Todays Agenda Stages of Change and models of substance abuse - - PowerPoint PPT Presentation

Today’s Agenda

• Stages of Change and models of substance

abuse specialist in child welfare and courts

• Questions and Answers
• Idaho Pre-Treatment Group
• Questions and Answers
• Mendocino County, California Intake

Support Group

• Questions and Answers
• Wrap up

1

A Program of the

Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment

and the

Administration on Children, Youth and Families Children’s Bureau Office on Child Abuse and Neglect

4940 Irvine Blvd., Suite 202 714.505.3525 Irvine, CA 92620 www.ncsacw.samhsa.gov ncsacw@cffutures.org

Stages of Change

Prochaska & DeClemente Rollins & Miller

Pre-contemplation

Contemplation Preparation Action Maintenance Relapse

Permanent Exit

WHEEL OF CHANGE

Stages of Change Theory

Parent’s Stage of Change and Motivational Tasks for Child Welfare Workers

Parent’s Stages of Change Motivational Tasks for Child Welfare Worker Pre-contemplation - No perception of having a problem or need to change Increase parent's perception

• f the risks and problems with

their current behavior; raise parent's awareness about behavior Contemplation - Initial recognition that behavior may be a problem and ambivalence about change Foster and evoke reasons to change and the risks of not changing; help parents see that change is possible and achievable

Parent’s Stage of Change and Motivational Tasks for Child Welfare Workers

Parent’s Stages of Change Motivational Tasks for Child Welfare Worker Decision to Change - Makes a conscious determination to change; some motivation for change identified Help parent identify best actions to take for change; support motivations for change Action – Takes steps to change Help parent implement strategy and take steps

Parent’s Stage of Change and Motivational Tasks for Child Welfare Workers

Parent’s Stages of Change Motivational Tasks for Child Welfare Worker Maintenance - Actively works on sustaining change strategies and maintaining long-term change Help parent to identify triggers and use strategies to prevent relapse Lapse or Relapse - Slips (lapses) from a change strategy or returns to previous problem behavior patterns (relapse) Help parent re-engage in the contemplation, decision, and action stages

8

Substance Abuse Specialists in Child Welfare and the Courts

9

Many communities began program models

ￚ Persons in Recovery act as Parents Advocates ￚ Multidisciplinary Teams for Joint Case Planning ￚ Counselor Out-stationed at Child Welfare Office ￚ Paired Counselor and Child Welfare Worker

Mid to late 1990s – Practice Models

10

Lessons and Challenges

• Program Structure

– Purpose – Roles and responsibilities – Location and settings

• Collaborative Structure

– Underlying values and principles – Funding – Training and supervision – Outcomes and evaluation

11

• Title IV-E Waiver Demonstration sites (DE, IL, NH)
• Previous history of collaboration (IL, MA, Sacramento)
• Respond to State consent decree (CT)
• Reduce costs of out-of-home placements and/or

reduce time of children in foster care

• Remove barriers and improve linkages between CWS

and substance abuse treatment to better serve clients

• Improve the capacity of CWS to serve parents with

substance use disorders problems

• Improve collaboration between systems

Lessons and Challenges Purpose

12

• Case management, screening and/or assessment
• Referral to treatment and facilitate access to treatment
• Urine testing (CT, DE, IL, Sacramento, San Diego)
• Consultation to CW
• Training to CW and potentially the court
• Support to parents while in treatment
• Conduct home visits (CT, DE, IL, Sacramento)
• Information sharing with CW and/or courts
• Develop and implement substance abuse capacity

building plans for CW (MA)

Lessons and Challenges Roles and Responsibilities

13

• Employed by state, county CW agency, community-

based AOD treatment agency, contracted service provider or Self-employed and contracted by CW

• Area/regional/county/district CW offices (CT, DE, MA,

NH, WA)

• Contracted service provider’s office, near to juvenile

court (IL, Sacramento, San Diego)

Lessons and Challenges Location and Settings

14

• MOU or other agreement formally outlines joint values

and principles for the program (Sacramento, WA)

• MOU or other agreement outlining joint values

influences the implementation of program, but was not developed for the program, specifically (Sacramento, MA)

• MOU or other agreement outlines systems’ and or
• ther programs’ roles in program implementation (CT,

DE, IL, San Diego)

Lessons and Challenges Underlying Values

15

• State funds – CT, DE, MA
• Federal funds (i.e., Title IV-E, IV-B) – IL and NH
• Multiple sources (i.e., partial state funding, tobacco

settlement, agency budget reallocation) – Sacramento, San Diego and Washington

Lessons and Challenges Funding

16

• Licensed/certified addiction counselor (all)
• Licensed clinical SW with addiction certification (CT)
• Supervised by Child welfare (CT, NH, WA)
• Supervised by contracted service provider (IL,

Sacramento, San Diego)

• Dual supervision (DE, MA)
• Regular meetings to maintain program purpose

and/or foster collaborative relationships

• Receives CW “New Worker Training” (DE, MA, NH)
• Participates in cross training

Lessons and Challenges Training and Supervision

17

• Regularly collects data (CT, DE, IL, NH, Sacramento,

San Diego)

• Collects standardized data (IL, NH, Sacramento, San

Diego)

• Regularly analyzes data (IL, Sacramento, San Diego)

Lessons and Challenges Outcomes and Evaluation

Factors Critical to Success

• Cross training and training on how to use the specialist
• Specialists’ background and expertise
• Location of specialist
• Same specialist serves client through length of case
• Collaborative relationship and constant communication

between CWS, treatment, specialists, and others

• Buy-in from different systems
• Top leadership decided integrative practice was a priority
• Sustainable funding

Lessons Learned

• Obtaining buy-in is a slow process and does not

happen overnight

– Importance of developing joint values and principles – Importance of obtaining buy-in from different systems and treatment providers – Importance of involving courts during program’s design phase

• Hiring qualified specialists might be difficult and

time consuming

• Importance of requesting funding that allows for

expand role and/ or hiring more specialists

Lessons Learned

• Training CWWs on how to use specialists
• Importance of having available resources/

capacity to handle increased caseload

• Importance of addressing clients’ ancillary needs
• Importance of flexibility to meet the (changing)

needs of systems

• Planning and budgeting for ongoing data

collection/evaluation of program is important

– Importance of collecting standardized data

Chuck Halligan, M.B.A. Carol Fowler, L.C.S.W. Sue Rose Salmon, M.H.S./A.C.A.D.C

 Parental substance abuse is a major factor

in Child Protection cases

 Substance abuse treatment is at capacity  Motivation for treatment fluctuates  Waiting periods for treatment 3 to 5 weeks  Over 25% dropout rate waiting for treatment  Substance abuse services are contracted

with private providers

 Improve connection between child

protection parents and substance abuse providers.

 Increase access to substance abuse

services.

 Support parents during waiting period.  Decrease recurrence of child

maltreatment.

 Decrease number of days in foster care.

 Child Protection referral  Children at home or just placed in

shelter care

 Parental substance abuse is a factor

 Substance Abuse Liaisons will be

available in target communities

 Substance abuse assessments will

be completed by SA Liaison

 Direct referral to treatment provider  Substance Abuse Liaison will provide

pre-treatment services until entry into treatment

 Child care and transportation available for

parents to attend meetings

 Motivational interviewing and stages of

change will be utilized

 Substance Abuse specialist will be co-

located with child protection staff

 Child protection staff training and support

 Weekly pre-treatment group or

individual meetings

 In person  To resolve ambivalence about SA assessment and treatment  Increase motivation for entry into and completion of treatment

 Drug/alcohol assessment completed

by SA Liaison

 Data  Liaisons expanded across the state  Funding

 Availability  Client contact  Engagement

 Individual  Pre-Treatment Group

 Relationship  Motivational Interviewing

 Goal Setting  SOCRATES

 Group  Individual

 Special Needs  Interpreter

 Accessibility

 Client  Social Worker

 Formal/Informal

 Consultation  Training

 Linking

 Client  Social Worker  Provider

 Specific Group  Client Awareness  Client Readiness

 Building Relationships  Staff Training

 Liaison  Education on Drug Addiction Issues  Brown Bag Lunches

 Movement to Client-Centered/Family-

Centered

 Awareness of Community Providers  Collaboratives

 Knowledge Surrounding Removal Issues  Treatment Experience

 ASFA  Continued Education for Community

Partners

 Court  GAL  MDT

 Integration of Family Centered

Practice Principles

 Broader Assessment

 Impacts of Substance Use  Recurrence of Maltreatment

 Strengthened Communications

 Community Treatment Providers  Stakeholders

Mendocino County Intake Support Group

Deborah Lovett Nancy Sutherland

Emergency Response Referral Investigation Detention/VFM FEG Intake

• Review of Case Plan
• Establish of Primary

Goals & Objectives

• Establish a Time Line

Intake Support Group

• Anger
• Denial
• Importance of Change

Process First Case Staffing

• Parent, SW, FEG

Facilitator, Clinician

• Confirm Case Plan and

Time Table

• Establish Roles

Case Plan Conference

• Strength Based

Assessment

• Service Plan
• Case Plan

FEG 4-6 Weeks

• Intro of Purpose
• Work on Safety and Tell

Story

• Establish of Safety in

Group Weekly FEG Conference @ State Street

• Trans of FEG and Case Information
• FEG Recommendation and SW

decision

• ID Roles With Plan

Process Flow Chart

Intake Support Group

• Eight-week support group
• Available to parents after the detention

hearing

• Turning crisis into a window of opportunity

for change

• A CPS intervention can be the catalyst for

change

• The sooner a parents starts the Intake

Support Group the better

Co-Facilitators

Clinical therapist

Experience

Nancy Sutherland AODP

Experience

Intake Support Group

Purpose of the Group

• Deal with anger by clarifying the difference

between fear and anger

• Confront denial by helping parents begin taking

responsibility for the current crisis

• Educate the parent about the court process and
• f the importance of building a relationship with

the social worker

• Focus on the importance of change

Intake Support Group

Purpose of the Group

• Provide a Mental Health assessment

– Provide early identification of Mental Health issues and offer recommendations for Court or the case plan.

• Provide a Substance Abuse assessment

– Provide early identification of substance use disorders and facilitate parent entry into treatment services

Treatment Service Linkage

• Identify substance use disorders
• Conduct assessments, as needed
• Educate parent about treatment facilities

and services

• Facilitate parent entry into treatment

services

• Provide some case management services

Funding

• Grant from Children’s System of Care for

the substance abuse treatment facilitator