INTRODUCTION AND PURPOSE

The Division of State and Community Assistance of the Center for Substance Abuse Treatment (CSAT), in conjunction with the Administration on Children, Youth and Families (ACYF), held a two-day state team-building workshop August 7 and 8, 2001, in San Francisco, California. The workshop was titled, Protecting Children: Substance Abuse and Child Welfare Working Together. This was the third of four CSAT/ACYF meetings to be held on this topic in 2001. These workshops are designed to help build the State infrastructure necessary to bring about coordinated delivery of care for children in the child welfare system and their parents in substance abuse treatment.

The Federal sponsors invited States to send teams of six individuals representing single State alcohol and other drug agencies, State child welfare agencies, members of the judiciary, and other agencies and individuals involved with families, including foster care, TANF, Medicaid, advocacy groups, and consumers. Team members completed a Collaborative Values Inventory prior to attending the workshop, which was designed to help them start thinking about the values and principles they share and those on which they need work to reach consensus.

In addition to their work in values clarification and State team-building, workshop attendees heard presentations on such topics as the Adoption and Safe Families Act (ASFA), family drug courts, and successful approaches to collaborative work. They attended concurrent working sessions on confidentiality; interdisciplinary training; working with the judicial system; methamphetamine use and production and its effects on children and youth; safety and resilience of children in substance abusing families; and recognizing and understanding issues for women with co-occurring disorders and their children. The agenda for this workshop evolved from a national planning meeting held in Bethesda, MD, in November 2000.

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Tuesday, August 7

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WELCOME

H Richard (Rick) Sampson, Director
Division of State and Community Assistance
Center for Substance Abuse Treatment
Substance Abuse and Mental Health Services Administration
This is the third in a series of workshops focused on improving the interaction between the child welfare and substance abuse treatment and prevention fields. The fact you responded to our invitation so promptly speaks to a growing awareness of our moral imperative as healers to help families heal. In planning meetings and discussions with you, you told us that your number one need was the opportunity for both systems to come together to examine your respective values and beliefs and how those attitudes affect the way you work together. That's what we're here to do.

We tell you that you should collaborate at the State and local level, so why not us? For the past several years, CSAT and ACYF have been working together to build relationships. We have an important mission, and we're pleased and honored that you have joined us.

Sharon Fujii
Pacific Hub Director
Administration for Children and Families
We're pleased that you are here. The issues affecting children in the child welfare system are affected by their parents' substance abuse problems. They are not disconnected, and we must look at both if we're going to deal with these families effectively. Typically, we handle crises, but early intervention and prevention are key.

Families don't encounter problems in discrete categories, as our funding is designed. We need to take a holistic approach that focuses on the best interests of our customers.

Collaboration is not easy, especially at the Federal level, but we hope to facilitate and promote opportunities to collaborate and problem-solve. We want to work with you to find better solutions for children and their families.

The mandate within the U.S. Department of Health and Human Services is to create "one department," through interagency collaboration, that best meets the needs of the people we are here to serve. We've seen the results and the benefits of such efforts, and we know it can make a difference.

Emory M. Lee
Acting Regional Director, Region IX
U.S. Department of Health and Human Services
Greetings from Secretary of Health and Human Services Tommy Thompson. Assuring the well-being of vulnerable children is a priority for Secretary Thompson, and collaboration is a directive from his office. We have a great deal of need and scarce resources, so we have to restructure how we do business. His directive is to create "one department," something we are emphasizing in Region IX.

The Administration's management reforms call for creating agencies that are citizen-centered, results-oriented, and market-based. Business as usual is not acceptable. Ultimately, the collaborative efforts of the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Administration for Children and Families (ACF) are designed to provide better services to the public.

Kathryn Jett, Director
California Department of Alcohol and Drug Programs
Welcome. In my many years in public service-including public health, women's health, crime prevention, and substance abuse prevention-I realized that what it all comes down to is a family, and how the children in that family are treated. We have to foster collaboration to support the right of children to grow up in healthy families.

The collaboration is perhaps most important between the child welfare and substance abuse treatment systems. We need cross-training and shared risk assessments and data. We can make tremendous progress if we focus on who the client is and what are our values. We're delighted to host this meeting and look forward to partnering with our colleagues in social services. We're here to capitalize on the opportunities this workshop offers.

Wesley Beers
Acting Branch Chief, Children's Services
California Department of Social Services
Welcome to this third in a series of four workshops. We've worked together with the substance abuse treatment system on some pilot projects that reveal various barriers and successes. But these changes are not adopted system-wide. AFSA creates new challenges with its mandates for child safety, permanency, and well-being. We're going to be measured by outcomes, a discussion that is long overdue, but we can't meet these indicators if we're running a crisis-based system.

In California, we have 600,000 referrals to child welfare that don't rise the level of opening a case. We have to push backward into prevention and intervention so we can reach these families before a crisis occurs.

Because of this workshop, we have a unique opportunity to begin systems change and bring these ideas to reality. We can't speed up treatment, but we can intervene earlier to avoid crises. We have to move from pilot projects to full-scale successes.

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GENERAL SESSIONS

Adoption and Safe Families Act: Foundations for Collaboration
H Richard (Rick) Sampson
Thank you for helping me keep my word to some foster children in a therapeutic foster care program I ran in North Virginia. I promised I would always be their advocate.

We have to be careful about labeling kids who act out and get in trouble. If you scratch below the surface, you discover it's all about family. These kids are victims, but they are also incredible, remarkable children who have much to contribute. It takes time and effort to bring families together.

Collaboration is easy when resources are plentiful, but scarce resources lead to conflict and blame. Ten to 12 States will see a decrease in their substance abuse treatment budgets in the coming year. Eighteen budgets will be flat, and the rest will see a conservative increase. Nationally, we're only serving 35 percent of the individuals in need of publicly funded substance abuse treatment. One State here is only meeting 17 percent of need.

The lines at our doors are huge, and the resources aren't there. We need to collaborate with everyone, including the criminal justice and mental health systems and a host of specialized services. The child welfare system is seeing increasing caseloads and referrals, and the foster care system is overburdened. We see young mothers addicted to crack. We know they love their children, but they are overwhelmed by drugs. These are the issues that tear families apart.

We need to share what brings us together and solve what keeps us apart. It's not about us. It's about kids and bringing healing to people in need.

Irene Bocella, M.S.W.
Child Welfare Program Specialist
Office of Child Abuse and Neglect
Administration on Children, Youth and Families
Administration for Children and Families
AFSA required the Secretary of Health and Human Services to prepare a report to Congress on substance abuse and child protection. Published April 1, 1999, the report is titled Blending Perspectives and Building Common Ground. This report provides the context for what we are doing here. It includes information on the extent and scope of the problem, effective service delivery approaches, and recommendations for next steps.

The number one recommendation is to build collaborative working relationships between the child welfare and substance abuse treatment systems. In line with this recommendation, CSAT and ACYF have a three-year interagency agreement to share resources to produce publications and co-sponsor meetings such as this, among other activities. This is the third of four workshops, and the previous two have been very productive and substantive. You deal with these problems on a daily basis, and we need to know how to help you. Thank you for joining us.

Values Clarification: Building Toward a Joint Mission
Nancy K. Young, Ph.D., Director
Children and Family Futures
Irvine, CA
Fifty-three meeting participants responded to a pre-workshop questionnaire called the Collaborative Values Inventory. The survey was designed to help the child welfare and substance abuse treatment systems 1) clarify the underlying values in collaborative work; 2) develop common principles and goals; and 3) uncover differences in values that may impede cross-system collaboration. Often, differences in basic values and beliefs are the cause of the problem when even seemingly successful collaborations hit a roadblock. These differences can't be dismissed; they must be identified and discussed.

The survey provides State teams the opportunity to begin a discussion about some key questions, including: 1) What do we believe together? and 2) What don't we agree on? It also allows them to compare their individual State responses to the regional responses as a whole.

Individuals who completed the survey represent alcohol and other drug services (19); children's services (22); dependency/family court personnel (5); Medicaid providers (2); and others (5). There was strong agreement among these respondents in some areas.

For example, 51 of 53 respondents agreed that solving the problems caused by alcohol and other drug use would improve the lives of a significant number of children, families, and others in need. A majority of respondents (61 percent) also agreed that alcohol and other drug providers should prioritize women from the child welfare system as their most important clients to receive services.

However, some interesting differences emerged, which can help pinpoint important areas States need to discuss. For example, 66 percent of respondents overall, and 80 percent of alcohol and other drug providers, disagreed with the statement that "illegal drugs are a bigger problem in our State than use and abuse of alcohol." However, 60 percent of court respondents agreed that illegal drugs are a bigger problem than alcohol. This is an important issue. Do we treat parents who have methamphetamine problems the same as we treat persons with alcohol problems? Are there clinical issues and child and family risk issues that are different for different substances?

Other areas without clear agreement include whether or not a parent who abuses alcohol or other drugs can be an effective parent. Court respondents overwhelmingly disagreed with the statement that "there is no way that a parent who abuses alcohol or other drugs can be an effective parent." However, alcohol and other drug providers and child welfare respondents were more evenly split in their opinions on this issue.

The various systems also had divergent views on the usefulness of urine screens for determining a parent's readiness to retain or regain custody of his/her children (court respondents find them useful), and whether allowing more services to be delivered by for-profit agencies would improve the effectiveness of services. Though 78 percent of respondents believe that services should not be delivered by for-profit agencies, 100 percent of alcohol and other drug providers believe that non-profit agencies would be more accountable. Because the privatization of child welfare systems and the implementation of Medicaid managed care are key issues in many communities, you need to be aware of how your alcohol and other drug agencies view this issue if you are planning to contract with for-profit treatment providers.

A majority of respondents (71 percent) agreed that requiring all clients, regardless of income, to make some kind of payment for services would improve the effectiveness of services. Court respondents were 100 percent in agreement with this concept.

More than half (60 percent) of all respondents agreed with the statement that "the most important causes of the problems of children and families cannot be addressed by government; they need to addressed within the family and by non-governmental organizations such as churches, neighborhood organizations, and self-help groups." But respondents from agencies other than those in the alcohol and drug and child welfare systems overwhelmingly agreed. Community groups may have a stronger belief in the ability of non-governmental agencies to address these issues.

Interestingly, alcohol and drug respondents did not agree that people in recovery from substance abuse are the most effective counselors to work with their peers, but a majority of child welfare respondents agreed with this idea. This response is counter to conventional thinking. If there is disagreement among respondents, what impact might this have on program policy?

Overall, nearly three-quarters (71%) of respondents disagree that confidentiality of client records is the most important barrier that keeps alcohol and other drug providers and child welfare agencies from working together. One hundred percent of alcohol and other drug providers and court respondents disagreed that confidentiality is the key barrier, but child welfare respondents were evenly split on this issue. A majority of respondents in both systems believe that most parents will be successful in alcohol and drug treatment and in family services.

Using the survey results, states can work together to discover what issues are important to them and how those issues play out in the ways they work together. Finally, they can ground these principles in reality by relating them to the three primary daily practice activities that take place between the two systems: 1) intake, screening and assessment; 2) engagement and retention in care; and 3) the provision of services to children.

Judicial Decisions: The Eyes of the Child
The Honorable William R. Byars, Jr.
Children's Law Office
University of South Carolina
I'm going to talk about issues that are near and dear to my heart. But this wasn't always the case.

When I became a judge in South Carolina, I consulted with other judges about how they handled child welfare cases. They told me what they were told by the judges who were there when they came to the bench. There was a tendency to continue doing things the old way even in cases where the reasons for doing so were lost in time. I continued operating the way other judges told me to until I realized that the system was not working.

Before the Adoption and Safe Families Act (ASFA) was enacted, we had 500,00 children in foster care, 100,00 of whom were not going to permanent homes. In addition, our child protection system had become, in effect, a parent protection system. When the child got hurt we did not treat the child, we treated the parent. In 40 percent of cases, according to national statistics, the only service the child received was an assessment. We put our resources into treating the parents and put the children in foster care. They were raised there until they became juvenile delinquents. Then we spent a lot of money locking them up. That was the history of our system.

Children were not going back to their mothers; they were remaining in limbo. I also realized that a great many families who wanted to adopt children were going to other countries because we had our own children locked away. I felt that it was the fault of the child welfare system, which just needed to follow the directions of the court. When the Kellogg Foundation invited me to Kalamazoo, MI, to discuss some new ideas in this area, I didn't realize the meeting would change my life.

I learned that in order to reform the system, we must first have a paradigm shift. I also observed the level of caring this community has for children. They not only took children into their homes, they took children into their families. They adopted kids. I saw a commitment, a "fire-in-the belly" that I envied.

I returned to South Carolina and started to think about a paradigm shift and how to apply it to real cases with real kids who have real problems. More specifically, how does a paradigm shift apply to the court room and how does it apply to abused and neglected kids? We have to view the child welfare system through a child's eyes. Let me give you an example. Think about time through a child's eyes. When a judge continues a case for 90 days, that may be considered a short period of time for the law, but it may seem like forever to a child who is not living at home. We view the system through the eyes of a judge, or a lawyer, or a social worker, but the correct way to view the system is through the eyes of a child.

Children also know fear and helplessness. Ninety percent of the cases we see have substance abuse behind them, and often the child doesn't know who is coming through the door or what aspect of that parent they will encounter. They often do not know who will be there or who will make decisions about their lives. These children really feel powerless and are full of fear.

For 20 years we knew that the South Carolina system was broken, but we didn't know how to fix it. We had been to the state legislature many times but nothing seemed to happen. Every time legislation would come up, members of each profession involved in the child welfare system would argue to change the bill to make it better for their profession. Nothing got done, and legislators were confused.

Several years ago we decided to meet to resolve this issue. The process required several months of meeting to take the system apart and put it back together. These meetings are not easy, but if the system needs to be changed, we have to include everyone. We can't have change without a unifying vision, and that vision must be through the eyes of a child.

What are some of the fact that we know about substance abuse? We know most prisoners in jail have a substance abuse problem and that 50 to 80 percent have been abused. We believe that most of the mothers who abuse kids have a substance abuse problem. Confidentiality regulations often become a barrier to treating mothers in the child welfare system and hurt the people that they were intended to protect. We must follow the law but also work to change it when it is not accomplishing its intent.

We know that children of parents who abuse substances are more likely to abuse substances themselves, so we must began treating children through prevention. We spend most of our monies on the perpetrators, and we must not leave the children out of the loop.

Alcohol and drug abuse professionals belong in the court room. They should not abrogate their responsibility to others to develop the treatment plans. We need to have someone who knows the system initiate the call to the treatment program. If we continue to do the same things, nothing will change.

In the past family courts were concerned with two components-legal services and social welfare services. We now view the system as having three components, much like a three-legged stool. The legs of the stool are legal services, social welfare services, and now substance abuse services. All three legs of the stool must be present.

It doesn't take more money to change the system, it takes passion. We need to convene meetings of like-minded persons and, above all, see things through the eyes of a child.

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Wednesday, August 8

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SUCCESSFUL APPROACHES/BEST PRACTICES

Connecticut: Retention of Women in Treatment
Thomas Gilman, J.D.
Deputy Commissioner
Connecticut Department of Children and Families
Project SAFE began in 1995 after three infant deaths in three months. Substance abuse was involved in each case, but the parents had not been screened. Project SAFE is a program for evaluation and treatment of alcohol and other drug dependency among parents in the child welfare system. The program is a collaboration among the State Department of Children and Families (DCF), the State Department of Mental Health and Addiction Services (DMHAS), and Advanced Behavioral Health (ABH), a network of nonprofit behavioral health providers.

Project SAFE services include a statewide centralized intake through a toll-free number. This gives DCF social workers priority access to ABH providers for drug screens, substance abuse evaluations, and a variety of outpatient substance abuse treatment services. The program also uses centralized data reports and electronic billing. The ABH provider network manages the quality of care.

As part of Phase I, Project SAFE staff created a specialized screening tool that includes information about both substance abuse and child welfare issues, and developed specific consent forms. DCF hired substance abuse specialists-licensed clinical social workers who are also certified alcoholism counselors-to serve as consultants, trainers, and provide some direct services to families.

The strengths of Phase I included: 1) a direct link between child welfare and substance abuse treatment; 2) priority access to substance abuse services for child welfare clients; 3) the simplicity of the system for child protective services workers; 4) the use of standardized clinical summaries and preferred practices; 5) a centralized data collection system; and 6) the development of DCF supportive housing for recovering families.

The limits of Phase I included: 1) limited collaboration between DCF and DMHAS, despite serving joint clients; 2) low rates of engagement and retention in treatment; 3) poor client outcomes; 4) a behavioral health approach narrowly focused on addiction; and 5) different values and priorities between the two systems.

Phase II includes a focus on improved outcomes for women, children, and families. Focus groups of clients and providers indicated that success with this population is based on the following: 1) respect and empathy toward the client; 2) direct and clear communication: 3) ongoing motivation and engagement; and 4) good relationships among child protective services staff and substance abuse treatment providers. Nancy Young of Children and Family Futures helped the State develop a strategic plan for the DCF/DMHAS collaboration.

The Phase II Project SAFE program serves between 5,000 and 6,000 unduplicated clients a year. Eighty-four percent of these parents are referred by DCF social workers because of allegations of substance abuse in the child protective services report. Alcohol is the most significant problem substance for men (80 percent), and cocaine is the most significant problem substance for women (60 percent). Cocaine use by women in the child welfare system is disproportionately higher than it is in the adult treatment system as a whole.

Judith Ford, M.A., M.F.T.
Director of Women's Behavioral Health and Trauma
Connecticut Department of Mental Health and Addiction Services
Most women served by Project SAFE are ages 18 to 35. Fifty percent are Caucasian, and the balance are African American and Latina. They are in low paying jobs, with many on welfare, and they have co-occurring trauma, depression, and other anxiety disorders. They also experience significant social stressors, including their involvement with child protective services, current violence, and homelessness or risk of homelessness.

All of these women are mothers, but that fact is not being addressed in substance abuse treatment. Our culture places a high value on the maternal role, and a mother is evaluated as a person by her success in this role. It is difficult for women to discuss their ambivalence about their roles as mothers. Most treatment programs stress a woman's role as a parent to provide for the physical needs of her children, and her very involvement in the child welfare system implies she has been a failure in this role. Fear of losing her children is a negative incentive. Few treatment programs address issues of emotional attachment and nurturing that allow a woman to discuss her feelings about her child and give her a positive incentive to stay in treatment.

To help women and their children heal, Project SAFE Phase II services include the following:

• Outreach and engagement. Outreach workers help women meet immediate survival needs and build on their strengths.
• On-site child care. Having their children with them makes mothers feel more comfortable, and it allows substance abuse treatment providers to see how families interact.
• On-site parenting support. On-site parenting groups provide mothers with education and support in the context of their substance abuse treatment.
• Trauma education and treatment. Trauma services include assessment, a three-session education model, and trauma-sensitive treatment.
• Comprehensive substance abuse evaluations. Project SAFE is field testing a family-focused substance abuse evaluation that includes a trauma screen, as well as information about anxiety and mental health and motivation to change.

Much of the hard work of coordination and collaboration takes place at the local level. Statewide, the Department of Mental Health and Addiction Services and the Department of Children and Families partnership is based on: 1) designated leadership and project responsibility; 2) joint program planning and evaluation; 3) regional service team meetings; 4) cross-training forums; 5) co-contracting; and 6) resource development and shared funding. The development of personal relationships and agreement on objectives also are key.

Sacramento County's Experience: Trials, Tribulations, and Triumphs
Toni Moore, M.P.A., L.C.S.W.
Alcohol and Drug Services Administrator
Sacramento County Department of Health and Human Services
Sacramento County has made several significant changes in alcohol and other drug treatment and child welfare services since the mid 1990s, and each time we have learned that you have to implement change in "baby steps." Most people and systems don't want wholesale changes; we've discovered that incremental changes work better.

Alcohol and Other Drug Treatment Initiative. The first major change was the Alcohol and Other Drug Treatment Initiative (AODTI) in 1994. Our vision was to incorporate alcohol and other drug treatment services as an integral part of the health and human services delivery system and to build and expand service capacity. This effort was predicated on four key premises:

• Health, social service, and criminal justice caseloads are driven by alcohol and other drug abuse.
• Current treatment capacity can meet less than 25 percent of demand.
• Agency staff can serve as the first line of defense.
• Both the client and the system need to be held accountable.

Further, we recognized that a risk assessment for the child is incomplete without an AOD assessment of the parent. As a result of this initiative, child welfare clients received priority for AOD treatment, and we expanded our interim and group services to help achieve treatment on demand. Child welfare social workers served as AOD group co-facilitators to help bridge service gaps. Our child welfare agencies offered a 16-week parent education class, co-facilitated with substance abuse and mental health treatment staff. This doesn't replace the need for treatment but helps motivate people who are not ready to take that step.

We offered three levels of training on AOD treatment, and nearly all our child welfare workers completed level two. We also had to help our AOD providers fall in line with the various time clocks affecting families, including TANF and ASFA. Unfortunately, after two child deaths, our community adopted a zero tolerance attitude toward substance abuse, which overwhelmed the child welfare system with referrals and made it difficult for social workers to begin treatment "where the client is at." Finally, this program was initiated at the director's level, which made buy-in from front-line staff more difficult.

Strategies for Family Change. AODTI only took us so far. With Strategies for Family Change in the late 1990s, we wanted to blend the "best of the best" practice elements from the child welfare and alcohol and other drug treatment systems. This is a multidisciplinary, neighborhood-based, strengths-based approach that treats the whole family as the client. We find that most AOD and child welfare treatment plans look alike, so we stress providing a menu of accessible services tailored to the unique needs of the family.

Because having a resilient workforce is critical to this effort, we provide eight days of training, much of which we spend on values, attitudes, and change. We help staff look at their own attitudes about change and examine how difficult it is to make changes in their own lives. We emphasize communication, coordination, and collaboration at four levels-administrators, managers, supervisors, and front-line staff. This means the process moves more slowly, but it also helps ensure internal buy-in.

We find that confidentiality can be a non-issue if you have parents present at case staffings. Also, we noted that child welfare and criminal justice staff want information but are reluctant to give it. Information needs to go both ways.

System of Care Model. It's one thing to say that child welfare clients get priority for AOD treatment and another to make it happen. You may need to take some punitive action to reinforce this goal, such as not paying providers for serving nonpriority clients. That doesn't leave much room for clients who want and need treatment but are not in trouble.

Our System of Care Model, also implemented in the late 1990s, relies heavily on making a thorough assessment of the client's and family's needs, including a complete biopsychosocial assessment and an indication of the individual's readiness for treatment. This is different than the initial screening to determine the need for a service referral.

All of our providers use the Addiction Severity Index (ASI) and the American Society of Addiction Medicine (ASAM) placement criteria. We train our AOD providers in assessment, treatment matching, and strategic case planning using the ASI, but this latter goal can be difficult to implement. We also train them in the critical time frames that affect families and children.

Assessment Data. Good data can help inform your decision-making. For example, we found that women wait twice as long for treatment and residential placements, so we needed to put our money there. Females are 75 percent of our AOD caseloads and now get more than half of our treatment slots. We know that AOD involvement among our child welfare clients is 80 percent, and that those individuals who remain in treatment longer have better results. We consider three months a minimum stay, but six months or longer is better.

Unfortunately, we have seen little improvement in child welfare outcomes as a result of our efforts. Part of this may be the child welfare approach that parents don't get their children back until everything is done. If we are measuring family reunification at the end of treatment, we're not going to pick this up. We'd like to see reunification when services and supports are still in place.

Model Programs. Model programs that put some of these principles into place include the following:

• Options for Recovery (OFR). Begun in 1989, OFR is the Sacramento County perinatal program the prioritizes pregnant women and those at the front door of the child welfare system. This is a collaborative effort of the Alcohol and Drug Services Division, the Volunteers of America, and the Chemical Dependency Center for Women. This program was designed to last two years, but that is too long to meet the ASFA timelines for child permanence.
• Early Intervention Specialist (EIS). Two child welfare/AOD specialist social workers are stationed at juvenile court to focus on families with children under age 5. They help engage parents and present them with easy-to-understand information about the court process and how to get their children back. Flying in the face of conventional wisdom about denial, 98 percent of parents are willing to admit a problem and receive treatment.
• Specialized Treatment and Recovery Services (STARS). Eight recovery specialists, located across the street from the juvenile court, offer support and monitoring of AOD-related case activities. They act as liaisons among clients, the child welfare and AOD treatment systems, and the courts. Clients and social workers have been receptive to this program.
• Dependency Drug Court. Planning for dependency drug court has been tedious, but we persevered. The court begins September 1, 2001. We hope to speed up the time for permanency planning and increase our family reunification rates. Again, in the spirit of taking baby steps, we are focusing on families with children under age 5.
• Other Efforts. These include a jail treatment program for incarcerated pregnant and parenting women; an AOD outreach specialist for pregnant clients involved in voluntary family maintenance services; AOD staff stationed at neighborhood multi-service centers and one child welfare service office; and focused case management for families involved in both juvenile and criminal court programs.

Lessons Learned. Communication and cooperation are better than nothing but do not represent true systems integration. What we're calling complementary practice is a compromise that includes a focus on the family, uses case management and case and family conferencing, and works to resolve confidentiality issues among systems.

We found it's important to involve all key stakeholders and to have internal buy-in from within organizations. This is contrary to the popular notion that you have to have a champion at the top; we found that's not what makes collaboration happen.

In addition to training, which is 25 percent of the solution, you need good tools, data, quality assurance mechanisms, and resources. And you need to be willing to share those resources. Some of your providers will be resistant to change; you may need new providers. We've shifted resources among providers based on who produces. Finally, and most importantly, remember to take care of yourself.

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STATE TEAM REPORTS

One of the most important goals for this CSAT/ACYF workshop was to bring together State child welfare and substance abuse treatment systems to begin or continue collaborative efforts. Ms. Nolan asked State team representatives to consider three key questions as they met together during the two-day workshop. The questions and the State responses, as reported to the group as a whole, follow.

• Where were you at the start of the workshop as a State team?
• Where are you at the end of the workshop as a State team?
• Where are you going?

North Dakota
North Dakota team members have been working well together at the director's level but sometimes feel like "change agents swimming upstream." As a result of the workshop, they have a renewed commitment to integrate systems and to look at their programs through the eyes of the people they serve. They plan to increase the dialogue among the child welfare, criminal justice, Medicaid, and substance abuse treatment systems and to implement some cross-training initiatives.

Montana
The workshop was timely for team members from Montana, where several current legislative and programmatic initiatives-including creation of an interagency children's council and authorization for a Medicaid expansion to provide services to adolescents-can serve as a vehicle to carry their agenda. They talked about the possibility of new initiatives, including shared data systems, and the need to improve linkages among mental health, TANF, substance abuse, and social services providers.

Colorado
The Colorado child welfare system is a state-supervised, county-run managed care program. The child welfare and substance abuse systems have blended money and values and made the child welfare client the priority for substance abuse treatment. Certified alcoholism counselors are co-located in child welfare offices. Together, team members decided to seek additional state resources for their joint efforts, to improve the education of judges concerning substance abuse, and to continue their focus on outcomes.

Washington
This was the first time some members of the Washington team met. Local and regional programs are working together, but there are no formal collaborative efforts at the State level. Locally, substance abuse treatment staff are stationed at some TANF offices. Team members will encourage identification of barriers to collaboration at all levels of service-state, regional, and local-and promote cross-training of staff. They also will suggest that State agencies consider hiring across systems (e.g., hiring substance abuse staff in the child welfare agency).

Idaho
Team members from Idaho participated in a court summit on families and children at the state level. Key stakeholders discussed common values, including the need to preserve families and protect children from the destruction that substance abuse causes. Their work led to development of a family drug court. Team members discussed the need to identify additional stakeholders, including representatives from mental health, vocational rehabilitation, and TANF. They plan to reassess processes and outcomes and share this information on a statewide level.

Alaska
Alaska team members acknowledged that there is a certain amount of institutional denial among substance abuse and child welfare staff about which agency deals with families in trouble. On the positive side, the State has a community intervention project that brings wellness activities to native groups and a public housing project in Anchorage that serves mothers in need of substance abuse treatment. A family drug court is in the planning stages. Team members hope to encourage better communication at the State level and identify other key stakeholders.

California
California team members are mandated by the governor to collaborate and to blend funds. A steep cut in funds due to the state's energy crisis had made collaboration even more essential. Multidisciplinary task forces are grabbling with these issues. In addition, Proposition 36, which requires treatment on demand for individuals arrested for non-violent drug possession and use has strained the capacity of treatment providers. Team members see a need to further streamline services and make them more efficient to take full advantage of limited resources.

Hawaii
Hawaii has strong early childhood programs and culturally appropriate substance abuse treatment services. The State is also developing a prototype family drug court. Team members agree that relationships among staff are key, but they are no substitute for resources. They acknowledged the need to have additional players at the table, including TANF and Medicaid, and they set a follow-up meeting to discuss cross-training.

South Dakota
Child welfare and substance abuse treatment agencies in South Dakota have developed a family assessment service with the department of corrections, and all three agencies created a program for pregnant teens. They State also offers a continuum of care for juveniles. Many of these activities are funded by the State Department of Social Services. Team members discussed the need to do more outreach and case management with families in child protective services, to increase the number of families they assess, and to have substance abuse treatment professionals in court.

Utah
The child welfare and substance abuse treatment agencies are located on the same floor in the State Department of Human Services, but staff members don't discuss their programs with each other. Staff from both agencies had an opportunity to plan together with the juvenile court administrator and foster parent who joined their team. Team members already do some cross-training and joint research, but they need to develop a timeline and make assignments. They plan to use their state's drug court as a change agent, since 60 percent of child welfare cases come through this program.

Oregon
Team members found the workshop helpful even though they have been collaborating for years. Oregon held statewide forums around the need to develop shared values between the child welfare and substance abuse treatment systems. Their joint planning and training efforts have resulted in fewer removals of children from the home and a higher family reunification rate. Still, team members feel a need to formalize their collaborative efforts and to develop a statewide and local strategic plans. They also need to develop treatment models for special populations, such as methamphetamine users.

TOC