Thursday, July 17, 2014

Appendix A Glossary of Terms

 

Addiction – the overpowering physical or psychological urge to continue alcohol or drug use in spite of adverse consequences. Often, there is an increase in tolerance for the drug and withdrawal symptoms sometimes occur if the drug is discontinued.

Adjudicatory Hearings - held by the juvenile and family court to determine whether a child has been maltreated or whether another legal basis exists for the State to intervene to protect the child.

Adoption and Safe Families Act - signed into law November 1997 and designed to improve the safety of children, to promote adoption and other permanent homes for children who need them, and to support families. The law requires child protective services (CPS) agencies to provide more timely and focused assessment and intervention services to the children and families who are served within the CPS system.

Alcoholism – a dependency on alcohol characterized by craving and loss of control over its consumption, physical dependence and withdrawal symptoms, and tolerance.

AOD – alcohol and other drugs.

Assessment – evaluation or appraisal of a candidate's suitability for substance use disorder (SUD) treatment and placement in a specific treatment modality or setting. This evaluation includes information regarding current and past SUDs; justice system involvement; medical, familial, social, education, military, employment, and treatment histories; and risk for infectious diseases (e.g., sexually transmitted diseases, tuberculosis, HIV/AIDS, and hepatitis).

CASA - court-appointed special advocates (usually volunteers) who serve to ensure that the needs and interests of a child judicial proceedings are fully protected.

Case Closure - the process of ending the relationship between the CPS worker and the family that often involves a mutual assessment of progress. Optimally, cases are closed when families have achieved their goals and the risk of maltreatment has been reduced or eliminated.

Case Plan - the casework document that outlines the outcomes, goals, and tasks necessary to be achieved in order to reduce the risk of maltreatment.

Caseworker Competency - demonstrated professional behaviors based on the knowledge, skills, personal qualities, and values a person holds.

Central Registry - a centralized database containing information on all substantiated/founded reports of child maltreatment in a selected area (typically a State).

Child Abuse Prevention and Treatment Act (CAPTA) - see Keeping Children and Families Safe Act.

Child Protective Services (CPS) - the designated social services agency (in most States) to receive reports, investigate, and provide intervention and treatment services to children and families in which child maltreatment has occurred. Frequently, this agency is located within larger public agencies, such as departments of social services.

Cognitive Behavioral Therapy – a school of psychotherapy that originated in the United States and subscribes to a behavioral emphasis on stimulus-response relationships and psychological learning theory.

Concurrent Planning - identifies alternative forms of permanency by addressing simultaneously both reunification and legal permanency with a new parent or caregiver, should reunification efforts fail.

Craving – a powerful, often uncontrollable, desire for drugs, alcohol, or other substances.

Cultural Competence - a set of attitudes, behaviors, and policies that integrates knowledge about groups of people into practices and standards to enhance the quality of services to all cultural groups served.

Denial – a psychological defense mechanism disavowing the significance of events. Denial also can include a range of psychological maneuvers designed to reduce awareness of the fact that using a substance (or engaging in a behavior) is the cause of an individual's problems rather than a solution to those problems. Denial can be a major obstacle to recovery.

Detoxification – process in a structured medical or social milieu in which the individual is monitored for withdrawal from the acute physical and psychological effects of drug or alcohol addiction.

Differential Response - an area of CPS reform that offers greater flexibility in responding to allegations of abuse and neglect. Also referred to as "dual track" or "multi-track" response, it permits CPS agencies to respond differentially to children's needs for safety, the degree of risk present, and the family's needs for services and support. See "dual track."

Disclosure – a communication of client- or patient-identifying information or the communication of information from the record of a client or patient who has been identified.

Dispositional Hearings - held by the juvenile and family court to determine the disposition of children after cases have been adjudicated, such as whether placement of the child in out-of-home care is necessary and the services the children and family will need to reduce the risk of maltreatment and to address its effects.

Drug – a substance that, by its chemical nature, affects the structure or function of a living organism.

Dual Diagnosis (also Dual Disorder) – a term used to describe a condition in which a single person has more than one major clinical psychological or psychiatric diagnosis. Often, this phrase is used to describe people who have a severe mental illness as well as a co-existing SUD.

Dual Track - term reflecting new CPS response systems that typically combine a nonadversarial service-based assessment track for cases where children are not at immediate risk with a traditional CPS investigative track for cases where children are unsafe or at greater risk for maltreatment. See "differential response."

Evaluation of Family Progress - the stage of the CPS case process during which the CPS caseworker measures changes in family behaviors and conditions (risk factors), monitors risk elimination or reduction, assesses strengths, and determines case closure.

Family Assessment - the stage of the child protection process during which the CPS caseworker, community treatment provider, and the family reach a mutual understanding regarding the behaviors and conditions that must change to reduce or eliminate the risk of maltreatment, the most critical treatment needs that must be addressed, and the strengths on which to build.

Family Group Conferencing - a family meeting model used by CPS agencies to optimize family strengths in the planning process. This model brings the family, extended family, and others important in the family's life (e.g., friends, clergy, neighbors) together to make decisions regarding how best to ensure the safety of the family members.

Family Unity Model - a family meeting model used by CPS agencies to optimize family strengths in the planning process. This model is similar to the Family Group Conferencing model.

Full Disclosure - CPS information to the family regarding the steps in the intervention process, the requirements of CPS, the expectations for the family, the consequences if the family does not fulfill the expectations, and the rights of the parents to ensure that the family completely understands the process.

Guardian ad Litem - a lawyer or lay person who represents a child in juvenile or family court. Usually this person considers the best interest of the child and may perform a variety of roles, including those of independent investigator, advocate, advisor, and guardian for the child. A lay person who serves in this role is sometimes known as a court-appointed special advocate or CASA.

Habituation – the result of repeated consumption of a drug that produces psychological, but not physical, dependence. The psychological dependence produces a desire (not a compulsion) to continue taking drugs for the sense of improved well-being.

Home Visitation Programs - prevention programs that offer a variety of family-focused services to pregnant women and families with new babies. Activities frequently encompass structured visits to the family's home and may address positive parenting practices, nonviolent discipline techniques, child development, maternal and child health, available services, and advocacy.

Immunity - established in all child abuse laws to protect reporters from civil law suits and criminal prosecution resulting from filing a report of child abuse and neglect.

Initial Assessment or Investigation - the stage of the CPS case process during which the CPS caseworker determines the validity of the child maltreatment report, assesses the risk of maltreatment, determines if the child is safe, develops a safety plan if needed to ensure the child's protection, and determines services needed.

Intake - the stage of the CPS case process in which the CPS caseworker screens and accepts reports of child maltreatment.

Interview Protocol - a structured format to ensure that all family members are seen in a planned strategy, that community providers collaborate, and that information gathering is thorough.

Involuntary Commitment – process by which patients who have not committed any crime are brought to SUD treatment against their wishes by relatives, police, or through a court proceeding. Also known as "protective custody" or "emergency commitment."

Juvenile and Family Courts - established in most States to resolve conflict and to otherwise intervene in the lives of families in a manner that promotes the best interest of children. These courts specialize in areas such as child maltreatment, domestic violence, juvenile delinquency, divorce, child custody, and child support.

Keeping Children and Families Safe Act - The Keeping Children and Families Safe Act of 2003 (P.L. 108-36) included the reauthorization of the CAPTA in its Title I, Sec. 111. CAPTA provides minimum standards for defining child physical abuse and neglect and sexual abuse that States must incorporate into their statutory definitions in order to receive Federal funds. CAPTA defines child abuse and neglect as "at a minimum, any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm."

Kinship Care - formal child placement by the juvenile court and child welfare agency in the home of a child's relative.

Liaison - a person within an organization who has responsibility for facilitating communication, collaboration, and coordination between agencies involved in the child protection system.

Mandated Reporter - individuals required by State statutes to report suspected child abuse and neglect to the proper authorities (usually CPS or law enforcement agencies). Mandated reporters typically include professionals, such as educators and other school personnel, health care and mental health professionals, social workers, child care providers, and law enforcement officers. Some States identify all citizens as mandated reporters.

Memorandum of Understanding – an agreement between two or more organizations to define a given relationship and each party's responsibilities within the agreement.

Multidisciplinary Team - established between agencies and professionals within the child protection system to discuss cases of child abuse and neglect and to aid in decisions at various stages of the CPS case process. These teams also may be designated by different names, including child protection teams, interdisciplinary teams, or case consultation teams.

Neglect - the failure to provide for a child's basic needs. Neglect can be physical, educational, or emotional. Physical neglect can include not providing adequate food or clothing, appropriate medical care, supervision, or proper weather protection (heat or coats). Educational neglect includes failure to provide appropriate schooling, failure to address special educational needs, or allowing excessive truancies. Psychological neglect includes the lack of any emotional support and love, chronic inattention to the child, exposure to spouse, drug, or alcohol abuse.

Neurotransmitters – a group of chemicals in the brain that transmit nerve impulses from one neuron to another across a space called a synapse. Drugs act on the brain at the neurotransmitter level. The presence of a drug in the brain changes how many neurotransmitters are available to send nerve impulses from one neuron to the next. The level or amount of a drug in the brain affects how well different kinds of chemical signals are transmitted, changing how an individual thinks and feels.

Out-of-Home Care - child care, foster care, or residential care provided by persons, organizations, and institutions to children who are placed outside their families, usually under the jurisdiction of juvenile or family court.

Parens Patriae Doctrine - originating in feudal England, a doctrine that vests in the State a right of guardianship of minors. This concept has gradually evolved into the principle that the community, in addition to the parent, has a strong interest in the care and nurturing of children. Schools, juvenile courts, and social service agencies all derive their authority from the State's power to ensure the protection and rights of children as a unique class.

Parent or Caretaker - person responsible for the care of the child.

Patient Placement Criteria – standards of, or guidelines for, SUD treatment that describe specific conditions under which patients should be admitted to a particular level of care, under which they should continue to remain in that level of care, and under which they should be discharged or transferred to another level. They generally describe the settings, staff, and services appropriate to each level of care and establish guidelines based on diagnosis and other specific areas of patient assessment.

Physical Abuse - the inflicting of a nonaccidental physical injury. This may include, burning, hitting, punching, shaking, kicking, beating, or otherwise harming a child. It may, however, have been the result of over-discipline or physical punishment that is inappropriate to the child's age.

Prevention – the theory and means for reducing the harmful effects of drug use in specific populations. Prevention objectives are to protect individuals before signs or symptoms of substance use problems appear, to identify persons in the early stages of substance abuse and intervene, and to end compulsive use of psychoactive substances through treatment.

Primary Prevention – activities geared to a sample of the general population to prevent child abuse and neglect from occurring. Also referred to as "universal prevention."

Protective Factors - strengths and resources that appear to mediate or serve as a buffer against risk factors that contribute to vulnerability to maltreatment or against the negative effects of maltreatment experiences.

Protocol - an interagency agreement that delineates joint roles and responsibilities by establishing criteria and procedures for working together on cases of child abuse and neglect.

Psychological Maltreatment - a pattern of caregiver behavior or extreme incidents that convey to children that they are worthless, flawed, unloved, unwanted, endangered, or only of value to meeting another's needs. This can include parents or caretakers using extreme or bizarre forms of punishment or threatening or terrorizing a child. Psychological maltreatment also is known as emotional abuse or neglect, verbal abuse, or mental abuse.

Recovery – achieving and sustaining a state of health in which the individual no longer engages in problematic behavior or psychoactive substance use and is able to establish and accomplish goals.

Relapse – the return to the pattern of substance abuse or addiction, as well as the process during which indicators appear before the client's resumption of substance use.

Response Time - a determination made by CPS and law enforcement regarding the immediacy of the response needed to a report of child abuse or neglect.

Review Hearings - held by the juvenile and family court to review dispositions (usually every 6 months) and to determine the need to maintain placement in out-of-home care or court jurisdiction of a child.

Risk - the likelihood that a child will be maltreated in the future.

Risk Assessment - the measurement of the likelihood that a child will be maltreated in the future; frequently carried out through the use of checklists, matrices, scales, and other methods.

Risk Factors - behaviors and conditions present in the child, parent, or family that likely will contribute to child maltreatment occurring in the future.

Safety - absence of an imminent or immediate threat of moderate to serious harm to the child.

Safety Assessment - a part of the CPS case process in which available information is analyzed to identify whether a child is in immediate danger of moderate or serious harm.

Safety Plan - a casework document developed when it is determined that the child is in imminent or potential risk of serious harm. In the safety plan, the caseworker targets the factors that are causing or contributing to the risk of imminent serious harm to the child, and identifies, along with the family, the interventions that will control them and ensure the child's protection.

Secondary Prevention - activities targeted to prevent breakdowns and dysfunctions among families who have been identified as being at risk for abuse and neglect.

Service Agreement - the casework document developed between the CPS caseworker and the family, which outlines the tasks necessary to achieve risk reduction goals and outcomes.

Service Provision - the stage of the CPS casework process during which CPS and other service providers offer specific services to reduce the risk of maltreatment.

Sexual Abuse - inappropriate adolescent or adult sexual behavior with a child. It includes fondling a child's genitals, making the child fondle the adult's genitals, intercourse, incest, rape, sodomy, exhibitionism, sexual exploitation, or exposure to pornography. To be considered child abuse, these acts have to be committed by a person responsible for the care of a child (for example a babysitter, a parent, or a day care provider) or related to the child. If a stranger commits these acts, it would be considered sexual assault and handled solely by the police and criminal courts.

Substance Abuse – a pattern of substance use resulting in clinically significant physical, mental, emotional, or social impairment or distress, such as failure to fulfill major role responsibilities, or use in spite of physical hazards, legal problems, or interpersonal and social problems.

Substance Dependence – see "addiction."

Substance Use – consumption of low or infrequent doses of alcohol and other drugs, sometimes called experimental, casual, or social use, such that damaging consequences may be rare or minor.

Substance Use Disorder (SUD) – a medical condition that includes the abuse of or addiction to (or dependence on) alcohol or drugs.

Substantiated - an investigation disposition concluding that the allegation of maltreatment or risk of maltreatment was supported or founded by State law or State policy. A CPS determination means that credible evidence exists that child abuse or neglect has occurred.

System of Care – a comprehensive continuum of child welfare, SUD, and other support services coordinated to meet the multiple, evolving needs of clients.

Tertiary Prevention – treatment efforts geared to address situations in which child maltreatment already has occurred, with the goals of preventing child maltreatment from occurring in the future and of avoiding the harmful effects of child maltreatment.

Tolerance – a state in which the body's tissue cells adjust to the presence of a drug in given amounts and eventually fail to respond to ordinarily effective dosages. Consequently, increasingly larger doses are necessary to produce desired effects.

Treatment - the stage of the child protection case process during which specific services are delivered by CPS and other providers to reduce the risk of maltreatment, support families in meeting case goals, and address the effects of maltreatment.

Universal Prevention – activities and services directed toward the general public with the goal of stopping maltreatment before it starts. Also referred to as "primary prevention."

Unsubstantiated (also Not Substantiated) - an investigation disposition that determines that there is not sufficient evidence under State law or policy to conclude that the child has been maltreated or is at risk of maltreatment. A CPS determination means that credible evidence does not exist that child abuse or neglect has occurred.

Withdrawal – symptoms that appear during the process of stopping the use of a drug that has been taken regularly.

 

https://www.childwelfare.gov/pubs/usermanuals/substanceuse/appendixa.cfm

Endnotes

 

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2 DeBellis, M. D., Broussard, E. R., Herring, D. J., Wexler, S., Moritz, G., & Benitez, J. G. (2001). Psychiatric co-morbidity in caregivers and children involved in maltreatment: A pilot research study with policy implications. Child Abuse & Neglect, 25(7), 923–944; Dube, S. R., Anda, R. F., Felitti, V. J., Croft, J. B., Edwards, V. J., & Giles, W. H. (2001). Growing up with parental alcohol abuse: Exposure to childhood abuse, neglect, and household dysfunction. Child Abuse & Neglect, 25(12), 1627–1640; Chaffin, M., Kelleher, K., & Hollenberg, J. (1996). Onset of physical abuse and neglect: Psychiatric, substance abuse, and social risk factors from prospective community data. Child Abuse & Neglect, 20(3), 191–203. back

3 Kelleher, K., Chaffin, M., Hollenberg, J., & Fischer, E. (1994). Alcohol and drug disorders among physically abusive and neglectful parents in a community-based sample. American Journal of Public Health, 84(10), 1586–1590. back

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5 U.S. Department of Health and Human Services, ACF. (1999). Blending perspectives and building common ground. A report to Congress on substance abuse and child protection [On-line]. Available: http://aspe.hhs.gov/hsp/subabuse99/subabuse.htm. back

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https://www.childwelfare.gov/pubs/usermanuals/substanceuse/endnotes.cfm

Chapter 8 Putting It Together: Making the System Work for Families

 

In This Chapter

While many child protective services (CPS) and substance use disorder (SUD) treatment agencies find collaboration challenging, it is crucial to achieving positive outcomes for families involved with both systems. This chapter presents principles to guide CPS agencies in forming collaborative relationships with SUD treatment and other agencies. It proposes techniques to improve collaboration at both the policy and the frontline levels. This chapter also discusses confidentiality issues, which often determine what types of information can be shared during the collaborative process.

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Setting the Stage: Principles to Guide Collaboration

As discussed earlier, CPS and SUD treatment agencies often have different structures, funding streams, and definitions of success. These differences affect collaboration at the Federal level as well as at the administrative and frontline levels in States and counties.

Families whose members have SUDs and who are involved with the child welfare system have multiple and complex needs as well as strengths. Their needs often span many social service disciplines. No single person, agency, or profession has the capacity to address all of their circumstances. Collaboration builds on the individual strengths of each agency and family member, forging shared approaches that are more effective than an individual response.

Collaboration is grounded in interdependent relationships and is more important when the problems are complex, the needs are varied, and the systems are different. In order to be effective, collaborative relationships should include the following:

  • Trust that enables individuals to share information, to speak honestly with each other, and to respect other points of view
  • Shared values that are honored by all participants
  • A focus on common goals in spite of the fact that participants come from agencies that have different missions, philosophies, or perceptions
  • A common language that all participants can understand and that is not unnecessarily technical or filled with acronyms
  • Respect for the knowledge and experience that each participant and each profession brings to the relationship, which includes recognizing the strengths, needs, and limitations of all participants
  • A collective commitment to working through conflict that encourages participation by all group members
  • A desire to share decision-making, risk taking, and accountability that supports group members in participating in important decisions and assuming responsibility for the outcome of group decisions.126

One of the biggest challenges facing both CPS caseworkers and SUD treatment providers is securing services from other social service agencies with whom relationships may not exist. For example, families involved with either CPS or SUD treatment agencies most likely will need some combination of the following services: mental health, domestic violence, income support, housing, transportation, health care, child care, and early childhood education. While collaboration with all these service providers is important, the need for mental health, domestic violence, and income support services among families receiving child welfare services and affected by substance abuse is especially critical and warrants special attention.

CPS, SUDs, and Court Involvement

The court system is a key partner of both the child welfare and the SUD treatment systems. The courts ultimately decide if a child should be removed from or returned to a home. Therefore, judges and other court staff should have a general knowledge of SUDs and child welfare issues and how those issues are relevant to each case. This requires cross-training as well as ongoing communication and collaboration among the three systems. Along with making decisions to remove from or to return a child to the home, courts also may be involved with these same families through the criminal justice system or the drug courts.

If families also are involved in the criminal justice system, caseworkers may want their case plans to require the completion of all conditions of probation or parole in order for the parents to care for their children. However, the criminal justice system and the juvenile court system may have very different goals with respect to parental SUDs, with one focusing on the prevention of further criminal behavior (an emphasis on public safety) and the other focusing on the welfare of the children in the family.

Many States and communities are utilizing drug courts, which serve as an alternative to a strictly punitive, non-treatment oriented approach. Drug courts integrate public health and public safety and make treatment a priority.127 They use ongoing, active involvement by judges to provide structure and support, and they hold both families and agencies, such as CPS, accountable for the commitments they make. Drug courts steer individuals with SUDs who commit nonviolent crimes, such as larceny or drug dealing, to treatment instead of jail; follow sentencing guidelines that set standards to ensure equity for jail time based on the crime; and utilize community partnership programs that encourage police, probation and parole officers, treatment providers, and citizens to work together to create healthy and safe environments that benefit everyone. Additionally, drug courts:

  • Assess the substance user's needs
  • Create an effective, mandated treatment plan
  • Provide the necessary follow-up to assist with the treatment process.

Accountability for the participant attending treatment rests with the drug court. In one study, more than two-thirds of participants mandated by drug courts to attend treatment completed it, which is a completion rate six times greater than most previous efforts.128

Drug courts are becoming an increasingly popular alternative for responding to methamphetamine use. The ability to respond quickly and consistently to violations of the treatment plan, coupled with the accountability measures and the ever-present threat of going to jail due to a violation, make drug courts one of the most effective mechanisms for dealing with methamphetamine use.129 For additional information on drug courts and methamphetamine use, visit http://www.ojp.usdoj.gov/BJA/pdf/MethDrugCourts.pdf.

Family Treatment Drug Courts (FTDCs) are specialized drug courts designed to work with parents with SUDs who are involved in the child welfare system. A national evaluation found that FTDCs were more successful than traditional child welfare case processing in helping substance-abusing parents enter and complete treatment and reunite with their children.130

For more information on drug courts in general, refer to the National Drug Court Institute/National Association of Drug Court Professionals website at http://www.ndci.orgexternal link and the Office of Justice Programs Drug Court Clearinghouse and Technical Assistance Project publication, Juvenile and Family Drug Courts: An Overview, available at http://www.ncjrs.org/html/bja/jfdcoview/welcome.html.

For more information on the courts and CPS, refer to the User Manual Series publication, Working with the Courts in Child Protection, at http://www.childwelfare.gov/pubs/usermanuals/courts/.

In many States, CPS and social welfare are housed within one umbrella social services agency. While this configuration does not guarantee that collaboration will occur, it eliminates some of the structural problems often encountered when agencies do not share a common organizational context.

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Collaboration at All Levels

Collaboration among agency officials at the highest levels is a necessary, but not always sufficient, condition for collaboration on the frontline. Suggestions for fostering collaboration are discussed below.

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Collaboration at the State Level

There are several steps that State CPS and other officials can take to promote collaboration among their agencies:

  • Establish ongoing interagency task forces and authorize members to make decisions. The task forces should be charged with addressing issues that make it difficult for staff to coordinate services. Topics might include designing integrated screening or assessment instruments, developing mechanisms to track participants across different agencies, or proposing methods for staff to share information under the rules of confidentiality.
  • Create joint mission statements with SUD treatment and other agencies and promote the mission statement through notices, memos, or policy directives that are signed by officials from each agency.
  • Prepare integrated funding requests to support integrated programming activities. Develop and execute shared advocacy strategies for securing those funds.
  • Require cross-training of staff and schedule staff from other systems to deliver that training. Hold these training sessions at other agencies.
  • Co-locate staff in each other's agency.
  • Create interagency agreements such as Memorandums of Understanding (MOUs). For more information about MOUs, see Appendix H, Memorandums of Understanding.

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Collaboration on the Frontline

There are several steps that frontline staff and supervisors can take to promote collaboration among their agencies:

  • Visit each other's programs, talk to program participants, and meet each other's staff. CPS caseworkers should visit SUD treatment programs, observe activities, and hear from families who are in recovery. Similarly, SUD treatment professionals should visit CPS offices and accompany caseworkers on some home or field visits.
  • Convene multidisciplinary case staffings, some of which should include family members. During these meetings, caseworkers and families should develop shared plans for services, allocate tasks, and discuss ways they can share responsibility for activities and outcomes.
  • Discuss differences in a way that helps everyone understand each other's point of view, the rules, each one's limitations, and the scope of authority.

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Techniques for Promoting Collaboration

Collaboration is not likely to occur unless staff from participating agencies have opportunities to understand their partners and to work together to solve shared problems. SUDs and child maltreatment are complicated issues; staff who work in one field generally know little about the other field. In addition, both SUDs and maltreatment are clouded by sensational media stories, shame, and stigma, making it especially important that frontline practitioners have access to accurate information. Information sharing, professional development and training, and co-location are examples of techniques that can promote collaboration.

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Information Sharing

The easiest way for CPS caseworkers and SUD treatment providers to collaborate is to share information. Information sharing between colleagues can range from general information about each system (e.g., agency protocols) to case-specific information (e.g., a permanency plan or strategy for handling a parent's possible relapse). CPS caseworkers should be knowledgeable, however, of any confidentiality laws that restrict what information they are allowed to share. Confidentiality issues are discussed later in this chapter.

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Professional Development and Cross-training

Professional development provides structured learning experiences that go beyond teaching about new rules or forms. Professional development allows caseworkers to understand their discipline better, to advance their careers, and to feel part of an important human services system. Cross-training means teaching workers from one field, such as CPS, about the fundamental concepts and practices of another field, such as SUD treatment.

CPS agencies can design professional development and cross-training programs in ways that mirror the interagency relationships they want to develop—relationships in which individuals are encouraged to explore and to discuss values, ideas, and policies.

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Co-location

Some CPS agencies have SUD treatment providers on site. Co-location demonstrates that agency officials consider cooperation and collaboration to be agency priorities and integral elements of agency culture. If senior officials decide to co-locate staff, they are more likely to realize that collaboration is an expected method of conducting business, not merely an agency buzzword.

Co-location can be highly effective in helping CPS caseworkers and SUD treatment providers develop relationships that are essential to delivering comprehensive and well-organized services. It can change what are often a series of sequential referrals into concurrent discussions (case staffings) that bring greater expertise to case planning. Caseworker stress and burnout can be reduced if several people participate in making difficult and sensitive decisions regarding child placement. Co-location also may make it easier for family members to participate in designing their service plan, to comply with requirements that come from both treatment and CPS agencies, and to understand the roles that different caseworkers perform in helping them succeed.

Co-location, however, is not a perfect solution. It does not automatically create relationships or guarantee collaboration. Co-location can introduce management challenges related to supervision, space, pay differences, performance requirements, or work expectations. Furthermore, it can be administratively complex and, at times, programmatically inappropriate when too many people are involved with one family. When this happens, families may feel overburdened, they may worry that their confidences have been violated, or they may think that decisions are being made without their involvement.

Online Tutorials for Knowledge-building and Cross-systems Work

The National Center on Substance Abuse and Child Welfare, an initiative of the Administration for Children and Families and the Substance Abuse and Mental Health Services Administration, has developed four free online self-tutorials to build knowledge about SUDs and child welfare and to support and facilitate cross-systems work. The tutorials are each intended for a specific audience: child welfare professionals, substance abuse treatment professionals, judicial officers and attorneys in the dependency system, and legislators. A certificate for claiming Continuing Education Units is available upon successful completion of each tutorial. The tutorials are available at http://www.ncsacw.samhsa.gov/tutorials/index.asp.

For more information on training resources, visit http://www.childwelfare.gov/management/training/.

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Confidentiality and Information Sharing

As CPS and SUD treatment agencies work more closely, they are faced with deciding how and when to share information about families. Both agencies recognize the importance of allowing families to have privacy to discuss and to address such difficult, sensitive problems as SUDs and child maltreatment. Both also must adhere to a variety of laws and regulations that govern disclosure of information and protect family privacy.

At times, staff within each agency may feel that laws regarding confidentiality make it difficult to share or to receive information, and confidentiality rules may be put forth as a reason for their inability to communicate. For example, a CPS caseworker may become frustrated if an SUD treatment provider cannot share information regarding a parent's progress in treatment; the caseworker may feel that this information might inform child custody decisions. On the other hand, an SUD treatment provider may become frustrated when decisions regarding a child's placement are made without a CPS caseworker discussing how it may affect the parent's progress in treatment. However, a study of seven innovative CPS agencies and SUD treatment programs noted that while Federal and some State laws are obstacles to information exchange, these laws did not create insurmountable barriers to collaboration.131 This section discusses confidentiality laws and ways to share information appropriately.

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Confidentiality Laws

Laws addressing various aspects of confidentiality involving professional relationships, communications, and situations vary. These laws may focus on:

  • SUD treatment privacy requirements
  • Mandated reporting of child abuse and neglect
  • Privacy of CPS records
  • Client-therapist confidentiality statutes
  • Research programs and data collection on human subjects.132

SUD treatment confidentiality laws are based on the view that individuals with SUDs are more likely to seek treatment if they know that information about them will not be disclosed unnecessarily to others. Without the assurance of privacy, the fear of public disclosure of their problem possibly could prevent some individuals from obtaining needed treatment.

At times, however, there are important reasons for agencies to share information when working with the same families. Federal SUD treatment regulations specify circumstances under which it is appropriate that information be shared, including if the information relates to reports of child abuse or neglect.

See Appendix I, Confidentiality and the Release of Substance Use Disorder Treatment Information, for a list of circumstances in which patient record information can be released. Additionally, the Child Abuse Prevention and Treatment Act of 1974 (P.L. 93–247) requires that States allow for the public disclosure of information regarding a death, or near death, of a child when it is the result of maltreatment.

SUD treatment providers are subject to mandatory child abuse reporting laws in their States, requiring treatment staff to report incidents of suspected child abuse and neglect. However, this exemption from standard confidentiality requirements applies only to initial reports of child abuse or neglect. It does not apply to requests or even subpoenas for additional information or records, even if the records are sought for use in civil or criminal investigations. Thus, patient files and patient-identifying information protected by the Federal confidentiality law still must be withheld from CPS agencies and the court unless there is some other authorization such as patient consent, an appropriate court order, or in some cases, a Qualified Service Organization Agreement (QSOA). Consent forms and QSOAs are discussed later in this chapter.

Key considerations related to the types of information that can be shared between CPS caseworkers and SUD treatment providers include:

  • CPS case information. Factors surrounding the case, any previous case history, the family environment, and other factors that are informative to the SUD treatment provider in conducting the assessment and in developing the treatment plan. CPS caseworkers must obtain appropriate consent to share this information.
  • SUD screening information. Federal law and regulations allow CPS caseworkers to share with SUD treatment personnel information gathered during a screening for the purpose of referring an individual for an assessment.
  • SUD diagnosis and treatment information. An SUD treatment agency may not disclose this information without written consent or court order. This is true even if the CPS agency referred the family member to the treatment program and mandated the assessment. For an example of a consent form, see Appendix J, Sample Qualified Service Organization Agreement and Consent Form.
  • Attendance in treatment programs. SUD treatment programs may report a family member's attendance at treatment, or their failure to attend, as long as the patient has signed a written consent that has not expired or been revoked. Attendance is often a key component of the family's case plan.
  • A treatment participant's relapse. SUD treatment programs may report information about relapse to CPS caseworkers if that information is covered by a valid written consent signed by the patient. However, for many CPS agencies, the key information may be whether the family member is making satisfactory progress in treatment, even if relapse has occurred.
  • Combined case plan. Most of the discussion between SUD treatment providers and CPS caseworkers will be permissible as long as the information discussed is covered by a valid written consent form. It is advisable to tell family members that their case will be discussed at periodic meetings or telephone calls and specifically who will participate in the discussions.

If CPS caseworkers release the results of a substance abuse evaluation or any information regarding a client's treatment, they violate Federal regulations related to confidentiality. Everyone, not just SUD treatment providers, is bound by Federal confidentiality statutes, and CPS caseworkers can be prosecuted for violating these laws. Caseworkers should clarify with their supervisor or their agency's attorney any questions they may have about this statute and should document any legal advice given that pertains to this statute.

Subpoenas

A subpoena to testify in court is not sufficient to require the release of confidential information, as specified under Federal regulations related to confidentiality, nor is a police search warrant. If subpoenaed to court to testify, an SUD treatment provider should first refuse, citing Federal regulations related to confidentiality. Only with a judge's subsequent court order that finds a just cause to ignore this law in this particular case may a counselor testify without a client's written consent.

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Ways to Share Information Appropriately

In order for the CPS caseworker and SUD treatment provider to communicate, it is important to obtain the client's consent early, preferably at the time of the referral to treatment. Clients involved with CPS agencies may consent voluntarily to information disclosures in order to aid investigations of child maltreatment because their refusal to cooperate may result in losing custody of their children. However, information that has been disclosed through consent may not be used in criminal investigations or to prosecute the person. A consent form is only valid until the date, event, or condition on which it expires, or at any time when the treatment participant or client revokes consent. Therefore, it is a good idea to set the expiration date far enough into the future to ensure that needed information can be retrieved by the other agency. It is permissible to have the consent form contain an end date that fits circumstances.133 (See Appendix I, Confidentiality and the Release of Substance Use Disorder Treatment Information, for details about what should be included in a voluntary consent form.)

Another way that information can be shared between systems is through a QSOA. SUD treatment providers may disclose information under a QSOA without the patient's consent. A QSOA is an agreement between two service organizations to share information about and to protect the confidentiality of individuals they serve. A QSOA should not be confused with an MOU, which usually is an agreement between two or more organizations to provide services to a common set of clients.

A qualified service organization is one that provides services to the SUD treatment program. CPS agencies meet this definition if they provide services that help the SUD treatment agency serve the client. The heads of both the SUD treatment agency and the CPS agency must sign this agreement. Once signed, QSOAs permit disclosure of information to enable the organization to provide a service to the alcohol and drug abuse treatment program. QSOAs cannot be used for other purposes, such as obtaining reimbursement. Information obtained as part of a QSOA may not be re-disclosed to any other agency without permission.134 See Appendix J, Sample Qualified Service Organization Agreement and Consent Form, for a sample QSOA form.

Confidentiality is an important part of communication. The parameters and limitations of communication have to be established locally. Furthermore, administrative procedures need to be put in place to encourage communication among staff . When approached with care, confidentiality rules do not automatically limit communication. Rather, they set the context within which staff can share important information, and families can be assured that sensitive aspects of their lives will be protected.

It is important to note, however, that regardless of privacy rules and confidentiality of information under Federal laws, mandatory reporters of child abuse and neglect are required to report suspected cases of child maltreatment, according to an Information Memorandum issued by the U.S. Department of Health and Human Services in September 2005. The memorandum "to affirm the obligation of mandatory reporters to report child abuse and neglect under State and Federal laws" refers specifically to exceptions to the confidentiality and privacy rules in the Health Insurance Portability and Accountability Act (HIPAA), the Public Health Service Act Title X family planning program, and the confidentiality rules relating to patient records in federally funded alcohol and drug abuse treatment services.135

Federal Guidelines Regarding Confidentiality

The following are examples of Federal guidelines for patient confidentiality in cases involving SUDs or child maltreatment:

  • The Code of Federal Regulation, Alcohol and Drug Abuse Treatment Confidentiality, 42 C.F.R., Part II, provides guidelines for maintaining patient confidentiality, including rules for information sharing, for SUD treatment agencies. They can be viewed at http://www.access.gpo.gov/nara/cfr/waisidx_03/42cfr2_03.html.
  • The Child Abuse and Neglect Prevention and Treatment Act (CAPTA), 45 C.F.R. 1340.14, requires States to have guidelines for maintaining confidentiality of child abuse and neglect reports. It can be viewed at http://www.access.gpo.gov/nara/cfr/waisidx_03/45cfr1340_03.html.
  • HIPAA of 1996 (P.L. 104–191) provides standards for health plans, health care providers, and health care clearinghouses to ensure the security and privacy of health information, including access to records. HIPAA also upholds mandatory child abuse reporting laws. For more information on HIPAA and its relationship to SUD treatment, visit the Substance Abuse and Mental Health Services Administration website at http://www.hipaa.samhsa.gov/hipaa.html.

For more information on child maltreatment legal issues and laws, visit http://www.childwelfare.gov/systemwide/laws_policies/.

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Conclusion

For staff in any agency, it is easy to lose sight of the other systems and agencies that share a common client base. Families that experience SUDs and child maltreatment have needs, problems, and strengths that are diverse and complex. As a result, they often require the services of multiple agencies. It is critical that CPS caseworkers and SUD treatment providers have an understanding of the other system as well as the skills and desire to work toward a common goal. It is equally important that families are consulted in order to make certain that the collaborative structure helps them to address their SUDs and to ensure the safety and well-being of their children. With all of the parties committed to working jointly toward the same goals and being open to innovative approaches, successful outcomes can be achieved.

 

https://www.childwelfare.gov/pubs/usermanuals/substanceuse/chaptereight.cfm