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
Stages of Change Theory Pre-contemplation Permanent Relapse Contemplation Exit WHEEL OF CHANGE Maintenance Preparation Action Prochaska & DeClemente Rollins & Miller
Parent’s Stage of Change and Motivational Tasks for Child Welfare Workers Parent’s Stages of Motivational Tasks for Child Change Welfare Worker Pre-contemplation - No Increase parent's perception perception of having a of the risks and problems with problem or need to change their current behavior; raise parent's awareness about behavior Contemplation - Initial Foster and evoke reasons to recognition that behavior change and the risks of not may be a problem and changing; help parents see ambivalence about change that change is possible and achievable
Parent’s Stage of Change and Motivational Tasks for Child Welfare Workers Parent’s Stages of Motivational Tasks for Child Change Welfare Worker Decision to Change - Help parent identify best Makes a conscious actions to take for change; determination to change; support motivations for some motivation for change change identified Action – Takes steps to Help parent implement change 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 Help parent to identify works on sustaining change triggers and use strategies to strategies and prevent relapse maintaining long-term change Lapse or Relapse - Slips Help parent re-engage in the (lapses) from a change contemplation, decision, and strategy or returns to action stages previous problem behavior patterns (relapse)
Substance Abuse Specialists in Child Welfare and the Courts 8
Mid to late 1990s – Practice Models Many communities began program models ￚ Paired Counselor and Child Welfare Worker ￚ Counselor Out-stationed at Child Welfare Office ￚ Multidisciplinary Teams for Joint Case Planning ￚ Persons in Recovery act as Parents Advocates 9
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 10
Lessons and Challenges Purpose • 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 11
Lessons and Challenges Roles and Responsibilities • 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 12 building plans for CW (MA)
Lessons and Challenges Location and Settings • 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) 13
Lessons and Challenges Underlying Values • 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 other programs’ roles in program implementation (CT, DE, IL, San Diego) 14
Lessons and Challenges Funding • 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 15
Lessons and Challenges Training and Supervision • 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 16
Lessons and Challenges Outcomes and Evaluation • 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) 17
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
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