Safety Planning When Substance Abuse is Present PRESENTERS: MELISSA KIMBALL, SARAH NEILSON & SHERRI LEVESQUE Agenda Pretest Basic drug categories Emerging trends Heroin, Methadone, Suboxone Break Time Reading the different cues of someone on a substance What Makes an Addict? The phases of addiction Treatment Planning Levels, risk reduction and relapse prevention Break for Lunch Drug Testing/Confidentiality Engaging the Reluctant Parent Activity Break Safety planning when a parent is using Activity Review, questions, Take-A-Ways Lets Discuss the Drug Categories What are the categories? Opiates- Heroin, Morphine, Codeine, Opium, etc. Depressants- Alcohol, Barbiturates, benzodiazepines, Marijuana etc. Stimulants- Cocaine, Amphetamines, Nicotine, etc. Hallucinogens- LSD, Mescaline, Marijuana, hashish, MDMA, etc. Cannabinoids- Marijuana Designer Drugs- Spice, K2 (anything manmade that mimic) Opiates Possible Effects Euphoria Drowsiness Respiratory depression constricted pupils nausea Effects of Overdose Slow and shallow breathing Clammy skin Convulsions Coma Possible death Have you heard of Narcan Parties? Depressants Possible Effects Slurred Speech Disorientation Drunken behavior Life-threatening withdrawal Effects of Overdose Shallow respiration Clammy skin Dilated pupils Weak and rapid pulse Coma Possible death Stimulants Possible Effects Increased alertness Excitation Euphoria Increased pulse rate Increased blood pressure Insomnia Loss of appetite Violence Mood swings Effects of Overdose Agitation Increase in body temperature Hallucinations Convulsions Possible death Hallucinogens Possible Effects Illusions and hallucinations Poor perception of time and distance Euphoria Relaxed inhibitions Increased appetite Disoriented behavior Effects of Overdose Longer, more intense trip episodes Psychosis Fatigue Paranoia Possible death Emerging Trends FLAKKA (alpha-PVP) KROKODIL MOLLY CAFFEINE POWDER SYRUP, PURPLE DRANK, SIZZURP, LEAN SALVIA DABS PUPPY CHOW The Very Nature of Heroin Use is the Inherent Probability of Lethality at Each Use Lets Discuss Heroin What are the Signs of Heroin Use? Methadone Maintenance Monitoring Medication Lets take a Break. WHEN WE COME BACK, WE WILL ADDRESS YOUR QUESTIONS What Does Substance Abuse Look Like? What Makes a Person Dependent? What About Treatment? Level of Use 1 - Experimentation Level of Use 2 Regular Use Level of Use 3 Heavy Use Level of Use 4 Chronic Use Levels of Care Chart to Show Addiction Relapse Prevention Plan What negative consequences did my use of substances cause? What positive things did my use give me? What is my diagnosis? What are my relapse triggers? Who is my sober network? How will I know I am entering relapse? What areas do I need to keep on putting effort into when I leave therapy? Enjoy Lunch! Drug Testing Cross Reactivity Detection Periods Medication Cheat Sheet Substance Abuse & Mental Health Services Administration (SAMSA) How Do We Engage Reluctant Parents? Offer to meet them at their place of work Use their words Show them alternatives Suspend your own judgements and life experiences Activity Time! Resources (Your packet has more) Drugs.com - Identify pills, punch in alcohol for example and then the medication a client is taking and it will tell you what interactions they may have which will help understand a clients behaviors and you can learn about any medication you have ever heard of. Noslang.com slang interpreter for sexting, drug use, you name it. Just put in what the slang is and it will spit out the definition. Regularly updated. Telespoof.com used by parents and youth to make it appear a phone call is coming from one place (home for example) when it is really coming from their cell or another state even. The Center for Substance Abuse Research offers all kinds of information on drug trends, drug information and free publications on a variety of topics Family Watchdog will let you search for any registered sex offender for free and will tell you the location they live as well as their crimes NH Alcohol and Drug Treatment Locator This website allows you to put in a city you live by and then it will show you all of the treatment options in that area for substance abuse. It also has links to on-line support services, twelve step meetings and a variety of other information. It is relatively new and people are encouraged to share the website. NH Alcohol and Drug Treatment Locator futures.org-website with resources specific to NH and surrounding areas/towns. Safety Assessment & Planning When Substance Abuse is Present Purposes of safety assessment & planning To identify children who have been or are likely to be seriously harmed in the very near future Limited to critical and immediate danger To develop short-term intervention plans when necessary to stabilize or make alternate placement (Safety Plan or Removal) How do we engage and assess at the same time? Sometimes we have already established the parent is using, sometimes not In either instance, focusing on how everyday life tasks of that developmental stage are accomplished yields critical assessment information about the care of the child(ren) Track the details of those situations at both the family and individual level Focus attention on understanding exceptions to the problem, as well as the problem situation itself New Hampshire Integrated Assessment - 24 Hour Safety Tool What are the DANGEROUS situations Per Policy? Serious Physical Injury by Caregiver or adult household member Serious suspicious physical injury by unknown individual and caregiver or other household member cannot be ruled out Threat of serious injury Serious emotional injury What are the DANGEROUS situations Per Policy? Domestic violence likely to injure child/youth Excessive discipline Sexual abuse by caregiver or other adult household member Sexual abuse by unknown individual and caregiver or other adult household member cannot be ruled out Caregiver fears he/she will seriously harm child What are the DANGEROUS situations Per Policy? Caregiver does not meet the childs current/imminent needs for food, clothing, shelter, and/or medical or mental health care The living situation is physically hazardous and immediately threatening to the childs health or safety, based on the childs age/development Caregiver does not or is unable to protect the child from actual serious harm or risk of serious harm by others What are the DANGEROUS situations Per Policy? Caregiver does not provide supervision necessary to protect the child, based on the childs age and development Other Unexplained child/infant death Criminal behavior occurring in the presence of the child What are some DANGEROUS situations specific to substance abuse? If caregivers are dealing drugs, there will be a lot of different people coming and going into/out of the home, possibly having access to the child(ren). There are potential risks of home invasion as the buyers may want to rob the dealer/substance abusing parent. The parent may be under the influence and unaware of what is going on and what they are subjecting their child(ren) to. What are some DANGEROUS situations specific to substance abuse? A substance abusing parent could be under the influence while caring for their child, or someone elses child. A substance abusing parent could leave their stash somewhere where it may be accessible to the child(ren). Use Your Senses to Assess! What do you see, smell, hear, not hear, not see, etc. Are there signs of drug dealing high risk behaviors, arrests, extreme vacations being taken, routines, how many cars does the family own, weather appropriate clothing, child(ren) are parentified and acting more mature than what is expected at their developmental stage. Is someone who is suspected of using heroin, wearing a hooded sweatshirt in the middle of summer? What is a Safety Plan and When Should We Use One? Safety Plans are used only when there is a danger (not risk) to the child(ren). Safety Plans should be followed up on within fourteen days, if not before, per NHIA policy. A safety plan should: Address the threats to the childs safety Have explicit time limits Be realistic, i.e. the family can implement and follow through Be specific Include a method for monitoring Consider the involvement of others to ensure the protection of the child. Plan Break Down Is this a detailed plan? How will this plan be monitored? How will DCYF or the family know if its not working? Are all involved in the plan on board with the plan? Is it SMART? Specific Measurable Achievable Realistic Timely Please Remember Substance addiction can interfere with some critical strengths of the parent that would support a safety plan: Caregiver is able and willing to: Actively participate in creating and carrying out a plan to protect the childs safety Use resources necessary to ensure safety Have supportive relationships with one or more persons who are willing to participate in effective safety planning AND the caregiver is willing to accept their help Provide for the childs basic needs Demonstrate effective problem solving Exhibit self-control and put the childs safety ahead of his/her own wants Safety Planning with Substance Abuse. Parents who have presented in Family Voice Panels in District Offices through Better Together with Birthparents have shared that they understand they use and have an addiction, but they come up with their own safety plans. These may or may not be sufficient as safety plans. What do you think? Please discuss this with your neighbor. This may include setting up the child(ren) in the living room with puzzles, a movie, games, watching a sibling, etc. They may have a sober friend come by to watch the child(ren) while the substance abusing parent uses a substance. Safety Planning with Substance Abuse. Safety plans must take into account such factors as: Sobriety of caregiver when making plan Level of substance use (abuse vs. addiction) Type of substance being used Age/vulnerability of child Realistic availability of a sober caregiver In hearing a fathers story, he has stated there is no true safety plan as the parent using will say anything thing to ensure the worker leaves Parents also indicated that the initial hesitation of admitting there may be an issue can stem from concern about admitting to a crime Safety Plans should only be used instead of removal, if they realistically ensure safety and can be monitored. Safety Plans that are dependent on the word or action of the alleged substance abusing parent are not sufficient to mitigate danger, YOU CAN ALWAYS STEP OUT AND CALL YOUR SUPERVISOR!! Lets Safety Plan Together! Parents in Family Voice Panels report the following is most effective when DCYF staff: Acts Human, understanding that mistakes and addiction can happen to anyone Builds trust Looks beyond the tip of the iceberg, explores more through appropriate questions Engages the family/parent in a respectful manner Gives the parent/family TIME when you go out to the house, try not to come across rushed as the parent can sense/feel this. Parents are looking for validation, which is where normalizing the developmental tasks can be helpful. Show empathy Knows their own triggers and own history of abuse/neglect/substance abuse CPS Safety Plan Lets take a look at a plan created during a visit.. CPS Safety Plan Lets take a look at a plan created during a visit.. Lets talk about vicarious trauma, your coping skills and hobbies and the reason you come to work. CPS Safety Plan Lets take a look at a plan created during a visit.. CPS Safety Plan Lets take a look at a plan created during a visit.. CPS Safety Plan Lets take a look at a plan created during a visit.. Referral: Mom has two children, a 3yo and a 6yo. She admits to using heroin once in her life, last week, with a friend. During this time, she was not supervising the children. Housing is a concern as they are homeless and couch-surfing. Dad is in jail. Aunt Lucy is a support to the family. CPS Safety Plan Lets take a look at a plan created during a visit.. When we DO need to seek Removal Ways in which we establish possible Evidence of use Admission by parent, Reports from others, Drug tests, Evidence of dishonest reporting about drug usage, Physical observations of symptoms or behaviors (many little things pulled together) When we DO need to seek Removal DCYF has met with the parents in an attempt to engage the family in seeking treatment for their substance use. The parents have refused to engage in treatment despite the potential lethality of heroin use by both parents, Mr. Ds recent overdose, and Ms. Ds admitted heroin use. The refusal to engage in treatment places the children in imminent danger due to the childrens young ages and Mr. D and Ms. Ds use of drugs while caring for the children. When we DO need to seek Removal DCYF met with parents in order to assess safety of the children. Given the potential lethality of the heroin use described above, the parents were unable/unwilling to enter into a safety plan that would mitigate the danger to the children. The child are very likely to suffer serious impairment due to their young age and need for constant care and supervision. When there is NO danger identified, There is No Safety Plan needed What About An Action Plan? Safety plans are just for DANGEROUS Situations Action plans can be used to try to mitigate risk Some examples for an action plan could be THANK YOU!! PLEASE DONT FORGET TO FILL OUT AN ACTION PLAN AND EVALUATION FOR THIS TRAINING. THANK YOU AGAIN FOR YOUR TIME.