0555b664__Alcohol_and_Other_Drug_Issues__Program_Improvement_Plan__PIP_
[State] New Jersey Among all reasons identified for children coming to the attention of the child welfare agency, substance abuse by parent was cited in 27 cases (54%). Primary reasons for opening a child welfare agency case included substance abuse by parent in 12 cases (24%). Services with particularly long waiting lists in some localities are family preservation services, substance abuse treatment services, and mental health services. Services provided to the families included, but were not limited to, the following:� in-home services to address hygiene, in-home counseling, housing services, medical services, case management services, parenting aid services, substance abuse evaluation, substance abuse treatment (inpatient and outpatient), day care, prenatal care, family and individual counseling, sexual abuse assessment, independent living services, psychiatric assessment, and domestic violence counseling. Key service gaps identified by stakeholders pertained to affordable housing, substance abuse treatment, and mental health assessment and treatment services.� Stakeholders reported that the lack of these services makes it very difficult to reunify children with their families in a timely manner and to ensure that youth emancipated from foster care will make a successful transition to independent living. Critical gaps in the service array are bilingual services, therapeutic foster care services, insufficient family preservation services, substance abuse treatment services (particularly for women with children), and mental health services for children and parents. In addition, services are not available to families and children in all political jurisdictions covered in the State�s CFSP, and where services are available, long waiting lists often impede accessibility of those services. Stakeholders commenting on foster care re-entry noted that the State�s incidence of re-entry into foster care is not high. They noted that when children re-enter foster care it usually is due to substance abuse relapse by parents. Most stakeholders commenting on Reunification, Guardianship, or Permanent Placement with Relatives expressed the opinion that there are multiple barriers to achieving reunification in a timely manner. Key barriers identified included a freeze on Section 8 housing (and withdrawal of Federal funds for that program); a lack of sufficient services for parents, particularly substance abuse services; a lack of adequate visitation between parents and children in foster care; and a lack of recognition by parents of the problem that brought about the child�s removal. Stakeholders also said that parents often are not given adequate assistance in obtaining services. As one stakeholder noted, many parents with substance abuse problems are given a bus pass and a list of providers and are expected to manage their own treatment According to the Statewide Assessment, Children entering care due to juvenile justice issues (including delinquency) and/or family crises are more likely to return home within one year (50%), than are children removed from home due to either parent or child substance abuse (34% return home within one year). Stakeholders were in general agreement that a major impediment to effective assessment is large caseworker caseloads. They noted that basic issues, such as substance abuse and domestic violence, are missed in the assessment process because the caseworkers do not have time to do it properly. As of October 2003, each region in New Jersey had contracts for the following mental health services: crisis care, day treatment, group counseling, in-crisis service, personal case management, psychological assessment and consultation, psychotherapy, and substance abuse assessment and rehabilitation. Stakeholders expressed concern that some delays in achieving TPR were due to (1) the need to transfer a case from DYFS to ARC before filing for TPR, (2) the agency not completing the necessary paperwork, (3) the reluctance of some courts to grant TPR when there is no identified adoptive resource for the child, or (4) the court finding that reasonable efforts were not made. Stakeholders suggested that this latter situation appears to occur most frequently when parents have substance abuse problems and are not able to access treatment services. There was general agreement among stakeholders that there is a lack of adequate resources at each level of the process. Stakeholders noted that the Program Improvement Office of the Office of Program Integrity and Accountability has a QA system that conducts independent reviews when there has been a specific situation, such as a high publicity case, or when they are asked by the DHS Commissioner or Governor to do an independent review.� Although these reviews tend to be reactive rather than proactive, stakeholders reported that recent reviews indicated a need for DYFS to (1) pay more attention to substance abuse, (2) look at the family as a unit rather than focusing on a particular child, (3) pay more attention to domestic violence in the home, and (4) provide continued ongoing training of experienced caseworkers. As reported in the Statewide Assessment, all new Family Service Trainees (the entry-level field caseworker title) are required to attend a Pre-Service Training Program during the first month of employment.� This consists of 14 class days interspersed over 20 workdays, with 6 field days, which are coordinated to provide field experiences that reinforce the classroom material. Once the 20 days are completed, all new Family Service Trainees are required to attend 8 foundation courses duringtheir second through eleventh month of employment. These courses are: Child Sexual Abuse Identification, Interviewing Skills, High Risk Indicators, Permanency Planning, Medical Indicators of Child Abuse and Neglect, Child Sexual Abuse Investigation, Understanding Substance Abuse, and Computer/SIS Skills. The Renaissance Academy was launched for experienced Family Service Specialists hired prior to August 1997. Approximately 400 staff received training in the following areas: High Risk Indicators, Permanency Planning, Medical Indicators of Child Abuse and Neglect, and Understanding Substance Abuse. The Statewide Assessment notes that experienced DYFS staff at Regional Treatment Centers (RTC) are required to take the following courses during their first 2 years at the RTC: Substance Abuse in RTC Teens, Adolescent Depression and Suicide, and Talking with Teens re: Love/Sex. Contracted group homes and residential treatment centers must develop a training plan and ensure the training of all staff members in at least the following areas: the home�s statement of purpose; emergency procedures; protocols for medication; infection control procedures; and the home�s behavior management policy. The in-service training requirement for staff is a minimum of 12 hours of training annually in the following areas: the principles of behavior management; alcohol and substance abuse; human sexuality and AIDS; and suicide prevention. According to the Statewide Assessment, although there is a large array of services in the State, the current availability of services is insufficient to address the needs within the State�s child welfare system. Key services that are not available on a Statewide basis include substance abuse treatment services�respondents indicated that there are insufficient resources to treat parents and adolescents who are substance addicted and little or no services for maternal/infant stabilization to prevent removal or facilitate rapid reunification. This was reiterated by the Commissioner�s Workgroup on Substance Abuse and Child Welfare. The Statewide Assessment notes that DYFS provides secondary and tertiary pre-placement prevention services to children and families who have been the subject of a Child Protective Services investigation. This is done either directly by DYFS staff, by contract, or through referral to community services. These services are aimed at addressing the risk/safety issues that must be resolved in order for the child(ren) to remain safely at home. The following pre-placement prevention services are available: Family Preservation Services, Domestic Violence Core Services, a Healthy Families Program, a Teen Parenting Programs, and a Child Protection Substance Abuse Initiative. The Statewide Assessment notes that DYFS provides services to support the safe and timely reunification of children with their families. These services include: DYFS Case Management Services, Intensive In-Home Services, Mental Health and Behavioral Health Services, a Family Unification Housing Program, Family Group Conferencing, Supervised Visitation Services, Foster Care Support Services, Substance Abuse Treatment Services, Head Start, WIC, food banks, child care, and after school programs. As indicated in the Statewide Assessment, New Jersey also recognizes the need to coordinate services in complex cases and has responded by forming workgroups and committees that involve experts in child abuse, domestic violence and substance abuse at State, regional, and county levels. Physical health of the child was rated as anArea Needing Improvement. In one case, the child was born drug addicted, but no medical services were received once the child left the hospital. It was noted in the Statewide Assessment that children�s physical health needs are always considered during the conduct of an assessment. Caseworkers are required to collect relevant medical information on specific health conditions, e.g. HIV, pre-natal drug exposure or other serious medical conditions prior to placement.�
Increase Substance Abuse services by increasing treatment slots, contracting Substance Abuse Specialists for DYFS offices and implementing 24 hour assessment referral for youth in need DYFS will hire a physician as a Medical Director to oversee all aspects of DYFS� response to health, mental health and substance abuse policies, practice and coordinated program development. The Medical Director will develop an interdisciplinary support team of medical consultants including participation from the areas of psychiatry, psychology, licensed clinical social work, and licensed certified alcohol and drug abuse, at a minimum. A Comprehensive Health Evaluation for Children (CHEC) will be implemented for children entering foster care within 30 days of placement. This evaluation will include a screen for substance abuse and developmental assessments.�� Provide additional resources in the core service areas of housing, domestic violence, substance abuse, mental health, and physical health, and make flexible funding available, which will permit the acquisition of services that are unconventional and/or not currently available from a contracted provider but determined integral to implementing the case plan.� DYFS, DFD, and the substance abuse community have agreed to use the same assessment tools to determine the best substance abuse treatment options for families.� Guidelines regarding level of care will use American Society of Addiction Medicine (ASAM) criteria. Increase the available substance abuse treatment slots, including outpatient, intensive outpatient, long term residential beds, residentially assisted partial care, and methadone maintenance.� In addition, develop an additional 150 treatment slots for adolescents. The allocation and effectiveness of substance abuse resources will be reviewed on an annual basis to permit adjustment so that expansion improves access and targets resources to the areas of highest need. Additional certified substance abuse specialists will be contracted to work in each DYFS office to perform substance abuse assessments, treatments referrals, case consultation and training. Integrate adolescent Mental Health services into a Substance Abuse program using the federal (SAMHSA) model that is anticipated to create up to 250 slots over two years of the PIP reporting, including new treatment slots for substance abusing teenage mothers with young children who want to keep their children during treatment.�
A Review of Alcohol and Other Drug Issues
Program Improvement Plan (PIP)