Integrating Substance Abuse Competency Within A Child

Welfare SystemKim Bishop-Stevens LICSW

Loretta Butehorn PhD

Jan-Feb 2007

Child Abuse and Neglect and Substance Abuse

• 8.3. million children with substance abusing parent

• 50% of cases in care substance impaired

• 52% out of home placement due to substance abuse

-2001 Child Welfare League of America

Why we’re here

Massachusetts Child Welfare System

• State run system

• 6 Regional Offices with 29 Area Offices

• 3,500 Staff

• Yearly Budget $700 Million

• Serving 23,000 Families • 75,000 Total Consumers• 40,000 Children

1998 Project on Addressing Substance Abuse DSS-MA

• Charge to build a system wide capacity to respond

Via -Substance Abuse Unit-Standardized screening-Monthly case consultation-Increased training-Urine testing protocol-Cross systems collaboration

Substance Abuse Unit

• 2000 - 1 person

• 2001 - 2 people

• 2005 Central Office Unit and 1 person per 6 Regions of State

Structural and Staffing Choices

• Central and Regional hiring and supervision

• Hired seasoned substance abuse professionals

• Cross trained them in child welfare

Unit members

• Skill set

• Paradigm

• Shift from Clinical to Systemic Perspective

• Group Process

Goals

1. Assess current capacity

2. Build capacitya. Knowledge base

b. Identify key collaborators within system

c. Develop strong relationship with community partners

Stage of Development of Unit

Process

• Team building

• Group process

Content

• Integrating child welfare perspective into a clinical substance abuse treatment perspective

• Single/double loop learning

Clinical Development

• Child welfare expertise

• Skill development in training

• Consultation skill set

• Collaboration with internal and external peers

• Systemic sophistication

When does substance use=child abuse/neglect?

Harm reductionstrategies

Level of parentl insight into risk factors

Age of child

Stage of change

Hx of RxStrengths of

Parents

MH/DV NeedsOf Parent

Poverty

Support system

Bonding of parentand child

Special Needs Of child

AOD Impairment

When Does Substance Use=Abuse/neglect

Of children

Theoretical model

• How long does it take to think it though

• Capacity building: where is work coming from, what info is not overwhelming

• Stages of change with service planning

• Does change happen in supervision, case conference, training, language use

External goals: building collaboratives

Internal goals: building competence

Initial goals: enter system and form relationships

Substance Abuse Unit

System Shifts

2000 Substance Abuse Unit formed

2001 Commissioner initiates Core Values

2002 Family Networks Planning

2002 Child Welfare Institute

2003 Program Improvement Plan Developed

2003 Continuous Quality Improvement

2004 Teaming Pilots Initiated

2004 Division of Policy and Planning

System Shifts

2004 Working with Families Right from the Start

2005 Family Recovery Collaborative

2005 Substance Abuse Unit Expanded-1 person per region

2006 Family Networks Implemented

2007 Co-Directors of Integrated Practice

FamilyCollaborative

WWFRFS

Substance Abuse Unit Formed

Family Networks

CORE VALUES

Core Values

• Child Driven

• Family Centered

• Community Focused

• Strength Based

• Committed to Diversity/Cultural Competence

• Committed to Continuous Learning

Family Recovery Collaborative

• NCSACW Technical Assistance

• Partnership between State Agencies, Courts and Tribe

• Products• Memorandum of Understanding• Shared Principles and Values• Draft Communication Protocol• Development of Engagement Model

Integrated Practice

Mental Health Issues

Domestic Violence

Substance Abuse

CQI

Family EngagementAnd

Teaming

Child WelfareInstitute

Family Networks

PRACTICEPOINT

CORE VALUESDISPROPORTIONALITY

ADOLESCENTPERMANENCY

The future