Chemical Dependency in

1. Chemical Dependency in Child Welfare

2. By the End of this Session You will be able to: • Define substance abuse & related terms • Define “disease” as related to substance abuse & describe its characteristics • Recognize the progression/stages of substance abuse • Utilize the GAIN-SS tool • Describe how to partner with providers

3. A two parent family had their three children removed because they were chronically failing to supervise them. Both parents used drugs and alcohol. One parent has been engaging in treatment for 6 months and has clean UA’s since the start of treatment. The other parent has engaged less frequently in treatment and provided few UA’s. Are the children safe to return home?

4. Should the case be kept open? How can the child, and the parent, be protected? After being involved with a family for several months, the FVS worker meets with a single mother to discuss closing her case. She has maintained her home in an adequately sanitary fashion and engaged in outpatient treatment for alcohol abuse. The mother discloses that she’s pregnant, and is very afraid of her boyfriend. She states that he has threatened her and her child, and that she doesn’t know what to do.

5. Can the children safely resume their custodial time with their mother? An intake comes in after a mother is arrested driving drunk with her children in the car. The children remain with the other parent while the investigation occurs. The mother completes a drug and alcohol assessment which recommends participation in their education program, but not treatment. Per the evaluation the mother is not alcohol dependent.

8. Definitions

9. Addiction

10. Characteristics of a Disease

11. Elements of Disease

12. Symptoms Associated with Stages

13. Stages of Substance Abuse

14. Levels of Substance Use and Risk of CA/N • General categorization of substance use is as follows: • Substance use • Abuse • Dependence. • Any level of substance use by a parent can place a child in imminent harm, create present danger or create impending danger of physical abuse and/or neglect. • It is important to determine if substance use is a factor in an unsafe situation for a child.

15. Impact of Drugs on the Brain • Causes significant changes in brain chemistry • Disrupts normal communication between neurons. • Continued use can impact the ability to experience pleasure. • Engaging in a compulsive behavior, even in the face of negative consequences. • Inability to limit intake of the addictive substance • Long lasting or permanent changes to the brain

16. Brain Scan

17. Introduction to Global Appraisal of Individual Needs (Gain-SS)

18. Global Appraisal of Individual Needs – Short Screener (GAIN-SS) • A validated screening tool used with adults and youth (ages 13 years and older). • The GAIN-SS identifies a need for a chemical dependency, mental health or co-occurring assessment. The identified needed assessment would be referred to and completed by a community professional. • This tool does not identify service needs, only the need for further assessment.

19. When to Administer the GAIN-SS • During the first 45 days of an open CPS investigation or FAR • If a case is not going to be transferred and is a high standard referral, a GAIN-SS screen must be completed • FVS or CFWS social workers will complete a GAIN-SS screen if one has not yet been completed during the CPS investigation • CHET Screeners will administer the GAIN-SS to youth 13 years and older if one was not administered during the investigation

20. Results of Mental Health Component of GAIN-SS

21. Asking About Pre-Natal Exposure • Impacts can be: • large or small • temporary or long term • Many myths prevail • “Crack babies” • Alcohol and nicotine are most common • They have significant and profound long term effects

22. Pre-natal Exposure

23. Fetal Alcohol Spectrum Disorder Often includes: • Physical markers including growth problems and facial differences • Intellectual disability • Poor executive functioning (planning, anticipating, learning from experience)

24. FASD: Assessment and Treatment Children under 3: Early Intervention Services Children 3 and over: School District 10X more prevalent in children in care

25. Neonatal Abstinence Syndrome • Related to opiate use only • Increased symptoms and discomfort as time passes • Often requires hospitalization and treatment • More significant from methadone than heroin

26. Chemical dependency and treatment

27. Treatment Works • Periods of abstinence, or reduced substance use are a result of effective intervention and treatment • Treatment outcomes show a decrease in negative outcomes for addicts • Relapse is part of recovery. Increased and/or continued support and interventions assist in regaining abstinence.

28. Types of Treatment • Acute detox • Sub-acute detox • Intensive Inpatient • Recovery House • Long Term • Intensive Outpatient • Outpatient • Aftercare .

29. Opiate Substitution Treatment • Client receives medication : • To assist in stabilizing brain chemistry • In conjunction with outpatient counseling. • Effective ONLY with opiate class drugs • Pregnant mothers generally are prescribed this modality as a way of remaining free from illegal substances and maintaining their pregnancy • - Infant will likely need to detox after its birth as a result of this method of treatment • Of a number of treatment options methadone is the most commonly used modality.

30. Referral Options/Issues • Treatment access • Obtaining Funding • Knowing the Resources

31. Certified Chemical Dependency Provider Directory A directory that includes chemical dependency service providers certified by the Division of Behavioral Health and Recovery (DBHR).  Certified agencies are listed alphabetically within each county. http://www.dshs.wa.gov/dbhr/dadirectory.shtml

32. Utilizing UAs • UAs are a tool to be used in monitoring levels of a substance (decreasing/increasing levels) in a person’s system • UA Best Practice will be discussed in more depth during 2 day training • Random, observed UA’s are the most accurate type of testing • UAs are a tool and can be augmented by the client. • UAs should not be the basis in deciding permanency – such as reunification • Other methods for collecting information on a person’s level of usage are hair follicle testing, oral swabs and blood tests – these tend to be less utilized due to increased cost of testing

33. UA’s What they tell us: • A particular drug or class of drugs was used • General time frame this happened What they can’t: • Exactly when a drug was used • How much of the drug was used • Overall skill acquisition

34. Partnering with treatment providers

35. Treatment Referral and Initial Conversations • Provide the sequence of events around the problem • Share the safety plan • Share the consensus on the Family and Individual Level Objectives (Case Plan) • Describe how evidence of change will be noticed • Follow-up the referral with a conversation

36. Service Expectations for Implementing and Sustaining Change • Deliver services within the family developmental context • Ensure that the service produces a product (specific action plan) • Assist family members learn the details of their behavior patter • Assist clients in practicing small steps of change • Documentation of behavior change

37. Need for Collaboration • Expected family outcomes may differ based on perspective • CA looks at safely reunifying children with parents • CDPs are working with the client to address addiction • CA concerns about the family need to be shared with the CDPs • It is critical the CDP and CA Social Worker understand the very different roles each have with the family • Talk early and often • Share lapses • Invite providers to meetings