Screening and Referral Chemical Dependency Screening and Referral

Competencies SW 122-01 Ability to recognize indicators of substance abuse SW 122-02 Understands the difference between substance use and a substance use disorder SW 122-03 Ability to gather information to determine whether a child is unsafe due to the caregivers substance use SW 122-04 Understands the stages of recovery and the implications for child welfare work SW 122-05 Ability to assist clients in accessing treatment

Competencies SW 122-06 Understands the implications of prenatal use of substances and the possible effects on child development SW 122-07 Understands when a plan of safe care is required SW 122-08 Understands the importance of partnering with substance abuse providers, identifying goals related to safe parenting, and coordinating services for each client SW 122-09 Understands when and how drug testing is helpful in case and safety planning

Many Perspectives CW system MH system Legal system C/D system Does the person have a substance use disorder? CW system How does it impact the children? Legal system MH system Is the substance legal? Is it impacting their mental health?

Chemical Dependency System Substance Use Disorder Mild Moderate Severe Uses the DSM-V criteria Must have a diagnosis to pay for treatment

Which substances are the most… Dangerous? Addictive?

Substance Abuse Treatment Admissions Statistics from 2009 (most recent available) gathered from: http://www.drugabuse.gov/publications/drugfacts/treatment-statistics Shows percentages.

Philosophies of Treatment

Types of Treatment Detox Intensive Inpatient Intensive Outpatient Outpatient Aftercare

Opiate Substitution Treatment Provided via a treatment program Removes dangers or obtaining and taking street drugs Used for pregnant mothers - Infant will likely need to detox Methadone is most common

Co-Occurring Substance Abuse and Mental Health Disorders

Trauma History*

Stages of Recovery

Treatment Works Treatment outcomes show a decrease in negative outcomes for addicts https://ncadd.org/images/stories/videos/testimonial.mp4

Screening How might you ask about substance use? Based on the information you already have? Based on the client’s stage of change? Your go-to questions

Indicators of Substance Abuse Signs and Symptoms

How might substance use impact children?

Prenatal exposure may have a current impact

Asking About Pre-Natal Exposure Ask about use of drugs and alcohol during pregnancy Impacts can be: large or small temporary or long term Alcohol and nicotine are most common & have significant and profound long term effects

Pre-natal Exposure Alcohol Nicotine Cocaine Marijuana Opiates Meth @ birth Fetal Growth Strong Effect Effect No Effect Birth defects ? Long Term Growth Behavior Cognition Language This chart is taken from the journal Pediatrics, an article from 2013 summarizing the current body of research on the impacts of exposure to a variety of substances of abuse during pregnancy. As you can see, the substance that has the most profound effect across almost every measure both at birth and long term is alcohol. The question marks represent areas where the research is conflicting or insufficient to draw conclusions. The paper cited the relative “newness” of methamphetamine exposure as a reason that long term consequences are still not clearly understood. They state there have not been enough reliable, independent, large, and long term research projects to provide information about this drug’s impact on children as they grow and develop. Citation for chart: Behnke, M. & Smith, V. C. COMMITTEE ON SUBSTANCE ABUSE and COMMITTEE ON FETUS AND NEWBORN. (2013) Prenatal Substance Abuse: Short- and Long-term Effects on the Exposed Fetus. Pediatrics. 131 (3) , pp. e108 – e125. DOI: 10.1542/peds.2012-3931. Retrieved from: http://pediatrics.aappublications.org/content/131/3/e1009.full.pdf

Fetal Alcohol Spectrum Disorder Often includes: Physical markers Intellectual disability Poor executive functioning Planning Anticipating learning from experience

FASD: Assessment and Treatment Children under 3: Early Intervention Services Children 3 and over: School District 10X more prevalent in children in care

Neonatal Abstinence Syndrome Related to opiate use only Increased symptoms and discomfort as time passes Often requires hospitalization and treatment More significant from methadone than heroin

Plan of Safe Care For Substance Exposed Newborns Case Note Medical care Safe housing/sleep Child care plan Emergency numbers Resources Referrals

Referring for Assessment WHEN???

Referring for Assessment 1-866-789-1511 http://warecoveryhelpline.org/ http://www.dshs.wa.gov/dbhr/dadirectory.shtml

Referring for Assessment What information do we provide?

Partnering with treatment providers

Utilizing Drug Tests Random, observed UA’s are the most accurate type of testing UAs are a PIECE of information, not the whole picture UA’s don’t necessarily provide information about child safety Other types of drug testing exist as well

Drug Tests What they can’t: Exactly when a drug was used How much of the drug was used Overall skill acquisition What they tell us: A particular drug or class of drugs was used General time frame this happened