NCSACW Technical Assistance: Lessons Learned from Four States and Guidance to States and Communities Putting the Pieces Together: 1 st National Conference on Substance Abuse, Child Welfare and the Dependency Court Baltimore, MD July 15, 2004 Nancy K. Young, Ph.D., Director Joe Anna Sullivan, IDTA Program Manager Shaila Yeh, M.S.W., Associate 4940 Irvine Blvd, Ste 202 Irvine, CA Phone: Fax:

Developing Knowledge and Providing Technical Assistance to Federal, State, Local Agencies and Tribes to Improve Outcomes for Families with Substance Use Disorders in the Child Welfare and Family Court Systems

10 Elements for Cross-System Linkages Among CWS, ADS and Dependency Court  Underlying Values  Daily Practice-Screening and Assessment  Daily Practice-Client Engagement and Retention in Care  Daily Practice-AOD Services to Children  Joint Accountability and Shared Outcomes  Information Sharing  Training/Staff Development  Budgeting/Program Sustainability  Building Community Supports  Working with Related Agencies and Support Systems From CSAT Technical Assistance Publication (TAP) 27: Navigating the Pathways *Revised March 2003

Program of In-Depth TA

In-Depth TA Program  Goal - Improve outcomes for families by: Assisting selected states in the development of a scope of work and strategic plan Supporting and guiding states in the implementation of plan Providing access to other resources and expertise

In-Depth TA Program  Each state assigned a Consultant Liaison (CL) available approximately 30 hours per month (offsite and some onsite) Focus on statewide impact Support state in forming multi-system leadership team capable of developing and implementing policy and practice change

Cont. Support state in developing and implementing sustainable policies and programs Catalyst for Change

In-Depth TA Program  Solicitation for Requests released in April 2003 State and Territory CWS and ADS Directors CIP Directors 5 Nominated Tribes  States/Territories/Tribes needed to demonstrate sustainable collaborative efforts between substance abuse, child welfare, tribes and family judicial systems

In-Depth TA Program  Sites Selected Colorado Florida Michigan Virginia

In-Depth TA Program  Consultant Liaisons Elizabeth Breshears - Michigan Elizabeth Breshears - Michigan Kari Demetras - Virginia Kari Demetras - Virginia Mary Nakashian - Colorado Mary Nakashian - Colorado Joe Anna Sullivan - Florida Joe Anna Sullivan - Florida Nicolette Pach – Judicial Consultant Nicolette Pach – Judicial Consultant

Process of IDTA

In-Depth TA Program  Initial planning calls with each state, consultant liaison, IDTA manager and NCSACW staff (July and August, 2003)

In-Depth TA Program  Kick Off meetings – Two days of intensive, onsite work with state team to develop the scope of work Colorado – August 6 & 7, 2003 Virginia – September 8 & 9 Michigan – September 11 & 12 Florida – September 18 & 19

Process of IDTA  Scope of Work for In-Depth TA Developed by each site’s statewide team during Kick Off Developed by each site’s statewide team during Kick Off SOW defines roles and responsibilities of state team, NCSACW and Consultant Liaison SOW defines roles and responsibilities of state team, NCSACW and Consultant Liaison SOW reviewed and approved by Federal Project Officer SOW reviewed and approved by Federal Project Officer

Process of IDTA  The Contract  SOW includes: Statement of Purpose or Mission Statement of Purpose or Mission Work Products and Outcomes Work Products and Outcomes Action Steps and Target Dates Action Steps and Target Dates Who is Responsible Who is Responsible

Tools of Collaboration

Collaborative Values Inventory  What Do We Believe about Alcohol and Drugs, Services to Children and Families and Dependency Courts? Assesses how much a group shares ideas about values that underlie its work Assesses how much a group shares ideas about values that underlie its work Helps surface issues that may not be raised if collaborative begins work with emphasis on programs and operational issues Helps surface issues that may not be raised if collaborative begins work with emphasis on programs and operational issues Facilitates discussion around areas of common agreement and divergent views Facilitates discussion around areas of common agreement and divergent views Supports work toward consensus on principles as basis of state or local priorities for implementing practice and policies changes Supports work toward consensus on principles as basis of state or local priorities for implementing practice and policies changes

Collaborative Capacity Instrument  Reviews and Assesses the Status of Linkages Across ADS and CWS Agencies and Dependency Courts Self-assessment for ADS and CWS agencies and dependency courts preparing to work together or who are seeking to move to a new level of cooperation Self-assessment for ADS and CWS agencies and dependency courts preparing to work together or who are seeking to move to a new level of cooperation Designed to elicit discussion among and within both sets of agencies and the court Designed to elicit discussion among and within both sets of agencies and the court

Summary of State Products What Are the States Working On? The Elements of Collaboration – moving from the conceptual to applied practice

Summary of State Products Values and Principles  All states are working on formalizing collaboration through MOUs or other agreements – common values & principles  Most intend to issue a state-level MOU/agreement and encourage or require their development at the local level  MOU as marketing tool

Summary of State Products Daily Practice: Screening, Assessment, Engagement & Retention  All states are looking at core elements of screening, assessment, engagement and retention and developing protocols  Defining communication streams and practices  CO – survey to identify most important elements for daily practice (a little marketing too!)

Summary of State Products Daily Practice: Screening, Assessment, Engagement & Retention  FL – Model of Preferred Practice Influence child casework overall Multidisciplinary, family-focused and cross-system Ongoing function of assessment Linkages to other needed partners  MI and VA – protocols will include detailed implementation plans

Summary of State Products Daily Practice: Services to Children of Substance Abusers  Holistic and comprehensive approach to family and child needs  EPSDT and services to children

Summary of State Products Joint Accountability and Shared Outcomes  Establishing cross-system common goals and measurable outcomes for families  Evaluating what is to come from In-Depth TA and the collaboration

Summary of State Products Joint Accountability and Shared Outcomes  Evaluating the implementation of plans across system partners  Multi-tasking – other evaluation needs such as CFSRs and legislated reports

Summary of State Products Information Sharing and Data Systems  All states are working on improving information quality and quantity within and across systems  Data systems cost money – existing springboards  Track needs, services, progress and success throughout family’s involvement with services

Summary of State Products Budget and Program Sustainability  Funding is tight everywhere – new dollars are scarce  Develop funding map to maximize existing funds  Lay low – good time for planning and development activities  Pilot programs – can’t afford one time shots  Build a structure to support collaborative work

Summary of State Products Training and Staff Development  Joint, cross-system training needed to implement new protocols  Use existing resources  Women’s work and training are never done

Summary of State Products Working with Related Agencies  Essence of collaboration and In-Depth TA  Who am I related to?  Who do I need to get to know better to serve families?  When and how do we work together?  Agencies exist at many levels – state-level work as a means of modeling to local communities

Summary of State Products Working with the Community and Supporting Families  Family focus in all states  FL and VA – explicitly looking at community resources and mentoring opportunities to achieve and support lifelong recovery and healthy families

It’s All About Healthy Families

Lessons Learned A Panel Discussion  Kari Demetras  Liz Breshears  Mary Nakashian  Nicolette Pach  Joe Anna Sullivan, moderator

Q: Why work to build collaborative policies, programs and relationships?  Better outcomes for families – ability to respond to a broader range of needs  Better use of scarce resources  No one system has the skills, training or time to respond comprehensively to whole family’s needs  Collectively, multiple systems possess much greater knowledge about families  Collectively, multiple systems have a wider range of service and response options

More benefits of collaboration …  With assistance from other systems, Child welfare will be better able to address CFSR deficiencies and Program Improvement Plan strategies  Better address new CAPTA requirements for substance exposed newborns  Teamwork brings a wealth of perspectives and strengths  Multidisciplinary casework is better able to assess the needs and strengths of families  Together we can help families recover and stay together

Q: What should we consider in getting started?  How many families involved with child welfare have substance use disorders impacting placement or child safety and risk decisions?  How many substance abuse treatment clients have children who may be at risk of abuse or neglect?  Does child welfare have the funds and expertise to adequately provide all substance abuse treatment needed by families and required to meet reasonable efforts standards?  In times of tight budgets, retrenching and planning for the future is a great use of time  Even if there is no new money, what can we do differently without new money?

Q: Who should be at the table?  The basics: child welfare, substance abuse prevention and treatment, dependency court – but consider mental health, domestic violence, law enforcement, TANF and Medicaid, etc.  Co-equality of participants (no system “trumps” another at this table)  Reach high and low, near and far (State and local gov’t staff, policy and program planners, service providers, consumers, etc.)

Q: How do we create a workplan?  Retreat (off-site if possible)  Consider establishing a core group of 3-6 to plan for the meeting  Allocate at least two days for the initial meeting  Bring in a neutral outsider to facilitate  Be task oriented – know what you want to accomplish

More on workplans  Agree on discrete products that should come out of your plan  Good plans are measurable, include reasonable timelines, and indicate who is in charge of the various action steps  Agree on a method to monitor progress: who, when, how

Q: How might we structure work processes and meetings?  Identify leadership  Consider having levels of participation: Leader Leader Core team Core team Work horses Work horses Advisors Advisors  Share the work through specific work groups (ad hoc or standing?)  Let purpose drive frequency, length and meeting format

Q: What challenges might be anticipated?  Lack of a common language  Perception that it’s too difficult or not worth it  Competing priorities  Staff turnover  No new funds  Data/Information Blanks

Never, never, never, never, never, never give up.

SAFERR Screening and Assessment for Family Engagement, Retention and Recovery – SAFERR: Guidance for States and Communities Serving Families with Substance Use Disorders in Child Welfare Services and Dependency Courts

Rationale  Goals of DHHS in the 1999 Report to Congress, Blending Perspectives and Building Common Ground; Assuring timely access to comprehensive substance abuse treatment services Assuring timely access to comprehensive substance abuse treatment services Improving the ability to engage and retain clients in care and to support ongoing recovery Improving the ability to engage and retain clients in care and to support ongoing recovery  One of NCSACW’s most common technical assistance requests  In-Depth TA State applications consistently mentioned the need for assistance with this area  Lack of tested models and instrumentation

Development  October – Key Expert Meeting  November – Review and Input from Community Expert Panel  December – Review at NCSACW Researchers’ Forum  February – Shared with In-Depth TA State Teams

Purpose  To introduce the concepts of screening and assessment for family engagement, retention and recovery  To provide guidance to States and communities to make appropriate adaptations that lead to improved outcomes for children and families

Organization Assessment is a continuum and series of tasks to determine:  Presence and Immediacy Is there an issue present? What is the immediacy of the issue?  Nature and Extent What is the nature of the issue? What is the extent of the issue?  Developing and Monitoring Change, Transitions and Outcomes of Treatment and Case Plans What is the response to the issue? What is the response to the issue? Are there demonstrable changes in the issue? Are there demonstrable changes in the issue? Is the family ready for transition? Is the family ready for transition? Did the interventions work? Did the interventions work?

Premises 1.Limited information exists on the crossover issues 2.CWS cannot and should not do it alone 3.Assessment cannot be “siloed” 4.Assessment if not a one-time process 5.Assessment must attend to culture and gender 6.It’s the team not the tool 7.Joint training is fundamental

Premises 8. People make decisions, tools don’t 9. The role of supervisors is critical 10. Timing is essential for earliest intervention 11. It’s about the whole family 12. Child development assessments are crucial 13. There is no research-based answer 14. This is rocket science

Definitions of Terms and Processes  Screen  Child Abuse Report  Immediate Need Triage  In-Person Safety Assessment  Preliminary Protective Hearing  Diagnosis  In-Person Response/ Risk Assessment  Court Findings  Multi- Dimensional Assessment  Family assessment  Petition Filed; Preliminary Protective Hearing

Definitions of Terms and Processes  Treatment Plan  Case Plan  Adjudication and Dispositional Hearing; Court- ordered Case Plan  Treatment Monitoring  Case Plan Monitoring  Court Review Hearings  Transition Planning  Permanency Determination  Permanency Hearing  Recovery Management  Family Well Being  Case Closed  Outcome Monitoring

Prerequisites to Effective Screening and Assessment  Collaboration No one set of workers has skills, training or time to respond comprehensively to whole family’s needs  Communication Together the systems posses much greater knowledge about families than on their own  Team-building Co-located staff Multidisciplinary teams Staffings

Critical Role of Values and Shared Principles  Issues to Address Who is the client – parent, child, family? Who is the client – parent, child, family? Can AOD users/abusers/addicts/alcoholics be effective parents? Can AOD users/abusers/addicts/alcoholics be effective parents? What is the goal – recovery, child safety, family preservation, economic self- sufficiency, meeting statutory timelines for permanency? What is the goal – recovery, child safety, family preservation, economic self- sufficiency, meeting statutory timelines for permanency?

Critical Role of Values and Shared Principles  How to Address these Issues Use tools such as the Collaborative Values Inventory to uncover underlying issues and develop common principles for working across systems Use tools such as the Collaborative Values Inventory to uncover underlying issues and develop common principles for working across systems Ensure conversation happens at policy, supervisory and front-line levels Ensure conversation happens at policy, supervisory and front-line levels

Common Themes Among Systems’ Principles Despite differences among CWS, ADS and dependency courts there is commonality in their value bases and how they approach families Common themes include:  Need for individualized service responses  Timeliness of service provision  Sensitivity to gender and culture  Focus on family-centered approaches

SAFERR Guidance Three Systems, Three Processes & Three Levels  Three Systems CWS CWS ADS ADS Dependency Court Dependency Court  Three Processes Presence and Immediacy Presence and Immediacy Nature and Extent Nature and Extent Treatment and Case Plan Development and Monitoring Treatment and Case Plan Development and Monitoring

 Three Levels  Fundamentals for Improved Practice Basics for Collaborative Practice  Better Practice More Advanced Level of Collaborative Practice backed up with Data  SAFERR Model Practice  Three Systems and Families are Working Together in Collaborative Practice with Monitored Outcomes SAFERR Guidance Three Systems, Three Processes & Three Levels

Presence and Immediacy  Questions to be answered Is there an issue present? Is there an issue present? What is the immediacy of the issue? What is the immediacy of the issue?  How they are typically answered  Each system has typically screened for their own area of expertise, as well as receiving referrals from outside agencies Screens for SUDs in ADS Screens for SUDs in ADS Child abuse report and safety assessment in CWS Child abuse report and safety assessment in CWS

Presence and Immediacy  Summary of Guidance ADS screens for status of children ADS screens for status of children CWS screens for SUDs CWS screens for SUDs Court ensures that screens are being conducted Court ensures that screens are being conducted Standardized tools and protocols for communication across systems Standardized tools and protocols for communication across systems Data collected is recorded in statewide database Data collected is recorded in statewide database

Nature and Extent  Questions to be answered What is the nature of the issue? What is the nature of the issue? What is the extent of the issue? What is the extent of the issue?  How they are typically answered  Diagnosis and multi-dimensional assessment in ADS Use, abuse, dependence Use, abuse, dependence Client motivation and stages of change Client motivation and stages of change Level of care Level of care  Risk assessment and family assessment in CWS Practice-based models Practice-based models Empirical models Empirical models Family strengths and level of functionality Family strengths and level of functionality

Nature and Extent  Summary of Guidance SUD diagnostic information shared with CWS within 7 days SUD diagnostic information shared with CWS within 7 days Multi-dimensional assessment conducted by ADS within 30 days and shared with CWS within 7 days Multi-dimensional assessment conducted by ADS within 30 days and shared with CWS within 7 days Precipitating incidents in CWS case shared with ADS Precipitating incidents in CWS case shared with ADS CWS observations and screen results shared with ADS CWS observations and screen results shared with ADS Risk and family assessment information shared with ADS within 30 days Risk and family assessment information shared with ADS within 30 days Court receives all diagnostic and assessment information Court receives all diagnostic and assessment information CWS, ADS, court/attorneys and family meet to discuss assessment results and develop case plan CWS, ADS, court/attorneys and family meet to discuss assessment results and develop case plan

Developing and Monitoring Change, Transitions and Outcomes of Treatment and Case Plans  Questions to be answered What is the response? What is the response? Are there demonstrable changes? Are there demonstrable changes? Is the family ready for transition? Is the family ready for transition? What happens after discharge? What happens after discharge? Did the interventions work? Did the interventions work?  How they are typically answered Development and monitoring of individual treatment plans (ADS) and case plans (CWS) Development and monitoring of individual treatment plans (ADS) and case plans (CWS) Success is monitored by the lack of return to the systems Success is monitored by the lack of return to the systems

Developing and Monitoring Change, Transitions and Outcomes of Treatment and Case Plans  Summary of Guidance ADS treatment plans include objectives related to child safety and well-being ADS treatment plans include objectives related to child safety and well-being CWS case plans incorporate objectives related to parents’ treatment and recovery CWS case plans incorporate objectives related to parents’ treatment and recovery Court supports treatment and case plan monitoring and compliance Court supports treatment and case plan monitoring and compliance Plans are jointly reviewed Plans are jointly reviewed Team development and monitoring of a single family- driven plan Team development and monitoring of a single family- driven plan Outcome data is routinely monitored, shared and used for program planning Outcome data is routinely monitored, shared and used for program planning

Where are we Headed with SAFERR?  Compendium of Products – Fall 2004  Summary, Prerequisites & Guidance for Policymakers  Details of the Programmatic Content  Appendices of Instruments and Tools  Implementation Workbook  Key Steps for implementation  Tools

Other Things to Look For  Compendium of Training Curricula  Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers  On-line Tutorials  Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals