Planning Community Module 3: Screening and Assessment
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Children and Family Futures Office of Juvenile Justice and Delinquency Prevention Family Drug Court Technical Assistance Program
Today’s presentation and handouts are available for download at: http://www.cffutures.com/webinars This project is supported by Award No. 2009-DC-BX-K069 awarded by the Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs
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4940 Irvine Blvd, Suite 202 Irvine, CA 92620 714.505.3525 2 www.cffutures.org
Welcome! AGENDA • Opening Remarks • Understanding Screening and Assessment in the Larger Context: Project vs. System • Drug Testing • Introduction to Family Drug Court Screening and Assessment • Family Drug Court: Core Screening Elements • Family Drug Court: Core Assessment Elements • Next Steps • Questions and Discussion
Introductions • Phil Breitenbucher, MSW Program Director Director, Children and Family Futures • Sid Gardner, MPA President, Children and Family Futures • Theresa Lemus, RN, MBA, LADC Program Associate, Children and Family Futures
Overview of Learning Academy Module Format
How do I ask questions? For your convenience, there are two ways to ask questions during this webinar presentation: 1. Type and send your questions through the Question and Answer log located on the bottom half on your panel/dashboard. 2 There will also be time at the end 2. of the webinar for you to ask questions via the conference line.
Where we’ve been thus far… Special Topics •Engaging Defense Attorneys •Engaging Fathers •Understanding Disproportionality & Disparity •Understanding Trauma •Marketing to Stakeholders •Cost Benefits Analysis 8
Polling Question #1 Which best describes your position? • Attorney Att or Judge J d • Drug Court Coordinator • Social Worker • Substance Abuse Treatment Provider • Other Understanding Screening and Assessment in the Larger Context: Project vs. System Sid Gardner, MPA 9
Screening and Assessment Screening and assessment differ across systems. t • Screening: Determines eligibility and appropriateness for participation in drug court. • Assessment: Helps to identify specific types of services and determine the intensity of treatment needed. 11
Re-visiting Module 1: Mission and Underlying Values How does your mission impact screening and d assessment? t? • Whom do you serve? • Difference in perception of the primary client: the parent, the child, the family family. • Difference in perception of the target population 12
What is the intent of your screening and assessment protocol?
Drop-off Analysis 50,000 Children with Substantiated Abuse/Neglect 33,000 Parents
Who is your target population? • Scope – Universality vs. Specific Segments of the Population – Screening In vs. Screening Out – Does your program address other issues that families are experiencing? • Scale – Are you experiencing difficulty filling slots? – Do you need more slots?
60% of Parents Need Assessment 19,800 50% Go for Assessment 9,900 80% Need Treatment 7,920 50% Go to First Session 3,960 30% Complete 90 Days – 1,188 13
50% Reunify or Stay with Parents 594
Current Screening Practices
Polling Question #2 In your jurisdiction, what is the percentage of child welfare cases affected by parental substance use? • 0-20% • 20-40% • 40-60% • 60-80% • 80-100%
• No state currently has universal screening i ffor child hild welfare lf cases • Some states and localities report much higher rates of substance abuse based on – Worker training – Agreement on the tool to be used – Interagency agreements on what will happen as a result of a positive screen 15
Parental Substance Use Cited as Factor in Child Welfare Case* Parental or Alcohol Drug Abuse as Substance Abuse as Primary Reason for Case Opening Factor in Cases of Child Removal 2007 AFCARS Data Parental Alcohol or Drug Abuse as Factor in Cases of Child Removal (N=190,900 Cases)
SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007-2008 Annual Average Total U.S. Births 2007: 4,317,000 Substance Used (Past Month)
Any Illicit Drug
2 4 2 18 8 8
Use During Pregnancy
8 14 Binge Alcohol Use 31 8 27
*This chart depicts 10 of 52 states. **In Round 1, these data were not included in the first cohorts of States reviewed, it was an added item in subsequent States.
Drug Testing Why are we addressing this? • Drug g testing g is the most frequently q y used indicator for substance use in child welfare practice • Test results may influence decisions on child removal, reunification and Termination of Parental Rights • Courts often order drug g testing g as a standard p protocol for parents in the child welfare system
Drug Testing • Lack of standardized recommendations for drug testing in child welfare practice
Theresa Lemus, MBA, RN, LADC 19
Polling Question #3 A person that uses substances (drugs and/or d/ alcohol) l h l) cannott b be a ““good” d” parent. • True • False
SPECTRUM OF ADDICTION
A Problem for Child Welfare and Court Officers: The most frequently used marker of substance abuse problems in child welfare and family court does not tell you anything about the individual’s place on the spectrum
EXPERIMENT AND USE 21
What Questions Can Drug Testing Answer? • Whether an individual has used a tested substance within a detectable time frame
What Questions Can Drug Testing Not Answer? • A drug test alone cannot determine the existence or absence of a substance use disorder • The severity of an individual’s substance use disorder • Whether a child is safe • The parenting capacity and skills of the caregiver
Drug Testing • For a more in-depth presentation on D Drug T Testing, ti please l visit: i it http://www.cffutures.org/files/presentatio ns/DrugTestingPresentation_05202010. pdf Introduction to Family Drug Court Screening and Assessment Phil Breitenbucher, MSW 25
What Are the Differences Between Screening and Assessment?
Screening and Assessment are part of an ongoing i d decision-making i i ki process • Screening determines eligibility and appropriateness for participation in drug court. • Assessment helps to identify specific types of services and determine the intensity of treatment needed.
Types of Screening Family Drug Court screening typically consists of two steps: 1. Justice System/Program Screening • Does the client meet the pre-determined eligibility criteria? • Eligibility criteria can include child welfare case history, age of children, criminal history, etc. 2. Clinical Screening • Does the client have a substance abuse disorder? • Can current treatment services meet the client’s substance abuse needs? • Are there other clinical features (e.g.: mental health disorders)?
Goals of Screening: Program Eligibility Determine: • Are legal and statutory eligibility requirements met?
Goals of Screening: Program Suitability Identify and Assess: • Individuals with a history of violent offenses/behavior • Environmental factors (e.g., employment, residential stability, domestic violence history) or other disorders (e.g., mental health, cognitive deficits) to assure appropriate services are available to treat the participant • Client’s motivation, including perception of benefits and disadvantages of program participation.
Goals of Screening: Programmatic Considerations • Define major areas of client strengths and needs • Orient the potential client to program requirements • Obtain consents for records and access to collateral contacts
Goals of Assessment Examine the scope and nature of substance abuse history • Understand the impact substance abuse has had on the individual, including its influence on the child welfare case
Goals of Assessment Identify: • The specific psychosocial problems to be addressed in treatment, including mental health disorders. • Specific needs to be addressed in treatment planning and the appropriate level of care. • The full range of service needs, pursuant to treatment planning. planning • Specific employment, housing, child care, educational and other needs.
Goals of Assessment • Match participants to appropriate types of drug court services
Characteristics of Screening and Assessment
What Factors Help to Shape the Drug Court Screening and Assessment Process?
Determine FDC Eligibility
• Substance Abuse Allegations •Child Child Welfare History and Status of CW Case •Explain Program •Releases Signed
•FDC Case Manager •Attorney •Child Child Welfare Social Worker
Determine: 1) Appropriateness of treatment 2) Individual’s willingness and readiness for treatment
•Brief assessment of substance use, social history, other disorders •Motivation/willingness to participate •Releases Signed
•Substance Abuse Specialists (SAS) •FDC Case Manager
Diagnosis Admission Treatment Planning
•Examine scope and nature of substance abuse issue •Identify full range of service needs, pursuant to treatment planning •Match client to appropriate services
•Clinically trained and qualified substance abuse counselor, psychologist, psychiatrist, social worker or nurse
• What treatment options are available to the d drug courtt program? ? • Number of program referrals • Background, expertise and training of screening staff • Eligibility criteria
Importance of Comprehensive Screening and Assessment in Drug Court • Candidates for drug court programs typically have a wide range of co-occurring co occurring issues and disorders. • Failure to detect these issues could lead to: – Misdiagnosis – Neglect of appropriate interventions – Inappropriate treatment planning and referral – Over- or under-treatment of mental health symptoms with medications – Disruption of treatment services and demoralization of other participants – Poor treatment outcomes
Components of a Comprehensive Family Drug Court Screening and Assessment Protocol • Eligibility screening is based on established written criteria. • Child Welfare Social Workers, Substance Abuse Specialist and/or FDC Case Managers are designated to screen cases and identify potential participants. • Eligible participants for family drug court are promptly advised about program requirements and the benefits of participating. • Initial appearance before the family drug court judge occurs immediately after FDC intake, to ensure program participation.
Components of a Comprehensive Family Drug Court Screening and Assessment Protocol • The court requires that eligible participants enroll in AOD services immediately. • Individuals are initially screened and later periodically assessed by both the FDC and treatment personnel to ensure that treatment services and individuals are suitably matched: – Ongoing assessment is necessary to monitor progress, to change the treatment plan as necessary, and to identify relapse cues cues. – Participants are matched to treatment programs according to their specific needs. Guidelines for placement in various levels of treatment should be developed.
Motivational Interviewing • MI identifies a client’s motivation, including perceived benefits and disadvantages of participation in the family drug court program and is a best practice approach that incorporates the following objectives: – Seeks to understand the person's frame of reference, particularly via reflective listening; – Expressing acceptance and affirmation; – Eliciting and selectively reinforcing the client's own self motivational statements expressions of problem recognition, concern, desire and intention to change, and ability to change; – Monitoring the client's degree of readiness to change, and ensuring that resistance is not generated by jumping ahead of the client; – Affirming the client's freedom of choice and self-direction.
Background and Demographic Information • Name, address, age, race/ethnicity, and gender, number and age of children • Identifying contact numbers used by the court, child welfare and/or the treatment provider • Status of Child Welfare Case • Child Welfare History (prior cases, etc) • Criminal History (any violent crimes?) – Outstanding Warrants, Pending Cases
Family Drug Court: Core Screening Elements Theresa Lemus, MBA, RN, LADC 41
Substance Use • • • • •
Signs of acute drug or alcohol intoxication Acute signs of withdrawal from drugs or alcohol D Drug t l tolerance effects ff t Results of recent drug testing Self-reported substance abuse – – – – –
Age and pattern of first substance use History of use Current pattern of use (e.g., quantity, frequency, method of use) “Drug(s) of choice/use” (including alcohol) Motivation for using
• N Negative ti consequences associated i t d with ith substance b t use • Prior involvement in treatment • Family history of substance abuse (include family of origin as well as current family) • Other observable signs and symptoms of substance abuse (e.g., needle marks/injection sites, impaired motor skills)
Mental Health • Acute mental health symptoms (e.g., depression, hallucinations, delusions) • Suicidal thoughts and behavior • Other observable mental health symptoms • Age at which mental health symptoms began • Prior involvement in mental health treatment, and use of psychotropic medication • Cognitive impairment • Past or recent trauma such as sexual/physical abuse • Family history of mental illness
Other Indicators • Motivation and readiness for substance abuse treatment • Perceived level of substance abuse problems • Social factors (e.g., living with an abusive or substance-involved partner, sole economic provider responsibilities, housing issues, child p ) that may yp present obstacles care, transportation) for FDC participation
What Instruments Should Be Used in Family Drug Court Screening? • Family Drug Courts should use standardized substance abuse screening g instruments to enhance the consistency y and validity of results. • May have to utilize more than one screening tool to screen for mental health. • Examples: – UNCOPE – Substance Abuse Subtle Screening Inventory (SASSI) – Alcoholism Screening Test (MAST), and the – GAIN SS
Factors For Selecting Screening Instruments • Reliability: Consistency of results obtained over time. • Validity: Extent to which instruments can effectively identify substance abuse problems. • Cost: Some, like the UNCOPE are public domain, others cost.
Core Component: Release of Confidential Information 1. Name of participant general designation g of the individual who is 2. Name or g permitted to disclose information 3. Identify FDC staff designated to release information in connection with monitoring participant progress 4. Purpose of the disclosure 5. Specifies type of information to be released 6 The period during which the release remains in effect 6. -e.g. Anticipated length of program participation; anticipated duration of the child welfare case 7. Signature of the FDC participant 8. Date on which the release form was signed.
What Information Should Be Included in a Family Drug Court Assessment? • • • • • •
Family Drug Court: Core Assessment Elements
• • •
Theresa Lemus, MBA, RN, LADC
Child Welfare Case Status and History Criminal justice history and status Substance abuse history, history current symptoms, symptoms and level of functioning Mental health history, current symptoms, and level of functioning History of interaction between mental health and substance use disorders Family history of substance use disorders (including birth complications and in utero substance exposure) Medical and health status S i l/f il relationships Social/family l ti hi (i (including l di involvement in domestic violence and child abuse or neglect) Employment/vocational status Educational history and status Literacy, IQ, and developmental disabilities
• • •
Treatment history and response to/compliance with treatment Prior experience with peer support groups Cognitive appraisal of treatment and recovery – Motivation and readiness for treatment – Self-efficacy in adopting lifestyle changes (e.g., maintaining abstinence, complying with medication) – Expectancies related to substance use (both positive and negative) Participant conceptualization of treatment needs Resources and limitations affecting the ability to participate in treatment (e.g., transportation problems, homelessness, child care needs) Interpersonal coping strategies, problem solving abilities, and communication skills
Assessment Information Continued…. • Negative effects of substance abuse on current overall health stat status, s and need for immediate medical attention • Impact of current environment on child welfare, addiction, treatment & recovery - living arrangements - basic needs - transportation • Impact of key relationships and their potential effect on child welfare, welfare addiction, addiction treatment & recovery -family & friend support system -significant other - other (church, community, etc.) • current socioeconomic status and background
Other Important Factors • • • •
Gender Trauma Culture Substance Exposed Newborn and Children
For More Information on Substance-Exposed Infants: To Obtain a Copy: National Center on Substance Abuse & Child Welfare (714) 505-3525 http://www.ncsacw.samhsa.gov /improving/daily-practice-client.aspx
Polling Question #4 In our program, the following system conducts d t eligibility li ibilit screening: i • Child Welfare • Drug Court Coordinator • Substance Abuse Treatment Provider • Combination
Next Steps • Understanding your Child Welfare D Department’s t t’ S Screening i P Process • Revisiting your FDCs Screening and Assessment Protocols • To access these webinar materials, visit: http://www.cffutures.org/webinars p g
• More of the Learning Community! Phil Breitenbucher, MSW
Hot off the press! Registration for Module 4: Engagement and dR Retention, t ti iis N Now O Open!! https://www1.gotomeeting.com/register/77 0351240
For More Examples of Screening and Assessment Tools: Appendix D: Examples of Screening and Assessment Tools Appendix F: Examples of Safety and Risk Assessments for Use by Child Welfare Staff To Obtain a Copy: National Center on Substance Abuse & Child Welfare (714) 505-3525
References • The Addiction Technology Transfer Center, Motivational Interviewing. Retrieved 07.29.10 from http://www.motivationalinterview.org/. • U.S. Department of Health & Human Services, SAMHSA Tip 35. Retrieved 07.29.10 from http://kap.samhsa.gov/products/brochures/pdfs/TIP35.pdf. • Peters, R. H. and Petyon, E. Guideline for Drug Courts on Screening and Assessment. May 1998. American University, Justice Programs Office, in association with the U.S. Department of Justice, Office of Justice Programs, Drug Courts Program Office.