Chemical Dependency in Child
Welfare
Presented by:
MeLinda Trujillo, DBHR
Amy Martin, DBHR
Introductions
• Trainers
MeLinda Trujillo – Treatment Manager
Division of Behavioral Health and Recovery
Amy Martin – Youth Treatment Manager
Division of Behavioral Health and Recovery
• Training Ground Rules and Personal Reactions
Training Agenda
Introduction
 The Basics of Alcohol and Other Drugs
 Collaborative work with other
Professionals & Families
 Trauma in Substance Abusing Families
 GAIN SS Screening Tool
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Introduction to Alcohol
and Other Drugs
A Basic Understanding
Why Do People Use Alcohol and
Other Drugs?
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Biological
Psychological
Social
Cultural, and
Environmental factors
Research notes that men and women often
experience different progressions from
substance use to abuse and dependence.
Levels of Substance Use and Risk of
Child Abuse and Neglect

General categorization of substance use is as
follows:
◦ Substance use
◦ Abuse
◦ Dependence.
Any level of substance use by a parent can place
a child in imminent harm, create present danger
or create impending danger of physical abuse
and/or neglect.
 It is important to determine if substance use is
a factor in an unsafe situation for a child.
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HANDOUT
Impact of Drugs on
the Brain
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Causes significant changes in brain chemistry
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Disrupts normal communication between neurons.
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Continued use can impact the ability to experience pleasure.
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Engaging in a compulsive behavior, even in the face of negative
consequences.
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Inability to limit intake of the addictive substance
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Long lasting or permanent changes to the brain
Brain Scan
Treatment Works
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Periods of abstinence, or reduced substance use are a
result of effective intervention and treatment
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Treatment outcomes show a decrease in negative
outcomes for addicts
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Relapse is part of recovery. Increased and/or
continued support and interventions assist in regaining
abstinence.
Types of Treatment
Continuum of Care in Washington State
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Acute detox
Sub-acute detox
Intensive Inpatient
Recovery House
Long Term
Intensive Outpatient
Outpatient
Aftercare
HANDOUT
Opiate Substitution Treatment

Client receives medication :
◦ To assist in stabilizing brain chemistry
◦ In conjunction with outpatient counseling.
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Effective ONLY with opiate class drugs
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Pregnant mothers generally are prescribed this modality
as a way of remaining free from illegal substances and
maintaining their pregnancy
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Infant will likely need to detox after its birth as a result of this method of
treatment
Of a number of treatment options methadone is the
most commonly used modality.
Referral Issues/Options
Treatment access
 Obtaining Funding
 Knowing the Resources

Certified Chemical
Dependency Provider
Directory
A directory that includes chemical dependency service
providers certified by the Division of Behavioral Health
and Recovery (DBHR). Certified agencies are listed
alphabetically within each county.
http://www.dshs.wa.gov/dbhr/dadirectory.shtml
Tools for Working with
Substance Abusing Individuals
in the Child Welfare System

UAs are a tool to be used in monitoring levels of a substance
(decreasing/increasing levels) in a person’s system
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UA Best Practice will be discussed in more depth during 2 day training
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Random, observed UA’s are the most accurate type of testing
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UAs are a tool and can be augmented by the client.
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UAs should not be the basis in deciding permanency – such as
reunification
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Other methods for collecting information on a person’s level of usage
are hair follicle testing, oral swabs and blood tests – these tend to be less
utilized due to increased cost of testing
Need for Collaboration
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Expected family outcomes may differ based on perspective
◦ CA looks at safely reunifying children with parents.
◦ CDPs are working with the client to address addiction
CA concerns about the family need to be shared with the
CDPs
It is critical the CDP and CA Social Worker understand the
very different roles each have with the family.
CDP confidentiality guidelines are based on 42 CFR Part 2.
CA Social Workers guidelines are based on Health Insurance
Portability and Accountability Act of 1996 (HIPPA).
Redisclosure of information received from a chemical
dependency program are subject to 42 CFR Part 2. HANDOUT
Keep in mind that…
One person can’t collaborate.
Child Safety
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CDPs are not trained to the policies & procedures of
CA in great depth.
CDP risk factors mean something very different. They
can provide information related to treatment progress
that can help the social worker to better understand
potential risks of abuse and/or neglect of children
involved.
Parents diagnosed as chemically dependent may not be
as responsive to skill development training (anger
management classes, parenting classes, etc.) if their
recovery program has not been established.
INDICATORS FOR PROGRESS IN THE SUBSTANCE ABUSE
RECOVERY PROCESS: ZERO TO THREE MONTHS
Zero to
Three
Months
Poor
Some
Moderate
Progress/ Progress/Contempl Progress/Prep/
Precontempl
ation/Prep
Action
ation
Chemical
Parent remains o
Dependency in denial of
Treatment
substance
abuse/chemical
dependency
o
and has not
completed
substance
abuse screen.
Reduction of
initial resistance
and
defensiveness
Parent has
completed
chemical
dependency
assessment and
entered into
chemical
dependency
treatment
o
Attendance o
in chemical
dependency o
treatment
becomes
more
consistent
Substantial Progress/Action/
Maintenance
Regular attendance in chemical
dependency treatment
Parent has recognized and accepted
the negative consequences of own
substance abuse
If applicable, parent has participated
in collaborative service planning
meeting with child welfare worker and
chemical dependency treatment
worker
HANDOUT
Trauma in Substance Abusing
Families
Working Definition of Trauma

Trauma is the unique individual
experience of an event or enduring
conditions in which The individual’s ability to integrate his or her
emotional experience is overwhelmed; or
 The individual experiences a threat to life,
bodily integrity or sanity.
Exercise Questions
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What originally brought you into the field?
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Which clients do you most enjoy working with? What is it
about them that you enjoy?
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Which clients do you least enjoy working with? What is it
about them that you do not enjoy?
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What was your role in your family growing up?
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Do you see any relationship between your role and the
clients you enjoy or don’t enjoy?
Group Discussion
What did you notice your discussions?
 How was this activity for you personally?
 What if any emotions came up?
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Some Consequences of Trauma
Alcohol, tobacco and other drug abuse to
manage intense emotional states
 Other self destructive behaviors
 Either numb or over-reactive emotional
states
 Attention problems
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Over/Under Responsibility
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A reframe of co-dependency as a concept - is taking
responsibility for myself legal?
Does each spouse take on responsibilities that make
sense to the situation?
Do the children take on parenting roles?
Children placed in this role may have difficulty accepting
and recognizing help and support. They may feel they
have to be strong for parent or parents.
Focus on others to avoid focus on self.
Maintain known dysfunctional family dynamics better
than unknown family dynamics.
Self Care for Practitioners
Often secondary trauma is experienced while working with clients.
As professionals, we are sometimes triggered on a very deep level by
experiences that we had long thought were dealt with.
It’s crucial to ensure that you have ways of caring for yourself and
working through these experiences.
Issues of transference and counter-transference arise with clients most
often when we haven’t cared for ourselves.
Victimization and Connection
to Substance Abuse
90% of public behavioral health clients have
been exposed to trauma (Muesser et al., 2004)
 Most have multiple experiences of trauma
 34 to 53% report childhood sexual or physical
abuse (Kessler et al., 1995)
 43 – 81% report some type of victimization
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Resiliency Factors
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Intelligence
Determination
Quality of relationships
Creativity
Caring for self
Accepting help from others
Introduction to Global
Appraisal of Individual
Needs – Short Screen
(GAIN-SS)
Global Appraisal of Individual
Needs – Short Screener
(GAIN-SS)
•A validated screening tool used with adults and youth
(ages 13 years and older).
•The GAIN-SS identifies a need for a chemical
dependency, mental health or co-occurring assessment.
The identified needed assessment would be referred to
and completed by a community professional.
•This tool does not identify service needs, only the need
for further assessment.
HANDOUT
When to administer the
GAIN-SS screen:
During
the first 45 days of an open CPS
investigation
◦If a case is not going to be transferred and is a high standard
referral, a GAIN-SS screen must be completed
• FVS or CFWS social workers will complete a
GAIN-SS screen if one has not yet been completed
during the CPS investigation
• CHET Screeners will administer the GAIN-SS to
youth 13 years and older if one was not
administered during the investigation
Results of Mental Health
Component of GAIN-SS
If
an adult or youth answers “YES” to the suicide
question, regardless of any other answers, the social
worker/CHET screener will:
o
Refer the client to the local crisis line, or
o
Notify a Designated Mental Health Professional (DMHP) to the
positive suicide response on the screen
Mental Health and/or
Substance Abuse Assessment Referral Process
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If the screen results produce two or more “YES”
responses, the social worker will:
◦ Make a referral to a community mental health provider or
substance abuse professional for further assessment
◦ If there are substance abuse indicators and mental health
indicators, the social worker will make a referral to a community
professional for a co-occurring disorder assessment
• A referral can be made even if there are no questions
with a “YES” answer on the screen
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If a client is already involved in substance abuse or
mental health services, a new referral is not needed.
Reflecting…
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What, if anything, did you find out/discover about yourself and
your work during this session?
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What would you like to be sure to take with you and hold onto
from this session?
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What, if anything, would you like to get rid of or eliminate from
your regarding your work with clients or in their behalf?
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What, if anything, moved you during this session?
Thank You
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Questions?
MeLinda Trujillo
melinda.trujillo@dshs.wa.gov
 Amy Martin
amy.martin2@dshs.wa.gov
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