women, children and methamphetamine sharon amatetti, m.p.hnancy k. young, ph.d. samhsa, csatnational...
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Women, Children and Women, Children and MethamphetamineMethamphetamine
Sharon Amatetti, M.P.HSharon Amatetti, M.P.H Nancy K. Young, Ph.D.Nancy K. Young, Ph.D.SAMHSA, CSATSAMHSA, CSAT National Center on SubstanceNational Center on Substance
Abuse and Child WelfareAbuse and Child Welfare
Presented at The Methamphetamine Summit: Presented at The Methamphetamine Summit: Methamphetamine Treatment: Effective PracticesMethamphetamine Treatment: Effective Practices
May 25, 2006May 25, 2006
4940 Irvine Blvd, Suite 2024940 Irvine Blvd, Suite 202 714-505-3525714-505-3525Irvine, CA 92620Irvine, CA 92620 www.ncsacw.samhsa.gov www.ncsacw.samhsa.gov
45% of admissions are women45% of admissions are women This is a higher percentage of women This is a higher percentage of women
admissions than for any other drug except admissions than for any other drug except tranquilizerstranquilizers
methamphetamine - ~ 1:1 methamphetamine - ~ 1:1
cocaine - 1:2 cocaine - 1:2
heroin - 1:2+heroin - 1:2+ marijuana & alcohol - 1:3marijuana & alcohol - 1:3
Since women are often caretakers of Since women are often caretakers of children, more children are likely affectedchildren, more children are likely affected
Gender DifferencesGender Differences
Source: Vaughn, C. (2003)
Methamphetamines as Primary Substance by Methamphetamines as Primary Substance by Gender and Pregnancy Status: 1994-2004Gender and Pregnancy Status: 1994-2004
0%
3%
5%
8%
10%
13%
15%
18%
20%
23%
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Pregnant Females Non-Preg Females Males
Percent of Total Admissions
Source: Analysis of Treatment Episode Data Set (TEDS) Computer File
Female Treatment AdmissionsFemale Treatment Admissions States with Highest Percentage of Meth/Amphetamine as Primary SubstanceStates with Highest Percentage of Meth/Amphetamine as Primary Substance
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Hawaii Idaho Nevada California Utah Oregon Arkansas Iowa Nebraska
1996 1998 2000 2002 2004
Source: Analysis of Treatment Episode Data Set (TEDS) Computer File
Meth/Amphetamine AdmissionsMeth/Amphetamine Admissions
By Gender - 2004By Gender - 2004
54.8%
45.2% 43.6%
56.4%50.5% 49.5%
0%
10%
20%
30%
40%
50%
60%
70%
All ages 12-14 year-olds 15-17 year-olds
Male Female
Source: Treatment Episode Data Set (TEDS)
0%
5%
10%
15%
20%
25%
30%
35%
40%
1994 1996 1998 2000 2002 2004Cocaine Alcohol Heroin/Opiates Marijuana Meth/Amphet/Stimulants
Trends in Primary Substance UseTrends in Primary Substance UseTreatment Admissions for Pregnant Females by Primary Substance 1994-Treatment Admissions for Pregnant Females by Primary Substance 1994-
20042004
Percent of Pregnant Women’s Admissions for Meth/Amphetamine and Marijuana
More than Doubled over 10 Years
Source: Analysis of Treatment Episode Data Set (TEDS) Computer File
Use During PregnancyUse During Pregnancy
Substance Used Substance Used (Past Month)(Past Month)
1st Trimester1st Trimester 2nd Trimester2nd Trimester 3rd Trimester3rd Trimester
Any Illicit DrugAny Illicit Drug
Alcohol UseAlcohol Use
Binge Alcohol Binge Alcohol UseUse
SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003
7.7% women 315,000 infants
19.6% women 802,000 infants
10.9% women446,000 infants
3.2% women131,000 infants
6.1% women250,000 infants
1.4% women57,000 infants
2.3% women94,000 infants
4.7% women192,000 infants
0.7% women29,000 infants
State prevalence studies report 10-12% of infants or State prevalence studies report 10-12% of infants or mothers test positive for alcohol or illicit drugs at birthmothers test positive for alcohol or illicit drugs at birth
Vega et al (1993). Profile of Alcohol and Drug Use During Pregnancy in California, 1992.
Infant Development, Environment, and Infant Development, Environment, and Lifestyles (IDEAL)Lifestyles (IDEAL)
2004 Data Collection from Known High Use Communities2004 Data Collection from Known High Use Communities
0
5
10
15
20
25
30
Alcohol Tobacco Marijuana Methamphetamine Any Illicit Drug
Per
cen
t o
f In
fan
ts E
xpo
sed
Methamphetamine and Other Substance Use During Pregnancy: Preliminary Estimates From the Infant Development, Environment, and Lifestyle (IDEAL) Study. Maternal and Child Health Journal (2006).
Gender Differences and Gender Differences and Implications for TreatmentImplications for Treatment
Considerations for Treating Women Addicted to Methamphetamine
Co-occurring mental health problemsCo-occurring mental health problems
TraumaTrauma
Body imageBody image
Source: M.L. Brecht, Ph.D. (2004)
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
Somat
izatio
n
Obsess
ive-
Compul
sive
Inte
rpers
onal S
ensi
tivity
Depress
ion
Anxiet
y
Hostili
ty
Phobic A
nxiety
Parano
id Id
eatio
n
Psychotic
ism
all significant at p< .001
Me
an
BS
I Sc
ore
Female
Male
Behavior Symptom Inventory (BSI)Scores at Baseline
Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005
0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
16.00
18.00
20.00
Mean BDI Score
p < .001
Me
an
BD
I Sc
ore
Beck Depression Inventory (BDI) Scores at Baseline
Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005
0%
5%
10%
15%
20%
25%
30%
35%
40%
To lose weight To relieve depression
*p< .001
Male Female
Self-Reported Reasons for Starting Methamphetamine Use
Richard Rawson, Ph.D., Presentation to SAMHSA, August 2005
Gender Differences and Implications for Treatment
Co-occurring mental health issues complicate Co-occurring mental health issues complicate treatment and require longer duration for treatment and require longer duration for treatmenttreatment
Violence linked to meth use is related to trauma Violence linked to meth use is related to trauma and safety needs which must be addressed in and safety needs which must be addressed in treatmenttreatment
Body image and nutrition need to be addressedBody image and nutrition need to be addressed
Histories of Violence among Clients Treated for Methamphetamine
Persons in tx for meth reported high rates of Persons in tx for meth reported high rates of violenceviolence 85% women85% women 69% men69% men
The most common source of violence:The most common source of violence: For women, was a partner (80%)For women, was a partner (80%) For men, was strangers (43%)For men, was strangers (43%)
History of sexual abuse and violenceHistory of sexual abuse and violence 57% women57% women 16% men16% men
Source: Cohen, J. (2003)
Prevalence of Co-Occurring Problems, and Violence and Trauma
Women in treatment 2X more likely to have Women in treatment 2X more likely to have history of sexual and physical abuse than history of sexual and physical abuse than general populationgeneral population
Women who are dependent on meth usually Women who are dependent on meth usually have more severe problems than their male have more severe problems than their male counterparts in many areas of their lifecounterparts in many areas of their life
Speaks to the need for comprehensive, and Speaks to the need for comprehensive, and trauma-related servicestrauma-related services
Source: CSAT TIP 36Source: CSAT TIP 36
Screen carefully forScreen carefully for Psychological problemsPsychological problems Abuse and violenceAbuse and violence
Recognize pervasive gender differencesRecognize pervasive gender differences
Address substance abuse and psychological Address substance abuse and psychological problems in an integrated treatment modelproblems in an integrated treatment model
Judith Cohen, Ph.D. Presentation to NASADAD June 2005
Gender Differences and Implications for Treatment
Children of Parents with Children of Parents with Substance Use DisordersSubstance Use Disorders
So how many are there?So how many are there?
Children Living with One or More Children Living with One or More Substance-Abusing ParentSubstance-Abusing Parent
4.5
2.8
6.2
7.5
8.3
8.4
10.6
0 2 4 6 8 10 12
Need Treatment for Illicit Drug Abuse
Dependent on Illicit Drugs
Dependent on Alcohol
Dependent on AOD
Dependent on Alcohol and/or NeedsTreatment for Illicit Drugs
Used Illicit Drug in Past Month
Used Illicit Drug in Past Year
Numbers indicate millions
COSAs and Child Abuse/Neglect VictimsCOSAs and Child Abuse/Neglect Victims
0.2
0.5
1.8
3.0
8.3
Placed in Out ofHome Care
SubstantiatedVictims
Investigations
Abuse/NeglectReports
Living withAlcoholic/Addict
Parent
In Millions 0 2 4 6 8 10
How Big a Problem is How Big a Problem is Methamphetamine in CWS Methamphetamine in CWS
Caseloads?Caseloads?
We don’t really have the numbers…We don’t really have the numbers…
Persons who Initiated Substance Persons who Initiated Substance Use by YearUse by Year
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
Children in Foster Care New Cocaine Users
New Crack Users New Methamphetamine Users
New Heroin Users
What is the Relationship?What is the Relationship?
It is not solely the use of a specific It is not solely the use of a specific substance that affects the child welfare substance that affects the child welfare system; it is a complex relationship system; it is a complex relationship between between The substance use patternThe substance use pattern Variations across States and local Variations across States and local
jurisdictions regarding policies and jurisdictions regarding policies and practicespractices
Knowledge and skills of workers Knowledge and skills of workers Access to appropriate health and social Access to appropriate health and social
supports for familiessupports for families
How Many Parents in Treatment How Many Parents in Treatment have Children? have Children?
How Many are “At Risk” of Child How Many are “At Risk” of Child Abuse or Neglect? Abuse or Neglect?
How Many are involved with Child How Many are involved with Child Welfare Services?Welfare Services?
We don’t really have the numbers…We don’t really have the numbers…
Parents Entering Publicly-Funded Parents Entering Publicly-Funded Substance Abuse TreatmentSubstance Abuse Treatment
Had a Child under age 18Had a Child under age 18 59%59%
Had a Child Removed by CPSHad a Child Removed by CPS 22%22%
If a Child was Removed, Lost If a Child was Removed, Lost Parental RightsParental Rights 10%10%
Based on CSAT TOPPS-II Project
Past Year Substance Use Past Year Substance Use by Youth Age 12 to 17by Youth Age 12 to 17
37.833.6 34.4
21.7
0
5
10
15
20
25
30
35
40
Alcohol Illicit Drug
Ever in Foster Care Not in Foster Care
Office of Applied Studies, SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care
Compared to African-American Youth, Caucasians were more likely to use alcohol (41.4% versus 29.8%) and illicit drugs (36.2% versus 26.7%)
Percent of Youth Ages 12 to 17 Needing Substance Percent of Youth Ages 12 to 17 Needing Substance Abuse Treatment by Foster Care StatusAbuse Treatment by Foster Care Status
10.4
5.9
13.1
5.3
17.4
8.8
0
2
4
6
8
10
12
14
16
18
Need for AlcoholTreatment
Need for Illicit DrugTreatment
Need for Alcohol orIllicit Drug Treatment
Ever in Foster Care Not in Foster Care
Office of Applied Studies, SAMHSA (2005) Substance Use and Need For Treatment among Youths Who Have Been in Foster Care
Alcohol
MarijuanaTobacco
Inhalants
Downers
Hallucinogens
PCP
Cocaine
Methamphetamine
Opiates
Tranquilizers
Ecstasy
Crack
13yr. 15 17 19 21 23
97-100% have usedOver 50% have usedLess than 50% have used
Average Age First Use of Substance
Source: M.L. Brecht, Ph.D., presented at NASADAD Annual Meeting, June 2005
Risks to Children Risks to Children When Parents Use When Parents Use MethamphetamineMethamphetamine
Different Situations for ChildrenDifferent Situations for Children
Parent uses or abuses methamphetamineParent uses or abuses methamphetamine
Parent is dependent on methamphetamineParent is dependent on methamphetamine
Parent “cooks” small quantities of methParent “cooks” small quantities of meth
Parent involved in traffickingParent involved in trafficking
Parent involved in super lab Parent involved in super lab
Mother uses meth while pregnantMother uses meth while pregnant
Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005
Each situation poses different risks and requires Each situation poses different risks and requires different responsesdifferent responses
Child welfare workers need to know the different Child welfare workers need to know the different responses requiredresponses required
The greatest number of children are exposed The greatest number of children are exposed through a parent who uses or is dependent on through a parent who uses or is dependent on the drug the drug
Relatively few parents “cook” the drugRelatively few parents “cook” the drug
Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005
Different Situations for ChildrenDifferent Situations for Children
Parent Uses or Abuses MethParent Uses or Abuses Meth
Risks to safety and well-being of children:Risks to safety and well-being of children:
Parental behavior under the influence: poor judgment, Parental behavior under the influence: poor judgment, confusion, irritability, paranoia, violenceconfusion, irritability, paranoia, violence
Inadequate supervisionInadequate supervision Inconsistent parentingInconsistent parenting Chaotic home lifeChaotic home life Exposure to second-hand smokeExposure to second-hand smoke Accidental ingestion of drugAccidental ingestion of drug Possibility of abusePossibility of abuse HIV exposure from needle use by parentHIV exposure from needle use by parent
Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005
Parent Is Dependent on MethParent Is Dependent on Meth
Risks to safety and well-being of children:Risks to safety and well-being of children: All the risks of parents who use or abuse, but the child All the risks of parents who use or abuse, but the child
may be exposed more often and for longer periodsmay be exposed more often and for longer periods Chronic neglect is more likelyChronic neglect is more likely Household may lack food, water, utilitiesHousehold may lack food, water, utilities Chaotic home lifeChaotic home life Children may lack medical care, dental care, Children may lack medical care, dental care,
immunizationsimmunizations Greater risk of abuseGreater risk of abuse Greater risk of sexual abuse if parent has multiple Greater risk of sexual abuse if parent has multiple
partnerspartners
Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005
Parent “Cooks” Small Quantities of MethParent “Cooks” Small Quantities of Meth
All the risks of parents who use or are dependent All the risks of parents who use or are dependent on meth, with added risks of manufacturing:on meth, with added risks of manufacturing: Chemical exposure and toxic fumesChemical exposure and toxic fumes Risk of fire and explosionRisk of fire and explosion
Children more at risk:Children more at risk: Higher metabolic ratesHigher metabolic rates Developing bone and nervous systemsDeveloping bone and nervous systems Thinner skin than adults which absorbs chemicals Thinner skin than adults which absorbs chemicals
fasterfaster Children tend to put things in their mouth and use Children tend to put things in their mouth and use
touch to exploretouch to explore
Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005 Source: Mason (2004)
Parent Involved in TraffickingParent Involved in Trafficking Presence of weaponsPresence of weapons
Possibility of violencePossibility of violence
Possibility of physical or sexual abuse by persons visiting Possibility of physical or sexual abuse by persons visiting the householdthe household
Possibility of incarceration and permanency issues for Possibility of incarceration and permanency issues for childrenchildren
Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005
Parent Involved in Super LabParent Involved in Super Lab Lower likelihood of children on the siteLower likelihood of children on the site Increased likelihood of parental incarcerationIncreased likelihood of parental incarceration
2000 2000 2001 2001 2002 2002 2003 2003
Number of incidentsNumber of incidents 8,971 8,971 13,270 13,270 15,353 15,353 14,260 14,260
Incidents with children Incidents with children presentpresent
1,803 1,803 2,191 2,191 2,077 2,077 1,442 1,442
Percent with children Percent with children presentpresent
20% 20% 16.5%16.5% 13.5%13.5% 10%10%
Children taken into Children taken into protective custodyprotective custody
353353 778 778 1,026 1,026 724 724
Number of Children in Meth LabsNumber of Children in Meth Labs
Source: El Paso Intelligence Center
4 years = 2,881; all children ~1,200,000
Field medical assessmentField medical assessment A medically trained professionals determines if the A medically trained professionals determines if the
child discovered at the scene of a meth lab seizure child discovered at the scene of a meth lab seizure needs emergency medical careneeds emergency medical care
Immediate care protocolImmediate care protocol Based on findings of the field assessment, immediate Based on findings of the field assessment, immediate
care is provided within 2-4 hours for those medical care is provided within 2-4 hours for those medical problems that cannot wait 24 hours to be treated at problems that cannot wait 24 hours to be treated at the baseline exam. the baseline exam.
Source: Colorado DEC
Medical Interventions for ChildrenMedical Interventions for Children
Baseline assessment protocolBaseline assessment protocol Conducted at a pediatric facility within 24 hours of lab Conducted at a pediatric facility within 24 hours of lab
seizure to ascertain a child’s general healthseizure to ascertain a child’s general health
Initial follow-up care protocolInitial follow-up care protocol Follow-up visit within 30 days to re-evaluate child’s Follow-up visit within 30 days to re-evaluate child’s
health status and any latent symptomshealth status and any latent symptoms
Long-term follow-up care protocolLong-term follow-up care protocol Follow-up visit within 12 months of baseline Follow-up visit within 12 months of baseline
assessment to monitor physical, emotional and assessment to monitor physical, emotional and developmental health, identify any late developing developmental health, identify any late developing problems, and provide appropriate intervention problems, and provide appropriate intervention
Source: Colorado DEC
Medical Interventions for ChildrenMedical Interventions for Children
Mother Uses While PregnantMother Uses While Pregnant
Scope of the problem:Scope of the problem:
An estimated 10% to 11% of all newborns are An estimated 10% to 11% of all newborns are prenatally exposed to drugs or alcohol; this prenatally exposed to drugs or alcohol; this amounts to 400,000 to 480,000 newborns per amounts to 400,000 to 480,000 newborns per yearyear
Only about 5% of prenatally exposed Only about 5% of prenatally exposed newborns are placed in out-of-home care; the newborns are placed in out-of-home care; the rest go home without assessment and rest go home without assessment and servicesservices
Sources: Vega; SAMHSA, OAS, National Survey of Alcohol and Drug Use During Pregnancy, 2002 and 2003
MOST GO HOME.MOST GO HOME.MOST GO HOME.MOST GO HOME.
80-95% are undetected and go home without assessment and needed services.
Many doctors and hospitals do not test, or may have Many doctors and hospitals do not test, or may have inconsistent implementation of state policiesinconsistent implementation of state policies
Tests detect only very recent useTests detect only very recent use
Inconsistent follow-up for woman identified as AOD using Inconsistent follow-up for woman identified as AOD using or at-risk, but with no positive test at birthor at-risk, but with no positive test at birth
CAPTA legislation raises issues of testing and reporting CAPTA legislation raises issues of testing and reporting to CPSto CPS
Mother Uses Meth While PregnantMother Uses Meth While Pregnant
Risk to child depends on frequency and intensity of Risk to child depends on frequency and intensity of use, and the stage of pregnancyuse, and the stage of pregnancy
Risks include birth defects, growth retardation, Risks include birth defects, growth retardation, premature birth, low birth weight, brain lesionspremature birth, low birth weight, brain lesions
Problems at birth may include difficulty sucking and Problems at birth may include difficulty sucking and swallowing, hypersensitivity to touch, excessive swallowing, hypersensitivity to touch, excessive muscle tension (hypertonia)muscle tension (hypertonia)
Long term risks may include developmental disorders, Long term risks may include developmental disorders, cognitive deficits, learning disabilities, poor social cognitive deficits, learning disabilities, poor social adjustment, language deficitsadjustment, language deficits
Sources: Anglin et al. (2000); Oro & Dixon, (1987); Rawson & Anglin (1999); Dixon & Bejar (1989); Smith et al. (2003); Shah (2002)
Mother Uses Meth While PregnantMother Uses Meth While Pregnant
Observed effects may be due to other Observed effects may be due to other substances, or combination of substances, used substances, or combination of substances, used by the motherby the mother
For example, if the mother also smokes, For example, if the mother also smokes, growth retardation may be significantgrowth retardation may be significant
Observed effects may be complicated by other Observed effects may be complicated by other conditions, such as the health, environmental, or conditions, such as the health, environmental, or nutritional status of the mothernutritional status of the mother
Source: Nancy Young, Ph.D., Testimony before the U.S. House of Representatives Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July 26, 2005
Mother Uses While PregnantMother Uses While Pregnant
Shah, R. (2005, June). From NASADAD presentation
Home environment is the critical factor in Home environment is the critical factor in the child’s outcomethe child’s outcome
Consequences can be mediatedConsequences can be mediated
Practice ModelsPractice Models
Key Barriers Between Substance Key Barriers Between Substance Abuse, Child Welfare, and the CourtsAbuse, Child Welfare, and the Courts
Beliefs and valuesBeliefs and values Competing prioritiesCompeting priorities Treatment gapTreatment gap Information systemsInformation systems Staff knowledge and skillsStaff knowledge and skills Lack of communicationLack of communication Different mandatesDifferent mandates
Many communities began program models in 1990sMany communities began program models in 1990s
Models of Improved ServicesModels of Improved Services
Family Treatment CourtsFamily Treatment Courts
Training and Curricula DevelopmentTraining and Curricula Development
Persons in Recovery act as Advocates for ParentsPersons in Recovery act as Advocates for Parents
Multidisciplinary Teams for Joint Case PlanningMultidisciplinary Teams for Joint Case Planning
Counselor Out-stationed at Child Welfare OfficeCounselor Out-stationed at Child Welfare Office
Paired Counselor and Child Welfare WorkerPaired Counselor and Child Welfare Worker
More Advanced Models of Team EffortsMore Advanced Models of Team Efforts
Workers out-stationed in collaborative settings: at Workers out-stationed in collaborative settings: at courts, at CWS agencies, at treatment agenciescourts, at CWS agencies, at treatment agencies
Increased recovery management and monitoring of Increased recovery management and monitoring of recovery progressrecovery progress
New methods and protocols on sharing informationNew methods and protocols on sharing information
Increased judicial oversight and family drug Increased judicial oversight and family drug treatment courtstreatment courts
New priorities for treatment access for child welfare-New priorities for treatment access for child welfare-involved familiesinvolved families
New responses to children’s needsNew responses to children’s needs
Common Ingredients of Family Common Ingredients of Family Treatment CourtsTreatment Courts
System of identifying familiesSystem of identifying families Earlier access to assessment and Earlier access to assessment and
treatment servicestreatment services Increased management of recovery Increased management of recovery
services and complianceservices and compliance System of incentives and sanctionsSystem of incentives and sanctions Increased judicial oversightIncreased judicial oversight
Judicial Oversight Models Judicial Oversight Models
• Integrated Integrated (e.g., Santa Clara, Reno, Suffolk)(e.g., Santa Clara, Reno, Suffolk)• Both dependency matters and recovery management Both dependency matters and recovery management
conducted in the same court with the same judicial conducted in the same court with the same judicial officerofficer
• Dual Track Dual Track (e.g., San Diego)(e.g., San Diego)• Dependency matters and recovery management Dependency matters and recovery management
conducted in same court with same judicial officer conducted in same court with same judicial officer during initial phase during initial phase
• If parent is noncompliant with court orders, parent may If parent is noncompliant with court orders, parent may be offered DDC participation and case may be be offered DDC participation and case may be transferred to a specialized judicial officer who transferred to a specialized judicial officer who increases monitoring of compliance and manages only increases monitoring of compliance and manages only the recovery aspects of the casethe recovery aspects of the case
Judicial Oversight Models Judicial Oversight Models
• Parallel Parallel (e.g., Sacramento)(e.g., Sacramento)• Dependency matters are heard on a regular Dependency matters are heard on a regular
family court docket family court docket • Specialized court services offered before Specialized court services offered before
noncompliance occursnoncompliance occurs• Compliance reviews and recovery Compliance reviews and recovery
management heard by a specialized court management heard by a specialized court officerofficer
Sacramento, California Model of Effective Sacramento, California Model of Effective Child Welfare and Substance Abuse Services Child Welfare and Substance Abuse Services
Comprehensive training—Comprehensive training—to understand substance to understand substance abuse and dependence and acquire skills to intervene abuse and dependence and acquire skills to intervene with parentswith parents
Early Intervention Specialists—Early Intervention Specialists—Social workers Social workers trained in motivational enhancement therapy are trained in motivational enhancement therapy are stationed at the family court to intervene and conduct stationed at the family court to intervene and conduct preliminary assessments with preliminary assessments with ALLALL parents with parents with substance abuse allegations at the first court hearingsubstance abuse allegations at the first court hearing
Improvements in Cross-System Information Improvements in Cross-System Information SystemsSystems—to ensure that communication across —to ensure that communication across systems and methods to monitor outcomes are in systems and methods to monitor outcomes are in place as well as management of the county’s treatment place as well as management of the county’s treatment capacitycapacity
Prioritization of Families in Child Protective Prioritization of Families in Child Protective ServicesServices—County-wide policy to ensure priority —County-wide policy to ensure priority access to substance abuse treatment servicesaccess to substance abuse treatment services
Specialized Treatment and Recovery Services Specialized Treatment and Recovery Services (STARS)(STARS)—provides immediate access to substance —provides immediate access to substance abuse assessment and engagement strategies abuse assessment and engagement strategies conducted by staff trained in motivational conducted by staff trained in motivational enhancement therapy. STARS provides intensive enhancement therapy. STARS provides intensive management of the recovery aspect of the child management of the recovery aspect of the child welfare case plan and routine monitoring and feedback welfare case plan and routine monitoring and feedback to CPS and the courtto CPS and the court
Dependency Drug CourtDependency Drug Court—provides more frequent —provides more frequent court appearances for court appearances for ALLALL parents with allegations of parents with allegations of substance use.substance use.
Sacramento, California Model of Effective Sacramento, California Model of Effective Child Welfare and Substance Abuse Services Child Welfare and Substance Abuse Services
Treatment Discharge Status by Treatment Discharge Status by Primary Drug Problem***Primary Drug Problem***
***p<.001
49.7
71.4
65.661.6 61.5
50.3
28.634.4
38.4 38.5
0
20
40
60
80
Perc
en
t
Satisfactory Unsatisfactory
Heroin Alcohol Methamphetamine Cocaine/Crack Marijuana
24-Month Child Placement Outcomes 24-Month Child Placement Outcomes by Parent Primary Drug Problemby Parent Primary Drug Problem
n.s.
0
20
40
60
Pe
rce
nt
Reunification Adoption Guardianship ContinuedReunification
Services
Long-TermPlacement
Other
Alcohol Heroin Cocaine/crack Marijuana Methamphetamine
Time in Out of Home Care at 24-Months after Time in Out of Home Care at 24-Months after Court Order to Participate in DDCCourt Order to Participate in DDCby Parent’s Primary Drug Problemby Parent’s Primary Drug Problem
25.123.7
20.3 19.0 20.2
0
5
10
15
20
25
30
Mon
ths
Alcohol Heroin Cocaine/Crack Marijuana Methamphetamine
National Center on Substance Abuse National Center on Substance Abuse and Child Welfareand Child Welfare
A Program of theA Program of the Substance Abuse and Mental Health Substance Abuse and Mental Health
Services AdministrationServices AdministrationCenter for Substance Abuse TreatmentCenter for Substance Abuse Treatment
and theand the
Administration on Children, Youth and FamiliesAdministration on Children, Youth and FamiliesChildren’s BureauChildren’s Bureau
Office on Child Abuse and NeglectOffice on Child Abuse and Neglect
NCSACW ProductsNCSACW Products
Understanding Substance Abuse and Facilitating Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers -Recovery: A Guide for Child Welfare Workers -A short monograph for front-line workersA short monograph for front-line workers
On-Line TrainingOn-Line Training
Understanding Child Welfare and the Dependency Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Court: A Guide for Substance Abuse Treatment ProfessionalsProfessionals
Understanding Addiction and Recovery: A Guide for Understanding Addiction and Recovery: A Guide for Child Welfare ProfessionalsChild Welfare Professionals
Coming in 2007: Understanding Substance Abuse Coming in 2007: Understanding Substance Abuse and Child Welfare Issues: A Guide for Judicial and Child Welfare Issues: A Guide for Judicial OfficersOfficers
Contact NCSACWContact NCSACW
www.ncsacw.samhsa.govwww.ncsacw.samhsa.gov
Project Director:Project Director:
Nancy Young, Ph.D.Nancy Young, Ph.D.
714-505-3525714-505-3525
Government Project Officer:Government Project Officer:
Sharon Amatetti, SAMHSA/CSATSharon Amatetti, SAMHSA/CSAT
240-276-1694240-276-1694
[email protected]@samhsa.hhs.gov
January 30, 2007January 30, 2007 Pre-conference symposium on substance-exposed Pre-conference symposium on substance-exposed
infants with Dr. Ira Chasnoffinfants with Dr. Ira Chasnoff
January 31 to February 2, 2007January 31 to February 2, 2007 National ConferenceNational Conference
Disneyland Hotel, Anaheim CaliforniaDisneyland Hotel, Anaheim California Sign up for information at Sign up for information at
[email protected]@cffutures.org
ANNOUNCINGANNOUNCING