1. Running the Marathon Sacramento Countys Ten Year Journey Enhancing Alcohol and Other Drug and Child Welfare Services to Families Toni J Moore Alcohol and Drug Administrator Carol Chrisman Juvenile Court Referee Geri Wilson Child Protective Services Division Manager Steve Nelson Parents Attorney

2. l AODTI – Mid 1990s l Cross Training Efforts l AOD System of Care l Early Intervention Specialists l STARS Services l CWS Changes and Benefits Presentation Overview l Dependency Drug Court Overview l Goals and Critical Components l Success Measures l Court System Changes and Results

3. l To incorporate alcohol and other drug treatment services as an integral part of the health and human services delivery system ëDHHS - Child Welfare, Mental Health, Public Health, Adult Protective Services, and Primary Health Care Alcohol and Other Drug Treatment Initiative (1994) PROGRAM VISION l To build and expand service capacity l To transform the department into a primary provider of AOD services l To achieve treatment on demand

4. Alcohol and Other Drug Treatment Initiative Premises l Health, social service and criminal justice caseloads are driven by AOD abuse l Current treatment capacity can meet less than 25% of demand l Agency staff can serve as the first line of defense l Both the client and the system need to be held accountable

5. l Addressing AOD issues is essential to competent practice l Risk Assessment for the child is incomplete without an AOD Assessment of the parent l Developing practical applications of harm reduction vs. a zero tolerance approach l CWS social workers serve as AOD group co- facilitators to help bridge service gaps Changes in Child Welfare Practice

6. l Ensure CWS Clients receive treatment priority l Expand interim and group services to help achieve treatment on demand l Promote treatment services that are responsive to other system involvement Changes in AOD Practice

7. Training to Build Service Capacity l Level One ë overview of chemical dependency ë beginning to intermediate AOD information ë introduction to assessment and treatment l Level Two ë advanced AOD information ë assessment and treatment skill building ë SASSI Certification training l Level Three ë group treatment service skills ë special treatment topics

8. Additional Training Components l Strategies for Family Change l Resiliency Training l Motivational Interviewing l Adolescent Treatment Training

9. l CWS Topics ëService System Overview ëDependency System Overview ëMandated Reporting Responsibilities ëRisk Assessment ëDecision-making ëCritical Time Frames AOD Treatment Provider Training

10. l Best Use of Resources l Ensure CWS and other multi- service users get service priority l Reduce the number of clients that fall through the cracks Alcohol and Other Drug System of Care

11. Alcohol and Drug Priority Clients For Publicly Funded Slots l Federal Priorities Pregnant HIV Injection Drug Users l Childrens Protective Services Clients l Multi-County Service Users Criminal Justice Involved (Pregnant and Juvenile Offenders) Public Assistance Recipients (CalWorks and Others)

12. System Tools l Screening and Service Referral l Preliminary Assessment l Treatment Authorization System of Care Tools Provider Partners Tools l Addiction Severity Index (ASI) l ASAM Patient Placement Criteria

13. l Three CWS-AOD Specialist Social Workers stationed at the Juvenile Court l Offer immediate AOD assessment and treatment authorization l Educate parents about the Dependency and Family Reunification Process Early Intervention Specialist Program Components

14. l Have an Alcohol and Other Drug Assessment l Begin Your Alcohol and Other Drug Treatment l Begin Drug Testing l Stay Clean and Sober EIS Tips for Parents How to Get Started

15. l Attend all Court hearings l Cooperate with your Court Investigator l Participate in services and follow all Court orders l Visit your children as often as possible l Meet with your Reunification Social Worker monthly and always keep them informed of your address, phone and message number l Services are offered for a short time only, failure to participate may result in losing your rights and your children being placed for adoption EIS Tips for Parents Steps you can take to reunify with your children

16. SOC – Number and Percent of Substances Reported on CWS Assessments as Most Frequently Used (2002-03)

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

18. Client Level of Functioning by Severity of AOD Problems 2002/03

19. Number of Referrals of CWS Clients by Type of AOD Service 2002/03 Tier 1 Residential = 248 (11%) Detox = 107 (5%) Total = 355 Tier 2 Outpatient = 412 (18%) Intensive Outpatient = 509 (22%) Day Treatment = 124 (5%) Total = 1,045 Total Referrals 2,291

20. l Offers early engagement and intervention l Ensures timely assessment and treatment authorization l Reinforces CWS and Court compliance l Expedites linkages to other service needs l Promotes system accountability l Provides workload relief for Social Workers Benefits of EIS Component

21. l 16 Recovery Specialists l Offer support and monitoring of AOD related case activities l Liaisons among clients, CWS AOD, treatment providers and the Court l Twice monthly reports for the Dependency Drug Court Specialized Treatment and Recovery Services STARS

22. l Provides support and advocacy for AOD impacted parents l Bridges treatment programs and CWS l Reduces trauma to family through effective coordination l Places emphasis on engagement and retention in treatment l Promotes system (reasonable efforts) and client accountability l Provides workload relief for Social Workers Benefits of STARS Component

23. l Complimentary Practice - should work with both the child welfare and CalWORKs time clocks (particularly AOD perinatal services) l Complimentary Practice - should have a family focus, and not work with only the child or parent l Complimentary Practice - should use case management services to bridge the gap between AOD treatment and child welfare services Key Elements of Complimentary Practice

24. l Complimentary Practice - should utilize case and family conferencing to ensure inclusion in treatment planning and implementation l Complimentary Practice - should work to resolve confidentiality issues between systems to reduce barriers to successful treatment l Complimentary Practice - should work to develop reasonable approaches to relapse reassess and re-motivate the parent reassess and re-motivate the parent reassess the risk to the child reassess the risk to the child Key Elements of Complimentary Practice

25. Drug Court History l 1992 – Criminal Justice Cabinet Formation l 1996 – Adult Criminal Drug Court Established l Mid-1990s – Enhanced AOD/CWS Linkages l 1999 – Began DDC Planning Efforts l 2001 – DDC Started l 2002 – Began Juvenile Drug Court Planning Efforts

26. l Drug 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 Court

27. l Increase collaboration between agencies l Ensure reasonable efforts Decrease time to assess and treat l Increase compliance with treatment l Increase 12 month permanent placements l Increase family reunification rates l Decrease time in foster care Goals of Drug Court

28. l Prompt assessment (1 day) l Prompt treatment (2-5 days) l Intensive case management Track I - twice weekly Track II - weekly Track III - twice monthly Critical Components: Treatment

29. l Parallel Track Court vs. Integrated Track (Santa Clara; Reno) vs.Dual Track (San Diego) l 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) l Timely sanctions and incentives Critical Components: Court

30. l Contacts with Recovery Specialist Case Managers (STARS) l Attendance in treatment l Attendance in support groups (e.g. 12-Step) l Test results for presence of drug/alcohol Reports to Drug Court

31. l Verbal reinforcement by judicial officer l Certificates of acknowledgement l Gift certificates to clothes closets l Tokens of acknowledgement recovery rocks Drug Court Incentives

32. l 1st: Reprimand from judicial officer l 2nd: 2 days in jail l 3rd:4 days in jail Drug Court Sanctions

33. Parent Characteristics Evaluation DataYear 1Year 2 l Average age32 l Women69% l Ethnic/racial diversity Caucasian: African-American: Hispanic: Other: 51% 25% 14% 10% 60% 18% 16% 6%

34. Parent Characteristics Evaluation DataYear 1Year 2 l Unemployed l < High School Grad 82% 46% 83% 44% l Homeless l Pregnant 44% 20% 53% 11% l Chronic Mental Illness l Methamphetamine 26% 46% 31% 55%

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

36. l Random tests 2-3 per week: all negative l Individual and group treatment: no absence l Recovery Specialist meetings: no absence l Support group/12-step: 3 or more per week l Drug Court appearances: no misses l Comply with court orders: all 180 Day Graduation

37. l 85% of parents with DDC involvement entered substance abuse treatment vs. 23% of the comparison group l 66% of parents with DDC involvement successfully completed their treatment within 12 months Parental Outcomes

38. l 33% (144) of DDC children reunified vs. 19% of the comparison group, creating a cost savings of $2,141,056 l DDC children reunified in 5.6 months vs. 7 months for the comparison group a foster care savings of $413,712 l The average length of stay for DDC children was 10.3 months vs. 22.8 months for the comparison group Child Outcomes

39. l Improved alcohol and drug services l Immediate access to services l Increased client contact l Less legal/factual issues regarding reasonable services addressing alcohol and drug issues l Accountability for all l Better information on clients progress l Empowerment of the client in their case Benefits from the Parents Attorney Perspective

40. l Improved Judicial Decision-making Good quality evidence of reasonable efforts Good quality evidence regarding parental participation and progress in services l Improved success in meeting statutory timelines l Improved outcomes for children through reunification, reduced placement moves and permanence l Less litigation over reasonableness of efforts Benefits from the Courts Perspective

41. CWS Redesign l Building on community partnerships l Family Resource Centers l Enhancing services to children Child Welfare Next Steps