Developing a Logical Framework and Plan for Conducting your ...

Lessons Learned from Cross
System Strategies in Child
Welfare

Lessons Learned from Cross System
Strategies in Child Welfare
Panelists:
•Nancy Hansen, MSW, DES/DCYF
•Carmen
Preciado, , LCSW, DES/DCYF
•Ron
Carpio, , MSW, TERROS
•Jack Robinson MA, LPC, LISAC , TERROS
•Tracy Stevens, M.A., Westcare Arizona
•Jesus Gonzales , insert, SEABHS
•Grace Diaz, B.A., AzPac

An Overview
of the
AFF Program

Why Did We Start This Work?
Families, Child Welfare, TANF
& Substance Abuse
• Over 10 years, fueled by substance
abuse, the number of abused and
neglected children has doubled:
– 1986 – 1.4 million
– 1997 – more than 3 million
– Eight times greater than the increase in the
children’s s population
• * ”No Safe Haven”,Center on Addiction & Substance Abuse at Columbia University

Adoptions and Safe Families
Act (ASFA)
• ASFA was passed into law by Congress in 1997.
• Congress was concerned over the length of time children
were living in foster care
• ASFA requires that the courts begin the process to
terminate the parental rights of parents who have had
children in foster care for 15 months out of the last 22
months.
• If a parent is in treatment for alcohol or drug abuse, they
might not lose their parental rights if they stay in treatment,
attend all court dates and show a desire/capcity
to be
reunited with their children.

Arizona Senate Bill
1280
• Innovative legislation - SB 1280 created
AZ. Families F.I.R.S.T. (Families in
Recovery Succeeding Together)
• A Steering Committee chaired by the
Governor’s s Office, with representation from
the Legislature, the Judiciary and Child
Advocacy guided ADES & ADHS in the
development and implementation
• Outcome Driven

What would it take
to do this work?
• Partnership between Arizona Departments of
Economic Security and Health Services
• Understanding systemic issues in Child
Welfare, Employment, Substance Abuse &
the Courts
• Statewide change of substance abuse
treatment for families in Child Welfare and
TANF towards Family Centered Practice

Legislative Outcomes
Increase and improve the:
• Availability
• Timeliness
• Accessibility
of Substance Abuse Treatment

Performance Measures
Reduction in:
• Recurrence of child abuse and neglect
• Substance abuse
• # of days in foster care
Increase in:
• Obtaining or maintaining employment
• # of children - permanency

Program
Entry
TANF
CPS
Report
Arizona Families F.I .R.S.T. - SB 1280 Model
Jobs
CPS
Pre-
Screening
Referral
Case
Management
in DES
Jobs
Case
Manager
CPS
Case
Manager
Screening, Service &
Funding Coordination
Outreach,
Engagement
& Screening
Assessment
Collaborative Partners
Supportive Services
• Child Care
• Transportation
• Housing
Substance
Abuse
Education
Out-Patient
Intensive
Out-Patient
Residential
Treatment
Aftercare
Within 24 hours Within 5 working Days
Referral Screening Assessment
Essential Elements
• Outreach & Engagement
•Motivat ional Interviewing & Ret ent ion
•Relapse Ma na gement
•Services for Children (Therapeutic Family Involvement)
•Peer Support, Mentoring or Recovery Coaches
•Gender-Specific Treatment
•Family Focused & Child Centered
• Culturally Responsive & Community Specif ic
Referral to First Therapeutic Service - 14 days

Essential Elements
• Outreach & Engagement
• Motivational Interviewing & Retention
• Relapse Prevention & Management
• Gender-Specific Treatment
• Family Focused & Child Centered
• Culturally Responsive
• Community Specific

Treatment Interventions
• Outreach Engagement/Re
Re-engagement.
• Comprehensive Assessment.
• Outpatient Substance Abuse Treatment.
• Residential Treatment.
• Case Management Services.
• Supportive Services.
• Aftercare Services.

Community Specific Best Practice
Strategies
• TERROS – Co Location
• Westcare – Sober Living Environments
• SEABHS – Integrated Family Teams
• AzPac – Drug Court

TERROS, Inc.
Families F.I.R.S.T. Co-location
Project
Ron Carpio, , MSW
Jack Robinson MA, LPC, LISAC

Project History
• Idea was presented in 2000
• Challenge to sell to both parties
• Team had experienced an unsuccessful
attempt
• Challenged by “Urban Legends”

Urban Legends
• Clients will not come for services
• Clients will be intimidated by CPS workers
• Clients will not see treatment providers as
separate from CPS
• CPS will interrupt and distract clients
• FF team building will be compromised.
• Reduces staff’s s availability to provide client
services
• Client confidentiality will be compromised

Implementation Process
• Established a co-location workgroup
• Workgroup met monthly
• Established pilot site
• Worked out the “bugs”
• Established next site
• Developed co-location process

Project Overview
• TERROS staff is co-located at 9 CPS sites
• Provide SA expertise at TDM meetings
• Improve coordination and communication
• Forum to educate CPS staff on addiction and
addiction treatment.
• Forum to educate FF staff on CPS responsibilities
and philosophy.
• Increase opportunities to engage families at the
CPS offices

Families F.I.R.S.T. Co-Location
Sites
• DCYF District Office
• 4000 North Central
Ave
• Glendale
• Thunderbird
• Gilbert
• Avondale
• Tempe
• South Mountain
• Talavi

SOBER HOUSING
WestCare Arizona
Tracy Stevens, M.A.
Area Director
Westcare Arizona

RURAL AREA
• The sober living houses are located in
Bullhead City, Arizona.
• We are a desert area with extremely
high temperatures.
• We provide services to clients in
Mohave and La Paz Counties which is
approximately a 500 square mile area.

WHY IS IT A PROGRAM NEED
• There are no Substance Abuse Residential
facilities for people seeking treatment in Mohave
or La Paz Counties.
• Our 12 step community is very small.
• There are a limited number of outpatient
substance abuse treatment providers in either
County.
• Most clients in this area are on AHCCCS and
there is only one AHCCCS provider throughout
Mohave County and only a couple in La Paz
County.

HOW IT WORKS
• Blossom House is a 90 day to 6 month program for women
(children).
• Emery House is 6 month program for men.
• Highly structured and peer motivated.
• Attendance at 12 step meetings daily.
• Attendance at gender specific house meetings weekly.
• Chores and curfews.
• Resume and job search guidance.
• Individual counseling available.
• Substance abuse and domestic violence counseling
provided at no cost.

HOW IT WORKS
• Random UA testing.
• Bus tickets provided.
• Vouchers for WestCare Thrift Store
provided.
• All household supplies, linens, dishes, etc…
provided.
• Staple foods provided.
• Therapeutic environment.
• Client’s s are required to seek and maintain
employment.

BLOSSOM HOUSE

EMERY HOUSE

CHALLENGES
• Clients often do not have the funds to
pay for 1 st weeks rent.
• Limited public transportation system.
• Client’s s have minimal education.
• Client’s s have very little prior work
experience.
• Due to criminal history, most client’s
can only obtain employment at fast
food restaurants.

CHALLENGES
• The areas largest employers are the
casinos. Many any client’s s are on
probation and this makes getting
fingerprint clearance almost
impossible.
• Since the houses are located in
Bullhead City, most clients do not want
to relocate to be in a sober
environment.

SUCCESSES
• Blossom House served 51 clients in
2006. Approximately 35% (17) are still
sober today.
• Emery House served 65 clients in
2006. Approximately 25% (16) are still
sober today.
• 8 women gave birth during their stay at
Blossom House to Substance Free
babies.

SUCCESSES
• 75% of women were employed at the time of
completion/discharge from Blossom House.
• 85% of men were employed at the time of
completion/discharge from Emery House.
• United Way has provided scholarship money to
help clients pay for first weeks rent.
• Developed excellent relationships with community
collaborators due to the success at both Emery
and Blossom House.

SEABHS
Integrated
Family Team Process
Jesus Gonzales
“Integrating Child and Adult services”
Revised 6/30/07

Integration of Child and Adult Services
Through integration of the AZ Vision and 12
Principles and the Principles of Person
Centered Planning, SEABHS developed an
integrated approach to serving families
where the process is the same for everyone
regardless of age, referral source, or focus
of treatment.

Complex Needs Families
Many of the families served by SEABHS have
both parents and children enrolled in behavioral
health services.
These are often complex needs families with
involvement in multiple state agencies including
Child Protective Services (CPS), Adult or
Juvenile Probation, Department of Corrections,
etc.
Traditional approaches to treatment have been
unsuccessful for these families.

MCAS - Pregnant and post-partum partum substance
abusing women. Services will be for the
mother and the at risk child(ren).
Arizona Families FIRST - Families involved in
CPS as a result of substance abuse issues.
Both MCAS and AFF populations are complex
needs families and include referrals through
the Arizona Families First program.

Coordination: Enrolled Parent and Child
• Integrated services for the family
• Single Family Team, including common members
and client-specific members
• Individualized service plan with
common family objectives as well
as individualized objectives
• Common FT meeting with separate
individual meetings as needed

SEABHS
SUCCESS
STORY

CHALLENGES

Drug Court
Grace Diaz, B.A.
AzFF Program Coordinator
Catholic Charities

Overview of Family Drug Court
• History: Drug
Court began in
February 1999 in
Prescott
• Purpose
• Participants
• Requirements

AFF Involvement
• Collaboration with FDC started in Jan 2001
• All FDC clients since 2001, have been AFF
clients
• Numbers: 166 as of 12/2006.
• Facilitation of treatment services
• Re-engagement
engagement

Participation in the drug court
staffing
• Comprehensive update to
the Judge
• Drug screening results
• Participation in treatment
• Client’s s progress across
multiple services
• Problem solve with other
team members around
specific issues

Provision of supportive services
• Facilitating acceptance into a halfway house
• Transportation assistance to treatment related
services.
• Assisting with purchase of drug screening
• Gender specific family counseling
• Aftercare services to benefit reunification

Benefits to Clients
Incentives
• Praise from the judge
• One on one dialogue with the Judge at each Court visit
• Positive reinforcement
• Reduction of community service time
• Progression through the phases
• Decrease in drug screen
• Decrease in court appearances
• Feeling of success
Graduation rate 42%

Consequences/Sanctions
• Warning from the Judge
• Increase in 12-Step meetings
• Additional community Service hour
• Jail time
• Increase in drug screens
• Increase in Court appearance
• Return to previous phase
• Change in probation status
• Termination from program and incarceration
• Filing of a petition to sever parental rights

Upon successful completion and graduation
participants may at that time benefit from:
• Family reunification
• Completion of drug treatment
• Dismissal of charges
• Honorable discharge from probation
• Employment
• Clean and sober lifestyle
• Development of pro-social network

Outcomes
• Drug Free babies
born since
inception of
program
• Children reunified
• Development of
healthy, sober,
friendships
• Creation of support
systems.

Best practice
approaches
contribute to
positive
outcomes for
children and
families!

New AFF Referrals
n = 4,727
SFY 2006
Referral Outreach
n = 4665
97% of new referrals
Individuals Accepting Services
n = 4,272
90% of new referrals
Individuals Assessed
n =3,171
67% of new referrals
New AFF Clients
n = 2,902
72% of total AFF clients
Coninuing AFF Clients
n = 1,112
28% of total AFF clients
Total AFF Clients
n = 4,014

Timeliness, Availability, and
Accessibility of Services
• More than 16,400 individuals referred
to the program in five years
• Over 90% were contacted through
outreach and engagement in five
years
• Rapid contact within a day or two
• Nearly 70% received a substance
abuse assessment
• Coordinated and comprehensive
array of services

Alcohol and Drug Problems
(2006)
• Over 50% of AFF clients reported using
alcohol or illegal substances in the 30
days prior to assessment
• Most common substances used:
– Methamphetamines – 29%
– Alcohol – 26%
– Marijuana – 24%
– Cocaine/crack – 8%
• Polysubstance use – 62%

• Over 60% of client program closures (n =
1605) demonstrated no drug use at all
during their participation in the program,
as verified by drug screenings.

Child Safety and Reduction
of Child Abuse and Neglect
• Children of AFF caregivers experienced less
subsequent neglect and abuse compared to
state averages.
– Out of 4,014 AFF clients, only 2% received a
“substantiated” report finding based on one or
more allegations filed subsequent to their
enrollment in the AFF program.
– Overall rate reported nationally for an 11-month
period was 8% (Fluke et al, 2005).

Permanency for Children
Through Reunification
• Children of AFF caregivers achieved
permanency at rates that exceeded
the state average.
– Over 900 children of AFF
caregivers achieved permanency
this year.
– 68% of AFF children reunified.
– 51% overall reunification rate
reported by CPS for the period
ending March 31, 2005.

In Summary
• During the course state fiscal year 2006,
4,014 individuals reported to Child Protective
Services for neglect or abuse of their
children, and known to have ongoing issues
related to the use of alcohol and drugs, have
been served by this innovative program.

• In 2006, more than 650 children have been
returned to the custody of their parents without
a recurrence of suspected neglect or abuse.
• Parents have experienced success in
addressing their substance use problems.
• More than 60% of clients who completed their
participation in AFF services demonstrated no
drug use at all during their participation in the
program, as verified by drug tests.

• Families have been able to access a
seamless network of treatment services and
supports designed to promote ongoing
recovery and family stability.

Conclusions
Special design of this program facilitates:
• Engagement of a hard to reach population
• Bridging systems to enhance client outcomes
• Integrating best practices to meet community
need

Questions
and
Answers

For More Information
• Aimee Amado –
DES/DCYF
AAmado@azdes.gov
• Carmen Preciado -
DES/DCYF
CPreciado@azdes.gov
• Ron Carpio or
Jack Robinson - TERROS
Ronc@terros.org
jackr@terros.org

For More Information
• Kristi Johnson – Westcare Arizona
kristi.johnson@westcare.com
• Grace Diaz – AzPac/ / Catholic
Charities
GDiaz@cc-az.org
az.org
• Jesus Gonzales or Dan Barden –
SEABHS
JesusGonzales@seabhssolutions.org
Dbarden@seabhssolutions.org