An Outsider’s Inside Approach Engaging Substance Abusing Women Involved with Child Welfare : Lessons Learned From Kentucky’s Targeted Assessment Program Presented by: Tracey Ellerbe, MSW Melissa Brown, MA

ASFA – 1997 Modifications to Existing Law Lessening of Reasonable Efforts Lessening of Reasonable Efforts Foster Kids on Fast Track To Adoption Foster Kids on Fast Track To Adoption De-emphasis on Family Preservation De-emphasis on Family Preservation

Shortcomings of ASFA Placed Blame Solely on Child Welfare System Placed Blame Solely on Child Welfare System Relied on Anecdotal Accounts of Child Fatalities Due to Lack of Data Relied on Anecdotal Accounts of Child Fatalities Due to Lack of Data Reasonable Efforts, if Any, Subjectively Defined Reasonable Efforts, if Any, Subjectively Defined Fiscal Incentives Discourage Reunification Fiscal Incentives Discourage Reunification (Stein, 2003)

Barriers to Safety in the Literature Maternal Substance Abuse54% Maternal Substance Abuse54% Intimate Partner Abuse & Violence40% Intimate Partner Abuse & Violence40% Depression65% Depression65% Mood, Anxiety, Psychotic D/O80% Mood, Anxiety, Psychotic D/O80% Learning Problems 25% - 50% Learning Problems 25% - 50% (Miller, et. al, 1999), (Martin, et..al, 2002), (Barusch, et. al, 1999)

Targeted Assessment Program ( TAP) A unique initiative funded by: KENTUCKY’S CABINET FOR HEALTH & FAMILY SERVICES

BALLARD CARLISLE GRAVES McCRACKEN FULTON HICKMAN CRITTENDEN CALDWELL TRIGG LYON LIVINGSTON MARSHALL MCLEAN HENDERSON UNION WEBSTER HOPKINS CHRISTIAN WOODFORD ROBERT ‘ SON MASON BRACKEN BOYLE FAYETTE JESSA MINE MERCER WASHINGTON ANDERSON GARRARD SPENCER SHELBY OLDHAM BOONE GALLATIN CARROLL TRIMBLE PENDLETON OWEN KENTON GRANT CAMPBELL HENRY HARRISON SCOTT FRANKLIN NELSON BULLITT JEFFERSON GRAYSON HARDIN BRECKINRIDG E MEADE MARION HART EDMONSON BARREN LARUE CALLOWAY SIMPSON TODD BUTLER MUHLENBERG LOGAN ALLEN WARREN HANCOCK DAVIESS OHIO METCALF RUSSELL ADAIR CLINTON CUMBERLAND MONROE CASEY PULASKI WAYNE McCREARY TAYLOR GREEN NICHOLAS BOURBON BELL JACKSON LAUREL ROCKCASTL E KNOX LINCOLN CLAY WHITLEY OWSLEY ESTILL MADISON KNOTT PERRY LETCHER LESLIE HARLAN LEE FLOYD BREATHITT PIKE POWELL BOYD MORGAN JOHNSON MARTIN WOLFE MAGOFFIN MONTGOMERY CLARK MENIFEE GREENUP ROWAN CARTER ELLIOTT LAWRENCE LEWIS FLEMING BATH Targeted Assessment Program Sites

WHATEVER IT TAKES Targeted Assessment Specialists provide these services: Assessment Assessment Case Management Case Management Referral, Service Connection & Follow-up Referral, Service Connection & Follow-up Home Visits and Transports Home Visits and Transports Consultations for DCBS Staff Consultations for DCBS Staff Trainings for DCBS/Other Agency Staff Trainings for DCBS/Other Agency Staff Community Collaboration Community Collaboration

First Keys to TAP’s Success Program Flexibility Program Flexibility Community Councils Community Councils On-site Location On-site Location Outreach Focus Outreach Focus Unique Clinical Approach Unique Clinical Approach

TAP Outreach Contacts for 1 st Response Letters2457 Phone Calls5762 Home Visits1905 Office Appointments2676 Professional Collaterals 11,453 Personal Collaterals 597 Total Contact Attempts 25,035 Average # to Reach 1 Client 5

Guiding Principles of Assessment and Engagement Holistic Holistic Gender Sensitive Gender Sensitive Client-Centered Client-Centered Collaborative Collaborative

Holistic Approach Assess for Co-existing Barriers Mental Health Mental Health Domestic Violence Domestic Violence Learning Problems Learning Problems Substance Abuse Substance Abuse

Gender Sensitive Approach Female Substance Abuse is Different Societal Expectations/Identification Societal Expectations/Identification Relationship Issues Relationship Issues Violence & Trauma Violence & Trauma Physiological Differences Physiological Differences Mental Health Problems Mental Health Problems

Client-Centered Approach Establish an Effective Partnership Develop a Trusting Relationship Develop a Trusting Relationship Approach Client Respectfully Approach Client Respectfully Admit We Don’t Have All the Answers Admit We Don’t Have All the Answers Listen Well to Client’s Story Listen Well to Client’s Story Identify Client’s Strengths Identify Client’s Strengths Meet the Client Where She is Meet the Client Where She is Avoid Criticism and Confrontation. Avoid Criticism and Confrontation.

Collaborative Approach Establish Effective Partnerships Develop Trusting Relationships Develop Trusting Relationships Be Respectful and Open-minded Be Respectful and Open-minded Admit We Don’t Have All the Answers Admit We Don’t Have All the Answers Ask Partners for Help and Feedback Ask Partners for Help and Feedback Listen Well and Use Partner Suggestions Listen Well and Use Partner Suggestions Avoid Criticism and Confrontation Avoid Criticism and Confrontation

Collaborating with Child Welfare Becoming Embedded Expertise Expertise Screening Screening Expectations Expectations Boundaries Boundaries Trust Trust One of the gang…sort of One of the gang…sort of

Roles Within Child Welfare Role model Role model Counselor Counselor Consultant/Trainer Consultant/Trainer Mediator Mediator Messenger Messenger Taxi Taxi

Collaborating with Child Welfare Creative Strategies Family Conferences Family Conferences Negotiating Case Plans Negotiating Case Plans Least vs. Most Restrictive Level of Care Least vs. Most Restrictive Level of Care Community Connections Community Connections Family Courts Family Courts Case Management/Follow-up Services Case Management/Follow-up Services

Collaborating with Clients Involved with Child Welfare Special Considerations Basic Mistrust of Systems Basic Mistrust of Systems Fear of Losing Children, Childcare Fear of Losing Children, Childcare Hopelessness, Sense of Powerlessness Hopelessness, Sense of Powerlessness Sabotage by Partner (IPV) Sabotage by Partner (IPV) Respite Respite Confidentiality Confidentiality ASFA ASFA

Collaborating with Clients Involved with Child Welfare Creative Strategies Negotiating Case Plans Negotiating Case Plans Negotiating Services Negotiating Services Client Control/Involvement in Plan Client Control/Involvement in Plan Strengths-based Assessment Summaries Strengths-based Assessment Summaries Community Connections Community Connections Information Information Pretreatment Pretreatment

Advocacy Attorneys and Court Attorneys and Court Family Conferences Family Conferences Service Providers/Community Partners Service Providers/Community Partners

More Keys to TAP’s Success: Holistic Approach Holistic Approach Engagement Efforts - Assumption of Omission Engagement Efforts - Assumption of Omission Hand-holding vs. “Enabling” Hand-holding vs. “Enabling” Modeling Modeling Intensive Case Management Intensive Case Management Transportation Transportation Persistent Follow-up Persistent Follow-up Community Relationships Community Relationships

Q & A