Women Involved in Multiple Systems and the Clinical Implications for Substance Abuse Treatment: Using a Single Coordinated Care Plan Francine Feinberg, Psy.D. and Patricia Aniakudo, MS Meta House, Inc. Acknowledgement goes to the State of Wisconsin, Department of Health and Family Services and the Management Group, Inc. for their support and information.

Handouts Barriers Core Values Child Welfare Stipulations Rules of Supervision TANF Employment Plan

Systems and their focus Child Protection – safety and health of children Substance abuse/mental health – the reduction/cessation of substance abuse and the reduction/cessation of symptoms TANF – employment and economic independence Criminal Justice – Public Safety and reducing recidivism

Systems differ in many ways Goals Expectations and requirements for success Definition of success based on its own outcomes Funding sources and accountability requirements

Coordination challenges While workers may be well trained to understand their own system, they may not have a good understanding of other systems. Front line staff in each system develop plans for the consumer without consideration to other plans being developed for the same consumer in other systems There may be little or no sharing of information between systems or it may be left to the consumer to carry information between systems.

Result Multiple meetings for client; sometimes scheduling conflicts Requirements to receive same service from multiple providers Frenetic pace to meet all requirements Client required to do the impossible Failure blamed on client resulting in severe consequences.

Wisconsin INITIATIVE in Milwaukee – State Partners Department of Workforce Development Division of Economic Support Department of Health and Family Services Division of Supportive Living Child and Family Services Health Care Finance

Identified Barriers Consumers are involved in multiple systems Separate goals Timelines Expectations Lack coordination Communication

Identified Barriers Systems lack consumer focus viewed as recipients of discrete services not as whole people viewed as having deficits lack of trust and understanding between consumers and the systems.

Identified Barriers The approach sometimes reflects societal stigmas toward people with mental health and substance abuse issues.

Identified Barriers The assessment and treatment system is not designed to adequately meet the needs of women who have complex mental health and substance abuse issues. Funding source structure and administration do not support consumer focus and achievement of outcomes.

Women that abuse substances Very likely to have experienced childhood sexual abuse. A high incidence of dysfunction in the families of origin.

Women that abuse substances Early separation from parents through divorce or death High incidence of parental deprivation or rejection High incidence of violence in the family of origin High potential of parental addiction

World view I am different from everyone else in a very negative way. No one can help me. Life is meaningless. The world is a dangerous place. I cannot protect myself from the dangers around me.

World view I am losing my mind. I feel empty. I need you but I know you will betray me. I cannot manage my life. If I don’t feel pain, I am not sure that I exist.

Multiple system involvement Child welfare Corrections TANF Substance abuse/mental health treatment

Meet Paula Homeless – living in a shelter Recently released from prison One child in foster care (age 3) One child with her (age 10) Constantly feels anxious, cries easily, has difficulty concentrating Substance use disorder – alcohol, cocaine, heroin

Child Welfare stipulations for reunification Stay in touch and cooperate with worker, meet with worker weekly to check progress Have a safe, suitable and stable home Have regular successful visits with your child Call child regularly Complete a psych evaluation Complete programs recommended by evaluation Resolve all criminal charges and cooperate with probation officer Complete: AODA program – have negative urine tests Parenting program Nurturing program Anger Management Have successful extended visits

Rules of Community Supervision Avoid contact with XX (Father of 3 year old & criminal partner) Complete AODA program and sign consent to release information to your agent Get a mental health evaluation and follow-through on recommendations Provide urine for analysis Meet with officer weekly Attend anger management classes Obtain employment Pay restitution, fines and supervision and court fees Obtain safe housing

TANF Employment Plan Basic Education/GEDHrs/wk: 10 Employment SearchHrs/wk: 15 Ongoing Dr. apptsHrs/wk: 5 Report to worker weekly

What are the clinical implications for Paula? Family history/system parallel Power differential Control Coping

Transformation of Service Delivery Develop an integrated service network that assists families in gaining self- sufficiency by building upon their strengths and supporting them through formal and informal service networks.

SYSTEM OUTCOMES Collaboration across funding streams Team Approach across systems Family centered and strengths based plans Consumer involvement at all levels Gender and Culturally responsive plans and services Sustain system change over time

CORE VALUES Family-Centered Consumer Involvement Builds on Natural and Community Strength-Based Unconditional Care Collaboration Across Systems Team Approach Across Agencies Ensuring Safety Gender/Age/Culturally Responsive Treatment Self-sufficiency Education and Work Focus Belief in Growth, Learning, and Recovery Outcome-oriented

Strength-Based Focus What does she have - rather than what she does not have What can she do - rather than what she cannot do What has she been successful at rather than how she has failed

Assumptions in Strength- Based focus Everyone has strengths People are experts on themselves Everyone deserves to be treated with respect and dignity People can make well-informed decisions when they are supported When people are involved in decisions about them the outcomes can improve A team is often more capable of creative and high quality decision making than an individual

The Single Coordinated Care Plan A team-based, family-centered care planning process to help clients achieve improved outcomes. Care teams consumer facilitator system representatives friends family other support people

Principles The consumer is central to the process focuses on the consumer's needs simultaneously addressing the requirements and mandates of each system Builds on the consumer's vision and strengths help the consumer meet her needs, as she defines them all participants work together to help the consumer meet her needs

Principles Built around natural supports Systems should fill the gaps Everyone on the SCCP team is accountable for doing his/her part. Goal is to help the consumer achieve self- sufficiency in meeting life goals.

Getting Started Identify who will be at the team meetings Ideal Many people formal and informal supports Reality Women with SUD’s often have no family, friends or community support when starting process Not everyone can come to every meeting from all the systems

Using the Single Coordinated Care Plan (SCCP) Go to: You will find: Introduction to the SCCP SCCP Process Guide SCCP Forms and Instructions SCCP Release Forms and Instructions Other information about the history, performance measurement and local participants.