1. Responding to Families: Timelines, Clocks and the Future Nancy K. Young, Ph.D., Director July 14, 2004 Baltimore, MD

2. Responding to Families: Timelines, Clocks and the Future  A Sense of Satisfaction  A Sense of Urgency We have much to feel good about in our efforts to combine forces to help children and families affected by substance use disorders and child abuse or neglect At the same time, we need a much greater sense of urgency in building on these victories to enter into the next phase of getting serious and getting to scale Two Opposing Ideas:

3. 1968 1973 1980s 1990s 2004 Timelines Looking Back

4. Timelines  1968 – Report of alcoholic mothers with babies with a distinctive, unusual appearance in France  1973 – Fetal Alcohol Syndrome named by a team of researchers in Seattle  Mid 1970s  Estimate of the number of children of heroin addicts and children of alcoholics  Fanshel reports substance abuse is common among families in child welfare Beginnings

5. Timelines  Impact of crack cocaine in urban centers  Chasnoff’s group begin to publish research on prenatal effects of cocaine  1983 National Institute on Drug Abuse (NIDA) College on Problems of Drug Dependence conference – First Poster Session on Children Prenatally-Exposed to Cocaine Early and Mid 1980s

6.  Number of children in foster care escalates Timelines Mid to Late 1980s

7. Foster Care Population 52% Increase over 6 Years Number of Children in Foster Care on Last Day of Federal Fiscal Year

8. Foster Care Population and Persons who First Used Crack or Meth in Past Year *All persons age 12 and over

9. Timelines Mid to Late 1980s  Child welfare agencies began responding to an epidemic of kids coming into care and cocaine  Schools began their efforts to understand prenatally-exposed children  1987 Los Angeles Unified School District develops pilot program to understand educational impact of prenatal cocaine exposure

10.  Federal Grant Support Began  National Center on Child Abuse and Neglect  94 programs, including Illinois, Connecticut, New Jersey  Piloted out-stationing substance abuse counselors in child welfare offices  NIDA research efforts  SAMHSA Specialized women’s treatment programs  Between 1997 and 1999  Five National Reports on Substance Abuse and Child Welfare Timelines1990s

11.  Responding to Alcohol and Other Drug Problems in Child Welfare: Weaving Together Practice and Policy (1998)  Foster Care: Agencies Face Challenges Securing Stable Homes for Children of Substance Aubsers (1998)  Healing the Whole Family: A Look at Family Care Programs (1998)  No Safe Haven: Children of Substance-Abusing Parents (1999)  Blending Perspectives and Building Common Ground: A Report to Congress on Substance Abuse and Child Protection (1999) Timelines1990s

12.  Many communities began program models Timelines1990s  Family Treatment Courts  Training and Curricula Development  Persons in Recovery act as Advocates for Parents  Multidisciplinary Teams for Joint Case Planning  Counselor Out-stationed at Child Welfare Office  Paired Counselor and Child Welfare Worker

13. Timelines1990s  Efforts by members of Congress and advocacy groups to ensure that substance abuse issues were addressed in the Adoption and Safe Families Act (ASFA)

14. Timelines Looking at our Achievements 1990 s 1980 s 2004

15. 1. Active working relationships and multiple models of connection  Courts, Child Welfare Agencies and Treatment Providers  Leadership provided by NCSACW consortium member organizations:  American Public Human Services Association - APHSA  Child Welfare League of America - CWLA  National Association of State Alcohol and Drug Abuse Directors - NASADAD  National Council of Juvenile and Family Court Judges - NCJFCJ  National Indian Child Welfare Association - NICWA Our Biggest Achievements Timelines

16. 2. Leadership of the Federal Government  1999 Blending Perspectives report, in response to ASFA  1999 Stakeholders forum called for a central focal point for these efforts  2000-2001 Regional forums held around the nation  2002 Funding of the National Center on Substance Abuse and Child Welfare Our Biggest Achievements Timelines

17. 3. Progress in the Dependency Courts  Judge McGee in Reno and Judge Parham in Pensacola Florida apply principles and strategies of adult drug courts to dependency proceedings.  Judge Milliken in San Diego initiated the first county- wide approach to parental substance use disorders Our Biggest Achievements Timelines  Courts increasingly document their effectiveness  The NCJFCJ and NADCP have provided strong foundations for expansion of model courts and development of family treatment courts

18. 4. Advances in the accountability agenda  Children’s Bureau’s Child and Family Service Review (CFSR) process  SAMHSA’s Plan to Transition the Substance Abuse Prevention and Treatment Block Grant (SAPTBG) to a Performance Environment Timelines Our Biggest Achievements  Missing boxes versus data protocols

19. 5. Development of a Comprehensive Framework and Policy Tools  10 Element Framework Our Biggest Achievements Timelines

20.  Information Sharing & Management  Training and Staff Development  Budgeting and Program Sustainability  Building Community Supports Connecting AOD, CWS, Court Systems: Elements of System Linkages* From CSAT Technical Assistance Publication (TAP) 27: Navigating the Pathways *Revised March 2003  Underlying Values  Screening and Assessment  Client Engagement and Retention in Care  AOD Services to Children  Joint Accountability and Shared Outcomes  Working with Related Agencies and Support Systems  Underlying Values

21.  Information Sharing & Management  Training and Staff Development  Budgeting and Program Sustainability  Building Community Supports  Working with Related Agencies and Support Systems Connecting AOD, CWS, Court Systems: Elements of System Linkages* From CSAT Technical Assistance Publication (TAP) 27: Navigating the Pathways *Revised March 2003  Underlying Values  Screening and Assessment  Client Engagement and Retention in Care  AOD Services to Children  Joint Accountability and Shared Outcomes  Underlying Values

22. 5. Development of a Comprehensive Framework and Policy Tools  10 Element Framework Our Biggest Achievements Timelines  Collaborative Values Inventory  Collaborative Capacity Instrument  Screening and Assessment for Family Engagement, Retention and Recovery -- SAFERR

23. Biggest Challenges: Clocks still running The Four Clocks

24.  CFSR’s have documented  Case reviews found parental substance use disorders were a factor in 16% to 48% of cases  Need for child welfare training in addictions  Gaps in services  Inadequate assessment and follow up on the underlying needs of families, including substance abuse  Substance use disorders in families with repeat cases The First Clock ASFA Timetable  Timeliness of intervention versus “Call me Tuesday”

25. National Study on Child and Adolescent Well-Being: Child Welfare Workers’ (CWW) Identification of Substance Abuse  Of the caregivers who are alcohol dependent  71% are classified by the CWW as not having an alcohol problem  Of the caregivers who are drug dependent  73% are classified by the CWW as not having a drug problem  CWW’s misclassify caregivers who are substance dependent most of the time

26.  Timeliness of Interventions  Taking CFSR findings seriously and including remediation strategies in Program Improvement Plans The First Clock ASFA Challenges

27. The Second Clock  Poverty and low-income work affect neglect, which is the majority of all reports  Neglect is often associated with both substance abuse and poverty  TANF resources have been used in innovative models for this population  Treatment aftercare focus on jobs and housing  TANF reauthorization proposes treatment be counted as a work activity TANF Timetable

28.  “A day at a time for the rest of your life” Recovery is a lifelong process with a disease management approach not emergency care  Low-dosage, 4-hour a week outpatient programs do not build on what we know about effective treatment for this population The Third Clock Recovery Timetable

29. The Third Clock Recovery Challenges  Comprehensive services and longer-term supports are critical  Clinical treatment, clinical support and community supports  Recognizing the needs of children of parents in treatment

30. Findings from TOPPS II on Status of Children  61% of women coming into treatment live with a child less than 18 years old  Among women with children, 31% had a child removed from home due to a child protection court order  Among women who had children removed from home, 41% had parental rights terminated to 1 or more child  8 out of every 100 women had their parental rights terminated

31.  Children of substance abusers need in-depth assessments and interventions that respond to their developmental status and the special needs created by substance use disorders in their family  grief, loss, separation, attachment  Adolescents who may have begun their own substance use The Fourth Clock Child Development Timetable

32. The Fourth Clock  Every 70 seconds a baby is born in this country who was prenatally exposed to alcohol or illicit drugs Child Development Timetable

33.  Communication – a critical factor in all four of the systems represented by the four clocks, and in several others that affect these children and families  Frontline workers  Program managers  Policy officials Putting the Four Clocks in Sync Communication, Linkages and Priorities

34. Putting the Four Clocks in Sync Communication, Linkages and Priorities  Communication: Who needs to know what when  Communication strategies, protocols, supports and policy that clarifies communication pathways  Linkage points across systems  10 elements of system linkages  Confidentiality is usually not about legal barriers, but often more about trust  Encouraging the flow of information

35.  Collaboration takes time  Priority – Community-wide agreement that these families receive the services they need Putting the Four Clocks in Sync Communication, Linkages and Priorities  Real reform is more than a collaboration meeting every month  Getting clocks connected to each other requires genuine collaboration… which takes time

36. Future Trends Four Trends: Pushing the Timeline into the Future 1968 1973 1980s 1990s 2004

37. 1. Substance-Exposed Births  We are learning more about the enormous costs of letting most of these babies go home without help  We are learning how powerful early intervention can be in improving the life chances of these children  We are learning more about how to prevent substance-exposed births  CAPTA Amendments  We need a national debate on both “upstream” prenatal screening and universal screening at birth Future Trends

38. 2. Growth of Family Drug Treatment Courts  Courts and their communities will need to decide how large-scale their interventions need to be  How timely their intervention  How to adapt family treatment court strategies to prevent child removal among families receiving child welfare services Future Trends

39. 3. The Pressures for Accountability  Only child welfare agencies and treatment providers that develop their capacity to measure their impact will survive the continuing hard fiscal climate  When resources are scarce, allocating them to ineffective programs has moral implications and real consequences for those children and families  Redefining “reasonable efforts” based on CFSR findings that substance abuse services are not available for reunification efforts in many states may heighten the focus on the array of available services Future Trends

40. 4. Family-Centered Policy and Practice  Intervening with families before children need to be removed is good economics and good practice  Pew Commission’s recommendations for changing the financing of the child welfare system to remove incentives for foster care underscore the need for front-end reforms  As child welfare links to reforms in home visiting, family support programs, and school-based interventions, these need to be measured against what they have done for the children living with parents with substance use disorders Future Trends

41.  The fifth clock is the one that is ticking on us…it measures how fast we get it…how rapidly we respond to human needs that grow larger by the day  We have to measure what we do against what needs doing, not against what we did last year The Fifth Clock Urgency

42.  Every 70 seconds a baby is born in this country who was prenatally exposed to alcohol or illicit drugs  Every minute and a half, one of those babies goes home without screening or any effort to begin early intervention  A baby and a family we already know are highly at risk The Fifth Clock Urgency

43. Listening to the voice of a child “I Have a Dream” Responding to Families: Timelines, Clocks and the Future This is the Fifth Clock

44. 1.http://www.arium.org/anthology/kvanbeer/kvbafas.html http://www.arium.org/anthology/kvanbeer/kvbafas.html 2.Chasnoff, I. Cocaine Use in Pregnancy, New England Journal of Medicine, 1985 3.Barth, R. (2003). Substance Abuse Findings from the NSCAW Presented at NCSACW Researchers’ Forum. December. 4.Grella, C. (2003). Presentation at the NCSACW Researchers’ Forum. December Responding to Families: Timelines, Clocks and the Future Notes