Prevention And Family Recovery

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Prevention and Family RecoveryAdvancing the Capacity of Family Drug Courts to Provide a Comprehensive Family-CenteredApproach to Improve Child, Parent and Family OutcomesBrief 2: Key Lessons for Implementinga Family-Centered ApproachApril 2017The Prevention and Family Recovery initiative is generously supported by theDoris Duke Charitable Foundation and The Duke Endowment.IntroductionFamily-centered services that focus on parent-child relationships are a criticalingredient of effective family drug courts (FDCs).1 The Prevention and FamilyRecovery (PFR) initiative strives to build the capacity of FDCs and their partner agencies to provide a more comprehensive family-centered approach—grounded in cross-systems collaboration and evidence-based practices—thatstrengthens the parent-child relationship to improve parent, child and familywell-being.In the first round of PFR, four geographically and culturally diverse FDCgrantees implemented different evidence-based interventions in varying countyand state sociopolitical contexts. The grantees’ journeys provide valuableinsights about the practice and policy changes needed for an FDC to shift frombeing an independent program within the court to an integrated cross-systemsfamily-centered collaborative.First Round of PFR Grantees Pima County Family Drug Court,Tucson, AZ Robeson County Family TreatmentCourt, Lumberton, NC San Francisco Family Treatment Court,San Francisco, CA Tompkins County Family TreatmentCourt, Ithaca, NYSee PFR Brief 1 for an overview of PFR,the four grantees and the families thatthey served.Putting PFR Lessonsinto PracticeThis second PFR brief providesnine key lessons that other jurisdictions can apply in their ownefforts to implement and integrateevidence-based parenting andchildren’s interventions and moveto a comprehensive familycentered approach. These lessons,which fall into three domains, canhelp inform the field as FDCs seekto institutionalize best practicesand systems reform for familiesaffected by parental substance usedisorders and child maltreatment.The nine lessons are briefly summarized below. To help others move these lessons into action, the brief highlightscritical components for effective FDC practice, shines a spotlight on breakthrough strategies and outlines other keyconsiderations. The other PFR briefs in the series and the companion case studies provide more detailed descriptionsand specific examples of how grantees changed the way they operate to improve outcomes for children and families.

Brief 2: Key Lessons for Implementing a Family-Centered ApproachLessons About FDC Core Practices and Collaborative Capacity1Increased, Renewed and Continued Focus on Cross-Systems CollaborativePartnerships is Needed to Expand and Sustain the FDCAll four FDCs had established cross-systems collaborative teams in place when PFR began. However, grantees quicklylearned that to successfully integrate parenting and children’s services into the FDC, they had to strengthen existing relationships between the core systems (e.g., child welfare, substance use disorder treatment and family courts) and cultivatenew partnerships with other diverse community agencies and providers.All core systems and community partners must be ready and willing to contribute time and resources to the effort andagree on its importance to improve outcomes for parents, children and families. The FDC, on its own, cannot carrysuch a large-scale initiative without the full commitment and buy-in of the partnering systems, particularly child welfareand the dependency court.With a growing broad-based collaborative, all staff and partners need to clearly understand their respective roles and responsibilities—within and outside the FDC—to operate effectively as a team. Roles and responsibilities may change asthe FDC expands its scope of services, increases its scale to serve more families and infuses effective practices into thelarger system of care for all families affected by substance use disorders and child maltreatment. Collaborative partnerswill also inevitably have to grapple with the substantial costs associated with a full-scale comprehensive family-centeredapproach that includes more intensive interventions, fully integrated and coordinated service delivery and extensivecross-systems collaboration.Continued collaborative progress requires patience and persistence, which paid off for grantees. They formalized manyof their new partnerships, particularly with parenting and children’s services providers and public health systems. Thesepartners are now core members of the team and regularly attend case staffings and court.Critical Components for Effective Collaboration to Deliver a Family-Centered Approach Shared mission, vision and goals and a common definition of participant success Judicial and other agency leadership Shared decision making Understanding of each partner’s operations, needs, values and competing demands Clear roles and responsibilities for all partners—individual team members as well as the agencies they represent Prioritizing collaboration as a means to better serve families Prioritizing the needs of families over the interests of individual agencies, organizations or systems Cross-systems training on best practices and proven interventions to improve parent, child and family outcomes2

Brief 2: Key Lessons for Implementing a Family-Centered ApproachSpotlight on Breakthrough Strategy to Strengthen CollaborationEnhanced or Restructured Clinical and FDC Case StaffingsAll PFR grantees restructured their case staffings to more effectively collaborate and share information across systems.Enhancements have resulted in staffings that: Are inclusive of more partners and service providers and provide a venue for meaningful partner input whereall voices are heard Focus discussions on desired behavioral changes of participants versus only program or treatment attendance Address the needs and progress of children, parents and the whole family Use court reports or staffing templates that incorporate parent and child information Discuss progress of all cases, not just those in non-compliance, and celebrate participants’ successes Allow the Judge and team more time to reflect on and process information Address ongoing program and service delivery improvementOn average, across the fourgrantees, substance usetreatment completion rateswere close to two-thirds(64.6%), which is substantially higher than treatmentcompletion rates for thegeneral child welfarepopulation.22The Effectiveness of Parenting and Children’sServices is Integrally Linked to Timely, EffectiveSubstance Use Disorder TreatmentA parent’s successful treatment engagement, retention and completion andtransition to sustained recovery is essential to positive child welfare and courtoutcomes. As a parent’s substance use disorder can negatively affect theirparenting capacity and bonding and attachment with their child, the provisionof quality treatment is critical to improved family functioning. Yet, like manyFDCs, when the grantees began PFR, the community substance use disordertreatment providers tended to operate disconnected from FDC operations.They were not routinely engaged in FDC staffings or court hearings.To effectively move to a family-centered approach and optimally supportfamily well-being, the court, child welfare and treatment providers had tostrengthen their relationships, increase communication and enhance information sharing. The FDC needed to better understand what treatment servicesare provided and, importantly, the effectiveness of that treatment for familiesin the FDC. Treatment providers needed to understand how parents’ successin treatment is directly linked to their parenting capacity and their relationships with their children and other family members.3

Brief 2: Key Lessons for Implementing a Family-Centered ApproachCritical Components for Effective Integration of Substance Use Treatment intoFDC Operations Mutual trust between court staff, child welfare workers and substance use disorder treatment providers Regular and ongoing meetings with providers, often facilitated by a neutral third party, to identify and resolvebarriers to effective service delivery, communication and coordinated case planning Treatment agency and community provider representation on the FDC’s governance structure (see also Lesson 3) Dedicated and engaged treatment liaisons that actively participate in staffings and attend court sessions Clarity on and evidence of how information about a participant’s progress in treatment informs the court’s caseplanning and decision making Training and education for treatment providers on the effects of parental substance use disorders on children andthe parent-child relationship and the benefits of a family-centered approach Training and education for court and child welfare staff on substance use disorders, the recovery process andresearch-based principles of effective treatment for parents and families, particularly those in the child welfaresystem Ability to obtain and openly discuss data on treatment referrals, admissions and discharges and the implicationsfor needed program or policy improvements3A Formal Governance Structure is Necessary to Prioritize, Oversee andSustain the FDC WorkAn established cross-systems oversight and governance infrastructure—with executive-level representation from all keypartners—is essential as FDCs expand their services and partnerships and strive to create larger cross-systems change.Regular, ongoing meetings are critical to identify and manage emerging issues and keep the team focused on its mission,vision and goals. Such a structure promotes accountability, collaborative decision making about program and policydecisions, and increased information sharing and communication. Further, a formal governance structure elevatesneeded discussions about the FDC’s outcomes and effectiveness (see Lesson 8). Such discussions are an importantmechanism to integrate FDC practices more fully into the larger court and child welfare systems.Critical Components for An Effective Governance Structure Three-tiered structure that includes an oversight committee, steering committee and core treatment team Cross-systems agency representation with members who have the authority to make needed practice andpolicy changes Collaborative decision making that involves all partners and is not driven primarily by FDC staff Defined mission statements Regular, ongoing meetings to identify and address emerging issues4

Brief 2: Key Lessons for Implementing a Family-Centered Approach5 Standing AgendaItems for SteeringCommittee MeetingsData dashboard – three to five criticaldata points that provide the leadership,team and key partners with current information to monitor progress on agreedupon, shared outcomes and identifyneeded program improvements. Ideally,performance is compared to the largersystem or business as usual.Systems barriers – discussion of pressing policy, resource and systems barriers(e.g., lack of housing, transportation,child care or specialized treatment forparents with children) identified by theoperational team and development ofstrategies to overcome them.Funding and sustainability – development of a long-term sustainability planand review of up-to-date inventory offederal, tribal, state and local fundingstreams that currently fund the FDC orcan be leveraged to support and sustainthe collaborative’s operations and goals.Regular review of and shared decisionmaking on resource allocations.Staff training and knowledge development – to establish an environment ofcontinuous learning and developmentand ensure interdisciplinary knowledge.Creation of a staff development plan thatincludes protocols for new team memberorientation; identifies training opportunities, gaps and needs; and outlinesexpertise to be shared with the entireoperational team.Outreach efforts – strategic planningabout opportunities to educate andengage others about FDC outcomes, theneeds of families in the FDC and thelarger dependency system, and FDC bestpractices proven to improve outcomes.Outreach should encompass diverseaudiences, including key FDC stakeholder groups (child welfare, attorneysand treatment providers), policy makersand funders, community developmentand service organizations (e.g., RotaryClub) and faith-based organizations.Widespread outreach creates a receptiveenvironment for parents going throughthe FDC and enhances the community’sunderstanding of substance usedisorders.4FDC Teams Need to Maintain a Consistent andStrong Focus on FDC Participant Recruitment,Timely Engagement and RetentionIn the midst of fully implementing parenting and children’s services enhancements and pursuing large-scale systems improvements, the grantees found theyhad to also refocus attention on a core issue: increased participant engagementand retention in the FDC. Grantees had invested substantial financial, humanand other resources to expand their program’s service array. Not maximizingor operating at their full FDC capacity meant that families needing these intensive, comprehensive family-centered services were missing out. In short, lowFDC enrollment translated to low referrals to parenting and children’s services.Grantees endeavored to reach a greater number of eligible participants andinvolve them earlier in their child welfare services. The grantee teamsrecognized that timely engagement in the FDC is essential to expedite referralsto needed parenting and children’s interventions (see also Lesson 6).Critical Components for Timely and Effective FDC Engagementand Retention Effective processes and protocols that ensure all eligible parents areidentified, referred and engaged in the FDC early in theirdependency case Streamlined FDC intake processes Engagement and buy-in of parent attorneys Use of data to identify and respond to drop-off points, barriers andservice gaps related to FDC engagement and retention Intensive, coordinated case management Phasing that aligns with progress towards reunification (see Spotlighton Breakthrough Strategy on page 6) Trauma-informed and trauma-responsive court practices andproceedings Use of motivational interviewing techniques by all members of FDCteam, including the Judge Appropriate response to relapse informed by a comprehensiveassessment of the parent’s situation and contributing factors Established plan for continuing care and recovery supports earlyin a parent’s FDC participation5

Brief 2: Key Lessons for Implementing a Family-Centered ApproachSpotlight on Breakthrough Strategy to StrengthenFDC Engagement and RetentionRethinking Traditional FDC Phasing Structures to Better Align with ProgressTowards ReunificationAs part of the shift to family-centered practice, all four grantees either implemented or were working towards a restructured, behavioral-based FDC phasing system that better aligns with the family’s progress towards reunification. Thegrantees moved away from a traditional FDC phasing structure focused primarily on achieving a certain number ofcompliances and set tasks. Instead, they sought to take into account parents’ strengths, readiness to move forward anddesired behavioral changes. As one of the PFR grantee FDC Judges explained, with a behavioral-based approach, participants better understand how progressing in phases relates to getting their children back. “They see a direct connection between if I do this, good things will happen with my family relationship.”Lessons About Evidence-Based Services Implementation and IntegrationOver the course of PFR, onegrantee learned that the SafeCarehome visiting model of parenting skills training fit best withthe work of the county’s publichealth nurses rather thananother community-basedprovider. The health departmentnurses were already skilled atproviding home-based services toat-risk families, such as familiesin the FDC who are affected byparental substance use disorders.65Developing the “Evidence-Based PracticeCapacity” of Sites is a Complex UndertakingEvidence-based program implementation in real-world practice settings ischallenging for even the most well-established FDCs. The PFR granteeslearned that evidence-based interventions—whether implementing newones or leveraging what already exists in the community—cannot simply bedropped into the existing FDC service array. Thoughtful planning andconsideration is needed of a myriad of issues (as outlined in the “KeyConsiderations” sidebar on page 7).Grantees’ experiences indicate that sites need to ensure they are meeting theneeds of the FDC target population and the larger community. Ample timeis needed to develop the readiness of FDC partners and the community. Allstakeholders need to understand the place of the selected evidence-basedinterventions in the system, why they may be different from current servicesfor families in the FDC, what the expected outcomes are and how toadvocate for these services for families. To then integrate and sustain theevidence-based interventions with fidelity into the larger FDC and partnersystems takes additional time, dedication and ongoing monitoring. (For furtherdiscussion on grantees’ experiences with evidence-based program implementation, see PFR Brief 4, Evidence-Based Program Implementation within theFDC Context: Finding the Right Fit.)

Brief 2: Key Lessons for Implementing a Family-Centered ApproachImplementing Evidence-Based Services that are a Good Fit for Families,the Collaborative and the Community – Selected Key ConsiderationsPractice LevelCollaborative and Community Level Extent to which the intervention meets families’needs and will result in the desired outcomes;decisions should be grounded in data Clear identification and agreement on the servicegap to be filled to prevent duplicating existingcommunity services Target population and eligibility criteria (e.g., doesthe program match the child’s age, is the intervention effective with populations whose characteristics match those of participants in the FDC) Degree of provider knowledge about andexperience with serving families in the childwelfare system who have a parental substanceuse disorder and other complex needs Readiness for services (e.g., where does the parentneed to be in their recovery to meaningfullyengage in services) Availability and duration of required training orcertification, including ongoing staff training andcoaching needs Placement of the child (e.g., is the child in outof-home care or in-home with their parent andhow might that affect the ability of the parent andchild to participate in services) Staffing contingency plans for turnover of trainedor certified staff or provider changes Location, time and accessibility of services (e.g.,are services provided at court, the treatmentfacility or some other community-based organization; does the day or time conflict with other caseplan requirements) Length of the intervention (e.g., is the family likelyto graduate from the FDC or have their dependency case closed before the intervention is over,increasing the likelihood that they may stopattending the program)6 Fidelity monitoring (e.g., how often and whoseresponsibility) Standardized screening and referral processeswith feedback loops between the FDC and thecommunity provider Protocols for information sharing and communication about families’ progress among providers andthe FDC team and other key partners Long-term sustainability of the interventionFDC Teams Need to Build Bridges to Connect Families to Services andService Providers to Each OtherEffective FDCs must connect families to the needed array of treatment and support services. They must also connectservice systems and community providers to each other to create a comprehensive family-centered system of care forthe families they jointly serve. Timely engagement in the FDC is an essential part of both connections so that fa

Prevention and Family Recovery Advancing the Capacity of Family Drug Courts to Provide a Comprehensive Family-Centered Approach to Improve Child, Parent and Family Outcomes Family-centered services that focus on parent-child relationships are a critical ingredient of effective family drug courts (FDCs).1 The Prevention and Family

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