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Description : Check out this medical PowerPoint presentation titled "Understanding Substance Use Disorders, Treatment, and Recovery" to learn about about substance use, treatment, and recovery. Learn about substances and their effects, the brain chemistry of addiction, and the continuum of substance use disorders – mild, moderate, and severe.

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Slide 1-

Module 2: Understanding Substance Use Disorders, Treatment, and Recovery Child Welfare Training Toolkit
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A program of the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Administration for Children and Families (ACF), Children’s Bureau www.ncsacw.samhsa.gov | ncsacw@cffutures.org Acknowledgment
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Learning Objectives After completing this training, child welfare workers will: Identify the types of substances and their effects, including methods of use Outline the continuum of substance use disorders as mild, moderate, or severe Understand the basic brain chemistry of substance use disorders Recognize the signs and symptoms of substance use in the context of child welfare practice Discuss substance use disorders in a cultural context Identify treatment modalities and the continuum of care Understand the recovery process, relapse prevention and long-term recovery maintenance
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(Children and Family Futures, 2017) Collaborative Values Inventory In different circumstances, any person could be a parent with a substance use disorder A person with a substance use disorder should not be held accountable for his or her negative behavior If parents with substance use disorders had enough willpower, they would not need substance use disorder treatment The stigma associated with substance use disorders prevents parents from seeking treatment
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Individual Factors That Increase Risk for Substance Use or Misuse Developmental Environmental Social Genetic Co-occurring mental disorders (U.S. Department of Health and Human Services, 2016)
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1970s 1980s–1990s 2000s 2010s Drug Epidemics of the Decades
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Stimulants Central Nervous System Depressants Hallucinogens (National Institute on Drug Abuse, 2018a; National Institute on Drug Abuse, 2016) Drug Classifications
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(National Institute on Alcohol Abuse and Alcoholism; National Institute on Drug Abuse, 2018a) Alcohol Cocaine Heroin Common Drugs
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(National Institute on Drug Abuse, 2018a) Methamphetamine Marijuana Opioids Common Drugs (cont’d)
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The Brain Science of Addiction
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American Society of Addiction Medicine (ASAM) “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social, and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.” (American Society of Addiction Medicine, 2011)
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Brain imaging studies show physical changes in areas of the brain when a drug is ingested that are critical to: Judgment Decision making Learning and memory Behavior control These changes alter the way the brain works and help explain the compulsion and continued use despite negative consequences (National Institute on Drug Abuse, 2018b) Drug Use and Addiction
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The Rise and Fall of the Cocaine High
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(National Institute on Drug Abuse, 2007) Effects of Cocaine on the Brain
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Dopamine and Substance Use Dopamine: A neurotransmitter that is released during a pleasurable experience Connected to the reward circuit of the brain Acts by reinforcing behaviors that are pleasurable Leads to neural changes that help form habits Released during substance use and reinforces the connection between the substance and the pleasurable experience Trains the brain to repeat the pleasurable experience (National Institute on Drug Abuse, 2018b)
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(Davis, 2007) Dopamine Receptors in Addiction
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(National Institute on Drug Abuse, 2013) Healthy Person Meth Use Disorder 1 month abstinence Meth Use Disorder 14 months abstinence (National Institute on Drug Abuse, 2013) Effects of Meth on the Brain
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Discussion Think about the parenting implications for a parent involved in child welfare who is actively using drugs or alcohol. Think about the implications for a parent involved in child welfare who has just stopped using drugs or alcohol and is trying to resume normal interactions with their child/ren. If you are tasked with observing a home visit, what conclusions might you draw? How do we balance compassion, understanding and patience with a parent’s temporarily compromised brain condition, while maintaining parent accountability and child safety?
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The Effect of Parental Substance Use on Families
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In-Home Indicators of Potential Parental Substance Use A report of substance use in the child protective services call or report Paraphernalia observed or reported in the home The smell of alcohol, marijuana, or other drugs on the parent or in the home A child reports use by parent(s) or adults in the home Parent’s behavior suggests intoxication Parent exhibits signs of a substance use disorder Parent reports their own substance use Parent shows or reports experiencing physical effects of a substance use disorder and/or withdrawal Note: This list is not meant to include all possible signs. (Breshears, 2009)
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Effects of Substance Use Disorders on Family Functioning Child development Household safety Psychosocial impact Parenting skills Intergenerational trauma and mental health problems (Smith & Wilson, 2016)
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Heroin Crack Cocaine Injecting, snorting, or smoking heroin causes initial euphoria, followed by an alternately wakeful and drowsy state Children may be left unsupervised by parents who “nod out” while under the influence of heroin (Breshears, 2009; National Institute on Drug Abuse, 2018a) The Risks of Parental Substance Use Disorders on Children: Alcohol and Illegal Drugs
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(Breshears, 2009; National Institute on Drug Abuse, 2018a) The Risks of Parental Substance Use Disorders on Children: Alcohol and Illegal Drugs
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The Risks of Parental Substance Use Disorders on Children: Prescription Drugs and Pain Medications (Breshears, 2009; National Institute on Drug Abuse, 2018a)
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Screening for Substance Use Disorders
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Screening: The Role of Child Welfare Workers Screening Signs and symptoms of parental substance use disorders during initial screening or assessment for child abuse and neglect Signs and symptoms of parental substance use disorders throughout the child welfare case Referral Refer parent to a substance use disorder treatment provider for further assessment The substance use disorder treatment provider may refer the parent to a treatment program (Breshears, 2009)
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The Purpose of Screening Determine the risk or probability that a parent has a substance use disorder Screen everyone Use observation, interviews, and standardized screening tools Refer for an assessment by a substance use disorder treatment provider if needed (Roberts & Nuru-Jeter, 2012)
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Substance Use Disorder Treatment
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A Treatable Disease Substance use disorders are preventable and treatable Successful substance use disorder treatment is highly individualized and entails: Medication Behavioral interventions Peer support - Dr. Nora Volkow, National Institute on Drug Abuse "Groundbreaking discoveries about the brain have revolutionized our understanding of addiction, enabling us to respond effectively to the problem" (National Institute on Drug Abuse, 2018c; Longo, 2016)
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Relapse Rates for Chronic Conditions (McLellan et al., 2000)
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(National Institute on Drug Abuse, 2018c) Purpose of Treatment Reduce the major symptoms of the illness Improve health and social functioning Teach and motivate individuals to monitor their condition and manage threats of relapse
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Impaired Control Larger amounts or over a longer time than originally intended Persistent desire to cut down A great deal of time spent obtaining the substance Intense craving 2. Social Impairment Failure to fulfill work or school obligations Recurrent social or interpersonal problems Withdraw from social or recreational activities 3. Risky Use Recurrent use in situations physically hazardous Continued use despite persistent physical or psychological problem that is likely to have been caused or exacerbated by use 4. Pharmacological Criteria Tolerance: Need for markedly increased dose to achieve the desired effect Withdrawal: Syndrome that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use Mild 2-3 Criteria Moderate 4-5 Criteria Severe 6+ Criteria Diagnosing Substance Use Disorders: DSM-5 Criteria (American Psychiatric Association, 2013)
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(American Society of Addiction Medicine, 2014) Overview of the Treatment Process
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Full Spectrum of Treatment and Services (National Institute on Drug Abuse, 2018c)
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Addiction is a complex but treatable disease that affects brain function and behavior No single treatment is appropriate for everyone Treatment needs to be readily available Effective treatment attends to multiple needs of the individual, not just his or her drug abuse Remaining in treatment for an adequate period of time is critical Behavioral therapies are the most commonly used forms of drug abuse treatment Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies Principles of Effective Drug Addiction Treatment: A Research Based Guide (National Institute on Drug Abuse, 2018c)
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An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs Many drug-addicted individuals also have other mental disorders Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse Treatment does not need to be voluntary to be effective Drug use during treatment must be monitored continuously, as lapses during treatment do occur Treatment programs should test patients for infectious diseases Principles of Effective Drug Addiction Treatment: A Research Based Guide (cont’d) (National Institute on Drug Abuse, 2018c)
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(Werner et al., 2007; Substance Abuse and Mental Health Services Administration, 2009) Services That Parents in Treatment May Need Access to physical necessities Medical care Psychological assessment, and mental health and trauma treatment Parenting and child development education Child care Social services, social support Family therapy and health education Family planning services
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(Werner et al., 2007; Substance Abuse and Mental Health Services Administration, 2009) Services That Parents in Treatment May Need Life skills training Language and literacy training Continuing aftercare programming Support in sustaining visitation with children Case management
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(Zweben, 2015; Wells, 2015; Munoz, 2014; Roggman & Cardia, 2016) Contact With Children Parents in treatment may—or may not—see their children Visitation is important to children and parents Interventions to treat substance use disorders, child neglect, and maltreatment are more effective if family centered Prepare children for visits with a parent in in-patient treatment
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Family-Centered Approach Recognizes that addiction is a brain disease that affects the entire family and that recovery and well-being occurs in the context of the family (Adams, 2016; Bruns, 2012)
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(Werner et al., 2007; Substance Abuse and Mental Health Services Administration, 2009) Continuum of Family-Based Services
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(Werner et al., 2007) Principles of Family-Centered Treatment Treatment is comprehensive and inclusive of substance use disorder, clinical support services, and community supports for parents and their families The parent or caregiver defines “family” and treatment identifies and responds to the effect of substance use disorders on every family member Families are dynamic, and thus treatment must be dynamic Conflict within families is resolvable, and treatment builds on family strengths to improve management, well-being, and functioning
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(Werner et al., 2007) Principles of Family-Centered Treatment (cont’d) Cross-system coordination is necessary to meet complex family needs Services must be gender responsive and specific and culturally competent Family-centered treatment requires an array of professionals and an environment of mutual respect and shared training Safety of all family members comes first Treatment must support creation of healthy family systems
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Mothers who participated in the Celebrating Families! Program and received integrated case management showed significant improvements in recovery, including reduced mental health symptoms, reduction in risky behaviors, and longer program retention (Zweben et al., 2015). Retention and completion of comprehensive substance use treatment have been found to be the strongest predictors of reunification with children for parents with substance use disorders (Green, Rockhill, & Furrer, 2007; Marsh, Smith, & Bruni, 2011). Women who participated in programs that included a “high” level of family and children’s services were twice as likely to reunify with their children, as those who participated in programs with a “low” level of these services (Grella, Hser & Yang, 2006). Benefits of Family-Centered Substance Use Disorder Treatment
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Understanding Treatment Progress Key factors in understanding treatment progress:* Participation in treatment Knowledge gained about substance use Participation in support systems Abstinence from substances Relapse prevention planning Treatment completion *You can work with your local treatment providers on what information should be included on progress monitoring updates. Some jurisdictions have created templates for ongoing progress monitoring communication that the treatment providers sends to child welfare regularly.
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(Oliveros, 2011; Breshears, 2009; Werner, 2007; Choi 2006) Treatment Completion Progress on treatment goals Sobriety and evidence that the parent can live a sober life Stabilization/resolution of medical or mental health challenges Evidence of a well-developed support system
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When Treatment Is Unavailable Be familiar with care and treatment options in the community Provide contacts for 12-step meetings and encourage parents to attend While waiting for optimal treatment: Help develop safety plans Plan regular contact Suggest lower levels of care
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The Cultural Context
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(Center for Substance Abuse Treatment, 2014) Cultural Competency in Substance Use Disorder Treatment Culture refers to: Race Ethnicity Age Gender Geographical location Sexual orientation Gender identity Incorporating community-based values, traditions, and customs can bring about positive change
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(Kim, 2017; Guerrero, 2017; Center for Substance Abuse Treatment, 2014) Culturally Relevant Treatment Culturally relevant substance use disorder treatment should: Be compatible with roles, values, and beliefs Identify and remove barriers to treatment Address language needs Be geographically accessible Be family-focused
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Substance Use Disorder Treatment:American Indian and Alaska Native Communities Federal trust relationship between recognized tribes and federal government Substance use disorder treatment: Through Indian Health Service (IHS) network or Indian nonprofit agency under contract with IHS Child welfare services: Under Indian Child Welfare Act (ICWA), tribes have jurisdiction over and operate child welfare services Ask about a child's ethnicity to determine if ICWA or IHS should be used (Park-Lee et al., 2018; Barlow 2018; Center for Substance Abuse Treatment, 2014)
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(Substance Abuse and Mental Health Services Administration, 2009) Gender-Specific Components Unique Considerations for Women Childhood abuse: physical, sexual, and/or emotional trauma Co-occurring mental disorder, domestic violence Comprehensive Treatment Model for Women Clinical treatment services Clinical support services Community support services
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Recovery
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What is recovery? A process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. Access to evidence-based substance use disorder treatment and recovery support services are important building blocks to recovery SAMHSA’s Working Definition What Is Recovery? SAMHSA’s Working Definition (Substance Abuse and Mental Health Services Administration, 2012)
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(Ghertner et al., 2018; Radel et al., 2018) Recovery Occurs in the Context of the Family Substance use disorder is a disease that affects the family Adults (who have children) primarily identify themselves as parents The parenting role and parent-child relationship cannot be separated from treatment Adult recovery should have a parent-child component including prevention for the child
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Can threaten parent’s ability to achieve and sustain recovery and establish a healthy relationship with their children, thus risking: Recurrence of maltreatment Re-entry into out-of-home care Relapse and sustained recovery Additional infants with prenatal substance exposure Additional exposure to trauma for child/family Prolonged and recurring impact on child well-being Focusing Only on Parent’s Recovery Without Addressing the Needs of Children… (U.S. Department of Health and Human Services, 2013)
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A Family Focus (Werner, Young, Dennis, & Amatetti, 2007)
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Recovery Support
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(National Institute on Drug Abuse, 2018b) Post-Treatment Expectations Recovery as “one day at a time” for the rest of a person's life Relapse Ongoing support: Economic, vocational, housing, parenting, medical, and social supports Re-engagement in the recovery process, should relapse occur Supporting recovery
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Continuing Care or Aftercare: Strategies To Support Recovery Alumni group meetings at the treatment facility Home visits from counselors Case management Parenting education and support services Employment services Safe and sober housing resources Legal aid clinics or services
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Continuing Care or Aftercare: Strategies To Support Recovery (cont’d) Mental health services Medical and healthcare referrals Dental health care Income supports Self-help groups Individual and family counseling Recovery or peer support specialist
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Liaison Links participants to ancillary supports; identifies service gaps Treatment Broker Facilitates access to treatment by addressing barriers and identifying local resources Monitors participant progress and compliance Enters case data Advisor Educates community; garners local support Communicates with team, staff and service providers Functions of Recovery or Peer Support Specialists (Huebner, 2018; Center for Substance Abuse Treatment, 2010)
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A Program of the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment and the Administration on Children, Youth and Families Children’s Bureau Office on Child Abuse and Neglect www.ncsacw.samhsa.gov ncsacw@cffutures.org
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References
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Adams, P. J. (2016). Switching to a social approach to addiction: Implications for theory and practice. International Journal of Mental Health and Addiction, 14(1), 86–94. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. American Society of Addiction Medicine. (2011). Public policy statement: Short definition of addiction. https://www.asam.org/docs/default-source/public-policy-statements/1definition_of_addiction_short_4-11.pdf?sfvrsn=6e36cc2_0 American Society of Addiction Medicine. (2014). The ASAM performance measures: For the addiction specialist physician. Chevy Chase, MD: American Society of Addiction Medicine. https://www.asam.org/docs/default-source/advocacy/performance-measures-for-the-addiction-specialist-physician.pdf?sfvrsn=5f986dc2_0 Barlow, A., McDaniel, J. A., Marfani, F., Lowe, A., Keplinger, C., Beltangady, M., & Goklish, N. (2018). Discovering frugal innovations through delivering early childhood home‐visiting interventions in low‐resource tribal communities. Infant Mental Health Journal, 39(3), 276–286. doi:10.1002/imhj.21711 Breshears, E. M., Yeh, S., & Young, N.K. (2009). Understanding substance abuse and facilitating recovery: A guide for child welfare workers. U.S. Department of Health and Human Services. Rockville, MD: Substance Abuse and Mental Health Services Administration. https://ncsacw.samhsa.gov/files/Understanding-Substance-Abuse.pdf Bruns, E. J., Pullmann, M. D., Weathers, E. S., Wirschem, M. L., & Murphy, J. K. (2012). Effects of a multidisciplinary family treatment drug court on child and family outcomes: Results of a quasi-experimental study. Child Maltreatment, 17(3), 218–230. References
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Center for Substance Abuse Treatment. (2010). Substance abuse specialists in child welfare agencies and dependency courts: Considerations for program designers and evaluators. HHS Pub. No. (SMA) 10-4557 Rockville, MD: Substance Abuse and Mental Health Services Administration. Center for Substance Abuse Treatment (US). (2014). Improving cultural competence. Rockville, MD: Substance Abuse and Mental Health Services Administration; Treatment Improvement Protocol (TIP) Series, No. 59, 1, Introduction to cultural competence. https://www.ncbi.nlm.nih.gov/books/NBK248431 Children and Family Futures. (2017). Collaborative values inventory. http://www.cffutures.org/files/cvi.pdf Choi, S., & Ryan, J. P. (2006). Completing substance abuse treatment in child welfare: The role of co-occurring problems and primary drug of choice. Child Maltreatment, 11(4), 313–325. doi:10.1177/1077559506292607 Davis, D. P. (2007). NIDANotes: NIDA’s division of clinical neuroscience and behavioral research. https://archives.drugabuse.gov/news-events/nida-notes/2007/10/nidas-newest-division-mines-clinical-applications-basic-research Ghertner, R., Baldwin, M., Crouse, G., Radel, L., & Waters, A. (2018). ASPE research brief: The relationship between substance use indicators and child welfare caseloads. https://aspe.hhs.gov/system/files/pdf/258831/SubstanceUseCWCaseloads.pdf Green, B. L., Rockhill, A., & Furrer, C. (2007). Does substance abuse treatment make a difference for child welfare case outcomes? A statewide longitudinal analysis. Children and Youth Services Review, 29(4), 460–473. doi:10.1016/j.childyouth.2006.08.006 Grella, C. E., Hser, Y. I., & Huang, Y. C. (2006). Mothers in substance abuse treatment: Differences in characteristics based on involvement with child welfare services. Child Abuse & Neglect, 30(1), 55–73. doi:10.1016/j.chiabu.2005.07.005 References
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Guerrero, E. G., Garner, B. R., Cook, B., & Kong, Y. (2017). Does the implementation of evidence-based and culturally competent practices reduce disparities in addiction treatment outcomes? Addictive Behaviors, 73, 119–123. Huebner, R. A., Hall, M. T., Smead, E., Willauer, T., & Posze, L. (2018). Peer mentoring services, opportunities, and outcomes for child welfare families with substance use disorders. Children and Youth Services Review, 84, 239–246. doi:10.1016/j.childyouth.2017.12.005 Kim, H., & Hopkins, K. M. (2017). The quest for rural child welfare workers: How different are they from their urban counterparts in demographics, organizational climate, and work attitudes? Children and Youth Services Review, 73, 291–297. doi:10.1016/j.childyouth.2016.12.024 Longo, D. L. (2016). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374, 363–371. Marsh, J. C., & Smith, B. D. (2011). Integrated substance abuse and child welfare services for women: A progress review. Children and Youth Services Review, 33(3), 466–472. doi:10.1016/j.childyouth.2010.06.017 McLellan, A. T., Lewis, D. C., O’Brien, & C. P., Kleber, H. D. (2000). Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. The Journal of the American Medical Association, 284(13), 1689–1695. Munoz, L. M. (2013). Preserving the bond: Child welfare professionals' perspectives on the opportunities and challenges of parent-child visitation. Dissertations. Paper 678. https://ecommons.luc.edu/cgi/viewcontent.cgi?referer=https://scholar.google.com/&httpsredir=1&article=1677&context=luc_diss National Institute on Alcohol Abuse and Alcoholism. Overview of alcohol consumption. https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption References
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National Institute on Drug Abuse. (2007). The brain & the actions of cocaine, opioids and marijuana. Bethesda, MD: National Institutes of Health; U.S. Department of Health and Human Services. https://www.drugabuse.gov/brain-actions-cocaine-opioids-marijuana National Institute on Drug Abuse. (2013). Methamphetamine. https://www.drugabuse.gov/publications/research-reports/methamphetamine National Institute on Drug Abuse. (2016). Hallucinogens. https://www.drugabuse.gov/publications/drugfacts/hallucinogens National Institute on Drug Abuse. (2018a). Commonly abused drugs charts. Bethesda, MD: National Institutes of Health; U.S. Department of Health and Human Services. https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts National Institute on Drug Abuse. (2018b). Drugs, brains, and behavior: The science of addiction. NIH Publication No. 18-DA-5605. Bethesda, MD: National Institutes of Health; U.S. Department of Health and Human Services. https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/preface National Institute on Drug Abuse. (2018c). Principles of drug addiction treatment: A research-based guide (3rd ed.). Bethesda, MD: National Institutes of Health; U.S. Department of Health and Human Services. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition Oliveros, A., & Kaufman, J. (2011). Addressing substance abuse treatment needs of parents involved with the child welfare system. Child Welfare, 90(1), 25–41. Park-Lee, E., Lipari, R. N., Bose, J., Hughes, A., Greenway, K., Glasheen, C., Herman-Stahl, M., Penne, M., Pemberton, M., & Cajka, J. (2018). Substance use and mental health issues among U.S.-born American Indians or Alaska Natives residing on and off tribal lands. CBHSQ Data Review. https://www.samhsa.gov/data References
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Radel, L., Baldwin, M., Crouse, G., Ghertner, R., & Waters, A. (2018). ASPE research brief: Substance use, the opioid epidemic, and the child welfare system: Key findings from a mixed methods study. https://aspe.hhs.gov/system/files/pdf/258836/SubstanceUseChildWelfareOverview.pdf Roberts, S. C., & Nuru-Jeter, A. (2012). Universal screening for alcohol and drug use and racial disparities in child protective services reporting. The Journal of Behavioral Health Services & Research, 39(1), 3–16. Roggman, L., & Cardia, N. (Eds.). (2016). Home visitation programs: Preventing violence and promoting healthy early child development. Springer International Publishing: Switzerland. doi: 10.1007/978-3-319-17984-1 Smith, V. C., & Wilson, C. R., AAP Committee on Substance Use and Prevention. (2016). Families affected by parental substance use. Pediatrics, 138(2), e20161575. doi: 10.1542/peds.2016-1575 Substance Abuse and Mental Health Services Administration. (2009). Substance abuse treatment: Addressing the specific needs of women. Treatment Improvement Protocol (TIP) Series, No. 51. HHS Publication No. (SMA) 13-4426. Rockville, MD: Substance Abuse and Mental Health Services Administration. Substance Abuse and Mental Health Services Administration. (2012). SAMHSA’s working definition of recovery. Rockville, MD: Substance Abuse and Mental Health Services Administration. https://store.samhsa.gov/product/SAMHSA-s-Working-Definition-of-Recovery/PEP12-RECDEF U.S. Department of Health and Human Services. (2013). Targeted grants to increase the well-being of, and to improve the permanency outcomes for, children affected by methamphetamine or other substance abuse: Fourth annual report to Congress. Washington, DC: Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. https://www.ncsacw.samhsa.gov/files/RPGI_4th_Report_to_Congress_reduced_508.pdf References
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U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: HHS. https://www.hhs.gov/surgeongeneral/reports-and-publications/addiction/index.html Wells, M., Vanyukevych, A., & Levesque, S. (2015). Engaging parents: Assessing child welfare agency onsite review instrument outcomes. Families in Society, 96(3), 211–218. Werner, D., Young, N. K., Dennis, K, & Amatetti, S. (2007). Family-centered treatment for women with substance use disorders: History, key elements and challenges. Washington, DC: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/sites/default/files/family_treatment_paper508v.pdf Zweben, J. E., Moses, Y., Cohen, J. B., Price, G., Chapman, W., & Lamb, J. (2015). Enhancing family protective factors in residential treatment for substance use disorders. Child Welfare, 94(5), 145–166. https://www.ncbi.nlm.nih.gov/pubmed/26827469 References
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Resources
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Center for Substance Abuse Treatment. (2010). Substance abuse specialists in child welfare agencies and dependency courts considerations for program designers and evaluators. HHS Pub. No. (SMA) 10-4557 Rockville, MD: Substance Abuse and Mental Health Services Administration. https://ncsacw.samhsa.gov/files/SubstanceAbuseSpecialists.pdf Center for Substance Abuse Treatment. (2015) Substance abuse treatment and family therapy. Treatment Improvement Protocol (TIP) Series, No. 39. HHS Publication No. (SMA) 15-4219. Rockville, MD: Substance Abuse and Mental Health Services Administration. https://store.samhsa.gov/product/TIP-39-Substance-Abuse-Treatment-and-Family-Therapy/SMA15-4219 Lander, L., Howsare, J., & Byrne, M. (2013). The impact of substance use disorders on families and children: From theory to practice. Social Work in Public Health, 28(3–4), 194–205. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725219/ National Indian Child Welfare Association. (2015). Setting the record straight: The Indian Child Welfare Act fact sheet. https://www.nicwa.org/wp-content/uploads/2017/04/Setting-the-Record-Straight-ICWA-Fact-Sheet.pdf National Institute on Drug Abuse. (2018). Commonly abused drugs charts. Bethesda, MD: National Institutes of Health; U.S. Department of Health and Human Services. https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (3rd ed.). Bethesda, MD: National Institutes of Health; U.S. Department of Health and Human Services. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition Resources
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Substance Abuse and Mental Health Services Administration. (2009). Substance abuse treatment: Addressing the specific needs of women. Treatment Improvement Protocol (TIP) Series, No. 51. HHS Publication No. (SMA) 13-4426. Rockville, MD: Substance Abuse and Mental Health Services Administration. https://store.samhsa.gov/product/TIP-51-Substance-Abuse-Treatment-Addressing-the-Specific-Needs-of-Women/SMA15-442 Substance Abuse and Mental Health Services Administration. (2016). A collaborative approach to the treatment of pregnant women with opioid use disorders: Practice and policy considerations for child welfare: Collaborating medical, and service providers. HHS Publication No. (SMA) 16-4978. Rockville, MD: Substance Abuse and Mental Health Services Administration. https://ncsacw.samhsa.gov/files/Collaborative_Approach_508.pdf Substance Abuse and Mental Health Services Administration. (2018). Finding quality treatment for substance use disorders. https://store.samhsa.gov/product/Finding-Quality-Treatment-for-Substance-Use-Disorders/PEP18-TREATMENT-LOC U.S. Department of Health and Human Services, Office of Minority Health. National culturally and linguistically appropriate services standards. https://www.thinkculturalhealth.hhs.gov/clas/standards Resources