parental substance use and child welfarebecause of parental substance abuse. $500,000 to the center...
TRANSCRIPT
PARENTAL SUBSTANCE USE AND CHILD WELFARE
MEGHAN MCCANN, J.D.
SENIOR POLICY SPECIALIST
NATIONAL CONFERENCE OF STATE LEGISLATURES
AGENDA
About NCSL
Overview of Substance Abuse Policy
Impact of Parental Substance Use on Child Welfare
Federal Legislation
State Statutes
State Legislation and Programs
NATIONAL CONFERENCE OF STATE LEGISLATURES
▪ Bipartisan, membership organization▪ Each of the 50 states and all territories
▪ 7,383 state legislators▪ 30,000+ state legislative staff
▪ Research, education, technical assistance▪ Mission:
▪ Improve the quality & effectiveness of state legislatures▪ Promote policy innovation and communication among state
legislatures▪ Ensure states have a strong, cohesive voice in the federal
system
WHAT DOES NCSL DO?
▪ Research▪ Website: www.ncsl.org
▪ Congressional Meetings
▪ Invitational Meetings
▪ Information Requests
▪ State Legislatures Magazine
▪ Trainings and Testimony
▪ Legislative Summit
▪ Social Media
BROAD IMPACT
Connection with
Families
Human Services
HealthCriminal Justice
▪ These families cross many different jurisdictions and issue areas
▪ Communication and collaboration is critical
WHAT ARE STATES DOING ABOUT IT?
Criminal Justice
Health
Human Services
▪ Process so far has been to hop from one to the other
CRIMINAL JUSTICE
A.K.A. the original drug treatment program
Naloxone
Access and education
Good Samaritan Laws
Providing immunity to those who call for help
Diversion
Treatment access through “the system;” a non-traditional criminal justice path to address substance abuse needs
Deflection
No entry into the criminal justice system at all. E.g., pre-arrest programs or law enforcement assisted diversion
HEALTH
Medication Assisted Treatment (MAT)
Methadone, Suboxone
Prescription Drug Monitoring Programs (PDMPs)
Linking prescription data to patients
Potential to be used to link data with other agencies (e.g., child welfare)
Prenatal Substance Exposure and Neonatal Abstinence Syndrome
Ensuring healthcare professionals know the signs
Education to health professionals and patients on safe sleep and drug treatment programs
Can trigger a child abuse and neglect report to child protective services
Treatment Access
All these systems are feeding the treatment programs and there is a treatment shortage
IMPACTS OF PARENTAL SUBSTANCE USE ON CHILD WELFARE
Increasing foster care caseloads
The number of children under the age of 1 entering foster care is increasing
Reason for removal associated with parental substance use
Correlation between opioids and foster care
IN FY2016, THERE WERE APPROXIMATELY 437,000 CHILDREN IN FOSTER CARE IN THE U.S., THE HIGHEST CASELOAD SINCE 2008. IN THE SAME YEAR, MORE THAN 270,000 CHILDREN
ENTERED CARE, THE HIGHEST NUMBER SINCE PRE-2008
Source: AFCARS
398,057
251,958
415,129
264,746
427,910
269,509
437,465
273,539
442,995
269,690
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
Children in Foster Care During FY Children Entering Foster Care During FY
# o
f C
hild
ren
AFCARS Measure
Number of Children in Foster Care and Number of Children Entering Foster Care
2011 2014 2015 2016 2017
THE NUMBER OF CHILDREN UNDER THE AGE OF 1 ENTERING FOSTER CARE IS INCREASING, THE HIGHEST PERCENTAGE, BY AGE GROUP, OF CHILDREN ENTERING FOSTER CARE
Source: AFCARS
43,085
45,535
47,219
49,234
50,076
38,000
40,000
42,000
44,000
46,000
48,000
50,000
52,000
2013 2014 2015 2016 2017
# o
f C
hild
ren
Fiscal Year
# of Children Under Age 1 Entering Foster Care during FYRepresents 19% of all Entries
THE NUMBER OF CHILDREN EXPERIENCING NEONATAL ABSTINENCE SYNDROME (NAS) IS ON THE RISE
3.4
4.85
5.8
0
1
2
3
4
5
6
7
2009 2010 2011 2012
Incidence of NAS per 1000 Hospital Births
Incidence of NAS per 1000 Hospital Births
Source: Patrick, S.W., Davis, M.M., Lehman, C.U., & Cooper, W.O., (2015), Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009-2012, Journal of Pathology, 35(8):650-5
FROM 1999-2014, THE INCIDENCE OF PARENTAL ALCOHOL OR OTHER DRUG USE AS A REASON FOR REMOVAL MORE THAN DOUBLED
15.8
26.3
31.8
0
5
10
15
20
25
30
35
1999 2007 2014
Per
cen
tage
Year
Percentage of all Children in Out-of-Home Care During Fiscal Year Where Parental
Alcohol or Other Drug Use was a Reason for Removal
Source: AFCARS
Massachusetts: 28% jump in the number of children removed from their homes in the last three years
Indiana: 40% jump in “children in need of services” from 2013-2015, while half of new cases cited substance abuse as a factor for removal
IN 2015, FOR THE FIRST TIME, AFCARS PROVIDED SPECIFIC DATA SHOWING REMOVALS DUE TO PARENTAL DRUG AND OTHER CO-OCCURRING REASONS FOR REMOVAL SUCH AS NEGLECT, CARETAKER INABILITY TO
COPE, ALCOHOL ABUSE OF A PARENT AND PARENT DEATH
Source: AFCARS
166,991
96,720
37,057
14,684
2,0960
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
Neglect Drug Abuse Parent Caretaker Inability to Cope Alcohol Abuse Parent Parent Death
# o
f C
hild
ren
Reason for Removal
Reason for Removal Related to Parental Substance Use in FY 2017
CORRELATIONFigure 5. Relationship between Overdose Deaths, Drug Hospitalizations, and Child Welfare Caseload Rates, 2011-2016
Note: All results are statistically significant, p < 0.01. Sample sizes range from 12,687 to 12,693 for overdose death rates and from 8,167 to
8,171 for hospitalizations, depending on the specific model. “Substantiated reports” include substantiated investigations and alternative
response. More detailed results are shown in Appendix Tables A2 and A3.
Source: https://aspe.hhs.gov/child-welfare-and-substance-use
1%
2.3% 2.4%
4.4%
0%
2%
4%
6%
8%
10%
12% Drug Overdose Deaths
Report
sof m
altre
atm
ent
Substa
ntiate
d r
eport
s
Foste
r care
entr
ies
1%
1.6%1.9%
3.0%
0%
2%
4%
6%
8%
10%
12% Drug Hospitalizations
Report
sof m
altre
atm
ent
Substa
ntiate
d r
eport
s
Foste
r care
entr
ies
FEDERAL LEGISLATION
Child Abuse Prevention and Treatment Act (CAPTA)
Comprehensive Addiction and Recovery Act (CARA)
SUPPORT for Patients and Communities Act; 2018 Opioid Package
FEDERAL LEGISLATION: CAPTA
The Child Abuse Prevention and Treatment Act (CAPTA)
Requires states to have policies and procedures for hospitals to notify Child Protective Services (CPS) of all children born who are affected by illegal substance use or withdrawal symptoms resulting from prenatal drug exposure or indications of Fetal Alcohol Syndrome Disorder (FASD)
Requires CPS agencies to develop a plan of safe care for every such infant referred to their agency and address the health and substance use disorder treatment needs of the infant
FEDERAL LEGISLATION: CARA
The Child Abuse Prevention and Treatment Act (CAPTA), as amended by the Comprehensive Addiction and Recovery Act in 2016 (CARA)
Removed the word illegal so CAPTA applies to all substance abuse
Requires the plan of safe care to also address the treatment needs of affected family or caregivers
Requires states to report in the National Child Abuse and Neglect Data System (NCANDS)
Requires states to develop a monitoring system to determine whether and how the local entities are providing referrals to and delivery of appropriate services for the infant and affected family or caregiver
Requires all children who are younger than three years who are substantiated victims of child maltreatment are referred to early intervention agencies that provide developmental disabilities services
FEDERAL LEGISLATION: 2018 OPIOID PACKAGE
At least 11 provisions addressing families.
$60 mil. set aside in CAPTA to support states in coordinating and implementing plans of safe care.
Family-focused treatment
Requires HHS guidance to states identifying opportunities to support family-focused residential treatment
$15 million to HHS to replicate “recovery coach” program
FY2019: states are eligible for federal matching funds when an at-risk child is placed in family-focused treatment or foster care
FY2020: State eligible for funding to provide “evidence-based substance abuse prevention and treatment services to families with children at risk of entering foster care.” Includes $20 mil. in awards to states to develop, enhance, or evaluate family-focused treatment programs.
DEFINING CHILD ABUSE AND NEGLECT
24 states and D.C. include prenatal substance exposure in the definition of child abuse and/or neglect.
STATE STATUTES: MAKING AND SCREENING REPORTS OF SUBSTANCE EXPOSURE
31 states and D.C. have specific procedures for reporting prenatal substance exposure.
STATE RESPONSE: PLANS OF SAFE CARE
At least 8 states have statutes that define, coordinate, fund, or implement plans of safe care.
STATE RESPONSE: PARENTAL RIGHTS
19 and D.C. states include long-term alcohol or drug-induced incapacity of the parent as a ground for determining unfitness for purposes of termination of parental rights.
STATE AND LOCAL PROGRAMS
Court-Based Programs
Family Drug Treatment Courts
Zero to Three Safe Baby Court Teams
Treatment Programs for Mothers and Babies
Child and Recovering Mothers (CHARM) Collaborative
Lily’s Place, West Virginia
Family Based Approaches
Connecticut Family Stability Pay for Success Project
Ohio Sobriety, Treatment and Reducing Trauma (START)
Regional Partnership Grants
One of the Regional Partnership Grant Recipients
Cross-system Collaboration
State legislatures have created special committees or task forces
Lots of local programs, few, if any, statewide/to scale programs
SAFE BABY COURT TEAMS
Bring stakeholders (e.g., child welfare agencies, substance abuse treatment providers, mental health treatment providers, other community supports) together with child, birth parents, foster parents etc. to help move towards reunification.
Viewed with a trauma-informed/ACEs lens
Sometimes called early childhood or infant-toddler courts because of focus on child development.
Less than 0.5% repeat maltreatment rate
REGIONAL PARTNERSHIP GRANTS
Components of Regional Partnership Grants:
Interagency collaboration
Integration of programs, services, and activities
Increase the well-being, improve the permanency, and enhance the safety of children who are in, or at risk of, out-of-home placements as a result of a parent or caregiver’s substance abuse.
Use of evidence-based practices
Address children’s behavioral, emotional, and social functioning, including the impact of trauma and its effect on the overall functioning of children and youth.
Implement varied interventions, such as family drug courts, comprehensive substance abuse treatment, or in-home parenting and child safety support for families.
MONTANA REGIONAL PARTNERSHIP GRANT
▪ Family Treatment Matters (FTM)
▪ In 2012, 56% of the 1,828 children placed in out-of-home care in Montana were removed because of parental substance abuse.
▪ $500,000 to the Center for Children and Families
▪ Implement of outpatient family treatment program (Family Treatment Matters) to families with children ages 0-12 who are in or at risk of out-of-home placement due to parental substance use.
▪ Co-Sponsor training series on cross-agency policies, communication/data barriers and multi-system practices for alcohol and other drug program, child protective services and other community partners.
▪ Participating families will receive a combination of substance abuse treatment, parenting/family strengthening services, life skills development for adults, and child development services.
▪ A caseworker will provide assistance with ancillary services as needed.
▪ The grantee has adapted its services specifically to address the needs of Native American populations.
QUESTIONS?
Meghan McCann
Senior Policy Specialist
NCSL’s Children and Families Program
303-856-1404