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Substance Use Disorders, Resilience, and Child Custody

Establishing a Nexus

How does the nature of this parent’s substance use impact this specific child based on their age, development, and unique needs.

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Clarify the Nature of Parent’s Substance Use

•Active use without regard to consequences?

• Long periods of abstinence? (common)

• Substance use prioritized over family responsibilities?

•Harm reduction strategies?•Only use when children are at

school, with the other parent, or when child not in the home?•Using less when with the child?•Giving custody to a family

member?

Identify Effects on Caregiving

Parents with substance use disorders are at heightened risk of diminished caregiving skills, neglect, and abuse

Decreased sensitivity and warmth, less interested in child’s needs

Fail to establish routines

When in withdrawal can be overly harsh

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Identify Effects on Attachment

“If I encounter an obstacle and/or become distressed, I can approach a significant other for help. He or she is likely to be

available and supportive. I will experience relief and comfort as a result of proximity to this person, and I can then return to

other activities.”

Waters, H. S. & Waters, E. (2006). The attachment working models concept: Among other things, we build script-like representations of secure base experiences. Attachment and Human Development, 8, 185–197.

“Secure-Base Script”

Identify Effects on Attachment

Long-term implications for future relationships

Miss emotional cues causing limited reciprocal interactions because less sensitive to needs/less responsive

Prolonged/repeated parent-child separations negatively impacts young child’s ability to attach to new people

The consistent presence of a supportive adult is one of the most importance protective factors

Mirick, R. G., & Steenrod, S. A. (2016). Opioid use disorder, attachment, and parenting: key concerns for practitioners. Child and adolescent social work journal, 33(6), 547-557.

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Identify Child’s Exposure to Trauma

Children of SUD parents

Parent SUD is associated with higher rates of problematic behaviors in children including:• truancy• school discipline problems• legal issues• Future substance use disorders

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Resilience

Many children experience difficult life events in their homes and communities. They experience fear, sadness, isolation, and loneliness.

But……

“[W]hen children have the skills, attitudes, beliefs, and resources of resilience, they can prevent, minimize or overcome these traumas.”

Grotberg, E. 2009. “Three Sources of Resilience.” Head Start Bulletin 80: 33–34, 102. 

Resilience cont.

•Children with more resilience will experience fewer mental health issues and medical problems

•Resilient children are likely to do better with longer separation periods and/or relocation

•Children with less resilience benefit from more frequent contact and less time away from a parent

• Individual therapy progress is likely to be quicker for resilient children as opposed to children with decreased resilience

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Headstart Resilience Checklist1. The child has someone who loves him/her unconditionally.2. The child has an older person outside the home she/he can tell about problems or f3. The child is praised for doing things on his/her own.4. The child can count on her/his family being there when needed.5. The child knows someone he/she wants to be like.6. The child believes things will turn out all right.7. The child does endearing things that make people like her/him.8. The child believes in a power greater than seen.9. The child is willing to try new things.10. The child likes to achieve in what he/she does.11. The child feels that what she/he does makes a difference in how things come out.12. The child likes himself/herself.13. The child can focus on a task and stay with it.14. The child has a sense of humor.15. The child makes plans to do things.

Resilience: Supportive Adult

For children who end up doing well in life despite adversity, the single most important factor is having at least one stable and committed relationship with a supportive adult (parent, relative, coach, teacher, etc.)

Center on the Developing Child at Harvard University (2015). Supportive relationships and active skill-building strengthen the foundations of resilience: Working paper no. 13.McEwen, B.S., & Morrison, J.H. (2013). The brain on stress: Vulnerability and plasticity of the prefrontal cortex over the life course. Neuron, 79(1), 16–29.

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Goal:

Create structure and predictability while fostering resilience

Goal: Address/Mitigate Triggers for Children (and Parents)

•Unpredictability•Sensory overload•Sensory cue to previous trauma •Chaotic transitions•Absence of control•Feelings of rejection or vulnerability•Confrontation, loud voices, and yelling •Physical touch•Loneliness and isolation

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Parenting Plans: General Preliminary Questions• How old is the child?

• How mature is the child?

• What is the child’s personality?

• How strong is the child’s attachment to each parent?

• Does the child or do the parents have any special needs?

• What are the child’s relationships with siblings and friends?

• Are the parents’ homes too far apart to maintain regular and

• frequent contact?

• How flexible are the parents’ and child’s schedules?

• What childcare arrangements are needed?

• How and where will exchanges take place?

• How will transportation be provided?

• How well can the parents communicate and cooperate?

• What are the child's and the parents' cultural and religious

• practices?

• Are there any parental fitness concerns, such as domestic violence, substance abuse, or mental health problems?

• What is each parent’s ability and availability to care for the child’s needs?

• Will the parent be able to exercise the parenting time consistently?

From Planning for Parenting Time: Arizona’s Guide for Parents Living Apart www.azcourts.gov/portals/31/parentingTime/PPWguidelines.pdf

Sample Parenting Plan Components for Addressing Trauma and SUD considerations

Graduated parenting plan with gradual increases in parenting time

Short periods away from each parent 

Parent education about parenting and trauma (in person or online program) 

Individual trauma‐informed therapy

Family therapy 

Random drug testing from facility w/ 7 days a week testing, including holidays 

MATs and Intensive inpatient and/or outpatient program if necessary

Substance use counseling/peer recovery specialist/sober coach

NA meetings, other peer support groups, and/or mindfulness recovery groups

Relapse plan

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Family Drug Courts/

Family Drug Treatment

Courts/Dependency Drug Courts

Family Drug Courts

Use a multidisciplinary, collaborative approach to serve parents and families with SUDs.

Uses intensive judicial monitoring and interventions to treat parents’ substance use disorders and other co-occurring risk factors.

Bring together SUD treatment, child welfare services, mental health, and social service agencies.

Non-adversarial.

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What are Family Drug Treatment Courts?

• Frequent review hearings

• Drug testing

• Support groups• Therapy

• Housing support

• Job support• Medication

Why Have Family Drug Courts?

“Most of the parents are given referrals by [DCFS] and they have to go out and get into their own drug program, do their own testing and visit their kids — they’re running around trying to comply with their case

plan. It’s very difficult. They don’t get a lot of support and that’s where they’re going to fall through the cracks.” - Marlene Furth director of

Los Angeles Dependency Lawyers (LADL),

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Why Have Family Drug Courts?

• Outcome research•Higher rates of reunification• Fewer out-of-home placements• Increased treatment completion rates

Differences Among Family Drug Courts

• Parallel Model v. Integrated Program Model • Whether maintenance medications are permitted• Whether a significant other can participate• Scope and availability of services• Eligibility criteria• Exclusion criteria

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Franklin County Family Drug Court

Located in Western Massachusetts

From 2013 – 2015: 50% increase in the number of fatal opioid overdoses

From 2011 – 2014: 300% increase in the use of Narcan by EMTs

Franklin Family Drug Court: Statistics

• 97% of FFDC participants reported experiencing a trauma in their lifetime.

• 64% likely met diagnostic criteria for PTSD.

• 88% had experienced serious depression.

• 94% reported serious anxiety or tension.

• 100% of children (n = 75) had at least 4 ACEs.

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Franklin County Family Drug Court

“The family drug court is not just about problem-solving. It is about healing. It is about doing something immediate to save lives, and to improve outcomes for families and our

Franklin County community. In one way or another, we are all impacted by the opioid crisis.”

- Probate and Family Court First Justice Beth Crawford

Franklin County Family Drug Court

Comprehensive substance use treatment

Wraparound services

Case management

Peer support

Educational support

Vocational support

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Franklin County Family Drug Court

Integrated treatment for co-occurring disorders, including trauma-informed care

Medication-assisted treatment for addiction, such as prescriptions for naltrexone, suboxone, or methadone.

MATs are accepted and encouraged practice for Family Drug Court participants.

Innovation in Family Drug Courts

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Serving Pre-Petition Clients

•Many jurisdictions are expanding family drug court services to pre-petition participants

Sacramento County Dependency Drug Court and the Early Intervention Family Drug Court

“The Specialized Treatment Recovery Services (STARS) provides parents with immediate access to substance use treatment options as well as, testing and support including a peer recovery specialist, who assists parents in entering and completing treatment, monitoring, and

accountability

• Family reunification increased from less than 18% to 48%

• Children's length of stay in foster care significantly decreased.

• Estimated that the family drug court and STARS saved the county at a minimum, $2,600,000 per year by reducing out of home care

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Provide All Services in the Home

•Milwaukee, WI: Accepted their first in-home case last month.

• Las Vegas, NV: Recently received a SAMHSA grant to provide all treatment services to the family within the home.

• Early identification and screening important • Some child protection agencies are using the UNCOPE

screening tool. Social workers screen all families for SUDs during initial investigations and then make timely referrals to family drug court.

Treatment for Parents and Children without Family Separation

•Washoe County, NV: Through a partnership with the non-profit Step 2, parents are given the option of receiving SUD treatment at a residential treatment facility where their child can remain with them.

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Child Services Coordinator

• Jefferson County, CO: Added a children’s services coordinator to the team to ensure compliance with recommendations in child’s assessment. Use a public health nurse to monitor children’s services and support parents in understanding their child’s developmental needs.

Intimate Partner Violence

•King County, WA: Developing protocols and procedures for managing cases involving IPV.

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Housing Support

• Lummi Nation Family Wellness Court, WA: partnered with a local provider who provides housing and wrap around services for all families in need. In many cases, housing is a barrier to reunification.

•Many other courts have partnered with their local housing authority or housing provider to establish priority housing for separated families.

Standardization of Parenting-Time Observations

• Jefferson County, CO: Pilot program to develop objective criteria for parenting-time observations to more accurately report on achievements and challenges.

•Concrete objectives that lead to increases or decreases in parenting time, changes to supervision levels, etc.

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Childbirth Support

• Franklin County, MA: Provides recovery-trained doulas to assist mother in prenatal and postnatal stages.

Research indicates that FDTCs have:• Higher rates of family reunification• Less time for children in foster care• Higher participation rates• Longer stays in SUD treatment

Summary, Family Drug Courts

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Contact Information

Stephanie Tabashneck, Psy.D, Esq.

StephanieTabashneck@gmail.com

www.StephanieTabashneck.com

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