10 Things I Learned at the Opioid Conference

The National Family Preservation Network (NFPN) helped coordinate a conference on opioids on May 3. Here are 10 things that I learned about opioids:
1. Opioids are depressants which slow the heart rate and breathing and thus overdoses can quickly cause death. Combining opioids with other drugs exponentially increases the risk of overdose and death.
2. The most frequently obtained source of illegal opioids is from a family member’s or friend’s prescription. Anxiety or depression are some of the main reasons for substance use.
3. Addiction is a chronic disease of the brain. Like any chronic illness, such as diabetes, addiction is difficult to treat. It takes time for the brain to recover and resume production of natural chemicals.
4. Detoxification is not sufficient. It is not treatment. The absence of drugs does not equal recovery.
5. 90% of opioid users require medication-assisted treatment. These medications help the brain to regain normal functioning.
6. Behavior therapies enhance the effectiveness of medications and help people stay in treatment longer. Behavior therapies engage people in treatment, modify their attitudes and behaviors related to drug use, and increase their life skills.
7. Addicts can be helped to overcome addiction, even if they don’t want help!
The outcomes for voluntary and involuntary treatment are similar.
8. Relapse is not a failure. It’s part of recovery. One exemplary drug court does not sanction participants for relapse. Rather, treatment is increased. The court does impose jail time for not showing up…so everyone shows up!
9. Children of substance-using parents are more likely to be abused and neglected, and more likely to be placed in foster care. Interventions include comprehensive assessment, safety plan, and increasing parental protective capacity.
10. Get as much training as possible on opioids. For a comprehensive overview of opioids, visit https://emedicine.medscape.com/article/287790-overview.

Here are additional resources:

NFPN offers a video training on substance use. Pricing starts at $275.

NFPN has trainers (board members) with expertise in helping address the effects of opioid use on families: parenting capacity and skills, motivational interviewing, trauma treatment, and depression. Contact NFPN for more information and rates.

For all questions and for information about resources and training, please contact Priscilla Martens, NFPN Executive Director, director@nfpn.org, phone 888-498-9047.

Posted by Priscilla Martens, NFPN Executive Director


Reunification Models

Reunifying families is receiving more attention with the opioid epidemic demonstrating that there are not and never will be enough foster homes. Another incentive is Evidence-Based Practice which requires that programs demonstrate effectiveness in order to receive federal and state dollars.

So reunification, neglected for too long, is now moving to the forefront. A number of states are implementing or reviving reunification programs. Michigan is one of the states that has prioritized reunification. Here is the Michigan model in a nutshell:
• Team leader (therapist) and family worker meet with the family 4 hours a week (8 hours during the first two weeks of services)
• The team is available 24/7
• Caseload is 6 for family worker and 12 for the team leader
• Services include solution-focused therapy and skill-based intervention
• Standard length of service is 4 months with possible extension up to 6 months
• The program costs $6700 per family while foster care averages $30,000 per child
• 85% of families in the program successfully reunify

The Michigan Family Reunification Program is listed on the California Evidence-Based Clearinghouse for Child Welfare but has not yet been rated.

To read a feature article on the program visit http://tucson.com/hard-work-of-reunification-often-entails-rehab-intensive-home-services/article_867a9156-2940-11e8-8744-83e4530d40cd.html

The most pressing social problem at this time is the opioid epidemic. One very promising model to helping families is drug treatment courts. These courts focus on families’ substance use and child welfare issues and seek to improve treatment and reunification outcomes. Children whose families participate in family drug courts spend less time in foster care and are more likely to reunify with their families (Lloyd, 2015).

For a case study of a successful family treatment court for substance abuse visit http://www.cffutures.org/files/PFR_Robeson_Standard_Final2.pdf

Several states are implementing new models of reunification including Nebraska and Mississippi. A demonstration program in Missouri is being tested in one county. All of these programs have in common that service delivery is provided by a team, not an individual worker.

The team approach provides a specialist who focuses on therapeutic treatment while the other team member(s) focuses primarily on skill building. Some of the advantages to this approach may include optimal division of labor within limited resources, built-in support and consultation with each team member having first-hand knowledge of the family, and capacity to serve more families.

While these programs look promising, there is no definitive research that has established their effectiveness. The National Family Preservation Network (NFPN) would welcome an opportunity to partner with a team-approach reunification program to study its effectiveness.

If your agency is interested in a partnership for a reunification study, please email director@nfpn.org or call 888-498-9047.

Posted by Priscilla Martens, NFPN Executive Director

Trauma-Informed Care in Child Welfare Practice

New research is demonstrating the effectiveness of trauma treatment models for families involved in the child welfare system.

Trauma Systems Therapy (TST) is an especially promising model for use in the child welfare system. It is a research-based, therapeutic model designed to improve functioning of children exposed to trauma. Child Trends conducted a research study in Kansas and found that children whose care teams had been trained in TST demonstrated significant improvements in well-being (behavioral and emotional regulation, functioning) and placement stability.

Child Trends also evaluated Trauma Systems Therapy for Foster Care. Resource parents receiving the training were more likely to keep their homes open to foster children, and children were less likely to experience a placement disruption.

Another model, ARC Reflections, teaches resource parents skills to enhance child well-being, stability, and permanency. It is based on Attachment, Self-Regulation, and Competency. Five North Carolina child welfare agencies tested the model. Resource parents showed significant increase in knowledge and skills about trauma-informed parenting and tolerance towards children’s misbehavior along with praise for positive behavior.

A summary of the Child Trends Evaluation of trauma-informed care for the child welfare system is available here: https://www.childtrends.org/trauma-informed-care-initiatives-show-promise-improving-practice-child-welfare-system/

Information on Trauma Systems Therapy is available here: https://med.nyu.edu/child-adolescent-psychiatry/research/institutes-and-programs/trauma-and-resilience-research-program/trauma-systems-therapy

The Trauma Systems Therapy manual is excellent training for both therapists and non-therapists as it is hands-on and interactive. Purchasing information is available here: https://www.guilford.com/books/Trauma-Systems-Therapy-for-Children-and-Teens/Saxe-Ellis-Brown/9781462521456

NFPN has an assessment tool for Trauma/Post-Trauma Well-Being with details here: http://www.nfpn.org/assessment-tools/trauma-assessment-tool

Posted by Priscilla Martens, NFPN Executive Director

Federal Funding for Preserving Families

Following nearly two years of consideration, the Family First Prevention Services Act was passed by Congress as part of the Bipartisan Budget Act of 2018 (H.R. 1892).

Starting October 1, 2019, all states for the first time will have the option of using foster care funds (Title IV-E) to pay for prevention services, or, more precisely, keeping families together. Those eligible for the prevention services include children (and their parents/kin caregivers) who are at imminent risk of out-of-home placement, children experiencing disrupted guardianships or adoption, and young people in foster care who are pregnant or parenting. There is no income eligibility requirement. Funding is an entitlement meaning that it will be available for any services that are eligible for reimbursement.

Criteria for services eligible for federal reimbursement include:
• substance abuse and mental health prevention and treatment services provided by a qualified clinician
• in-home parent skill-based programs including individual and family counseling
• services and programs must be trauma-informed
• services and programs that are evidence-based (promising, supported, or well-supported practice as defined in the legislation with a pre-approved list to be developed by the Dept. of
Health and Human Services)
• services provided for a maximum of 12 months
• states will be reimbursed for 50% of the cost of services, staff training, and the administrative costs for developing processes and procedures

Each child receiving services must have a written plan that identifies the strategy for keeping the child out of foster care and the services that are needed. States must include a well-designed evaluation for any practice used unless they receive a waiver based on compelling evidence of effectiveness. States must also document how they are tracking and preventing deaths from child abuse and neglect.

The legislation extends the Promoting Safe and Stable Families Program (Title IV-B, Subpart 2) for another 5 years (FY 2017-FY 2021). Mandatory funding of $345 million is provided each year plus whatever discretionary funding Congress allocates. There are two changes to the PSSF program that currently funds four types of services: family support, preservation, reunification, and adoption services:
• allows children to receive unlimited reunification services while in foster care
• children returning home from foster care will have access to 15 months of reunification services

A detailed summary of the legislation prepared by Children’s Defense Fund is available here: http://www.childrensdefense.org/library/data/family-first-detailed-summary.pdf

Posted by Priscilla Martens, NFPN Executive Director

Resources for Preserving Families

The mission of the National Family Preservation Network (NFPN) is to serve as the primary national voice for the preservation of families. In fulfilling our mission, NFPN has conducted research studies on family preservation and has developed over 50 resources to assist those who work with families. Information on the research and resources is available on the website at http://www.nfpn.org.

The field of family preservation has evolved over the past decades through, for example, research findings being translated into best practice, the use of reliable and valid assessment tools to measure family functioning, and the addition of booster/step-down services. Statewide evaluations of Intensive Family Preservation Services (IFPS) and periodic national surveys of IFPS provide data on the components and outcomes of effective intensive services.

In addition to research and resources, NFPN offers training and technical assistance on family preservation and in-home services. In recent years, we have focused more on video and online training. NFPN’s newest offering is video training on substance abuse and in-home services, a timely training in the midst of the opioid epidemic. Highlights of the training include effective therapeutic techniques and an interview with a mother recovering from substance abuse and reunifying with her children.

Here are descriptions and links to a selection of resources offered by NFPN, including the most popular ones:
IFPS ToolKit : Comprehensive guide for the development and maintenance of strong and effective IFPS services http://www.nfpn.org/preservation/ifps-toolkit

IFPS Nationwide Survey (2014): Comparison of high-quality IFPS programs in 12 states http://www.nfpn.org/preservation/2014-ifps-survey

Reunification Model: NFPN’s recommended model for intensive family reunification services http://www.nfpn.org/Portals/0/Documents/ifpspaper.pdf, starting on p. 11.

Continuous Quality Improvement: CQI instrument to ensure ongoing quality of IFPS programs, http://www.nfpn.org/preservation/cqi-ifps-instrument

Video training: Training on substance abuse for in-home services practitioners http://www.nfpn.org/videos/substance-abuse-and-in-home-services

Reliable and valid assessment tools for use with families: http://www.nfpn.org/Portals/0/Documents/assessment_tools_overview.pdf

Please contact NFPN (director@nfpn.org, 888-498-9047) if you need assistance with resources, T/TA, or wish to place an order. Our doors are always open for family preservation!

Posted by Priscilla Martens, Executive Director

Milestone Year

The National Family Preservation Network (NFPN) is wrapping up its 25th year of operation. We’re happy and grateful to continue fulfilling our mission as the primary national voice for the preservation of families.

The Preserving Families Blog is a mouthpiece for our voice. This past year the Blog has focused on key elements of preserving families such as assessment, nationwide surveys of Intensive Family Preservation Services, model programs, gatekeeping, safety, reunification, and federal funding for family preservation.

In 2018 we will be studying the opioid epidemic and collaborating with agencies to do everything possible to strengthen and preserve families involved with substance abuse.

Thank you for everything that you do to help families.

Merry Christmas and Happy New Year!

Posted by Priscilla Martens, Executive Director


With the most recent mass shooting, an incomprehensible tragedy, it’s a reminder that those in the helping profession are increasingly faced with trying to navigate a perilous journey while maintaining the safety of themselves and those they are trying to help.

While we tend to think of first responders as police, firefighters, and medical personnel, first responders are also in-home services workers who are on the front lines helping families. Let’s look at the issue of safety through one type of in-home services, Intensive Family Preservation Services (IFPS).

From the beginning, safety has always been the highest priority of IFPS. For over four decades, IFPS has had a stellar safety record. There have been very few deaths of a child during an IFPS intervention despite the fact that IFPS serves high-risk families. There are no known deaths of an IFPS worker during the course of an intervention.

Safety is baked into the model of IFPS. Frequent contact with the family, 24/7 availability of the worker, and very small caseloads serve as a protection for family members and assure a rapid response when a crisis occurs. The worker’s safety is enhanced through a high degree of training and skills, 24/7 back-up, and constant support of a supervisor. And the IFPS workforce share many traits in common with emergency responders such as integrity, communication skills, flexibility and adaptability, dedication, and team player.

In effect, the IFPS model itself contributes to the safety of the family and the IFPS worker. Thus, the best reason for model fidelity is that when it is weakened or abandoned, child deaths are the inevitable result. A tragic example occurred when the child welfare administrators in the state of Illinois thought they could keep families together and still save money by assigning workers high caseloads. Then a child was killed by his mother in 1993 and Illinois completely abandoned any resemblance to family preservation. Within a few years, Illinois had the highest rate of out-of-home placement in the nation. The foster care system was overwhelmed. Child abuse deaths statewide increased and there were also child abuse deaths in foster care. Not until Illinois again embraced preserving families through best practice did the deaths decrease along with a dramatic decrease in out-of-home placements. Safety outcomes also improved.

Here are some steps that we can all take to increase safety:

1. Be alert and prepared. We need to become more aware of our surroundings and what action to take if safety is threatened. When I’m in public places, I look for exits and places to take shelter if the worst happens. Ask your local emergency responders how to prepare for situations that threaten your safety and the safety of others around you.
2. Train your organization’s staff on safety. Here is one online resource for safety training for in-home services workers and it also includes training on ethics:
3. Advocate for keeping children safely in their homes and not overwhelming the foster care system. Here’s a summary of what happens in foster care panics: https://drive.google.com/file/d/0B291mw_hLAJsMGdWQ2NhYTM2Ulk/view.
4. Advocate to strengthen and expand IFPS programs as a strong safety model of in-home services. For a comparison of the safety record of foster care vs. IFPS visit https://drive.google.com/file/d/0B291mw_hLAJsMGdWQ2NhYTM2Ulk/view
5. Find ways to help your community. You have skills that are needed not only by your agency but also by your community as a whole. The community will benefit and so will you by investing in the well-being of your community.

Posted by Priscilla Martens, NFPN Executive Director