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 Presented at Putting the Pieces Together for Children and Families: The National Conference on Substance Abuse, Child Welfare and the Courts February 1, 2007 Nancy K. Young, Ph.D., Director 4940 Irvine Blvd, Ste 202 Irvine, CA Phone: Fax:

Developing since Summer 2003  Review and Input from Community Expert Panel  Review at NCSACW Researchers’ Forum  Shared with In-Depth TA State Teams  Consultant Liaisons and States Provided Input to Implementation Guide  Edits and Rewrites

SAFERR is based on the premise that when parents misuse substances and maltreat their children, the only way to make sound decisions is to draw from the talents and resources of at least three systems: child welfare, alcohol and drugs, and the courts. SAFERR is based on the premise that when parents misuse substances and maltreat their children, the only way to make sound decisions is to draw from the talents and resources of at least three systems: child welfare, alcohol and drugs, and the courts.

Principles  The problems of child maltreatment and substance use disorders demand urgent attention and the highest possible standards of practice from everyone working in systems charged with promoting child safety and family well-being.  Success is possible and feasible. Staff in child welfare, substance abuse, and court systems have the desire and potential to change individual lives and create responsible public policies.  Family members are active partners and participants in addressing these urgent problems.

Premises 1.The team is the tool, and people, not tools, make decisions 2.The family is the focus of concern 3.Problems don’t come in discrete packages; they are jumbled together 4.Assessment is not a one-person responsibility

Premises 5.Information is limited, and there is no research- based answer 6.There is no time to lose 7.ICWA creates specific guidelines for working with American Indian populations 8.Developing and sustaining effective collaborations is hard work

Organization of SAFERR I.Building Cross-System Collaboration  Creating the structure to create and sustain change II.Collaboration Within and Across Systems  What each system needs to know about itself and its partners III.Collaboration in Action: Working Together on the Front Line  Presents activities that create cross-system practice changes

Organization of SAFERR A. Facilitator’s Guide  Templates and exercises B. B.Fact Sheets  To educate administrators, legislators and stakeholders about the initiative C. Understanding the Needs of Children D. Screening and Assessment Tools for Substance Use Disorders

Organization of SAFERR Appendices E. Substance Use, Abuse, Dependence Continuum, and Principles of Effective Treatment F. Safety and Risk Assessments for Use by Child Welfare Staff G. Sharing Confidential Information H. Glossary of Terms I. Guide to Compliance with the Indian Child Welfare Act (ICWA)

Assessment is a Process Assessment happens along a continuum to determine:  Presence and Immediacy  Is there an issue present?  What is the immediacy of the issue?

Assessment is a Process Assessment happens along a continuum 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?

Assessment is a Process Assessment happens along a continuum 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 & Monitoring Change, Transitions & Outcomes of Treatment and Case Plans  What is the response to the issue?  Are there demonstrable changes in the issue?  Is the family ready for transition?  Did the Interventions Work?

Definitions of Terms and Processes  Screen  Child Abuse Report AOD Services CWS Services Court Services Is there an issue?

Definitions of Terms and Processes  Screen  Child Abuse Report  Immediate Need Triage  In-Person Safety Assessment  Preliminary Protective Hearing AOD Services CWS Services Court Services Is there an issue? What is the immediacy of the issue?

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 AOD Services CWS Services Court Services Is there an issue? What is the immediacy of the issue? What is the nature of the issue?

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 AOD Services CWS Services Court Services Is there an issue? What is the immediacy of the issue? What is the nature of the issue? What is the extent of the issue?

 Treatment Plan  Case Plan  Adjudication/ Dispositional Hearing; Court-ordered Case Plan AOD Services CWS Services Court Services What is the Response?

 Treatment Plan  Case Plan  Adjudication/ Dispositional Hearing; Court-ordered Case Plan  Treatment Monitoring  Case Plan Monitoring  Court Review Hearings AOD Services CWS Services Court Services What is the Response? Is there demonstra- ble change?

 Treatment Plan  Case Plan  Adjudication/ Dispositional Hearing; Court-ordered Case Plan  Treatment Monitoring  Case Plan Monitoring  Court Review Hearings  Transition Planning  Permanency Determination  Permanency Hearing AOD Services CWS Services Court Services What is the Response? Is there demonstra- ble change? Is family ready for transition?

 Treatment Plan  Case Plan  Adjudication/ 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 AOD Services CWS Services Court Services What is the Response? Is there demonstra- ble change? Is family ready for transition? What is to happen after discharge?

 Treatment Plan  Case Plan  Adjudication/ 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 AOD Services CWS Services Court Services What is the Response? Is there demonstra- ble change? Is family ready for transition? What is to happen after discharge? Did the intervention work?

Assessment Information must be Communicated Assessment happens along a continuum 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 & Monitoring Change, Transitions & Outcomes of Treatment and Case Plans  What is the response to the issue?  Are there demonstrable changes in the issue?  Is the family ready for transition?  Did the Interventions Work?

The SAFERR Model Development Builds Cross SystemCollaboration EstablishesIndividualand Cross System Roles and Responsibilities IdentifiesFront-LineCollaborativePractice Establishes and Monitors Individual and Cross-System Outcomes

The SAFERR Model Development Builds Cross SystemCollaboration EstablishesIndividualand Cross System Roles and Responsibilities IdentifiesFront-LineCollaborativePractice Establishes and Monitors Individual and Cross-System Outcomes

GOVERNANCE  Oversight Committee  Steering Committee  Subcommittees Builds Cross SystemCollaboration Most senior officials from all systems Direct staff to give this priorityDirect staff to give this priority Provide overall directionProvide overall direction Meet 3-4 times a yearMeet 3-4 times a year Receive interim reportsReceive interim reports

GOVERNANCE  Oversight Committee  Steering Committee  Subcommittees Builds Cross SystemCollaboration Senior managers from within systems Co-chaired or use facilitator Co-chaired or use facilitator Have decision-making authority Have decision-making authority Receive materials in advance for discussion Receive materials in advance for discussion Make decisions during meetings Make decisions during meetings Report collectively to the oversight committee Report collectively to the oversight committee

GOVERNANCE  Oversight Committee  Steering Committee  Subcommittees Builds Cross SystemCollaboration Senior managers from within systems Co-chaired or use facilitator Co-chaired or use facilitator Have decision-making authority Have decision-making authority Receive materials in advance for discussion Receive materials in advance for discussion Make decisions during meetings Make decisions during meetings Report collectively to the oversight committee Report collectively to the oversight committee The Charge to the Steering Committee: Create a mission statement based on exploration of values and principlesCreate a mission statement based on exploration of values and principles Enhance understanding of current systems & barriers to communicationEnhance understanding of current systems & barriers to communication Establish goals, milestone, products & implement plan to achieve themEstablish goals, milestone, products & implement plan to achieve them Create and oversee subcommitteesCreate and oversee subcommittees Identify training curricula and strategiesIdentify training curricula and strategies Monitor progress and evaluate outcomesMonitor progress and evaluate outcomes

GOVERNANCE  Oversight Committee  Steering Committee  Subcommittees Builds Cross SystemCollaboration Establishes Individual and Cross System Roles and Responsibilities Identifies Front-Line CollaborativePractice The Subcommittee(s) Comprised of county front line and supervisory staff;Comprised of county front line and supervisory staff; Charged by Steering Committee to conduct specific tasksCharged by Steering Committee to conduct specific tasks Participate in pilot tests of strategiesParticipate in pilot tests of strategies Report to the Steering CommitteeReport to the Steering Committee

GOVERNANCE  Oversight Committee  Steering Committee  Subcommittees TASKS  Mission & Principles  Shared Understanding on Language & Processes  Goals, Timetables, Products  Training Curricula/Strategy Builds Cross SystemCollaboration Establishes Individual and Cross System Roles and Responsibilities Identifies Front-Line CollaborativePractice

GOVERNANCE  Oversight Committee  Steering Committee  Subcommittees TASKS  Mission & Principles  Shared Understanding on Language & Processes  Goals, Timetables, Products  Training Curricula/Strategy MONITORING  Baseline Data  Progress Reports  Outcome Data Builds Cross SystemCollaboration Establishes Individual and Cross System Roles and Responsibilities Identifies Front-Line CollaborativePractice

The SAFERR Model Development Builds Cross SystemCollaboration EstablishesIndividualand Cross System Roles and Responsibilities IdentifiesFront-LineCollaborativePractice Establishes and Monitors Individual and Cross-System Outcomes

GOVERNANCE  Oversight Committee  Steering Committee  Subcommittees TASKS  Mission & Principles  Shared Understanding on Language & Processes  Goals, Timetables, Products  Training Curricula/Strategy MONITORING  Baseline Data  Progress Reports  Outcome Data CWS Understands  Basics of substance use & how use affects child development  How to screen for substance use  Treatment system & how to help people stay in treatment  Implications of tensions between Treatment Staff and CW timelines Builds Cross SystemCollaboration Establishes Individual and Cross System Roles and Responsibilities Identifies Front-Line CollaborativePractice

GOVERNANCE  Oversight Committee  Steering Committee  Subcommittees TASKS  Mission & Principles  Shared Understanding on Language & Processes  Goals, Timetables, Products  Training Curricula/Strategy MONITORING  Baseline Data  Progress Reports  Outcome Data CWS Understands  Basics of substance use & how use affects child development  How to screen for substance use  Treatment system & how to help people stay in treatment  Implications of tensions between Treatment Staff and CW timelines Alcohol and Drug System Understands  How substance use puts children at risk & how CWS must respond  Child maltreatment reporting requirements  How to screen for child safety Builds Cross SystemCollaboration Establishes Individual and Cross System Roles and Responsibilities Identifies Front-Line CollaborativePractice

GOVERNANCE  Oversight Committee  Steering Committee  Subcommittees TASKS  Mission & Principles  Shared Understanding on Language & Processes  Goals, Timetables, Products  Training Curricula/Strategy MONITORING  Baseline Data  Progress Reports  Outcome Data CWS Understands  Basics of substance use & how use affects child development  How to screen for substance use  Treatment system & how to help people stay in treatment  Implications of tensions between Treatment Staff and CW timelines Alcohol and Drug System Understands  How substance use puts children at risk & how CWS must respond  Child maltreatment reporting requirements  How to screen for child safety Court System Understands  Basics of substance use & child maltreatment  Its role in requiring assessments  The authority to prompt/require collaboration Builds Cross SystemCollaboration Establishes Individual and Cross System Roles and Responsibilities Identifies Front-Line CollaborativePractice

GOVERNANCE  Oversight Committee  Steering Committee  Subcommittees TASKS  Mission & Principles  Shared Understanding on Language & Processes  Goals, Timetables, Products  Training Curricula/Strategy MONITORING  Baseline Data  Progress Reports  Outcome Data CWS Understands  Basics of substance use & how use affects child development  How to screen for substance use  Treatment system & how to help people stay in treatment  Implications of tensions between Treatment Staff and CW timelines Alcohol and Drug System Understands  How substance use puts children at risk & how CWS must respond  Child maltreatment reporting requirements  How to screen for child safety Court System Understands  Basics of substance use & child maltreatment  Its role in requiring assessments  The authority to prompt/require collaboration Collaboratively all Three Systems  Establish joint policies/procedures to share information  Establish case plans  Develop shared indicators of progress  Monitor progress and evaluate outcomes Builds Cross SystemCollaboration Establishes Individual and Cross System Roles and Responsibilities Identifies Front-Line CollaborativePractice

The SAFERR Model Development Builds Cross SystemCollaboration EstablishesIndividualand Cross System Roles and Responsibilities IdentifiesFront-LineCollaborativePractice Establishes and Monitors Individual and Cross-System Outcomes

GOVERNANCE  Oversight Committee  Steering Committee  Subcommittees TASKS  Mission & Principles  Shared Understanding on Language & Processes  Goals, Timetables, Products  Training Curricula/Strategy MONITORING  Baseline Data  Progress Reports  Outcome Data CWS Understands  Basics of substance use & how use affects child development  How to screen for substance use  Treatment system & how to help people stay in treatment  Implications of tensions between Treatment Staff and CW timelines Alcohol and Drug System Understands  How substance use puts children at risk & how CWS must respond  Child maltreatment reporting requirements  How to screen for child safety Court System Understands  Basics of substance use & child maltreatment  Its role in requiring assessments  The authority to prompt/require collaboration Collaboratively all Three Systems  Establish joint policies/procedures to share information  Establish case plans  Develop shared indicators of progress  Monitor progress and evaluate outcomes CWS, SUDS and CS Have Collaborative Policies, Procedures and Tools to:  Screen for substance use and child maltreatment Builds Cross SystemCollaboration Establishes Individual and Cross System Roles and Responsibilities Identifies Front-Line CollaborativePractice

GOVERNANCE  Oversight Committee  Steering Committee  Subcommittees TASKS  Mission & Principles  Shared Understanding on Language & Processes  Goals, Timetables, Products  Training Curricula/Strategy MONITORING  Baseline Data  Progress Reports  Outcome Data CWS Understands  Basics of substance use & how use affects child development  How to screen for substance use  Treatment system & how to help people stay in treatment  Implications of tensions between Treatment Staff and CW timelines Alcohol and Drug System Understands  How substance use puts children at risk & how CWS must respond  Child maltreatment reporting requirements  How to screen for child safety Court System Understands  Basics of substance use & child maltreatment  Its role in requiring assessments  The authority to prompt/require collaboration Collaboratively all Three Systems  Establish joint policies/procedures to share information  Establish case plans  Develop shared indicators of progress  Monitor progress and evaluate outcomes CWS, SUDS and CS Have Collaborative Policies, Procedures and Tools to:  Screen for substance use and child maltreatment  Assess for substance use and child maltreatment Builds Cross SystemCollaboration Establishes Individual and Cross System Roles and Responsibilities Identifies Front-Line CollaborativePractice

GOVERNANCE  Oversight Committee  Steering Committee  Subcommittees TASKS  Mission & Principles  Shared Understanding on Language & Processes  Goals, Timetables, Products  Training Curricula/Strategy MONITORING  Baseline Data  Progress Reports  Outcome Data CWS Understands  Basics of substance use & how use affects child development  How to screen for substance use  Treatment system & how to help people stay in treatment  Implications of tensions between Treatment Staff and CW timelines Alcohol and Drug System Understands  How substance use puts children at risk & how CWS must respond  Child maltreatment reporting requirements  How to screen for child safety Court System Understands  Basics of substance use & child maltreatment  Its role in requiring assessments  The authority to prompt/require collaboration Collaboratively all Three Systems  Establish joint policies/procedures to share information  Establish case plans  Develop shared indicators of progress  Monitor progress and evaluate outcomes CWS, SUDS and CS Have Collaborative Policies, Procedures and Tools to:  Screen for substance use and child maltreatment  Assess for substance use and child maltreatment  Develop and implement collaborative case plans Builds Cross SystemCollaboration Establishes Individual and Cross System Roles and Responsibilities Identifies Front-Line CollaborativePractice

GOVERNANCE  Oversight Committee  Steering Committee  Subcommittees TASKS  Mission & Principles  Shared Understanding on Language & Processes  Goals, Timetables, Products  Training Curricula/Strategy MONITORING  Baseline Data  Progress Reports  Outcome Data CWS Understands  Basics of substance use & how use affects child development  How to screen for substance use  Treatment system & how to help people stay in treatment  Implications of tensions between Treatment Staff and CW timelines Alcohol and Drug System Understands  How substance use puts children at risk & how CWS must respond  Child maltreatment reporting requirements  How to screen for child safety Court System Understands  Basics of substance use & child maltreatment  Its role in requiring assessments  The authority to prompt/require collaboration Collaboratively all Three Systems  Establish joint policies/procedures to share information  Establish case plans  Develop shared indicators of progress  Monitor progress and evaluate outcomes CWS, SUDS and CS Have Collaborative Policies, Procedures and Tools to:  Screen for substance use and child maltreatment  Assess for substance use and child maltreatment  Develop and implement collaborative case plans  Monitor progress and evaluate results Builds Cross SystemCollaboration Establishes Individual and Cross System Roles and Responsibilities Identifies Front-Line CollaborativePractice

GOVERNANCE  Oversight Committee  Steering Committee  Subcommittees TASKS  Mission & Principles  Shared Understanding on Language & Processes  Goals, Timetables, Products  Training Curricula/Strategy MONITORING  Baseline Data  Progress Reports  Outcome Data CWS Understands  Basics of substance use & how use affects child development  How to screen for substance use  Treatment system & how to help people stay in treatment  Implications of tensions between Treatment Staff and CW timelines Alcohol and Drug System Understands  How substance use puts children at risk & how CWS must respond  Child maltreatment reporting requirements  How to screen for child safety Court System Understands  Basics of substance use & child maltreatment  Its role in requiring assessments  The authority to prompt/require collaboration Collaboratively all Three Systems  Establish joint policies/procedures to share information  Establish case plans  Develop shared indicators of progress  Monitor progress and evaluate outcomes CWS, SUDS and CS Have Collaborative Policies, Procedures and Tools to:  Screen for substance use and child maltreatment  Assess for substance use and child maltreatment  Develop and implement collaborative case plans  Monitor progress and evaluate results evaluate results Builds Cross SystemCollaboration Establishes Individual and Cross System Roles and Responsibilities Identifies Front-Line CollaborativePractice

The SAFERR Model Development Builds Cross SystemCollaboration EstablishesIndividualand Cross System Roles and Responsibilities IdentifiesFront-LineCollaborativePractice Establishes and Monitors Individual and Cross-System Outcomes

Assessment is a Process Assessment happens along a continuum 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 & Monitoring Change, Transitions & Outcomes of Treatment and Case Plans  What is the response to the issue?  Are there demonstrable changes in the issue?  Is the family ready for transition?  Did the Interventions Work?

Establishes and Monitors Individual and Cross-System Outcomes  Increased identification of substance use disorders among families reported for child maltreatment  Increased identification of potential child maltreatment for people assessed/treated for SUDS  Increased communication regarding screening and assessment for SUDS and child maltreatment  Informed decision making by CWS and CS regarding reunification, aftercare, terminations  Reduced duplication and burden with regard to case plan requirements  Increased engagement and retention of parents in treatment  Reduced risk of maltreatment of children  Increased family stability, reunification and well being