases, etc)
  • Criminal History (any violent crimes?)

– Outstanding Warrants, Pending Cases

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8/2/2010 22

Substance Use

  • Signs of acute drug or alcohol intoxication
  • Acute signs of withdrawal from drugs or alcohol

D t l ff t

  • Drug tolerance effects
  • Results of recent drug testing
  • Self-reported substance abuse

– Age and pattern of first substance use – History of use – Current pattern of use (e.g., quantity, frequency, method of use) – “Drug(s) of choice/use” (including alcohol) – Motivation for using

N ti i t d ith b t

  • Negative consequences associated with substance use
  • Prior involvement in treatment
  • Family history of substance abuse (include family of origin as

well as current family)

  • Other observable signs and symptoms of substance abuse (e.g.,

needle marks/injection sites, impaired motor skills)

Mental Health

  • Acute mental health symptoms (e.g., depression,

hallucinations, delusions) hallucinations, delusions)

  • Suicidal thoughts and behavior
  • Other observable mental health symptoms
  • Age at which mental health symptoms began
  • Prior involvement in mental health treatment, and use
  • f psychotropic medication
  • Cognitive impairment
  • Past or recent trauma such as sexual/physical abuse
  • Family history of mental illness
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8/2/2010 23

Other Indicators

  • Motivation and readiness for substance abuse

treatment treatment

  • Perceived level of substance abuse problems
  • Social factors (e.g., living with an abusive or

substance-involved partner, sole economic provider responsibilities, housing issues, child care, transportation) that may present obstacles p ) y p for FDC participation

What Instruments Should Be Used in Family Drug Court Screening?

  • Family Drug Courts should use standardized substance

abuse screening instruments to enhance the consistency g y and validity of results.

  • May have to utilize more than one screening tool to

screen for mental health.

  • Examples:

– UNCOPE – Substance Abuse Subtle Screening Inventory (SASSI) – Alcoholism Screening Test (MAST), and the – GAIN SS

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8/2/2010 24 Factors For Selecting Screening Instruments

  • Reliability: Consistency of results obtained over

time. time.

  • Validity: Extent to which instruments can effectively

identify substance abuse problems.

  • Cost: Some, like the UNCOPE are public domain,
  • thers cost.

Core Component: Release of Confidential Information

  • 1. Name of participant
  • 2. Name or general designation of the individual who is

g g permitted to disclose information

  • 3. Identify FDC staff designated to release information in

connection with monitoring participant progress

  • 4. Purpose of the disclosure
  • 5. Specifies type of information to be released

6 The period during which the release remains in effect

  • 6. The period during which the release remains in effect
  • e.g. Anticipated length of program participation;

anticipated duration of the child welfare case

  • 7. Signature of the FDC participant
  • 8. Date on which the release form was signed.
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8/2/2010 25

Family Drug Court: Core Assessment Elements

Theresa Lemus, MBA, RN, LADC

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What Information Should Be Included in a Family Drug Court Assessment?

  • Child Welfare Case Status and History
  • Criminal justice history and status
  • Substance abuse history current symptoms
  • Treatment history and response

to/compliance with treatment

  • Prior experience with peer support groups
  • Substance abuse history, current symptoms,

and level of functioning

  • Mental health history, current symptoms,

and level of functioning

  • History of interaction between mental health

and substance use disorders

  • Family history of substance use disorders

(including birth complications and in utero substance exposure)

  • Medical and health status

S i l/f il l ti hi (i l di Prior experience with peer support groups

  • Cognitive appraisal of treatment and

recovery – Motivation and readiness for treatment – Self-efficacy in adopting lifestyle changes (e.g., maintaining abstinence, complying with medication) – Expectancies related to substance use (both positive and negative)

  • Participant conceptualization of treatment

needs

  • Social/family relationships (including

involvement in domestic violence and child abuse or neglect)

  • Employment/vocational status
  • Educational history and status
  • Literacy, IQ, and developmental disabilities

needs

  • Resources and limitations affecting the

ability to participate in treatment (e.g., transportation problems, homelessness, child care needs)

  • Interpersonal coping strategies, problem

solving abilities, and communication skills

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8/2/2010 26

Assessment Information Continued….

  • Negative effects of substance abuse on current overall

health stat s and need for immediate medical attention health status, and need for immediate medical attention

  • Impact of current environment on child welfare, addiction,

treatment & recovery

  • living arrangements
  • basic needs
  • transportation
  • Impact of key relationships and their potential effect on

child welfare addiction treatment & recovery child welfare, addiction, treatment & recovery

  • family & friend support system
  • significant other
  • other (church, community, etc.)
  • current socioeconomic status and background

Other Important Factors

  • Gender
  • Trauma
  • Culture
  • Substance Exposed Newborn and

Children

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8/2/2010 27 For More Information on Substance-Exposed Infants:

To Obtain a Copy: National Center on Substance Abuse & Child Welfare (714) 505-3525

http://www.ncsacw.samhsa.gov /improving/daily-practice-client.aspx

Polling Question #4 In our program, the following system d t li ibilit i conducts eligibility screening:

  • Child Welfare
  • Drug Court Coordinator
  • Substance Abuse Treatment Provider
  • Combination

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8/2/2010 28 Next Steps Next Steps

Phil Breitenbucher, MSW

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Next Steps

  • Understanding your Child Welfare

D t t’ S i P Department’s Screening Process

  • Revisiting your FDCs Screening and

Assessment Protocols

  • To access these webinar materials, visit:

http://www.cffutures.org/webinars p g

  • More of the Learning Community!

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8/2/2010 29

Hot off the press! Registration for Module 4: Engagement d R t ti i N O ! and Retention, is Now Open! https://www1.gotomeeting.com/register/77 0351240

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8/2/2010 30 For More Examples of Screening and Assessment Tools:

Appendix D: Examples of Screening and Assessment Tools Appendix F: Examples of Safety and Risk Assessments for Use by Child Welfare Staff To Obtain a Copy: National Center on Substance Abuse & Child Welfare (714) 505-3525

http://www.ncsacw.samhsa.gov /improving/daily-practice-client.aspx

References

  • The Addiction Technology Transfer Center, Motivational
  • Interviewing. Retrieved 07.29.10 from

http://www.motivationalinterview.org/.

  • U.S. Department of Health & Human Services, SAMHSA Tip
  • 35. Retrieved 07.29.10 from

http://kap.samhsa.gov/products/brochures/pdfs/TIP35.pdf.

  • Peters, R. H. and Petyon, E. Guideline for Drug Courts on

Screening and Assessment. May 1998. American University, Justice Programs Office, in association with the U.S. Department of Justice, Office of Justice Programs, Drug Courts Program Office.

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8/2/2010 31

Questions and Discussion Questions and Discussion

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Phil Breitenbucher, MSW

Evaluation Please take a moment to complete our

  • evaluation. You will be re-directed to

the evaluation after exiting this webinar. Thank you! Thank you!

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8/2/2010 32

Sid Gardner, MPA President Children and Family Futures Phil Breitenbucher, MSW Program Director Children and Family Futures

Contact Information

y Phone: (714) 505-3525 sgardner@cffutures.org y OJJDP FDC TA Project Phone: (714) 505-3525 E-mail: pbreitenbucher@cffutures.org Theresa Lemus, RN, MBA, LADC Program Associate Children and Family Futures y Phone: (714) 505-3525 E-mail: tlemus@cffutures.org FOR RESOURCES Please visit our website: http://www.cffutures.org/projects/family-drug-courts

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