ATTC Messenger May 2016 Services for Children and Families Affected by Substance Use Disorders and Child Welfare: News You Can Use from the National Center on Substance Abuse and Child Welfare
Services for Children and Families Affected by Substance Use Disorders and Child Welfare: News You Can Use from the National Center on Substance Abuse and Child Welfare
National Center on Substance Abuse and Child Welfare
Approximately 11% (8.3 million) children live with one or more parents who is dependent on alcohol or needs treatment for illicit drug abuse (USDHHS, 2009). Most families with parental substance use disorders do not come to the attention of child welfare, however for those families who do, addressing substance use disorders effectively and collaboratively is critical. Substance use disorders in the home are frequently reported in cases of child abuse and neglect – a recent summary of research shows great variation in estimates of substantiated child abuse and neglect cases involving substance use by a custodial parent or guardian, with some regional prevalence estimates being higher than national estimates (Seay, 2015). There is a growing knowledge of how to best serve families affected by substance use and who are involved in the child welfare system as well as how to provide evidence-based services that support both the parent and the child to promote family recovery.
The National Center on Substance Abuse and Child Welfare (NCSACW) has identified effective strategies and synthesized lessons learned from demonstration grants in numerous communities to improve outcomes for children and families affected by parental substance use disorders. This article highlights strategies and outcomes from the Substance-Exposed Infants In-Depth Technical Assistance Program and the Children Affected by Methamphetamine Grant Program and offers links to free training and resources for treatment professionals to enhance their knowledge and strategies to work with families in the child welfare system.
Serving Infants with Prenatal Substance Exposure and their Families
Substance use treatment, child welfare, and medical providers, have been making significant efforts at the state and local level to collaboratively address the needs of infants prenatally exposed to substances. NCSACW manages a Substance Exposed Infants In-Depth Technical Assistance Program (SEI IDTA) to strengthen the capacity of states and local jurisdictions to improve the safety, health, and well-being of these infants and the recovery of pregnant and parenting women and their families. of particular focus are women with opioid use disorders and their infants with Neonatal Abstinence Syndrome (NAS). This 18-month initiative, funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), supports six States (one with a focus on Tribal communities) in efforts to strengthen collaboration and linkages across child welfare, addiction treatment, medical providers, and early child care and education systems. The States have identified a set of collaborative challenges that emerged in the first 18 months of the project, including:
- A lack of understanding of the Federal Child Abuse Prevention and Treatment Act (CAPTA) requirements associated with reporting of infants with prenatal exposure;
- A lack of plans of safe care for infants and their mothers at discharge from hospitals;
- An increase of infant fatalities and near fatalities related to parental substance use disorders;
- A lack of early identification and screening of pregnant women with substance use disorders by OB-GYNs and other prenatal care providers;
- A lack of understanding by prenatal care providers on how to refer and connect pregnant women with substance use disorders to appropriate treatment;
- A lack of appropriate, evidence-based and comprehensive Medication-Assisted Treatment (MAT) for pregnant women;
- A lack of connection to therapeutic services for pregnant women by physicians who prescribe medication (e.g. Buprenorphine);
- Inconsistent protocols within and across sites for identifying and treating NAS;
- Inconsistent referrals to and responses by child welfare systems to prenatally exposed infants and their families; and
- A lack of data within and across systems to demonstrate cost savings and improved outcomes.
Out of these challenges, the states have worked on implementing practice and policy changes, such as:
- Early Identification and Screening – Identifying best practices and guidelines for early identification and screening of pregnant women, substance exposed infants and their families.
- MAT Training and Education – Providing MAT training and education to child welfare workers.
- Data Collection – Making improvements to statewide data collection, data mapping on identified indicators and linking data systems to understand the costs associated with NAS and the treatment gaps and barriers.
- Statewide System of Care – Enhancing the system of care for pregnant and postpartum women and their families.
- State Legislation and Policies – Reviewing relevant state legislation and policies and practices to explore the impact to pregnant women with substance use disorders and prenatally exposed infants regarding substance use during pregnancy; identification and notification of infants with prenatal exposure and the development of plans of safe care; Conducting surveys to better understand challenges and barriers to implementing State laws regarding referrals of pregnant women with SUDs and infants with prenatal substance.
For more information about the SEI IDTA Program, visit our website or contact NCSACW at: [email protected]
Resources on Treatment for Opioid Use Disorders
NCSACW has developed a resource guide on best practices in the treatment of opioid use disorders and Neonatal Abstinence Syndrome (NAS). Please email us at [email protected] to request a copy of this resource guide and the practice and policy publications on opioid use disorders. NCSACW has also facilitated a series of webinars on the topic of treatment for opioid use disorders during pregnancy and Neonatal Abstinence Syndrome. Visit our website to learn more and access the webinar recordings.
SAMHSA will soon release A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders: Practice and Policy Considerations for Child Welfare, Collaborating Medical, and Service Providers. This guidance publication is intended to support the efforts of states, tribes, and local communities in addressing the needs of pregnant women with opioid use disorders and their infants and families. It also provides background information on the treatment of pregnant women with opioid use disorders, summarizes key aspects of guidelines that have been adopted by professional organizations across many of the disciplines, presents a comprehensive framework to organize these efforts in communities, and provides a collaborative practice guide for community planning to improve outcomes for these families. A set of appendices provides details on implementing the recommendations in the guide as well as a summary of lessons from one community’s experience over the past decade. Stay tuned and visit our website for an update on the release of this valuable document!
Services for Children Affected by Parental Substance Use: The Children Affected by Methamphetamine (CAM) Program
CAM Program Strategies
Comprehensive screening and supportive services for children and parents
Developmental and behavioral interventions for children
Parent training and education
Trauma-focused child and parent interventions
From 2010-2014, SAMHSA administered the Grants to Expand Services to Children Affected by Methamphetamine in Families Participating in Family Treatment Drug Court, whichsupported 12 Family Treatment Drug Courts. The goal of the program was to improve the well-being, permanency, recovery and safety outcomes of children and families who are in, or at-risk, out-of-home placement as a result of a parent’s or caregiver’s methamphetamine or other substance use disorder. The primary focus of the grant was to provide services directly to the children and to provide supportive services for parents, caregivers, and families involved in Family Treatment Drug Courts. NCSACW provided performance measurement and technical assistance to the grantees on a variety of topics including collaboration, program sustainability and substance use disorder treatment practices for parents and families.
Over the four-year grant period, several important implementation lessons emerged, including:
- Improved family functioning and relationships is a part of recovery – Addressing the needs of children required grantees to recognize improved child and family functioning as core elements in parents’ recovery. CAM grantees addressed child and family trauma, supported quality visitation and strengthened the parent-child relationship through evidence-based parenting, attachment-based therapy, and other therapeutic interventions. The CAM performance data showed statistically significant improvements from intake to closure in family functioning and adults stayed in substance abuse treatment (on average, about 6 months) and nearly half successfully completed treatment. The majority of adults also reduced their use of alcohol, marijuana and methamphetamine. Grantees also found they could increase retention in treatment when they engaged parents early in their recovery in parenting programs specifically developed for parents with substance use disorders that focused on teaching effective parenting skills, and provided opportunities for children and parents to repair their relationship. More than 90% of children remained in their home with their parent/caregiver throughout program participation and the majority of children exiting out-of-home care were discharged to reunification. Over two-thirds (68.2%) of CAM children were reunified with their families in less than 12 months less than 6% of reunified children re-entered foster care within 12 months after being returned home. This is about a third of the national average with standard services.
- Providing recovery support is a key engagement and retention strategy – Given the complex needs of participant families, grantees strengthened service referral and engagement efforts by employing specialized engagement or outreach positions, such as a Peer Mentors, Recovery Mentors, Recovery Resource Specialists, and Court-Appointed Special Advocates. These team members provided support and encouragement that improved participation and retention in treatment. Participants viewed these staff members as allies who could appreciate the challenges of addressing recovery and parenting issues simultaneously.
Visit our website for more information on the CAM program and read the CAM Brief for a summary of program strategies and outcomes.
Free Online Training for Treatment Professionals on Child Welfare
NCSACW recently launched an updated online tutorial for substance abuse treatment professionals. Through this course, students can learn more about the impact of child welfare and dependency court requirements on parents who are in substance use disorder treatment and who are involved with the child welfare system. The course is designed to highlight key considerations and effective strategies for working with these families to achieve reunification and recovery. This course is approved for 4.5 continuing Education Units (CEUs). Visit our website to take this free online training today.
The National Center on Substance Abuse and Child Welfare (NCSACW) is a national resource center that provides information, expert consultation, training and technical assistance to child welfare, dependency court and substance abuse treatment professionals to improve the safety, permanency, well-being and recovery outcomes for children, parents and families. NCSACW is funded through an intragency agreement between the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Administration for Children and Families (ACF).