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Recovery: The Family’s Process of Healing and Hope CMHACY Conference Steve Hornberger, MSW May 2014 Pacific Grove, CA.

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Presentation on theme: "Recovery: The Family’s Process of Healing and Hope CMHACY Conference Steve Hornberger, MSW May 2014 Pacific Grove, CA."— Presentation transcript:

1 Recovery: The Family’s Process of Healing and Hope CMHACY Conference Steve Hornberger, MSW May 2014 Pacific Grove, CA

2 Three Questions Generally, in my community when someone hears a family has an alcohol or drug problem they believe… Generally, in my community when someone hears a family has an alcohol or drug problem they believe… Working with a family in need of alcohol or drug treatment is challenging because… Working with a family in need of alcohol or drug treatment is challenging because… I have been successful working with a family receiving drug treatment when I … I have been successful working with a family receiving drug treatment when I …

3 Why are we here today  1 in 10 Americans  1 in 5 families  1 in 7 workers  1 in 20 newborns  35% of ALL school children  1 in 8 veterans  1 in 2 homeless  1 in 4 elderly  80% of those in jail  60% of families in children and youth services

4 Unmet Prevalence  In 2012, 23.1 million people aged 12 or older needed treatment for an AOD problem.  Of those, only 2.5 million received any treatment.

5 The System Gaps  Of the 20.6 million who needed treatment but did not receive it, only 1.1 million (5%) felt they needed it (denial gap)  Of that 1.1 million, 347,000 (31%) said they made an effort but were unable to get it (treatment gap)  753,000 (69%) reported making no effort (motivation gap). 5

6 Why are we here today  In 2005, federal, state and local government spending as a result of substance abuse and addiction was a least $467.7 billion or 10.7 % of their combined $4.4 trillion budget.  For each dollar of the $467.7 billion spent, 95.6 cents went to shoveling up the wreckage and only 95.6 cents went to shoveling up the wreckage and only 1.9 cents on prevention and treatment, 1.9 cents on prevention and treatment, 0.4 cents on research, 0.4 cents on research, 1.4 cents on taxation or regulation and 1.4 cents on taxation or regulation and 0.7 cents on interdiction. 0.7 cents on interdiction.

7 Impact  ½ of all children (35.6 million) live in a household where a parent or other adults use tobacco, drink heavily or use illicit drugs.  13% of children under 12 live in a household where a parent or other adults use illicit drugs.  1 in 4 children under the age of 18 has a family member who abuses alcohol or has alcoholism.

8 Intergenerational Connections  Approximately 45% of all NYS clients admitted to being a “child of an alcoholic or substance abuser”  A child of an AOD abuser is 3 to 4 times more likely to develop AOD problems as well as negative health, educational and employment outcomes  Over 90% of all women in residential substance abuse treatment report history of child abuse and/or neglect

9 Some CA BH Facts 1  Beliefs: About 3 in 5 (58.9%) 12- to 17-year-olds in California in 2011- 2012 perceived no great risk from drinking five or more drinks once or twice a week. About 3 in 5 (58.9%) 12- to 17-year-olds in California in 2011- 2012 perceived no great risk from drinking five or more drinks once or twice a week. About 7 in 9 (77.9%) 12- to 17-year-olds in California in 2011-2012 perceived no great risk from smoking marijuana once a month About 7 in 9 (77.9%) 12- to 17-year-olds in California in 2011-2012 perceived no great risk from smoking marijuana once a month About 3 in 10 (31.9%) 12- to 17-year-olds in California in 2011- 2012 perceived no great risk from smoking one or more packs of cigarettes a day About 3 in 10 (31.9%) 12- to 17-year-olds in California in 2011- 2012 perceived no great risk from smoking one or more packs of cigarettes a day

10 Some CA BH Facts 2  Usage: Among 12- to 17-year-olds in California, the mean age of first marijuana use was 13.8 years, and the mean age of first cigarette use was 13.2 years. Among 12- to 17-year-olds in California, the mean age of first marijuana use was 13.8 years, and the mean age of first cigarette use was 13.2 years. about 195,000 youths (6.2% of all youths) per year in 2008-2012* reported using cigarettes within the prior month about 195,000 youths (6.2% of all youths) per year in 2008-2012* reported using cigarettes within the prior month about 353,000 youths (11.2% of all youths) per year in 2008-2012* reported using illicit drugs within the prior month about 353,000 youths (11.2% of all youths) per year in 2008-2012* reported using illicit drugs within the prior month

11 Some CA BH Facts 3  Treatment: among persons aged 12 or older with illicit drug dependence or abuse, about 117,000 persons (12.4%) per year in 2008-2012 received treatment for their illicit drug use within the year among persons aged 12 or older with illicit drug dependence or abuse, about 117,000 persons (12.4%) per year in 2008-2012 received treatment for their illicit drug use within the year among persons aged 12 or older with alcohol dependence or abuse, about 212,000 persons (9.1%) per year in 2008-2012 received treatment for their alcohol use within the year among persons aged 12 or older with alcohol dependence or abuse, about 212,000 persons (9.1%) per year in 2008-2012 received treatment for their alcohol use within the year about 947,000 persons aged 12 or older (3.1% of all persons in this age group) per year in 2008-2012* were dependent on or abused illicit drugs within the year about 947,000 persons aged 12 or older (3.1% of all persons in this age group) per year in 2008-2012* were dependent on or abused illicit drugs within the year

12 Some CA BH Facts 4  Mental health: about 259,000 youths (8.4% of all youths) per year in 2008-2012* had at least one MDE within the year prior to being surveyed about 259,000 youths (8.4% of all youths) per year in 2008-2012* had at least one MDE within the year prior to being surveyed about 83,000 youths with MDE (32.0% of all youths with MDE) per year in 2008-2012 received treatment for their about 83,000 youths with MDE (32.0% of all youths with MDE) per year in 2008-2012 received treatment for their 72% of youths reported improved functioning from treatment received through the public mental health system 72% of youths reported improved functioning from treatment received through the public mental health system

13 Parent who is abusing alcohol or other drugs  May be less attentive to the child while drunk or high  May be unable to fulfill their role as a parent, including providing medical treatment  Is more likely to be diagnosed with a co- morbid psychological problem

14 Parent who is abusing alcohol or other drugs  May be chronically physically ill from using drugs or alcohol  Spends times procuring, using, and recovering from the alcohol or drug use instead of parenting  May be engaged in illegal activities  Places financial stress on the family system

15 Adverse Child Experiences Study 15

16 Adverse Childhood Experiences Study  Fairly common  Generally clustered  Have a cumulative effect on healthy development and health care status

17 HOPE

18 National Prevention Strategy

19 Priorities  Tobacco Free Living  Preventing Drug Abuse and Excessive Alcohol Use  Healthy Eating  Active Living  Mental and Emotional Well-being  Reproductive and Sexual Health  Injury and Violence Free Living Source: National Vital Statistics Report, CDC, 2008

20 EXTERNAL ASSETS Support 1. Family support 2. Positive family communication 3. Other adult relationships 4. Caring neighborhood 5. Caring school climate 6. Parent involvement in schooling Empowerment 7. Community values youth 8. Youth as resources 9. Service to others 10. Safety

21 EXTERNAL ASSETS (2) Boundaries & Expectations 11. Family boundaries 12. School boundaries 13. Neighborhood boundaries 14. Adult role models 15. Positive peer influence 16. High expectations Constructive Use of Time 17. Creative activities 18. Youth programs 19. Religious community 20. Time at home

22 INTERNAL ASSETS Commitment to Learning 21. Achievement motivation 22. School engagement 23. Homework 24. Bonding to school 25. Reading for pleasure Positive Values 26. Caring 27. Equality and social justice 28. Integrity 29. Honesty 30. Responsibility 31. Restraint

23 INTERNAL ASSETS (2) Social Competencies 32. Planning and decision making 33. Interpersonal competence 34. Cultural competence 35. Resistance skills 36. Peaceful conflict resolution Positive Identity 37. Personal power 38. Self-esteem 39. Sense of purpose 40. Positive view of personal future

24 DRUGS BRAIN MECHANISMS BEHAVIOR ENVIRONMENT HISTORICAL ENVIRONMENTAL - previous history - expectation - learning - social interactions - stress - conditioned stimuli - genetics - circadian rhythms - disease states - gender PHYSIOLOGICAL A complex behavioral and neurobiological disorder Source: National Institute on Drug Abuse Presentation

25 Risk and Protective Factors What is a Risk Factor? Something in a person’s life that increases the chance of a problem occurring. Risk Factors include: Availability of ATOD Availability of ATOD Family history of addiction – 4X Family history of addiction – 4X Parental use or positive attitude toward use Parental use or positive attitude toward use Other problems in the family: abuse, poverty, domestic violence Other problems in the family: abuse, poverty, domestic violence Behavior/learning problems Behavior/learning problems Friends who use and think it is fun or “cool” Friends who use and think it is fun or “cool” Early use Early use

26 Risk Factors in Families Lack of love, caring, and support Lack of love, caring, and support Low expectations for children’s success and school performance Low expectations for children’s success and school performance Lack of adult supervision and severe or inconsistent discipline Lack of adult supervision and severe or inconsistent discipline Lack of family rituals (e.g. family gatherings) Lack of family rituals (e.g. family gatherings) Poor family management or communication Poor family management or communication Sexual and physical abuse Sexual and physical abuse

27 Risk and Protective Factors What is a Protective Factor? Something that increases the likelihood that substance abuse can be resisted. Protective Factors include: Relationship to an adult outside the family Relationship to an adult outside the family Involvement in activities: clubs, scouts Involvement in activities: clubs, scouts Positive self esteem Positive self esteem Involvement in religious activities, providing hope, purpose, see beauty in the world, connection to Higher Power Involvement in religious activities, providing hope, purpose, see beauty in the world, connection to Higher Power

28 Risk and Protective Factors Family Protective Factors include: Strong bonds between children and parents Strong bonds between children and parents Involvement in children’s lives Involvement in children’s lives Clear limits/rules with consistently enforced consequences Clear limits/rules with consistently enforced consequences Clear, honest respectful communication Clear, honest respectful communication Chores for all family members Chores for all family members Family Rituals Family Rituals

29 Primary Conclusions 1. People were always more important than programs. 2. Often just one person made the difference. 3. Programs that helped simulated living in a healthy family. 4. Gandhi’s Story 1. People were always more important than programs. 2. Often just one person made the difference. 3. Programs that helped simulated living in a healthy family. 4. Gandhi’s Story

30 Wellness Models Are Emerging HEALTHY HEALTHY l I NOT ILL--------- l ----------ILL NOT ILL--------- l ----------ILL l l l NOT HEALTHY NOT HEALTHY

31 A Person/Family Centered Approach  Is Strengths Based –Assumes people have abilities, capacities  Role focused, not problem focused (problems interfere with performing desired roles, diagnosis is not a role)  Promotes direction of the process by the person/family  Adopts an individualized approach to services (not a cookie cutter set of programs)  Where changes made in individual circumstances may have system wide implications that benefit others (innovations)

32 CMS Definition “... identify and access a PERSONALIZED mix of paid and non-paid services and supports that will assist him/her to achieve PERSONALLY- DEFINED OUTCOMES in the most inclusive community setting. The individual identifies planning goals to achieve these outcomes in COLLABORATION with those that the individual has identified, including medical and professional staff ….”

33 Putting the Pieces Together in a Person-Centered Plan GOAL as Defined by Person Strengths to Draw UponBarriers Which Interfere Short-Term Objective BehavioralBehavioral AchievableAchievable MeasureableMeasureable Interventions/Action Steps Professional/”Billable” Services Professional/”Billable” Services Clinical & Rehab Clinical & Rehab Action Steps by Person in Recovery Action Steps by Person in Recovery Roles/Actions by Natural Supporters Roles/Actions by Natural Supporters

34 HEALING

35 What Do They Need? Caregivers: Caregivers: Words to share experiences Words to share experiences Understanding of family disease Understanding of family disease Time with their children for healing Time with their children for healing Making amends and forgiveness Making amends and forgiveness Children: Words to say what happened Words to say what happened Understanding of family disease Understanding of family disease Time with their caregivers to heal Time with their caregivers to heal Knowledge that it isn't their fault Knowledge that it isn't their fault

36 Family engagement/involvement: Why is it important?  Because it works!  Because it is the right thing to do  Stakeholders are advocating for it  System reforms are mandating it

37 Family Involvement Works Treatments involving families result in  Higher levels of abstinence (50 vs. 30%)  Fewer drug related arrests (8 vs. 28 %)  Fewer inpatient episodes (13 vs. 35%) Science Practice Perspectives. Vol. 2 No 2 August 2004 NIDA

38 Family engagement/involvement  Increased involvement equals increased ownership equals improved outcomes  Services can be organized on a continuum from family friendly to family focused to family centered to family driven.  Collaborative partnership of expertise, resources and experience.

39 What Do They Need? Caregivers: Caregivers: Words to share experiences Words to share experiences Understanding of family disease Understanding of family disease Time with their children for healing Time with their children for healing Making amends and forgiveness Making amends and forgiveness Children and Youth: Words to say what happened Words to say what happened Understanding of family disease Understanding of family disease Time with their caregivers to heal Time with their caregivers to heal Knowledge that it isn't their fault Knowledge that it isn't their fault

40 Talking Helps to Break the Silence 40 Talk with the children and family members affected by alcohol and drug addicts and explain the disease and 7 Cs I didn’t Cause it I can’t Cure it I can’t Control it I can take better Care of myself: by Communicating my feelings making healthy Choices by Celebrating myself.

41 What families must re-learn  Authority and discipline  Roles and responsibilities  Problem solving  Communication  Having fun together  Showing affection

42 Parent’s Support  Who in your family is already supportive of your recovery?  Who in your family is in recovery too?  Who keeps a healthy distance from family members who are not so stable?  How has your child’s caregiver been helpful in your recovery?  Who could help identify when you are headed in a negative direction? Who would see the warning signs?  How can these people help you maintain your recovery? How can you ask them for help?

43 EXAMPLES FROM OTHER SYSTEMS

44 Healthcare Institute of Medicine 2001 report, “Crossing the Quality Chasm: A New Health System for the 21 st Century,” Respect patients’ values, preferences and expressed needs Respect patients’ values, preferences and expressed needs Coordinate and integrate care across boundaries of the system Coordinate and integrate care across boundaries of the system Provide the information, communication, and education that people need and want Provide the information, communication, and education that people need and want Guarantee physical comfort, emotional support, and the involvement of family and friends Guarantee physical comfort, emotional support, and the involvement of family and friends

45 Healthcare cont Institute for Patient and Family Centered Care lists the following core concepts of patient and family centered care: Respect and dignity Respect and dignity Information Sharing Information Sharing Participation Participation Collaboration Collaboration

46 Child Welfare Child Welfare Information Gateway  family-centered and strengths-based approach  partnering with families in making decisions,  setting goals, and achieving desired outcomes  motivating and empowering families - to recognize their own needs, strengths, and resources - to take an active role in working toward change

47 Juvenile Justice National Juvenile Justice Network  Engage in deliberate outreach to meet families  Ensure family members are an integral part of advocacy  Empower families to participate in advocacy through education and training  Assist families with individual and system advocacy  Listen to families  Create a clear structure for engagement and participation  Level the field by providing adequate information and support

48 RECOVERY

49 What is Recovery Perspective  Substance dependence, while often manifested by socially unacceptable behavior (for which there must be responsibility), is an illness. This illness can best be prevented when science is used to inform family and community-based efforts to protect and build resiliency.  The illness is best treated by early identification and intervention or, if not halted before its acute development, by a continuity of care over a lifetime that is built on measures of individual wellness and ongoing opportunities for recovery

50 What does the science say Millions of Americans today receive health care for mental health or substance use problems and illnesses. These conditions combined are the leading cause of disability and death among women and the second highest among men. Institute of Medicine, 2006 Treatment is effective: When given a continuum of care, relapse rates for the treatment of alcohol, opioids, and cocaine are less than those for hypertension and asthma and are equivalent to those of diabetes (all of which are also chronic illnesses). Compliance to addiction treatment is greater than compliance rates for treatment of hypertension and asthma. O’Brien and McLellan, 1996

51 What does science say 2  Treatment is Effective and Sustainable  Addictions treatment has resulted in: 67% reduction in weekly cocaine use, 67% reduction in weekly cocaine use, 65% reduction in weekly heroin use, 65% reduction in weekly heroin use, 52% decrease in heavy alcohol use, 52% decrease in heavy alcohol use, 61% reduction in illegal activity, and 61% reduction in illegal activity, and 46% decrease in suicidal ideation one year 46% decrease in suicidal ideation one year post treatment. post treatment.  These outcomes are generally stable for the same clients five years post treatment  These outcomes are generally stable for the same clients five years post treatment.

52 Continuing Care is Cost Effective A recent study of a lifetime simulation model (multiple episodes of treatment over a lifetime) shows that for every $1 spent on treatment (chronic care provided in a continuum of care) society accrues $37.72 in benefits. Zarkin et al., 2005

53 What does the recovery research say Recovery Supports:  Increase entry and involvement in treatment – Moos & Moos, 2005  Can be the basis for self and peer care shown to be effective in addressing any illness requiring continuing care – Flaherty, 2006  Are often low-cost or free (such as peer-support groups, recovery mentors, recovery check-ups, et al.) – McKay, 2005  Reduce chronicity (reoccurrence/relapse) and diminish stigma – Moos & Moos, 2005

54 Addiction and Chronic Care ComplianceRelapse Rate ComplianceRelapse Rate Addiction/Chronic Illness Rate (%) (%) Alcohol30-50 50 Opioid30-50 40 Cocaine30-50 45 Nicotine 30-50 70 Insulin Dependent Diabetes Medication<50 30-50 Medication<50 30-50 Diet and Foot Care<50 30-50 Diet and Foot Care<50 30-50Hypertension Medication<30 50-60 Medication<30 50-60 Diet <30 50-60 Diet <30 50-60Asthma Medication<30 60-80 Medication<30 60-80

55 WHAT IS YOUR DEFINITION OF RECOVERY?

56 Recovery definitions  Recovery from alcohol and drug problems is a process of change through which an individual achieves abstinence and improved health, wellness, and quality of life. ( CSAT 2005 National Recovery Summit)  Recovery from substance dependence is a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship. (Betty Ford Institute, 2007)  My definition of recovery is life. Cause I didn’t have no life before I got into recovery. (Pathways study participant H.W. 42 years old African-American male)

57 SAMHSA’s new working definition  A process of change through which individuals improve their health and wellness, live a self- directed life, and strive to reach their full potential Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way; Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way; Home: a stable and safe place to live; Home: a stable and safe place to live; Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; Community: relationships and social networks that provide support, friendship, love, and hope. Community: relationships and social networks that provide support, friendship, love, and hope.

58 Recovery oriented systems of care 2 Recovery-Oriented Systems of Care shifts the question from How do we get the client into treatment? to How do we support the process of recovery within the person’s life and environment?

59 Recovery and Resilience Oriented System of Care

60 CLOSING THOUGHTS

61 The Vision A community where all members of a family affected by alcohol and other drugs know there are knowledgeable and caring others who: A community where all members of a family affected by alcohol and other drugs know there are knowledgeable and caring others who: understand what they are experiencing, understand what they are experiencing, care about them and are available, care about them and are available, can help them find emotional and physical safety, can help them find emotional and physical safety, can support their healing, health and wellness. can support their healing, health and wellness. 61

62 Opportunities and Challenges of a Lifelong Health System  Goal of system to optimize health outcomes and lower costs over much longer time horizons  Payers, including Medicare and Medicaid, increasingly responsible for care for longer periods of time  Health trajectories modifiable and compounded over time  Importance of early years of life Source: Halfon N, Conway PH. The Opportunities and Challenges of a Lifelong Health System. NEJM 2013 Apr 25; 368, 17: 1569-1571

63 Quality Care as Driver of Change  The next generation of measures will: Define quality as improving the life of a person; Place functional outcomes on par with clinical outcomes; Create measurement processes that track outcomes over time since functional needs and personal goals change Bruce Chernof, MD, Pres and CEO The SCAN Foundation March 2014

64 What you can do personally  Take good care of yourself, family, friends and colleagues  Learn about addiction and recovery, advocate for system collaboration and become a change agent  Define and monitor outcomes at four levels, the status quo is not good enough  Be bold, imagine a community where people live better lives, where children are safe, healthy, happy and educated, where people achieve their aspirations  Provide hope

65 What we can do together  Raise awareness,  Find allies,  Take action to end: Silence Silence Stigma Stigma Disparities Disparities  Promote the many roads to recovery

66 Proposed Shared Vision A community where all are safe, healthy and well, where each has a sense of belonging, purpose and opportunities to achieve their aspirations. A community where all are safe, healthy and well, where each has a sense of belonging, purpose and opportunities to achieve their aspirations.

67 Web Resources  Al-Anon and Alateen www.al-anon.alateen.org www.al-anon.alateen.org  Faces and Voices of Recovery www.facesandvoicesofrecovery.org www.facesandvoicesofrecovery.org  Federation of Families for Children’s Mental Health www.ffcmh.org www.ffcmh.org  Join Together www.jointogether.org www.jointogether.org  National Association for Children of Alcoholics (NACoA) www.nacoa.org www.nacoa.org  National Center on Substance Abuse and Child Welfare (NCSACW) www.ncsacw.samhsa.gov www.ncsacw.samhsa.gov

68 Web Resources 2  National Center on Addiction and Substance Abuse at Columbia (CASA) www.casacolumbia.org www.casacolumbia.org  National Clearinghouse for Alcohol and Drug Information (NCADI) www.ncadi.samhsa.gov www.ncadi.samhsa.gov  National Institute on Alcohol Abuse and Alcoholism (NIAAA) www.niaaa.nih.gov www.niaaa.nih.gov  National Institute on Drug Abuse (NIDA) www.nida.nih.org www.nida.nih.org  Substance Abuse and Mental Health Services Administration (SAMHSA) www.samhsa.gov www.samhsa.gov

69 Web Resources 3  National Center on Addiction and Substance Abuse at Columbia (CASA) www.casacolumbia.org www.casacolumbia.org  National Clearinghouse for Alcohol and Drug Information (NCADI) www.ncadi.samhsa.gov www.ncadi.samhsa.gov  National Institute on Alcohol Abuse and Alcoholism (NIAAA) www.niaaa.nih.gov www.niaaa.nih.gov  National Institute on Drug Abuse (NIDA) www.nida.nih.org www.nida.nih.org  Substance Abuse and Mental Health Services Administration (SAMHSA) www.samhsa.gov www.samhsa.gov

70 Additional Resources  NW ATTC Addiction Messenger http://www.attcnetwork.org/ series http://www.attcnetwork.org/ Series 16 (2004) on Recovery, Series 17 (2005) on Family Treatment, Series 29 (2008) Family Participation in Addiction Treatment  SE ATTC and Florida Certification Board, Engaging Family Members Into Adolescent Drug Treatment (2008) http://www.scattc.org/pdf_upload/Engaging_Families_Adol escent_Drug_Tx_FinalWEB.pdf http://www.scattc.org/pdf_upload/Engaging_Families_Adol escent_Drug_Tx_FinalWEB.pdf

71 Additional Resources 2  Generational Patterns of Resistance and Recovery Among Families with Histories of Alcohol and Other Drug Problems: What We Need to Know (2008)  Addiction recovery: Its definition and conceptual boundaries (2007) http://www.williamwhitepapers.com/

72 Additional Resources 3  The Institute for Health Improvement www.ihi.org www.ihi.org http://www.ihi.org/NR/rdonlyres/C810CCBB-2DEB-4678-994A- 57D9B703F98D/0/PartneringwithPatientsandFamiliesRecommendationsAp r08.pdf http://www.ihi.org/NR/rdonlyres/C810CCBB-2DEB-4678-994A- 57D9B703F98D/0/PartneringwithPatientsandFamiliesRecommendationsAp r08.pdf  Institute for Patient and Family Centered Care www.ipfcc.org www.ipfcc.org http://www.ipfcc.org/pdf/CoreConcepts.pdf  Child Welfare Information Gateway http://www.childwelfare.gov/pubs/f_fam_engagement/http://www.childwelfare.gov/pubs/f_fam_engagement/ http://www.childwelfare.gov/pubs/f_fam_engagement/ http://www.childwelfare.gov/pubs/f_fam_engagement/  National Juvenile Justice Network www.njjn.org www.njjn.org “An Advocates Guide to Meaningful Family Partnerships” http://njjn.org/media/resources/public/resource_1665.pdf http://njjn.org/media/resources/public/resource_1665.pdf

73 Additional Resources 4  PCORI Engagement Rubric http://www.pcori.org/assets/2014/02/PCORI-Patient-and- Family-Engagement-Rubric.pdf  IHI High Impact Leadership http://www.ihi.org/resources/Pages/IHIWhitePapers/HighI mpactLeadership.aspx  2013 Behavioral Health Barometer CA http://store.samhsa.gov/shin/content//SMA13- 4796/SMA13-4796CA.pdf  Motivational Interviewing with Adolescents http://doczine.com/474033.html#/Motivational_Interviewing _Strategies_to_Facilitate_Adolescent_.../

74 CONTACT INFORMATION Steve Hornberger, MSW Independent consultant 301-602-1264 sdh9726@gmail.com


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