1. Screening and Referral
Chemical Dependency
Screening and Referral

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

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

4. 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?

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

6. Which substances are the most…
Dangerous?
Addictive?

7. Substance Abuse Treatment Admissions
Statistics from 2009 (most recent available) gathered from: Shows percentages.

8. Philosophies of Treatment

9. Types of Treatment
Detox
Intensive Inpatient
Intensive Outpatient
Outpatient
Aftercare

10. 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

11. Co-Occurring Substance Abuse and Mental Health Disorders

12. Trauma History*

13. Stages of Recovery

14. Treatment Works
Treatment outcomes show a decrease in negative outcomes for addicts

15. 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

16. Indicators of Substance Abuse
Signs and Symptoms

17. How might substance use impact children?

18. Prenatal exposure may have a current impact

19. 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

20. 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: /peds Retrieved from:

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

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

23. 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

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

25. Referring for Assessment
WHEN???

26. Referring for Assessment

27. Referring for Assessment
What information do we provide?

28. Partnering with treatment providers

29. 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

30. 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