Arizona Families F.I.R.S.T: Engaging Clients Dually-Involved with Child Welfare Services and Treatment of Substance Use Disorders July 16, 2014 Summer Institute 2014 Center for Applied Behavioral Health Policy
Introduction and Agenda Presenters AFF Co-Investigator: Natasha Mendoza, PhD, LMSW Project Coordinator: Marisol Cortez, MSW Session Learning Objectives AFF – Arizona Families F .I.R.S.T . Research and Target Population Client Engagement Trauma-informed and Motivational Approaches
Session Learning Objectives Participants will be introduced to Arizona Families First programming 1. and be able to articulate its service provision. Participants will be able to cite current empirical evidence related to 2. families involved in both child welfare and substance abuse service systems. Participants will be given strategies for client engagement (i.e., 3. trauma-informed and motivational) in settings addressing substance use disorders with child-welfare involved adult caregivers.
AFF - Arizona Families F.I.R.S.T.
Arizona State Legislature In response to increased involvement of children in Arizona’s welfare system, Arizona legislature passed Senate Bill 1280 in the 2000 Legislative Session which created the Substance Abuse Treatment Fund Partnership. Today it is known as Arizona Revised Statute (ARS) 8-881.
What is AFF? Founded in 2001 Partnership result between Arizona Department of Economic Security (ADES) and the Division of Behavioral Health Services (DBHS) Program Goals Child safety 1. Accessibility to services for guardians/parents with 2. substance use disorder referred in the child welfare system Substance use disorder recovery for guardians/parents 3. Permanency through reunification 4. Guardians/parents self-sufficiency through employment 5.
Involvement in AFF Guardians/parents are referred by Child Protective Services to AFF service providers: TERROS SEABHS AZPAC Northern Referral basis: CPS report indicating child unsafety/maltreatment etc. Indication of substance use disorder
Service Providers Currently there are three AFF providers (TERROS, SEABHS and AZPAC Northern) as agencies providing services statewide except on tribal reservations. TERROS o TERROS Central: East Maricopa County and Pinal County o TERROS Southwest: West Maricopa County, La Paz and Yuma o TERROS Pima: Pima County SEABHS: Southeastern regions including Gila, Greenlee, Cochise, Graham, and Santa Cruz AZPAC Northern: Mohave, Yavapai, Coconino, Navajo and Apache
Five Servicing Regions
Child Protective Services and Substance Use Disorder Treatment According to the NSDUH, among women of childrearing age (18-49) who needed substance use treatment, only 10.4% received it. As a result, it is often the case that clients served by Child Protective Services and treatment agencies overlap.
Child Protective Services and Substance Use Disorder Treatment According to research, it’s important that Substance Use Disorder (SUD) support services aimed at improving treatment outcomes for individuals with SUD include; Case Management Services Twelve-Step Models Recovery Mentor Advocate Programs Abstinence Monitoring
ASU – Center for Applied Behavioral Health Policy: AFF Evaluating Agency Provides program monitoring Collects and analyze client-level data to produce quarterly and annual reports Technical support for data collection using Data Gateway Evaluating agency since 2006
Research and Target Population
What is Substance Use? In the most recent version of the DSM-5 substance abuse and dependency have been combined into one single disorder (APA, 2013). Prior to the DSM-5, each were classified individually. Abuse: improper use of substance and overuse. Dependence: habit-forming, reliance and feeling the need to use the substance.
Why People Become Addicted There is no one theory or explanation about why people become addicted. Factors contributing to addiction: Biological and genetic predisposition have been said to account for 40-60% of risk addiction Social environment and upbringing such as exposure to substance use Risk can also be affected by ethnicity, gender and developmental stage Nature and nurture contribute to vulnerability or resiliency to substance abuse.
Substance Use and Parenthood According to a national survey Age Range Percentage in 2007, 8.3 million children 0-2 years 13.9% lived with at least one parent who abused or was dependent 3-5 years 13.6% on alcohol or an illicit drug 6-11 years 12.0% (Office on Child Abuse and 12-17 years 9.9% Neglect, 2009).
Substance Abuse and Parenthood cont. According to the Office on Child Abuse and Neglect (2009), Children of parents with substance use problems are at higher risk of abuse and neglect. likelier to experience physical, academic, social, and emotional problems. three times likelier to be involved in substance use them selves later in life. https://www.youtube.com/watch?v=n5XakEKSIaM
Client Engagement A Motivational and Trauma-Informed Approach
Overview What this presentation is NOT …and what it IS Trauma-Informed Approach Motivational Enhancement Skill Development
Introductions Who am I? Who are you? Trauma-informed? Motivational Interventions?
What this Presentation is NOT NOT therapeutic training NOT a therapeutic intervention What this Presentation IS A way to diminish client resistance Enhance treatment engagement
Trauma-Informed Approach Changes the question from… “What’s wrong with you?” to “What happened to you?”
Trauma-Informed Approach “When a human service program takes the step to become trauma-informed, every part of its organization, management, and service delivery system is assessed and potentially modified to include a basic understanding of how trauma affects the life of an individual seeking services. Trauma-informed organizations, programs, and services are based on an understanding of the vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that these services and programs can be more supportive and avoid re- traumatization.” - The National Center for Trauma Informed Care
What is Trauma Trauma is the “direct personal experience“ of an event involving: actual or threatened death serious injury other threat to one’s physical integrity Trauma is “witnessing” an event that involves the above 3 factors as related to another person. Trauma is “learning about unexpected or violent” death, injury, or threat thereof as experienced by a significant other. Trauma can be: A single event A connected series of events Chronic lasting stress “…In short, trauma is the sum of the event, the experience, and the effect.” SAMHSA
Trauma “Individual trauma occurs in a context of community, whether the community is defined geographically as in neighborhoods; virtually as in a shared identity, ethnicity, or experience; or organizationally, as in a place of work, learning, or worship.” – SAMHSA, 2012
Trauma Triggers Triggers Seeing, feeling, hearing, smelling something that reminds us of past trauma Activate the alarm system The response is as if there is current danger Thinking brain shuts off in the face of trigger... It’s time to survive Past and present danger become confused
Triggers What triggers you? …to become angry, fearful, worried, or stressed? What triggers clients? …to become angry, fearful, worried, or stressed?
“ What makes you feel scared or upset or angry and could cause you to go into crisis?” Not being listened to Lack of privacy Feeling lonely Darkness Being teased or picked on Feeling pressured People yelling Arguments Being isolated Being touched Loud noises Not having control Being stared at Room checks Contact with family Time of year/time of day Clients have unique histories with uniquely specific triggers – it’s essential to ask & incorporate triggers in to treatment
Trauma-informed Staff Responsiveness Greet everyone as if they have a trauma history. Be knowledgeable about potential triggers and adjust your body language and voice accordingly. Understand that everyone is subject to their own reality which is different from yours.
Using Motivational Enhancement
Beliefs About Motivation (True or False?) Until a person is motivated to change, there is not much 1. we can do. It usually takes a significant crisis (“hitting bottom”) to 2. motivate a person to change. Motivation is influenced by human connections. 3. Resistance to change arises from deep-seated defense 4. mechanisms.
Beliefs About Motivation (True or False?) People choose whether or not they will change. 5. Readiness for change involves a balancing of “pros” and 6. “cons.” Creating motivation for change usually requires 7. confrontation. Denial is not a client problem, it is a therapist skill 8. problem.
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