Safety Planning When Substance Abuse is Present

Safety Planning
When Substance Abuse
is Present
PRESENTERS:
MELISSA KIMBALL, SARAH NEILSON & SHERRI LEVESQUE
Agenda…

Pretest

Break for Lunch

Basic drug categories

Drug Testing/Confidentiality

Emerging trends

Engaging the Reluctant Parent

Heroin, Methadone, Suboxone

Activity

Break Time

Break

Reading the different cues of someone
on a substance

Safety planning when a parent is using

What Makes an Addict? The phases of
addiction

Activity

Review, questions, Take-A-Ways

Treatment Planning – Levels, risk
reduction and relapse prevention
Let’s Discuss the Drug Categories
 What
are the categories?
 Opiates-Heroin, Morphine, Codeine, Opium, etc.
 Depressants-Alcohol, Barbiturates, benzodiazepines, Marijuana etc.
 Stimulants-Cocaine, Amphetamines, Nicotine, etc.
 Hallucinogens-LSD, Mescaline, Marijuana, hashish, MDMA, etc.
 Cannabinoids-Marijuana
 Designer
Drugs-Spice, K2 (anything manmade that mimic)
Opiates…
Possible Effects
Effects of Overdose

Euphoria

Slow and shallow breathing

Drowsiness

Clammy skin

Respiratory depression

Convulsions

constricted pupils

Coma

nausea

Possible death
Have you
heard of
Narcan
Parties?
Depressants…
Possible Effects
Effects of Overdose

Slurred Speech

Shallow respiration

Disorientation

Clammy skin

Drunken behavior

Dilated pupils

Life-threatening withdrawal

Weak and rapid pulse

Coma

Possible death
Stimulants…
Possible Effects

Increased alertness

Excitation

Euphoria

Effects of Overdose

Agitation

Increase in body temperature
Increased pulse rate

Hallucinations

Increased blood pressure

Convulsions

Insomnia

Possible death

Loss of appetite

Violence

Mood swings
Hallucinogens…
Possible Effects
Effects of Overdose

Illusions and hallucinations

Longer, more “intense” trip episodes

Poor perception of time and distance

Psychosis

Euphoria

Fatigue

Relaxed inhibitions

Paranoia

Increased appetite

Possible death

Disoriented behavior
Emerging Trends…
FLAKKA (alpha-PVP)
KROKODIL
MOLLY
CAFFEINE POWDER
SYRUP, PURPLE DRANK, SIZZURP, LEAN
SALVIA
DABS
PUPPY CHOW
“
The Very Nature of Heroin Use
is the Inherent Probability
of Lethality at Each Use…
”
Let’s Discuss Heroin…

What are the Signs of Heroin Use?

Methadone Maintenance

Monitoring Medication
Let’s take a Break….
WHEN WE COME BACK, WE WILL ADDRESS YOUR QUESTIONS
What Does Substance
Abuse Look Like?
What Makes a Person
Dependent?
What About Treatment?

Level of Use 1 - Experimentation

Level of Use 2 – Regular Use

Level of Use 3 – Heavy Use

Level of Use 4 – Chronic Use

Levels of Care
Chart to Show Addiction…
Relapse Prevention Plan

What negative consequences did my use of substances cause?

What positive things did my use give me?

What is my diagnosis?

What are my relapse triggers?

Who is my sober network?

How will I know I am entering relapse?

What areas do I need to keep on putting effort into when I leave therapy?
Enjoy Lunch!
Drug Testing

Cross – Reactivity

Detection Periods

Medication Cheat Sheet

Substance Abuse & Mental Health Services Administration (SAMSA)
How Do We Engage
Reluctant Parents?

Offer to meet them at their place of work

Use their words

Show them alternatives

Suspend your own judgements and life
experiences
Activity Time!
Resources… (Your packet has more)

Drugs.com - Identify pills, punch in “alcohol” for example and then the medication a client is taking and it
will tell you what interactions they may have which will help understand a clients behaviors and you can
learn about any medication you have ever heard of.

Noslang.com – slang interpreter for sexting, drug use, you name it. Just put in what the slang is and it will spit
out the definition. Regularly updated.

Telespoof.com – used by parents and youth to make it appear a phone call is coming from one place
(home for example) when it is really coming from their cell or another state even.

www.cesar.umd.edu – The Center for Substance Abuse Research offers all kinds of information on drug
trends, drug information and free publications on a variety of topics

www.familywatchdog.us – Family Watchdog will let you search for any registered sex offender for free and
will tell you the location they live as well as their crimes

NH Alcohol and Drug Treatment Locator – This website allows you to put in a city you live by and then it will
show you all of the treatment options in that area for substance abuse. It also has links to on-line support
services, twelve step meetings and a variety of other information. It is relatively new and people are
encouraged to share the website.

www.new –futures.org-website with resources specific to NH and surrounding areas/towns.
Safety
Assessment &
Planning When
Substance
Abuse is Present
Purposes of safety assessment &
planning

To identify children who have been or are likely to be
seriously harmed in the very near future


Limited to critical and immediate danger
To develop short-term intervention plans when
necessary to stabilize or make alternate placement
(Safety Plan or Removal)
How do we engage and assess at the
same time?

Sometimes we have already established the parent is using,
sometimes not

In either instance, focusing on how everyday life tasks of that
developmental stage are accomplished yields critical assessment
information about the care of the child(ren)

Track the details of those situations at both the family and
individual level

Focus attention on understanding exceptions to the problem, as
well as the problem situation itself
New Hampshire Integrated
Assessment - 24 Hour Safety Tool
What are the DANGEROUS situations
Per Policy?

Serious Physical Injury by Caregiver or adult household
member

Serious suspicious physical injury by unknown individual
and caregiver or other household member cannot be
ruled out

Threat of serious injury

Serious emotional injury
What are the DANGEROUS situations
Per Policy?

Domestic violence likely to injure child/youth

Excessive discipline

Sexual abuse by caregiver or other adult household
member

Sexual abuse by unknown individual and caregiver or
other adult household member cannot be ruled out

Caregiver fears he/she will seriously harm child
What are the DANGEROUS situations
Per Policy?

Caregiver does not meet the child’s current/imminent
needs for food, clothing, shelter, and/or medical or
mental health care

The living situation is physically hazardous and
immediately threatening to the child’s health or safety,
based on the child’s age/development

Caregiver does not or is unable to protect the child
from actual serious harm or risk of serious harm by others
What are the DANGEROUS situations
Per Policy?

Caregiver does not provide supervision necessary to
protect the child, based on the child’s age and
development

Other

Unexplained child/infant death

Criminal behavior occurring in the presence of the child
What are some DANGEROUS situations
specific to substance abuse?

If caregivers are dealing drugs, there will be a lot of
different people coming and going into/out of the
home, possibly having access to the child(ren).

There are potential risks of home invasion as the buyers
may want to rob the dealer/substance abusing parent.
The parent may be under the influence and unaware of
what is going on and what they are subjecting their
child(ren) to.
What are some DANGEROUS situations
specific to substance abuse?

A substance abusing parent could be under the influence while
caring for their child, or someone else’s child.

A substance abusing parent could leave their “stash” somewhere
where it may be accessible to the child(ren).
Use Your Senses to Assess!

What do you see, smell, hear, not hear, not see, etc.

Are there signs of drug dealing – high risk behaviors, arrests,
extreme vacations being taken, routines, how many cars does
the family own, weather appropriate clothing, child(ren) are
parentified and acting more mature than what is expected at
their developmental stage.

Is someone who is suspected of using heroin, wearing a hooded
sweatshirt in the middle of summer?
What is a Safety Plan and When
Should We Use One?

Safety Plans are used only when there is a danger (not
risk) to the child(ren).

Safety Plans should be followed up on within fourteen
days, if not before, per NHIA policy.
A safety plan should:






Address the threats to the child’s safety
Have explicit time limits
Be realistic, i.e. the family can implement and follow through
Be specific
Include a method for monitoring
Consider the involvement of others to ensure the protection of the
child.
Plan Break Down…




Is this a detailed plan?
How will this plan be
monitored?
How will DCYF or the family
know if it’s not working?
Are all involved in the plan on
board with the plan?
Is it SMART?
•
•
•
•
•
Specific
Measurable
Achievable
Realistic
Timely
Please Remember…
Substance addiction can interfere with some critical strengths of the
parent that would support a safety plan:
Caregiver is able and willing to:

Actively participate in creating and carrying out a plan to protect the child’s safety

Use resources necessary to ensure safety

Have supportive relationships with one or more persons who are willing to participate in
effective safety planning AND the caregiver is willing to accept their help

Provide for the child’s basic needs

Demonstrate effective problem solving

Exhibit self-control and put the child’s safety ahead of his/her own wants
Safety Planning with Substance Abuse….

Parents who have presented in Family Voice Panels in District Offices
through Better Together with Birthparents have shared that they
“understand they use and have an addiction”, but they “come up
with their own safety plans.” These may or may not be sufficient as
safety plans. What do you think? Please discuss this with your
neighbor.

This may include setting up the child(ren) in the living room with puzzles, a movie,
games, watching a sibling, etc.

They may have a sober friend come by to watch the child(ren) while the
substance abusing parent uses a substance.
Safety Planning with Substance Abuse….
Safety plans must take into account such factors as:

Sobriety of caregiver when making plan

Level of substance use (abuse vs. addiction)

Type of substance being used

Age/vulnerability of child

Realistic availability of a sober caregiver

In hearing a father’s story, he has stated “there is no true safety plan” as the parent using will say anything thing to
ensure the worker leaves

Parents also indicated that the initial hesitation of admitting there may be an issue can stem from concern about
admitting to a crime

Safety Plans should only be used instead of removal, if they realistically ensure safety and can be
monitored.

Safety Plans that are dependent on the “word or action” of the alleged substance abusing parent are
not sufficient to mitigate danger,

YOU CAN ALWAYS STEP OUT AND CALL YOUR SUPERVISOR!!
Let’s Safety Plan Together!

Parents in Family Voice Panels report the following is most effective
when DCYF staff:

“Acts Human”, understanding that mistakes and addiction can happen to anyone

Builds trust

Looks beyond the tip of the iceberg, explores more through appropriate questions

Engages the family/parent in a respectful manner

Gives the parent/family TIME when you go out to the house, try not to come across
rushed as the parent can sense/feel this.

Parents are looking for validation, which is where normalizing the developmental tasks
can be helpful.

Show empathy

Knows their own triggers and own history of abuse/neglect/substance abuse…
CPS Safety
Plan
Let’s take a look at a plan
created during a visit…..
This image cannot currently be displayed.
CPS Safety
Plan
Let’s take a look at a plan
created during a visit…..
This image cannot currently be displayed.
Let’s talk about vicarious
trauma, your coping skills
and hobbies and the
reason you come to
work.
CPS Safety
Plan
Let’s take a look at a plan
created during a visit…..
This image cannot currently be displayed.
CPS Safety
Plan
Let’s take a look at a plan
created during a visit…..
This image cannot currently be displayed.
CPS Safety
Plan
Let’s take a look at a plan
created during a visit…..
This image cannot currently be displayed.
Referral: Mom has two children, a 3yo and a 6yo. She admits
to using heroin once in her life, last week, with a friend. During
this time, she was not supervising the children. Housing is a
concern as they are homeless and couch-surfing. Dad is in jail.
Aunt Lucy is a support to the family.
CPS Safety
Plan
Let’s take a look at a plan
created during a visit…..
This image cannot currently be displayed.
When we DO need to seek Removal…
Ways in which we establish possible Evidence of use…
Admission by parent,
Reports from others,
Drug tests,
Evidence of dishonest reporting about drug usage,
Physical observations of symptoms or behaviors
(many little things pulled together)
When we DO need to seek Removal…
DCYF has met with the parents in an attempt to engage
the family in seeking treatment for their substance
use. The parents have refused to engage in treatment
despite the potential lethality of heroin use by both
parents, Mr. D’s recent overdose, and Ms. D’s admitted
heroin use. The refusal to engage in treatment places the
children in imminent danger due to the children’s young
ages and Mr. D and Ms. D’s use of drugs while caring for
the children.
When we DO need to seek Removal…
DCYF met with parents in order to assess safety of the children. Given the
potential lethality of the heroin use described above, the parents were
unable/unwilling to enter into a safety plan that would mitigate the danger
to the children. The child are very likely to suffer serious impairment due
to their young age and need for constant care and supervision.
When there is NO danger identified,
There is No Safety Plan needed…
What About An Action Plan?
 Safety
plans are just for DANGEROUS
Situations
 Action
plans can be used to try to
mitigate risk
 Some
be…
examples for an action plan could
THANK YOU!!
PLEASE DON’T FORGET TO FILL OUT AN ACTION PLAN AND EVALUATION FOR
THIS TRAINING. THANK YOU AGAIN FOR YOUR TIME.