Enhance Collaboration among Medical, Behavioral & Social Services for Mothers with SUDs

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Return to Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy During Opioid Use or ZOOM MAP - Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy during Opioid Use

Overview

Collaborative practice between the dependency court, child welfare, substance use treatment, and other services systems offers a multitude of practical strategies and solutions to improve outcomes for child welfare involved families affected by substance use disorders. Collaborative practice results in a wider realm of resources to address the complex needs of families than is traditionally available through one system. Families present with complex needs that the child welfare system cannot address alone. For instance, children affected by trauma and pre-natal substance exposure often require interventions and treatment, in addition to substance abuse and mental health treatment provided to parents. Emphasis on treatment interventions and supports that focus only on children or parents separately, often result in fragmented and uncoordinated care. Collaborative policies and practices are required to provide access to family-centered interventions that can address the multiple needs of families. Evidence is now emerging that collaborative policy and practice positively influence five core outcomes, or the 5Rs, for families in the child welfare system impacted by substance use disorders [1]:

  • Recovery: Parental recovery from substance use disorders
  • Remain at Home: More children remain in the care of parents
  • Reunification: Increased number and timeliness of parent-child reunification
  • Recidivism: Decreased incidence of repeat maltreatment
  • Re-entry: Decrease in number of children re-entering out-of-home care

see Tools & Resources for training examples

Key Information

In 1997, the Adoption and Safe Families Act (ASFA) was enacted to address child welfare cases that lingered in the court system while parents cycled in and out of treatment. The legislation created a need to find effective responses to substance abuse and maltreatment within families. Five national reports followed addressing the co-occurring issues of parental substance abuse and child abuse and neglect [2]. These reports are:

  • Responding to Alcohol and Other Drug Problems in Child Welfare: Weaving Together Practice and Policy (Child Welfare League of America, 1998)
  • Foster Care: Agencies Face Challenges Securing Stable Homes for Children of Substance Users (U.S. General Accounting Office, September 1998)
  • No Safe Haven: Children of Substance-Abusing Parents (The National Center on Addiction and Substance Abuse at Columbia University, 1999)
  • Healing the Whole Family: A Look at Family Care Programs (Children’s Defense Fund, 1998)
  • Blending Perspectives and Building Common Ground: A Report to Congress on Substance Abuse and Child Protection (Dept. of Health and Human Services, 1999)

Relevant Research

Impactful Federal, State, and Local Policies

Promising Practices

Models of collaborative intervention vary widely in approach. They include innovative strategies such as [3]:

  • Co-location of substance abuse specialists in child welfare offices or dependency courts
  • Family Drug Courts or Dependency Drug Courts
  • Collaborative case management and planning
  • Development of collaborative structures
  • Wraparound services
  • Improved cross-system communication protocols
  • Cross-agency training of staff

Promising Programs

Project Nurture

Project Nurture - Health Share of Oregon
Program Highlights (NUR)

  • Team-based approach to prenatal care that includes prenatal clinician, addictions specialist, mental health support, case management, peer support and parenting resources
  • Clinic and organizational leadership with program accountability and resources
  • Transparent, standardized process for screening and monitoring for substance use and for DHS involvement
  • Strong commitment to a planned, coordinated approach to the inpatient maternity stay, with protocols for pain management, DHS and social work involvement and discharge planning
  • Extended postpartum support lasting a full year, with pediatric care integrated with the mother’s care, ongoing addiction support, and peer support for parenting

Outcomes Being Tracked

  • Pre-term birth rates
  • Cost Savings

Available Tools and Resources

TR - Enhance Collaboration among Medical, Behavioral & Social Services

Sources

  1. ^ https://ncsacw.samhsa.gov/files/Forum_Brief_FINAL_092314_reduced_508.pdf
  2. ^ https://ncsacw.samhsa.gov/files/Forum_Brief_FINAL_092314_reduced_508.pdf
  3. ^ https://ncsacw.samhsa.gov/files/Forum_Brief_FINAL_092314_reduced_508.pdf
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