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

sharon.amatetti@samhsa.hhs.govsharon.amatetti@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

conference@cffutures.orgconference@cffutures.org

ANNOUNCINGANNOUNCING