Applying the Evidence: Afternoon Sessions


>>Check one,
two, three.>>Those of you are
here get to listen to the next panel. I hope you had good
conversations at once. This next panel will be moderated
by Shelly Weizman. We will be talking
about drug courts. Best practices
of insuring vacations to treat.>>I’m Shelly Weizman. I’m the associate
director for the public policy project. I’m also a person
in recovery. Thank you. For the last
20 years. I was thinking
this morning as I lay in bed
at 5 o’clock thinking about
this panel , before I came
into recovery, it is funny
to me now. It was not funny
at the time. I came into recovery
after a series of events which involved
an arrest. A town in Texas where
I was living. At the time of this
arrest, I was a teenager. My mom was dating the
chief of police. Fortunate or
unfortunate for me. But he struggles
later, I found recovery. I found out
years later, that it was actually
my mother that had orchestrated
that arrest. It is funny now. I think. It is part of my
story and journey. I ended up working in
programs and going to law school. I did a lot of really
great stuff. Recovery open
this up for me. At the time, that was
all she knew how to do. To help me was to
get me arrested. We have come
a long way in 20+ years. Have we, that much
further than that? There are many
communities where families
and parents and people who are in
the lives of people use drugs, do not
know what to do. They do not know how
to help their loved ones. People do not know
where to get help themselves. What I think about
the purpose of this event, you have these . innovations. Things that
communities are starting to do to
meet this need of helping people. We started thinking
at O’Neill of what the key intervention
points or. Where people could
access help easier. Right now, those
intervention points are in the criminal
justice system. I think about my
personal history and my work in the field. Law enforcement
and courts, there really is a
tremendous opportunity to
help people . If there is the right
understanding, leadership, and tools. I wanted to take a
moment and commend the people that
are here today. Particularly from the
judiciary area and law enforcement
communities. We talked about this
in the last panel. For a long time,
people were told that there was a lot
of different systems and people thought
that it was not their job. People ended up in the
criminal justice system and places where people may or
may not have known what to do. Started thinking
outside the box. The people on
this panel today and Judge Hannah, who
was not able to make it in person, but will
be scraping in. S k y p i n g i n when I think of
a future state of what systems could
look like, I think about people
on the panel. Their bios are in the folders
and online. I will not get into
reading each one of them. I want to introduce
people talk a little bit about the work
that they were doing before they go into
their spiel. When I was working
for the governor of New York, I went to
Buffalo to visit the opioid treatment court the judge
cannot champion. Judge Hannah champion. I was completely
blown away. I spent the first
part of my legal career as an attorney
representing people in a variety of
different areas. One of those places
was housing court in Brooklyn. It was maybe or maybe
not what Hell must be like. I’m sorry to say,
it is difficult to navigate and is very
challenging. It is very
adversarial. It is not geared
toward helping people generally. I want to these
courtrooms and Buffalo and you saw people
were ready to help someone find housing. To help someone
find a job. Peers who had
been through what that person
was going through. Judge J H an n ah was speaking to
people as an equal. That was something
that I’ve never seen before. It blew me away. I am glad that he is
able to join this panel today. He will talk more
about his work. David Lucas who I
recently connected with who works at the
Center for court innovation. They are doing
tremendous work innovating the
court system. I want to a community
court that was launched in
the neighborhood of Redhook in Brooklyn. I was blown
away by this. There were signs pointing people
where to go. It is really
confusing if you spent time in
a courthouse. You had someone from
Medicaid there and someone from
the human resource administration. Although courts that
you needed to go to work in the same
building. These are things that
we would think our common sense. These are things
that we think “Why do we not
already do them?” I met GK T J K when I was living
in Albany. An innovator and inspire . He has been through
drug court and jail and we talk
a lot about how can we as people who are in recovery,
but also in positions where we can influence
policy, what can we do? What is our vision
of a better world? I’m glad that
you are here. Chief Justice Rush of
the Indiana Supreme Court. I met her when she
was speaking on a project that she
was working on relating to the
education of the judiciary about
addiction. What is the role
of the judge? How can they become
more engaged. The reality is we
need all hands on deck for this thing. We are in very
fractured and sideload systems
even now. I’m excited to hear about the latest
projects that this wonderful task force is going to be
launching very soon. I will not steal
your thunder. I will have each
person talk for 8 to 10 minutes about their work and
their thoughts and experiences. We were asked some
questions and then open it up to
the audience. We will start
with judge H a nn ah>>Can everybody
hear me? I would like to thank
everyone for the invitation. I would like to
apologize for not being here today. I was called by my
Chief Judge to present on the panel
this morning. If the Chief Judge
asks you to do something, you drop
everything and make sure it happens. I would like to think
the IT staff. I want to command
everyone that is there. I want to
commend Miss Wiseman because I’m in recovery. We have to break down
this James and stigma of addiction. A lot of times people are afraid
to ask for help. Our court was started
because people were not making it
to treatment. Our drug courts were
started back in the 90s, but with the
ovoid intervention court in Fenton all,
they were my making it to their
court dates. We took down all
the barriers from recovery. People will give me
15 reasons why they will not try to cover it. No housing,
transportation, no Medicaid or funding. We try to take away
all the barriers so all they can do is
focus on getting better. That is our job. Most importantly, we
have day to day, daily face contact with
our clients. We call them clients. We have to instill
hope and respect in individuals. I will start with that . Most of our clients have burned every meaningful
contact that they have. Shelley said that
a lot of people have burned all
the bridges. People do not catch buses to
commit crimes. The commit crimes
around people that they love
and support. Once that support is
not there, they lose hope. Our job is
to make sure that they have
positive adult contact every day. We get involved in
almost every part of their life. Some of our clients
would rather go back to jail. I tell them that that
is not the option. My job is to make
sure they get better. The second we place
our hands on them, I want them to walk out
our of our courtroom. We place our clients
and medically assisted treatment within hours of
their arrest. We use methadone. You have heard horror
stories about people waiting for, five or six weeks to get into
a program. We break down that
barrier to give them the nice warm handoff from the sheriff to
us, to treatment. We take away all the
other barriers to make sure that they
are successful. We suspend their
criminal charges. We do not dismiss. We suspend, we
do not dismiss. From the onset, make sure that we
focus on the whole person and make sure
they get better. I will say, “Whether you like CNN
or Fox News, you will like our program.” The charges are not
getting dismissed. Buffalo is a city
of 500,000 people and you cannot get
around in Buffalo without a car. If you do not have a
car, you cannot get to work or treatment. We focused on getting
them driver’s licenses and bus tokens for transportation so they could go back
and forth to their appointment. We also want to
link with the peer report. We cannot do
this alone. It is easy for a guy
in a suit and glasses to sell someone and tell them to go to court and be
home at a certain time. If they had been
through it and then to talk to someone, sometimes you need to put
somebody in a headlock and let them know
that we are trying for you. You just have to
try yourself. We do not sanction or punished use. We sanction and
punish behavior. Our clients are in
the throes of addiction. I will use myself
as an example. I’m not supposed to
eat meat at all. I eat red meat once
or twice a week. My doctor told me he
was going to put me on medicine. If I do not listen, he said that I might
have to cut your foot off. I have to see him and
a couple of months and I’m on a
vegetable based diet and I’m drinking water
four or five times a day. When I see him I want
to mask the fact that I have a problem. I’m glad that I used
that as an analogy. Our clients want
to do better. Some of they may need to do better. Because it is
the illness, everything could stumble. Our job is not to
punish them, but to give them the tools
to do better. I always say this. I can brag about
this program. It is not for me
to brag about. I want to brag about
the success of our clients. The best thing is on
day one, our client is not the same person
that they are on date 150. They do not look the
same or talk like the same person. They want to give me
all the credit when I do not do anything. They deserve
the credit. I know I am preaching
to the choir. I like to get
this analogy. They say on a stale
scale from 1 to 10, what do people think your first shot of
dope is on a scale of 1 to 10? A lot of people might
say eight or 10. Your first
shot of dope on a scale of 1 to 10 is a 5000. It is 500 times
better than the greatest experience
of your life. You cannot sanction
someone because they are using. You have to give them
the tools to be successful. They could have
everything they want in their whole nature to say that they
will not use. This thing has
a pull on them. You have to be
mindful of that. I’m glad that Chief
Justice Rush is here. It is to educate
people like us . A lot of people get
old-fashioned. The old-fashioned
saying of let’s be tough on crime and
let’s be tough on drugs. These are our friends,
nieces, nephews, some of us have the
guts to admit that it is ourselves. We have to make sure
that that person is armed with the tools
to be successful. Especially when
they walk in. Another good thing,
we have a curfew. How can you have a
curfew for an adult? Some of you may be
too young for this. There was a song in
the 80s called Houdini. It was called “The
freaks come out at night.” I do not want my
clients to run into these freaks. I want our clients to be regimented. That will keep all of
us out of trouble. Get up, go to work, do
what you’re supposed to and go to treatment
and recovery support groups. At the end of the day,
they are exhausted and go to. Our job is to give
them the tools to be successful. I can talk for an hour
without taking a breath, but I will
close on two points and then we will open
up for questions again. The most important
part about this is getting people the
link to treatment immediately. This can be done
in every community. We did community
mapping to see all the agencies who are
supporting everything we do. We made sure that
the community that we have a
treatment agency here and there. A support group for
navigation support here. When individuals come to our court, you will walk
in their and will sound odd, but you will get service
for your addiction if you get addiction
immediately. You hear or
stories about stories . Someone drives them
back and forth and you get
transitional housing. Because of the
community mapping partners and
relationships with our community
partners. Because of which, the judge being
the convenient, I do not want to
steal her thunder, once you do that
as a judge or law enforcement officer
or or administrator, you bring the groups together
in a community. When our clients walk
in, I guarantee you they walked out of
that courtroom 100 times better than when
they first walk in. I will stop here
for now. We will be here
for questions. I want to thank you
for your attention and thank you
for having a conversation
on this topic.>>Thank you Judge. Linked to treatment
immediately. In judge H a nn ah ‘ s court there is a van outside to help. It was used with a
few hundred thousand federal dollars. It is not
multibillion-dollar reform. It is bringing
people together to do what needs
to be done. People want to help. There is an
organization in Buffalo called “Save
the Michael’s.” Two parents lost
their son Michael to this disease. This organization has
family members and volunteers that pick
people up at the court and drive them
to treatment. There are people
who want to help and people who want to get connected into
these efforts in every community. Thank you Judge. Our next panelist is the Hon. Loretta H. Rush.>>This is a view
from the bench. I’m the Chief Justice
of Indiana. I’m also the cochair
of the national judiciary opioid
task force. They asked me to do
that to and 1/2 years ago. 2 . 5 years ago. They thought it would
be great if I chaired it. There should be
resources for me, right? There was not. He really had to say what was our lane and
what is not your lane. How do we collaborate? We know it is
a crisis. Here are some facts. It jumped out at me. I know the Surgeon
General and he is from Indiana. Doctor Adams has been
a wonderful resource in connecting us to
the medical community. This is an
intersection of long medicine. Unlike any other
crisis I have ever seen. 96% of all the
cases filed are in the
state course. Courts. People with opioid
use disorder are 13 more likely to be involved in the
criminal justice system. Damn, we better
get it right. I swore. There is a lot of
work to be done. We had courts that
would say I am a vivitr o l court. We know what we know
and we do not know science. Those statistics
scare you to your foundation when
you are a judge. 1.3 cases filed
in Indiana. When you look at the
state court, there are tens of thousands of
state court judges across the country. Here is our role. We give consequences. We cut supply. We want to support
children and families. With this crisis, it
is saving lives. We know how to be
tough on drugs. We do not know how
to be smart. How do we start
training judges? If prosecutors and
public defenders and a whole system of
people that touch on these individuals who
are coming before us. There is no
go to place to get what is
evidence-based. In my court, where
do we go to get the information? How do we get the
entire judicial branch but the cases
are before us ? There is a lot of leverage
is that we can pull as chief justices. Unlike with the
last judge said. Judges can bring
people together. If you call and
I said about opioid center in
Indiana, they brought everyone. They brought teams
to train on. I agree with the
panel earlier. These community
solutions really are important. You know the tools
that you have and how do you get them there? A lot of judges will
say that they are a civil court judge and
not need to understand addiction. I say that this
is not true. Look at all
the dockets. There is almost not a
docket in the United States is not affected
by drugs. Some judges tell me
that I cannot be a problem. All my cases
have drugs. There could be
a guardianship. We have an usable
amount of grandparents raising
children. He will race
the next set? I want to housing
court one morning in Marion County. 275 evictions and
one morning. Think about a trauma in a child’s life. Losing their housing. None of them were
represented by an attorney. You have that. For judges, we are seeing more
and more people in our profession getting in the throes
of addiction. There is a North
Carolina judge who died of an opioid
overdose last week. I’ve been to
funerals were judges children have died. It is essential
for judges to have everything they need
for treatment. We have a report
that we will be announcing. A toolkit and
a website. 30 different bench
cards and tools. You may have to
school your judge. If you have a judge
that does not agree, you will see the
resource center. We talked about the
ADA implications . They’ve adopted best practices and
we have worked with doctors not to give
credit to HHS and the doctors. Getting medical legal
experts to see what the ramifications
are if you do not. We have a lot of
pregnant women in the court. We had to keep them in
jail so they would keep using. There is an
evidence-based practice for pregnant women. There is real
science for when M A T T can be used for
adolescents. That’s probation all the way through
the spectrum. Here’s the bottom
line of things that we are training. We have bench cards
on her website. The national report
will be announced at the national press
club on November 20. The Surgeon General
and the drugs are will be there. His public health and
law intersecting. M A T for pregnant women. We have so many
NAS babies and in the welfare
system, that is cause for immediate removal
at birth. We are looking at
that for the outcomes for one those children cannot be with her
mother can be poor. What can the child
safely be with the mother? We are ramping up
family recovering courts. Best practices came
out to have problem-solving courts
in the child welfare. That will be hitting
our website within the next week. In Indiana, we
have gone from six recovery cords
and I’m hoping to have a couple dozen by
the end of the year. It is very important,
both for the parent and for the child. To safely keep the
child with the children while they
are going through recovery. I think we can have
tremendous outcomes and reduce trauma
for children significantly. We have the
task force. We have been working
for the last 2 1/2 years. This is the prediction addiction resource
Center. Anytime you touched
the justice system, even if you
are a doctor, you can school
your judge. I’m not afraid of
making that call. These are some
of the tools. We have prenatal substance exposure. Everything is a
hyperlink and a bench card that you can get. If you want a hard
copy of it, the state Justice Institute is
subsidizing those and we will get you one. Email me . It is . The court’s role
in child welfare did a lot of work
with regard to the impact on children. I’m flying through
these. They are all there. Understanding the
basics of addiction. What is addiction? It is a chronic,
treatable disease. Two weeks ago in
Indiana, we trained all 600 of our trial
court judges. We had a doctor talk
about the neuroscience
of addiction. I’m not saying that
they liked being there. You have to understand
the science of addiction. We are capable of
learning enough so we can make better
decisions with regard to the people that
come before us. The treatment of
opioid disorder has medication
assisted treatment. A lot of judges have
been burned by methadone. With regard to
selling and abusing. You have to get to the basics of addiction
for them to understand that this
is part of the disease. If the information
that we have, if you have a 5%
chance of recovering from here when, if
you do not have medication based
treatment, why would we not all go for
medication based treatment? How do you deal
with Fent an ol in your courtroom? We have done a lot
with the rural communities. Throughout all these
bench cards, are examples of programs
that are working. We have to learn
what is working in different communities. Collaboration of
education and working extensively with our
tribal communities. We have a sample
template transfer agreement from
someone to get from state court to
a tribal well on its wellness court. Take about a veteran
in the federal system. They would not have
the same level of access. We have words
matter. We attacked the stigma
and the judges , we have to talk
about the addiction. We as a state came up
with an action plan a year ago. This is what we came
up with in Indiana. I want to talk about
the sequential intercept mapping
system. The judge talked
about the warm handoffs. We have done
trainings on the intercepts. I thought we brought
this together, all of our people would
be interested in intercepts two
and three. They were all
interested in intercepts zero. We have services
and art community so they do
not get deep and did. We have to bump up
what we have in intercepts zero
and one. They get a grant of
120,000 to start. The legal service
Corporation and open one task report does a
fantastic document. You think about
somebody with addiction , you do not
think about will they recover. There is so much to
deal with and you do not have the right
to an attorney. A wonderful example would be two things. The medical legal
partnerships are fantastic. It is an betting and
working with the medical community and
embedding attorneys in medical facilities. Think about it
homeless that coming in. He could deal with
the physical, and we are trying to
pair them together on that. The final thing, we
are setting up and partnering with the American Academy
of addiction society. We are having a
national training. We are sending doctors and
judges from every state to train
the trainer. We will have a product
that we are working on that is a medical,
legal resource guide. Would you go for that
information for the treatment? We are seeing a rash
of methamphetamines right now. These judges are
getting trained to train other justice
professionals back in their state. This guide will
be available. I talk really fast
to get through that. I’m flying out
at 4 o’clock. Do not ask many
questions after this.>>Thank you Chief
Justice. I start my clear career as a legal justice
attorney. We are not always
aware of the resources or the
big picture. For the most part,
people meanwhile and want to help. To give them easy to
access tools like that is huge. Game changing. Next up is TK . To talk about your
thoughts and experience on
this topic. Thank you for
having me. I will try to breeze
through this. I could talk about
this forever and I will not shut up. I would like to
go at some .2. My name is T K R a bi i . It is an alternative
to go to the ER for people who are
not at that level and need a bridge in term services to
be provided for them. Most importantly,
I am a person in recovery. Thank you. It is been over four
years since I have had a drink or drug. I’m also in recovery
for mental health as well. A brief overview of
how my use started, it started back when
I was in high school and I was 13
years old. It started off as we are in a simple
pathway of alcohol and marijuana. As the years went by
and as my addiction progressed,
eventually, it led to me finding heroin. People really become addicted to heroin. It was the love
of my life. The very first moment
I did it, I was in love with it. It did what I was
looking for. It numbed my thoughts
and feelings and I did not have to deal
with anything. Especially being
someone being diagnosed with bipolar
in anxiety and depression. That numbing feeling that I did not have
to have a care in the world. My use progressed
for a lot of years. Up until January
15 of 2015. I was with this kid
who I used to use with and we are going
to pick up and as we were leaving, I had
crashed my car into a fence. It was a very slow,
quick thing that happened and before
I knew it, my car was surrounded
by three cop cars. I was handcuffed in
the in the back of the cop car. That whole time, I
remember in that moment, my hand was bleeding
all over the back of the cop car. I was thinking about
that I had to call my mom and tell her that
I was going to jail. I was pissed off because I did not
get to use my drug. That was the biggest
thing on my mind. I want to jail. I’m originally from
Sullivan County New York. In the middle
of nowhere. When I was
in the jail , one of the hard parts
was obviously that my addiction had
progressed to the point where I was
going through active withdrawals. While I was in the
holding cell, there was no methadone
or anything. I was going through
withdrawal sitting in the jail
cell for two days waiting for the judge
to come in and read me my charges. Eventually, they
transferred me to the county jail and once I got to the
county jail, it took an additional two days
for me to finally get prescribed medication. Stigma plays
a big part in the substance
use disorder. I was baking for medication to
help me with the withdrawals. They could not
believe that I used heroin. Especially in
that area, was automatically
assumed that a young black male is not someone who
will be a candidate for heroin and being
addicted to opioids. That is a disease for
the young white kids. The kid I got
rested with, he got his medication
faster than I did. They did not believe
that I was a person who is addicted
to opioids. They gave me a
prescription and only gave it to me
for five days. There was nothing
left after that. For the remainder of
the time I was in jail, and there was
nothing for me to have. A big piece the
people forget is yes, it helps with the withdrawal
symptoms, but there is
also the mental components of
the craving. I still had that
mental component that I am now dealing with because
of the cravings. After I had my court date and got
bailed out of jail, there was no aftercare
for me while I was waiting for
everything. I had to search for treatment
for myself. It took a month after
I got out of jail to find treatment and
to be able to get prescribed medication. I will never forget. If you have never had a substance use
disorder, it is hard to imagine. I was sitting
in my house , at this point my car
was impounded and I had no car and no way
of getting any sort of substance. There is this little
voice that is in your head that is
chattering in your ear. I am sitting in my
bedroom, the same bedroom that I used in
every single day of my life. There was a voice in
my head saying “You need to use!” I felt
like I was going crazy. I was on the verge of
a mental breakdown. I needed to relieve
his anxiety and pressure. I called my dad on the
phone and started sobbing. I could not deal
with it. Eventually, we found
an outpatient clinic that was able to provide medication
for me. Once I got on this, it helped me
tremendously. Once you have stopped
using drugs, all of those things
that you have stuff down for so many years
of your life, all of those things all
come back up. The medication helped
me manage in the beginning to get
myself stable so I could continue to
work on the other things that I needed
to work on. As I got out of jail,
I was thankfully given drug court. It was a weird
situation. I was arrested in
Sullivan County, but I was in another drug court
and they were supervising my case because I
moved to another county. If I went back to
Sullivan County I would relapse
and die. I wanted to do
something different with my life. While I was in
drug court, it is very
interesting to see that dynamic
that goes on between the
coordinators and the participants. There is stigma
on both ends. That is a big barrier
that we are facing. The participants
think that I’m going to go to drug court
and they are going to send me to jail. I cannot trust these
people to help me. On the coordinators
side, they are thinking that people
get generalize. I have met with
people and work with people who had this
disorder and this is what they did, this
is what you will do. We will treat you
like every last person that we have
had come into the courtroom. There is a disconnect. There is no sort of
rehabilitation that could ever happen
because we are at each other’s throats. No one trust
each other. It is difficult
to cope through for a year. 15+ years on your
head to be in a place where you cannot trust
a person whose life is in your hands. It is difficult. I was on medication
and drug court and one of the biggest
problems that I had was for myself, I was
at the point in my recovery where I was
stable enough to navigate my recovery on my own without the
use of medication anymore. In drug court, they
did not think that I could do it. They would not . I had to fight to
allow them to let me stop taking
medication. They were telling me
“No, you have to stay on it for the
remainder of your stay.” There is a
stigma and generalization and
I think things do not become
individualized like they should be. For some people, if they need to be on
things for the rest of their life, they
have the right to do that. If somebody wants to
be on it for 2 miles, and decide that is
good for them, they have that right. Playing God with
people’s fates telling them what
they can and cannot do should be criminal. Eventually, I got off
the medication and they allowed
me to do it because my lawyer
yelled at them and I have the best
lawyer and I love her for that. Being in working with people who are still
going through the process, it is really
interesting to see. I have a client who
I was just working with. She was remanded
to prison. She tried to do
everything she could to not go to jail. While she was in the
process of getting sent to prison, one of
the biggest problems that we had was
continuing her prescription on the outside. It was easy for
her to get other medications, but for this one,
they did not want her to have it. Going into jail. I think this is the
most asinine thing I have ever heard. They are one
and the same. They will allow you
to take medication for anxiety, but
not for this. I see too often,
working in this field, we separate
things. It is either one
or the other instead of treating
them in tandem. Everyone is fighting
for funding. I will go on
a tangent. I will stop there. I really hope at the
end of the day that we are able to get to the
state where everyone is able to be on
the same page. I think there is a
lack of education on the coordinators
side. And on the people who
are participants in drug court. I think the more that
we can educate and talk with them about
the realities of it, the better off
everyone can be. We have to and
a stigma because it kills people. We need to get
it together. We have to ended the
best that we can. That is my spiel. I will shut up now.>>Thank you. David you are up.>>OK. Thank you for
sharing that. I think it dovetails
nicely with where I’m going. Good afternoon. I am honored to be
participating today and humbled by the
level of expertise in this room. Thank you to the
oatmeal Institute for including me. My name is David Lucas
and I’m from the center of court
and for an animate technical
assistance provider. Prior to this, I was
a treatment lead in a drug court up
in Canada. If you’re trying
to find my accent, is like Fargo,
but more north. I’m actually
from Winnipeg. I’m sorry for that. I will be speaking
about some of what M A T has taken up or not
taken up in drug court. Even if it says yes
to this, the story does not end there. How is rolled out
is important. I am also a
social worker. I want to send out
three core themes. They are important
for their hidden impact. The first is equity
and inclusion. Expanding access to M A T is a racial
justice issue. We need to
acknowledge this and courts. Present courts have
a problem with this. African Americans and Hispanics are
under representatives in treatment court. Both organizations
have created specialized toolkits
to try and remedy these disparities. We have drug courts , humane remedy to treat people with addiction and
an alternative to incarceration. As we have heard, the
rapid expansion of MAT and the key response
to this health crisis is uneven access
around racial lines. More white people,
and suburban areas have access to private
insured morphine. Black and brown in
urban settings they rely on methadone
clinics. Methadone clinics have more apparatus
for monitoring . They have medicalized
addiction for some and protected
it for some. It is kept at more
criminalized and exposed it for others. The urgency
we have today to solve this crisis, is tied to thousands
of deaths not by accident due to racism in healthcare. We need to think
about science and legislation. Pay close attention
to the subtle technologies of
whiteness built into these two responses. The second is
divergent. The version of
MIT medications. How we talk about
divergence. We still have a
long way to go. When diversion
is discussed in the drug
court context, the participant is
lying and probably should be sanctioned. I want to urge those coming from a
criminal justice background to stay
familiar with the research on this. Talk to people
who use drugs. It is an act
of mutual aid helping another
person going through withdrawal. It is also a form
of self medication. To deal with their
own systems. The deal with
affordability or pharmacy hours. A protective factor
against overdose. Many people use OAT because they do
not want to use something else. They do it to get on sick and not overdose. It is not true 100%
of the time, but the research tells us that
is the majority. His research also
tells us that most MAT is not sold,
it is given away. If you work on the
front lines or know people who are
in recovery, talk to them
about this. If diversion is
rampant into drug court, strengthen the therapeutic
rapport and quality. It is mostly a
survival method meaning that
sanctions and mistrust will not
fix anything. The last narrative is big formative Pharma. This had been over used. It played a role. It is not the
whole story. Addiction and
overdose will survive the rise and fall . With medication in
general, and really perpetuating
the idea that true accidents , the safest, freest,
and rewarding kind is not include
opiate based medications like
methadone. The remedy is to
understand that healthcare providers
are an essential part of drug courts care. Setting legal questions about their legal plan. In my opinion, it’s
incorporating a dedicated Doctor into
the full for the sake of additional
oversight. To me, this would
ineffectively enshrine a care model
that includes medical expertise and a key court decision making process. We did this
in Toronto. Universal help — healthcare
kind of help. It was hugely
positive. Here’s some
additional barriers. I will not go through
all of these because we do not have time. I want to focus on a
few that are hidden, but just as
impactful. Drug courts rely
on phase systems. They have to hit
certain benchmarks. They have to earn,
or retain different freedoms. There is a cycle of
treatment to get a job, or housing to demonstrate they are
building stability. There is no problem
with these incentives, but it’s
important to the purposes of our
conversation about MAT that they can
actually become a stick in the spokes
for everything I just mentioned. Not everything I just
mentioned, or housing providers that partner
will accept those using LAT, and many jobs do not line with pharmacy
hours. It can indirectly deter clients from
considering addiction medicines. The second column,
I’m calling micro practices because I
want to highlight our diffuse
responsibility to encourage addicts — addiction
medicines if desired. What kind of things
are we saying, or doing everyday in drug courts
that might deter participants from
wanting to use MAT. Are we publicly celebrating? Are we pushing
participants to go to 12 step
meetings. Are we monitoring
more urine screens onto clients
using MAT. Are we sanctioning
clients and treating them differently they
want to taper off? Are the personal
beliefs we have about one medication versus
another coloring this conversation? We see a lot of the
patrol, only course. There’s a lot. These can be
life or death situations. Especially the use
of jail sanctions. We have covered
that day, but it’s a
very common issue for a lot of
drug courts . If you call them in
these TA context, they say that there
is an overuse of jail sanctions. What else is
going on? We don’t have a
lot of MAT, but they have a lot
of overdose. It’s crazy to see that
they are still using jail as a section. Are we pushing medication? Lastly, and Pers perhaps without
realizing it, are we per Tories and — prioritizing this over health,
and safety over MAT. I’m going to end there
because I want to leave room for
discussion. I’ve created 15 recommendations
for drug courts for both MAT integration and
overdose prevention. If anyone is
interested, hit me up and I can
pass that along to you. Thank you.>>Thank you. I’m going to ask a
couple questions, then we will open it
up to the audience. I think we have about
10 minutes ( left. Thank you everyone. One opening
question . justice, you talk about how judges have bad
expense with methadone. People’s personal viewpoints kind of coloring are their decisions. TK talked about having
to wait, and wait again. Then it was the
pendulum swung the other way about how you could not get
off of it when he wanted to. David, you talked a
lot about the barriers. The ones that are
obvious, and some of the ones that
are not. We have definitely
seen this across
the board, and varying widely in drug treatment
courts. Should there
be a mandate? What is the role of the other branches
of government? I pose this
to the panel to identify these challenges that might be harming people , or in some cases
killing people. Should there be
some states that have required
in statute drug courts to make MAT or medications available and not conditioned drug court can participation on whether or not there is participation.>>The power of the ball dollar his son. son. The bigger issue is that it’s the
individualized treatment. If two people are addicted to Herriman . McCarran, they do
not need the same treatment. Educating them
on the idea that individualized
treatment. We just don’t know
what it’s going to look like. Now, CLAIRE MACENA:
Does not e I was judge when
crack cocaine. Shame on us that we did not
set up an addiction model at that point. You have this cook e i cutter approach. Everyone fit in that box. The more we learn that
the best practices , and tools that we
are training judges on. It’s
individualized and we have to trust the
doctors with regard to yes, they can we
not or know they need higher doses. We cannot be
substituting medical judgment. The partnerships are
so important because you get both voices
the same time. I don’t know if
they have a state legislation for MAT? We are setting
this out, you have some legal ramifications. There are 88
cases going against jails and
courts that have not allowed MAT. Your leadership has
to make some difficult phone
calls. A lot of the drug courts are related and dependent on grants.>>Other thoughts?>>I think you hit
the nail on the head with the
individualized treatment. That’s the biggest
problem is that no one gets individualized.
There is always . Even with people in
the community. They say they
know this person who used Suboxone or was
on methadone and they were nodding out the
whole time. Or, I know this person who used
Suboxone and they began selling
its people. There’s the one person
that comes in and does something that’s
not necessarily good in our eyes
and everyone gets treated
the same way. No one is able to thrive after that. I think someone
was talking about the aftercare portion. Even as that
is going on, and you have the
aftercare set up. Even if they are
in the treatment, once they leave the
court we have to make sure there still
something in place. The MAT can only help so much. We have to make sure
that they are linked with the resources. That is a small
portion of the problem.>>I will quickly add that I think a little
bit of extra oversight would be good. Drug courts rely on
incentive and sanction models. They could be
subjected to something named
differently. Where, if they were really lagging on
getting caught up with the services
they deliver, they should maybe not be able to ask much of their participants
especially if they are suffering from
opioid use disorders. There are ways to
pull people along more forcefully
because it’s a matter of life and death. TK, I am glad
you brought up aftercare. We could do a whole
conference on what aftercare means. Maybe one
on housing. It was mentioned this
morning, we have . Meth is on its way. We will need
something that accommodates people in all stages
of recovery. This goes way bond — beyond opioids in the
day you graduate.>>There is no perfect
process. There is no perfect
recovery. We have to take them as they are and have a plan and
system that works best for them. The correct part
is education. We have to educate
our friends, and colleagues to know that this
is the medication . If someone take medication for
high blood pressure, or
cholesterol. Anything. This is an necessary medication for our
clients to live a productive life.>>We have about
five minutes left. I wanted to make sure
that we had enough opportunity
for questions from the audience. You can come up to
the microphone place. please.>>Hello. My name is Traci
Gardner. I’m glad to see
Doctor Hanna. I will admit that when I first read about an
opera” I wanted — and opioid court,
I wanted to punch someone in the head. I talked to a couple
of lawyers. There was one that thought it would be
somehow discriminatory. I understand the imperative. We’re talking
about people at risk for overdose. Particularly
around opiates. But, it does. The kinder, softer
approach still hurts or itches. I appreciate that Judge Rush said, shame on us. We did not
do something during the crack era. I don’t think
there was any will to do so. We are having this
whole conversation , someone mentioned
earlier that we really need to
understand that the right people became
affected. We made public policy changes in record time. When, did not take us record time
to get here. I just need to say
that, because it was definitely my first
impression . What is a crack
court look like? I know that there
are problem solving courts. Mental health,
and alcohol. What is a crystal meth court look like? It takes us back to
what we need to do more holistically. Again, I will whine
and complain that I wish there
were more health people at this
conference because when health people
talk about opioid use disorder, they are going to
stick to where they’re comfortable. Which is the
clinical side. The compliance
of patients. And the best places for practitioners to
be able to. They need to be here. They are complicit
in this. I insist. They should be coming to
your court . Not that you have
to pull them in, but they should’ve been
there a long time ago. They need to
come and be “how can I help?” Must more enthusiastically than they are. I bring up money,
because putting a price on the heads of people who are in life and death
struggles seems to cut
through the BS in ways that we have not done yet.>>I think it’s much
more deeper than that. I say it almost every
place I go. I’m glad Judge Rush
said it too. It’s a shame that there was people
coming back in the 70s and 80s and
we lock them up. It was a shame during
the crack academic — at epidemic. We learn from
our past and we are committed to
make sure that we don’t make the same
mistake especially when people need help. That is the elephant
in the room. It’s like when people
use to smoke on an airplane. The science has caught
up to this. It’s a medical
problem. In the 70s, and
80s it was not viewed that way. Now, it’s viewed as
a medical problem. Maybe the right
institution era, or demographic has brought
it to ahead. But since it is, we
want to make sure our citizens and
participants and clients get the help and
resources that are needed.>>I want to think
the panel. I’m in addiction medicine therapist. TK, thank you for sharing your story. It’s appalling, you
should not have waited for the
medication. Thank you for sharing
your story. Congratulations
on your recovery. Thank you both Justices. I also . You are all
mentioning this a very appropriate lay. Treatment needs
to be tailored. When I treat patients
with hypertension, I don’t just. I don’t give
all of them the same medication. There’s a reason. There’s guidance. There’s guidelines in the data. Same thing with
addiction. Regardless of what
the substance use disorder is. The treatment needs
to be tailored to the individual. People should not
have to be tapered off. That is something I’m always talking
about with patients. At the same time, if they don’t need it they
do not need it. It goes back to
going individual conversations. I firmly agree,
and collaborating with my judicial
colleagues and whatever information
I can share and similarly, you
filled the many gaps in my knowledge. It wasn’t until
I started working for records
that I started interacting with public defenders
and judges. And offering
trainings, and we can learn from
one another. When I gave a talk at the College of
criminal Justice, this was a few years
ago, and there was a gentleman who was saying that
it’s all fine and well that you guys
are talking about addiction as a public
health problem. Where were you in the 80s? My community and
relatives were dying. My flip answer could
have been, in the 80s I was in high school. I recognize that when
I stand on the podium, I rep represent an entire profession. We apologize, and
were trying to learn from our mistakes
as we go forward. My impression of the
criminal justice system is that it’s
acknowledging that. We need to work
together. Thank you all for
your expertise.>>Thank you. Our time is up. I want to thank
the panelists. Thank you, Judge
Hanna from Buffalo. Thank you
all so much. (Applause)>>We have a networking
break now until 3 o’clock at which
time we will discuss child
welfare policy. Thank you.>>For the final panel
of the day, we are going to
discuss addiction child welfare policy. Providing healthier
outcomes for family and we have wonderful speakers who previously worked with the drug control policy he
will be the moderator . A writer from the
Pacific North West will discuss child warfare welfare policies . She has an a lot of
research in this area and will also
be speaking. And a doctor who is an addiction doctor. And Nancy, the director of
children and family futures he was an advisor to
our initiative and as I would like to
say repeatedly is one of the few
people in this country who has and
operates at the nexus of child welfare
and substance use. A very important
discussion we will have so Mary Lou I will
let you start.>>Thank you for
sticking around everyone. Personally, I’m just
interested in what these panels
have to say. It’s one of the
most pressing issues in this
whole sphere of substance
use disorders. Personally, I have
about 35 years in federal service. And in the nonprofit
sector. Many years at the Justice
Department, but at the end
of my year career I was
lucky enough to work with Regina and Michael at
the office of national drug
control policy. I was in the
White House in 2016, so obviously I’m no longer working
for the government. I’m a consultant. Today, we will talk
about addiction and child welfare
policy. You often hear people say that substance
use disorder affects so many
more people than just the
individual user. It affects their
loved ones, families, and whole
communities. That’s really
at the heart of what we are going
to talk about today. What about those
families? What happens to them? In particular, what about the
youngest ones? What about
the children? The children whose families are impacted by substance use
disorders. What happens to them, and their structure ? Their support system? Their loved ones? And what they have
always known? The real question is,
how do these families survive and how did
these children thrive? You can look at the
scope of the public, and we have data
on everything. Between 1999
and 2014. Our data is always
outdated. The pregnant women
with opioid use disorder Cummings in to hospital coming into hospitals
quadrupled at that time. From 2012 . 2016 just four years the
number of kids in foster care rose 10% across
the board. In some states,
a rose 50%. It was just
overwhelmed . They overwhelmed the
system paid we need to rethink, and reshape our responses and policies. The panelists who are
here with us today are the people who are really on
the front line of reshaping that approach. Reshaping
the policies and, in Elizabeth’s case, living
firsthand with the results of the policies that have been in effect. Elizabeth’s is a writer from
Pacific Northwest. She is now living in Florida where she is
fighting to regain custody of her
two children. You will hear her own
compelling firsthand experience. Laura is a really amazing social
science analysts and she’s the office Assistant
Secretary for children and
youth planning. Dr. Mishka Terplan is
a senior research scientist. He is board certified in gynecology, obstetrics and addiction medicine. She He has the home
package there. Doctor Nancy Young, they are the
executive director of children and
family futures. She really works on
improving outcomes for children
and families who are affected
by trauma , substance use
disorders, and by mental health disorders. We have it all. Research, policy,
treatment, and fighting on
the ground for custody
of children. I’m really pleased
with this panel. We will start with you, Nancy.>>I like Mary Lou
coming over here because I can see it a little bit better. Thank you for sticking
around to the afternoon, and thank
you for the invitation
to be here. The theme that we
have been hearing throughout the panel
today is reflected in this still
sideload after all of these years. Although, we have been
talking a lot about collaboration and what
we need to do to put these systems
together. We have all of these
effects of different trainings, and
different funding systems in different
ways in which we allow people
to publish in which journals. When we put pieces
together, there are a lot of barriers to
what we think about when we think about
family recovery. It says that it’s not
just the parents, but the children also have, in their own
right, the need to have intervention , prevention, and some times treatment. It is across
these systems. We should talk about
what we know. Others on the panel
will talk about some of the issues, and I thought I would
do a real high level of what we know. First, starting with
what we know about the data. These are the listed ones by state. The prevalence
that they report to the federal
government about the number and percent of
parents coming to the system who have a
substance use problem. Either alcohol,
or drugs that are a
contributive factor. When we think about that overall is 37%. You probably see that
indicator all the time. When you own know that for example
that these states are contiguous. New Hampshire,
and Maine. New Hampshire reports hardly any
parents, and Maine reports about 60%. There’s something
else going on besides the prevalence of alcohol or drugs in their
community. Some of the things
that we know is that the
variable, and these data systems
are not required. We don’t have
standardized ways in which we try and
determine which parent needs helps with a substance’s
abuse abuse problem. Sometimes the worker
don’t know wilds of the case
that this is a factor that needs to
be recorded, and if it is that,
then it’s really not easy and some of
the data systems to get it and
mark the file. Why do the the under Coutts? We think we know
a little bit about helping the parents. If you saw the
assessment Street announcement about
two weeks ago about their new
character who was a child of a parent with
a substance abuse disorder. Thereafter,
Naomi Riley wrote something in the
LA Times that says even within these
single states, when you look at the
numbers. They look fishy. If we want to see a
decline in the numbers it pays to follow
the time altered Sesame Street lesson. Be honest, and
learn to count. That graph is an indicator of
problems we have in policy about learning
to count. This is how we,
children and family futures, or putting
together our knowledgebase and
technical assistance when we are
working with states or
communities. That is very
complicate it, I know. I’m going to break it
down a little bit. This first row are
the kinds of practices that communities put
in place when they have to begin to start working
across the systems to identify , engage parents, make sure that
children have the interventions
they need, that the recovery
supports are in place, that the kind
of moderating that needs to happen to make sure that your
parents are able to get the services that
are in their case plan. All of those are the practice changes that we know from various federal
grant programs, and lots of evaluations
that have been done in the last 25 years. This is what people
do first. We also recognize
that there’s a whole set of system supports that have to
be in place to sustain that practice of working across
systems when we put whole
families together. That includes the
training, budgeting, and some of the things like information
systems. We have a little bit
of a discussion going on in our office . Is communication its
own systems element, or is it so important
across all of these practice and
policy arenas that it should
be diagrammed in a different way. It should be called
out in a different way, because without
the specific communication
protocol, we know that these systems do not
communicate. They do not work
together. This idea of
very specific protocol becomes key. All the way back to the adoption act. Putting those actions together,
there is conflict in the time. 12 months for
permanent plan, 12 months out of 22. It’s not in the best
interest of the child, social services
is to file a termination
of parents will write rights. These conflicting
timelines we have learned
some things over the last
15 or so years. That is that this is the road that is a standard process
of child welfare case. What we know is that
those practices make a difference about what the
timing is. In fact, in the
sobriety treatment and recovery team
program, they have a data about the outcomes
as well as the other waivers that have
been put in place that have looked at
the timing of this. When we look at committees, it’s
not OK to just do those practices. It’s about when you put
them in place, for a family. If a family
is not getting screened or assent assessed for
a substance use disorder, until after the disposition, it’s
too late paid we talk about how timing
matters and how you rearrange
staff and it’s not
a new cost. It’s about how you
rearrange it to make the timing happen. We also have one of
those practices that increase management of
recovering services and monitoring compliance. We have learned that
in a variety of places. Recent publication that is available is about recovery support
specialists and the different models that operate in
family treatment courts, and in child warm for welfare offices. I want to make sure
you have that recess. were source. If we give a parent with a list
of phone numbers, what you think happened? It doesn’t happen. This is the recovery
support and engagement that needs to happen
so there is hope that can be seen and hope
that can be put in place for that parent
to be able to be engaged. Another thing that
we know about the monitoring comes from
the family treatment court. In a recent
meta-analysis of 16 evaluations said that families that
participated in a family treatment court
were two times more likely to reunify
then families receiving
conventional services. If you are an
attorney, and you work in the child
welfare system, are your parents
getting access to these enhanced
services? What is reasonable? What is reasonable
effort? Is that a lover to
use in this policy arena to make sure that all
parents have access to the service
that they need. It was mentioned
earlier today about the family
treatment court standards. It just came out
within the last short period of time. I listed them, and there is the website where you can get the
full copy of that. How does that all
come together? We like to refer to the outcomes
as the 5R. Recovery, the number of children who
remain at home. Those that reunify,
repeat maltreatment. We have seen that
in multiple evaluations. It may not
necessarily mean that it’s in the
length of time in the out of home care, but
it’s definitely in the lower rates of
treatment when families have access
to these comp comprehensive
services and reentry to foster care. I look forward to the
discussion, and any questions that
you may have.>>Thank you, Nancy. I can see that they
are actually encapsulated
in the report. That the O’Neill
center did with the recommendations for
changes to be made in the child
welfare system. Thank you. Elizabeth, we will
hear from you next.>>My name is Elizabeth,
and I’m a writer and a journalist
fellow with talk poverty, as well as Reimagining
Communities Fellow with the National
Council for Incarcerated and
Formerly Incarcerated Women and Girls I
am diagnosed with PTSD and an
opioid use disorder. It’s I’m going to talk
about what it’s like to be a woman in
21st-century prohibition. I just want to remind
everyone here that most, if not all
of the issues that we are discussing today were not even exist
if drugs were not illegal. (Applause) That pause was for change in
slide, but thank you. My daughters have
been separated from me from
April 13, 2018. That’s a very
long time for me to be separated from a four-year-old,
and a five-year-old. They were to, and
for when they got separated
from me. When we were separate,
there was a convoluted case that
involved various weird accusations. Mostly centered on an
accusation of drug use. Once I gave them the various
body parts, they decided they
were not going to focus on that because
it was all negative. They would just talk
about the fact that I had this diagnosis and
I had a history of Doug treatment
paid and I have PTSD. There was an
in minutes that there was no end minutes
of neglect. My in-laws admitted. There was an
abandonment claim. They admitted that
they had been on the phone with me
the whole time. They knew how to
contact me, and it was me going away for a couple
of days. That didn’t matter. In the end, the judge ruled
against me. These are her words,
not mine paid because I great skill with language
I could sell ice to an Eskimo. So, since I’m a
writer and I know how to speak, I would
be lying. And because I spoke
to my brother-in-law about the possibility
of buying marijuana, somehow that was bad
coping skills and bad parenting. I wanted to highlight
what was really going on inside of the
courtrooms. For these really
absurd reasons, my daughters have been
separated for over a year. This is something
that’s really happening right
now to me. Not just to me. I speak every day to
parents around the country who are
dealing with very similar circumstances. Really absurd
accusations. Maybe they went
and used drugs outside of the home
one night, and there kids were
taken away. You children are being
ripped from their homes. Parents are being
forced to go through these hoops that often
times make no sense. In my documents
that I was given . To understand what the issue
was, and why my children were
being taken from it said that the mother
neglected the children and it included that the
mother neglected the minor children. I have a couple of
degrees in English and writing, but to me. That doesn’t
mean anything. I don’t know what
that means. If there was
something wrong that I had done as a mother that I in fact need
to correct, I don’t know what it is. No one has given
me a template for correcting that,
because that’s what they wrote. It means nothing
at all. I did appeal my case,
because I thought it was absurd that
it was even rules ruled against in the first base rate
was denied. The judges did
not give me any reason for denying
me-did I read the opposition argument
was essentially that they did not need
to wait for mall treatment to occur. I had PTSD. They didn’t
need to wait. Something bad was going to
happen because of who I am. They’re going to take
the kids, so they don’t need to wait. That’s a picture of
me and my daughters in Seattle. I some pictures of us,
but I chose that one in particular because
this case is in Florida where I had
recently moved. My husband’s
family lives there. If we were still in
Seattle, if I had never left, this case
would not exist. I was still have my
daughters with me. I’m not going to go
into all of the reasons I know that,
because I don’t really have the time
but they handle things differently. I’m not saying the
handle things perfectly. I know that I would
still have my daughters with me
with this case. It would probably not
have even gone to court in Seattle in
the first place. That is a huge fault
with our child where frail system and the
way we handled parents who have substance
use disorders-there is no
unity between states or jurisdictions. It’s not right that a
parent should have her rights to her children
terminated forever in one jurisdiction
because of that judge’s opinion or the laws in that
one jurisdiction what they would not be
upheld into different jurisdiction. This is the United
States of America. We should have sums orders oversight that stops
this from happening. This is a very, very
constant banality. This is to
contextualize where my story fits in with
other peoples. There are over 3
million children who are subject to child
welfare in the kitchen investigations
every year. These are being
intervened on by child services paid
at least two thirds, of the open maltreatment cases involve parents. Since his. substances paid
because of data collection issues,
that’s where they are at right now. This is a really
important issue. It’s something that
the majority of families that deal
with these cases are dealing with. That doesn’t
necessarily mean that two thirds of parents
are addicted to drugs or using
drugs in a chaotic manner, maybe they do
it once in a while. We need to make that
differentiation. A lot of times
they are getting sent to
treatment, and it doesn’t mean that they
need treatment. Maybe they were using
something one night. We need to accept
that it’s something that people do, it
doesn’t mean that they are bad parents
or people. I can’t talk too much
about the angle of them speak as I don’t
have the time, mentioned earlier that
I ever] researched these algorithms that
have been used across the country. In every single one
that I have looked at, substance use
disorder treatment has been a criteria. Some of them used to
give risk factors in individual families,
and some are used to determine general
risk factors are with the publisher. The treatment
is always using being used as
a criteria. Things really
important to note that substance use
disorder treatment. The people who are
seeking treatment are getting this on the
record, and it’s being used against
them. People who are not
seeking treatment, it maybe they do not get
caught with drugs. If there’s no reason
to know about it, they will not be included
in these algorithms. It will not be used against them. It’s the incentivizing
people to seek treatment. In my case in
particular, the investigator in
my case who filed the shelter petition
helps us at no point before filing the
petition attempted to contact me. In court she
admitted that. She stated that the reason why
she did it without speaking to
me because I had a history of going to
methadone treatment. That is us again. This is the status
of my current case. It’s on an adoption
track. They are trying to
move to have my children adopted
by my in-laws. Reason for that has
been to very complex factors. One of the biggest one
has been that the judge really doesn’t
like my biochemistry. Apparently I have low creatinine levels
so she is saying that my negative drugs screens are actually
positive. They are trying
to make the argument that
I’m diluting every urine test I have
her take. My income has never
been counted at any point
during my case. My caseworker is continuously being changed. I think him on
the fourth one. Maybe the fats. Every single time
that has happened, the new caseworker has
wanted a different kind of document. I’m a freelance
journalist. I don’t have the
average paystub I can turn into a wanted a
different document to prove that I have
money coming in. Suddenly, because
there’s a new case worker that past
document was not good enough. I did not turn in the
right one on time, and then they will count
as noncompliant for income. I have not been able
to take any of the mandated parenting
classes because of various issues with
the substance treatment that have
been available to me. I will give you
one example of issues with
substance use treatment, one of the
facilities they sent me to. There have been
three now. One of them how to treatment
group that was supposed to help us
learn skills or something. I don’t really know because I remember
one day I showed up and their computer
system was down. Why don’t you guys
just pay for the class and you
can go home. That was considered
treatment. For that particular
program I was actually paying
through insurance. I was billing them , and it would’ve been insurance fraud. I was marked as noncompliance. They also have
ignored my daughter’s own request to
see me more. and to come home. They have not taken
my daughter’s desires into
consideration. They have not taken
real facts into consideration. They have stated that I’ve been
reduced to a diagnosis and
paperwork. That’s pretty much
the status quo of the child were
fellow sister might appear to if they think it’s
helping families that have these diagnosis , I’m telling you
right now that not humming. We need a better way. My vote would
be to final although faster foster care funding into the social care network .>>Thank you for sharing
your story, I’m speechless. I’ve worked in the
criminal justice system for 30 years
and I saw some dysfunction. That one is pretty
amazing. Laura, you are next.>>Good afternoon. This audience is
well aware that medicated assistance is used for open
you had substance disorder. And the only study to
date, focused on MAT Mac specifically and
the child were fair . They were more than
twice as likely to retain or regain
custody of their children than those of people who did
not receive it. I’m the child welfare
analyst in an office within HHS that combines
research, and policy functions. It often rates I’ve worked for over
30 years on the interface between substance use
treatment systems. They can be more
effective working to other to help parents
achieve stable recovery, and ensure
that there children thrive. We are talking about
the different perspectives on
medication assisted treatment among professionals. These perspectives
contribute to the challenges and . They frequently get
in the way of families success in overcoming and keeping their
children safe. I will describe the study that
documented the relationship
between high rates of opioid use disorders
in a community and rising foster
care populations. I will discuss four
key themes that emerge from our interviews. With key stakeholders
in households across
the nation. By the time
I’m finished, and those over other presentations I hope you will have
an idea to take back to your own community about how
to improve the deliverability of MAT, and parents ability
to care what for their children. Overall, we found
that a 10% increase was associated with
a 2.3% increase in reports of
maltreatment and a 4.4 recruit increase in
the number in foster care. Those are just
numbers. To better understand
what was really going on at the service
delivery level, we went behind the numbers and
interviewed 188 stakeholders
and communities along the nation
prayed we talked with judges, treatment professionals and
others pretty to understand their
context and positions on the
opioid crisis. I want to give a
shout out to Beth at Mathematica. And her colleagues
who collective the qualitative
data for us. There are research
briefs on our website including one focused
on the findings related to M a T . For themes
emerged from the challenges with
our interviews. These include the
limited availability of appropriate
treatment. Misunderstandings of
MAT among stakeholders paid limited interaction between child welfare
agencies and treatment providers. And the need for
alignment of systems stakeholders for
alignment and system stakeholders. Letting briefly share with you some quotations from our treatment groups. Their programs . It is tripled when
they get a May 2. MAT. Oregon reported that MAT programs
are reported to be connected
to child welfare. We have heard from another
reporter’s with negative perspectives on MAT. They said that it was legalized drug
dealing. Similarly, New Mexico
expressed his view that two key people
on MAT is a legal way to keep
them addicted. You are masking
addiction with another substance. A child welfare
administrator told us that there were on MA tree MAT drugs for years. What are you doing to
help them if you are not weaning them off? This might sound
familiar to some of you. Let me move on to the
first challenge we identified in the study. A lack of appropriate
treatment. As this audience is
well aware, for child welfare populations, they are often
necessary to facilitate engagement and to establish
long-term behavioral change. The sites in our study
reported very limited availability. Especially programs
incorporating medication. Most pronounced in rural areas. In addition,
providers were not oriented to child welfare
clients paid many did not accept Medicaid
and were not prepared to connect
clients with support. A second challenge that we documented is that there’s a lot
of misunderstanding and a stigma
associated with MAT. We discussed that for most of the day. There were MAT
champions in most communities, there
were those that did not perceive it
as a legitimate form of therapy. Many were skeptical for the choice of medication for
pregnant women. They did not see it practice in their
communities as a program that
did not only include medication,
but in betting medication assistance . We heard repeatedly
from child welfare workers that did not
understand why medication should be
more than a short-term bridge to complete
abstinence. They were convinced
that long-term MAT was an acceptable
recovery strategy. 1/3 challenge
we identified was related to the interaction between
welfare workers and MAT providers. MAT providers were
not the intensive centered programs over time. They will were little capacity
to deal with full range issues. It was viewed to be too time-consuming
and under constant compensated by
funding screams streams. Finally, and closely
related we observe the range of
stakeholders contributing to child
welfare and SU D outcomes. They are not always
growing in the same direction. They distrusted
one another. No one seems to trust each other
pretty caseworkers and courts seem to be
funny about how to assess whether a
client on MAT was stable and could
safely remain or reunite with their
children appeared without significant
feedback between the provider, and
caseworker, child welfare systems often
fell back on using drug tests alone on
their measure of recovery. We can do better. There has never been
the kind of funding in support as there
is today. Medicare services
have taken steps to expand the array of
treatment services through Medicaid. There is technical
assistance available on sustaining family
centered programs and the family first
prevention services act prevents
an opportunity for welfare agencies
to pursue evidence based treatments
suited to their clients. We must educate
the courts, about MAT and their benefits paid
we have to develop consensus about what
it means in practice to incorporate MAT into child
welfare plans. We don’t declare
a child is safe just
because it waives a prescription
in the face of a prude caseworker prayed
we have to define what safety means in
the context of safety and recovery. We have to improve the
alignment of payment mechanisms prayed we
have to make should be paid for the
activities we want and are holding
both systems accountable. If it’s a fully
functioning family system, we want,
at the end of our involvement with the
end of our family . We have to ensure
that progress and to incentivize its achievement. Finally, here’s a
recap of key takeaways. There are both
challenges and opportunities. We need to ensure
appropriate family centered
services along with them in medication but it’s
not limited to medication. We need joint metrics
for treatment progress and child
safety and well-being that
is observable, transparent, and
agreed upon. If our agencies are
too busy assigning blame and re-engaging parents around their
well-being, and that of our children, we
will not get far. Let me close
by notice noting that the
products from our study will be found at our
website. My email is
hearing case you have questions
after the scent session about this
or any other work. This appeared as a
journal article in child and family services
review last year. Thank you for your
time, and I look forward to the
discussion. (Applause)>>Thank you so much , Laura. It’s interesting
to hear about MAT in this context. We have heard about it
with the drug courts, and the criminal
justice system. You can see that it’s
a really critical issue in the child
welfare context as well. Now, we will hear from Dr. Mishka Terplan as a treatment
provider.>>Thank you for
providing having me. I work at those
intersections between reproductive and behavioral help health . Thank you for
organizing this. I really think the
child welfare. The critical conversation
to be having from a provider
and public help health perspective. I’m really happy to
meet you, but I want to call out Nancy,
and Elizabeth. I have learned so much from knowing you. I’m honored
to be at the table with you. One part of
the epi-weight crisis, the epidemic
of Doster foster care has been increased. You can see from the
slide up on the right, there are some states
where three You can see from the slide up
on the right, there are some states where
3% to 5% anterior into the foster
care system. Some of this can mean that it’s a misunderstanding of treatment
and policy. We have done this
to ourselves. This is a collection
state policies. At the federal level , discrimination is illegal against pregnant
people. The weight is toward punitive. Against coursed mandatory
treatment, and etc. Whereas, generally
speaking, the arc of public
policy around addiction is bending away from
the punitive. We have heard programs that are
less punitive than they were in the past. For pregnant people
who use drugs, the weight of the policy
is becoming increasingly punitive. Why on the one hand
in society are we becoming less punitive
about addiction bought but more punitive
about substance use and pregnancy. One person that look
at this is Sarah Roberts. This is looking at alcohol policy. You could see
the increase in the rate of policy
related to alcohol: citing with the
war on drugs. But, the one driver of whether states increased punitive pause policy was whether
they had other restrictive
reproductive health policies. What is driving this
is not alcohol and substance policies. But, reproductive
health policy. At their core, it’s
really about autonomy and orderly
integrity. So. Our policies do not align
with science. Neither from studs
since problems, nor risk of substances. From the perspective
of the fetus, it does not know if it is legal,
or legal. Used as directed
or not. Yet, we apply that social/legal in the application
of policy. They are more likely to be exposed to tobacco, alcohol,
and then elicit. There are outcomes
that do not correspond to our
application of the child where
fair system. I’m not advocating
for punitive measures Ford smoking or drinking. I’m calling out
a misalignment between science and public policy and
public practice. At its core, the idea is that there must be a harm associated
with in particular, an
illegal substance. As providers,
and I you use that term broadly, we do a very bad job talking
about risk. We assume that
risk equals harm. We talk about . We do not
distinguish between absolute and
relative risk. Things that are on
the population level, i.e. the likelihood
of X due to exposure Y
is different than what an
individual may or may not explains. Our communication
of risk actually augments
this problem in and of itself. The career is Ameritech’s
in pediatrics and one of the
first people to get a grant looking at cocaine
outcomes. Her hypothesis is key is exposed
in uterine to cocaine have a decreased IQ at age 2. She found no
association of IQ and cocaine at age 2. However, amongst the
participants there was a wide range
of intergroup — IQ with individuals
in low, mid and high range. All participants were black living in extreme
policy — poverty in
Philadelphia for top what is it about the kids
with high IQ that are different
from kids with low or normal IQ. She did home visits and operationalized the care and looking at
learning, stimulation and other aspects associated with
increased IQ. There is only
one time not associated with IQ. That was the
physical environment and that tends to
be the only thing that home visitation
looks at. We have an
evidence-based example that we do
not apply to policy. When I think about what it is that
we do as providers we want every care to be evidence-based and person centered. Evidence-based needs grounded in
science and I think I have showed you that
we tend to apply illicit dichotomy to
our expectations, overemphasize illegal symptoms and overstate the
risks of in utero chemicals and grossly minimize
the importance of the caregiving environment
will top it means the right
to determine whether and when to become pregnant, and we need
to be attuned to the unique demands
we place on pregnant and parenting people,
in particular, on their bodies. In conclusion this is a photograph of my mother. She is pregnant
with me. This is early first trimester, smoking a cigarette and drinking wine. She stopped smoking and she never
smoked again. That attests to the power of
this pregnancy and affecting
behavior change. Secondly, most of us have
used summonses which some develop
addiction, and that means
most of us are also substance
exposed. Thank you. (Applause)>>Thank you, I love the picture of your mother. (Laughs) that could have
been my household with both parents
in the picture. There are some
common themes here that we have
heard about in earlier panels and particularly in this panel. I was certainly
struck by the number and
the impact of policies, misinformed policies and dysfunctional
systems. You all are doing
everything you can to address that . Maybe it was — is my criminal
justice bias but we are not basing
the policies and the application
of policies on science and facts. It is really
a misapplication of the human tendency
to judge. We just love
to judge other people and to look upon them as being weak. Systems were things
to work well . and I know Elizabeth you said this would
never have and you in Seattle . what is it that makes
her high functioning child welfare system where the policies
are intelligent and Farah. — And their>>We don’t have anyone the child wherefore
system here — welfare system and that is
important. I have never been to a community where that happened. They look for
allegations of abuse and neglect and different forms
of abuse and neglect, and removal as last resort. Is that applied
uniformly worker to worker, county
to county, state to state? No. As criminal justice
or healthcare I think we need to
stand back a minute. There are many
children who are abused and neglected
in our country and we cannot call
for the elimination of the protections
that we have put in place for children that
have experienced abuse or neglect
will top what makes a well
functioning filed — child welfare
system? A lot goes
into that. I can talk about
what makes a well functioning child abuse welfare
system, and I think we heard some of them
this morning from Michael that has worked with Doctor and they have created
and are intimating plans of safe care before the
baby is born, eliminating placement
whenever possible. It does not
eliminate all placements and
it should not because there
are risks and neglect factors and immediate
safety factors that do need to
be tended to. There are
communities that many of the
things I showed about the different
kinds of practice and supports
put in place, recovery supports
that are readily available in which that
is working.>>Part of what
you are saying is be prepared ahead of time, have other solutions
in place, tested solutions. Have it all set up so you can keep
families together when it is
appropriate. You mentioned
that removal is a last remedy . remedy of last
resort whole top there is some public
perception, certainly in the media, that if a person
is pregnant or is parenting and misuses drugs that is child abuse. That child cannot protect
themselves atop what is your
experience with that? Misha name I would like to hear
from you about it.>>Are you asking are parenting people
who use drugs unfit to parent? If that is the
question I would say the short answer
is No. I think you want
to take a step back and think about what
substance abuse is and what parenting is and what are the
core opponents — components in assuring child safety
and welfare of. That remains
incredibly important because there
are children who are being abused
and neglected, but that safety
barrier can be applied in
ways that and up harming children , mothers and families
as well. I don’t think there
is an individualized approach, a one-size-fits-all
system you find yourself
into. What do children
need. I would say people
need stability, love, and no violence. Those three are
completely possible in a parent
uses drugs. Those things
can be caused from child removal and lead to
instability and placed into
foster care environments in which it is
actually less safe and where harm can
and does happen. I don’t think
categorically using drugs
disqualifies you from being a parent. What we see applied is narratives
of deserving versus undeserving, and certain
categories of people whose drugs, people who are poor, being more caught up and that being
enforced through a lot of
things in society, but inclusive of child welfare
sometimes.>>I wanted to
briefly say pregnancy can be
a great motivator for recovery, and it was
certainly my biggest motivator. Is not an actual
cure for addiction. If we are
recognizing addiction is a
chronic relapsing brain disease, then we can say
pregnancy is a curable top if
pregnancy is a cure for chronic relapsing that we should
prescribe it more often. To your earlier
question I want to mention the
majority of child were four cases we
know for a fact 75% are not abuse, but neglect places
and that is her abuse — from poverty. These are things
that could be remedied through
more money and give these people
some money. If you don’t want
to give them money, give them some
social support. Don’t actually need
child service interventions to fix those
problems. We need to funnel
the foster care funding for better
social supports and it would fix
the vast majority of the cases
we have today.>>That is certainly
a possibility in the hope that that will move
into preventing child displacement. I want to add numbers because I think
it is important . three kids and
elementary school go home to a parent who is an alcoholic or uses drug. We do not remove
anything like that kind
of number. Of the 5 million
reports, 250,000 children are placed in
protective custody. About for hundred
thousand infants that are born with
prenatal substance exposure, about 50,000 infants are placed in out
of home care. I want to paint
that picture of we have this huge
number of children who are affected by
parental substance abuse and a very
solid number in which the
intervention is in the child
welfare system. I believe that
Congress and policymakers are
recognizing that is not the place
for most is belong if they can
be protected in their home for
many of the things that you spoke
about, Elizabeth, in terms of services and supports that are
needed for families.>>I think we all recognize also that every
jurisdiction has its own
teleworker system, and some of them are
functioning extremely well and really do right
by families, and some apparently you ran into one and some could
use some help top 10 in your earlier
question about substance-abuse is child abuse,
legally it depends upon
how the state defines it and determines what
child-abuse is. There are a wide
range of how the states do that and some are stronger
than others.>>Half of the states
have statutes in which prenatal
substance exposure are grounds to
substantiate abuse or neglect,
which doesn’t mean that that would
be great to removal,
but again, worker to worker
and county County and state to stay it depends
on the state on how that
is applied.>>The child welfare
system was designed to deal
with acute problems and designed as a
short-term supposedly intervention for an in and out
deal with the crisis. That is different
than the long-term chronic nature that symptoms of
Butte and recovery and there is a
fundamental mismatch in those perspectives.>>I think we will take
a few questions from the audience
fell and we have folks on
this side of the room, not the other.>>Hello, I am at the
family law clinic at the University of
Richmond I just would like to offer a response in regards
to one comment that was made
whole top I have worked in the
child welfare system for six years representing parents
accused of abuse and neglect in New York City,
specifically in the South Bronx. In my time
representing parents I was say a large
portion of the cases that I received dealt with parents
who were accused of abuse and neglect
because they had use of this is while
they were pregnant top meaning, they gave birth
to a child where they are the
child tested positive for a substance. Up until recently
in the past is — in the past
couple years those cases have not
been removal cases and it is not
because judges are saying this is
no longer neglect or abuse , but because they
don’t have to remove but they will place
them in a prisonlike setting. That is inpatient
drug treatment program. They would place
the clients into the programs
with they had no content with the outside
world, and a zero-tolerance drug
use policy, meaning if they used
summonses their child could
be removed from then in
the program. Often the replays
and programs were people had
severe mental illnesses, were
not always given the proper treatment, and the treatment
and recovery was a
one-size-fits-all but that. If they failed to
complete the programs, which often require
them to stay there from anywhere between
nine and 18 months, and oftentimes older children were not allowed
to,. If they gave birth
and had two children above age of five or
nine, which is the oldest program in New
York City, they were not allowed to bring
those children into care and those
children had to go into foster care. That was always
because the parent had a
substance abuse problem by the alleged
agency. I practices law in
three different states North Carolina,
Virginia and York and I have observed
different family courts across the country. It is completely
inaccurate to say that removal
still having solely because of
supposed abuse, they actually do. There is a very
long jurisdiction and there is no
one-size-fits-all as it relates to the
child were for system. We have to account
for racism, classism, poverty, rural versus
urban areas and these call — all go into effect when talking about
the jurisdiction of. I do mean handle
families because that is
what they do. The other thing I
really wanted to talk about is that because of
the federal guidelines and federal
timetables, many families are unable to reunite and that leads to
termination of parental rights. This is a very
common thread and I work with
preserve raise organization’s and
organization’s network to make sure there
are alternatives to Corporation — incarceration and termination of
parental rights can happen in some jurisdictions along the federal
guidelines of 15 to 22 months. In Virginia they are doing
at 12 months and Florida
six months and sometimes
as 60 days. I think this is an
important call to action to open up our minds
and know if there are 40,000 children put
into the system, even if the larger
number is 400,000 and if there are 50,000 children out of 3 million
children who have been
terminated that is 50,000
children too many. In many
jurisdictions also takes is one
termination or one finding to
fast-track the path for parents who
are involved in the child welfare
system. This is a great place
to open up the conversation and think about
people within these jurisdictions. (Applause)>>Thank you very much. Does anyone want
to comment?>>I should clarify that states don’t
have state statues to remove four
grounds of substance abuse alone. The allegations are
abuse or neglect in various forms of
abuse and neglect. I am not sure of New
York State statute on parental substance
abuse and how those
allegations will be filed or what grounds they
had for removal, unless there were
also substantiated findings of abuse or neglect.>>My finding
was the mother neglected the
minor children by neglecting the
minor children. That is enough
for Judge to take away
a child for top>>My name is Lisa and I am with
Movement for Family Power that supports the moving of
communities to fight back up
in child welfare and the child
welfare system. I want to hone in
on a very important point that drug use and substance abuse is very distinct from whether you pose a
risk of harm to your child such that you are
an unfit parent. Those are two
totally different things that conflict
with each other all the time. I was at the
legacy Memorial in Alabama that is a memorial to lynching
and slavery. It wasn’t just
law, policy, and people who
had plantations upheld the practice
of enslavement, it was a whole
medical and social science community that
created the science to hold the practice. When you look at the
medical literature on crack use during
pregnancy and the crack babies care and all of
those errors it harkens back to
that sizable top will be look at
current literature right now on the effects of
drug use on parenting, literature that is
extremely low quality to really pull coals
in this literature it harkens back to that science. We need to
remember that. People have
talked about the purpose of the
child wherever system is child protection. Remember the origin
of the child welfare system. Does anyone know
what the first effort was to take — to save children
from their abusive parents? The child welfare
system is responsible for
an enormous amount of abuse against
indigenous families. The very first
effort was the Orphans Trains
in New York City were white men were
worried about Irish and Italian
immigrant children and thought they were
a menace to satiety, went into homes and move them out to become
forced labor on farms and all
over the community. That is the origin of the child welfare
system and this is all fat. The child were
for system has always played a critical role in the genocide
of people who are country
did not want to deal with. It is not a
coincidence that everyone in the system is
poor, black, and brown because
it is not. Let us think
about this, before you are
accepted in a family treatment court
you must admit that yes I have
committed abuse and neglect against my child. How inhumane
is that. Someone talk about
leukemia today. Would be force
parents with the bulimia to admit to abusing
their children? — Force parents
with leukemia to submit to abusing
their children? Absolutely not.>>My name is Casey and how can we
resolve the dissonance between a federal
legal system that says it is not
allowed to discriminate against mothers who
are on medication and treatment and
a practice that does
discriminate against those
mothers will top what kind of role can
social workers play in reaching that gap, if a role et al.?>>Any of the panelists want to reply
to that?>>Medication assisted
treatments does work and it does not need
to be short-term or a detox aid which social worker
supported for that reason and not long-term
use. To advocate for the
parents would be helpful because in the
courtroom as a parent what you say does
not matter. That is my
experience. Even if it is
backed by fact or the plain truth if the social worker
the state attorney says otherwise, that I am wrong and they are right. That is pretty much
how it is regarded. These social workers can become advocates
on behalf of the parents that treatments is
effective, helpful when the parent
wants to use it, and that would be
very, very helpful.>>I think it’s
education beyond just the social workers and
we need to make sure that judges,
attorneys and a range of folks involved understand
medication assisted treatment, understand
addiction were generally and understand
child welfare. When they do not
know those things they resort to
gut feelings that have nothing
to do the science or in child welfare they resort to fear. When in doubt they fear our risk
the child will be hurt or die, and instinctually try to not have
that happen, and they overflow
that fear ! Over blow that fear and it
gets out of hand.>>On the national
Center of substance abuse and child
welfare there are free online
courses for social workers, treatment
professionals and judges and
attorneys. They were recently
updated to include opioid disorders so if you’re
in a community and your social
workers need that it is available
to them. It also has a
project underway with the Office
of Civil Rights in the department
of Health and Human Services to do what you are
saying in terms of education to attorneys
and judges about the legal
rights of persons with opioid abuse and other substances
will top>>You said you
had experience with a number of
different social workers, how knowledgeable
did you find them about assisted
treatment?>>In terms of doing
them for the case that have been turned
over to Mac they generally don’t
know very much about it and there was one
social worker, my husband who was on
long-term methadone, believed some doctor
said he should taper off methadone and that never
happened. I don’t know if
that was her belief or if she got the
case confused. That is one positive
aspect in a negative case where the caseworkers
have not been against medication, but they don’t
really know much about it. My caseworker was
reading off my blood test results and
she could not say my medication, and she was like
A right, yes, so it really isn’t
a positive.>>How do we improve
decision-making in the whole child
where fair system and it is you
challenge?>>We need to understand recovery and understand it is not every
caseworkers and judges personal
opinion that we have metrics
and can see and have more to
it than that of. And, again, make sure that
everybody is on the same page.>>There is an inherent
in equity within the system and Lisa made
a very good case for abolition of
child welfare. Regardless of the
institution of child welfare there is a need that
to families and mothers have, and because we apply
access to those can come from the
child welfare system and that are targeted
toward a Pacific — specific
population of people and that continues
to compound a type of discrimination. The only way I
see around this is by universalizing
social work assessment for all birthmothers
so that everyone gets a kind of assessment as to what their
needs are for materials, supportive
etc. and receive the care
so that they can parent to their great
disability and that those kids can develop to achieve their
full potential. Until we take it
out of the lane of substance use,
misuse and addiction while being attentive to the important
distinctions between those categories, it is going to keep
coming back to — keep falling back to personal in
equities.>>In my work
with Baltimore County health
Department . I was originally
brought to do work in the MAT
County Jail . we have incredible
demand in the place
where I work and that I support to educate all
kinds of staff who deal with the
child over system and throughout the
agency about the stigma of MAT. We had one training,
200 spots, works 300 people
wanted company top I want to thank you because you have put
your slides online and I have used them. People come, have
a great time and they learned
about this. It is helpful when
we recognize health and human services and
in a lot of places they have it. What is the
second-biggest health and human
services agency after CMS?>>Social Security?>>That is accountable
top $1.3 trillion in CMS is crazy Bill you. — Money. 53 billion top what could we do on the ground level and all the
places you go to bring together
the people from ACF with other agencies, particularly
Medicaid, and half of all
pregnancies and births in the US Medicaid is a ellipse Medicaid will pay for the baby
to be delivered, they will wind up on
ACF’s balance sheet and advocate back
to Medicaid. There is a lot of
opportunity for collaboration. I do have a question
for the panel. Have you seen other
examples of this, of the healthcare
folks talking to the social
services folks and working
productively, and what can we do to do more of that?>>Our office sponsored
a form a few weeks a day that brought together
a range of folks around the human
services aspect of substance
abuse issues. It was a great day and I think a lot
of the materials are online, but it was a great
conversation between health folks
and human services folks top to talk about how
the issue bubbles up in the child
welfare system and also in
employment programs, child support, there was a range
of human services programs that see it but don’t
always recognize the issues. Go on the website and there are
some sizable top>>I am Jeanette and probably the only
public welfare worker in the room. I can speak only
for Pennsylvania, but we are also stuck
in the system. As caseworkers on
the ground level we have no input
on policy, have to follow
the direction of administrators who have been in the
business for decades. It is not easy to
advocate for the client because your advocating for
the government. You advocate or
lose your job. If you want to do
the work for the children . and I think
that is what is missing in the system
. it is fragmented and not child focused
and it is punitive. I wish people would
stop blaming social workers all the time because we are stuck
in the system also a lot of times. Every state and
jurisdiction is different . I know why because
states opt out and it is weird that the situations
people mentioned would not have
happened in my jurisdiction because they have
great attorneys or judges get
the called for misconduct and no longer serve
in that court. It is people that
are elected, judges that
you a lot, state legislatures that make these
policies and will glow, and is not just the social workers.>>Thank you.>>I comment on the
question about Baltimore and where is
it working. Baltimore County applied for a waiver 15 or 20 years ago in order to shift
their funding and it would be
specific to parents with substance abuse sort of. They pulled
out of it and did not
implemented. Illinois did go
forward with it with a supermodel and
since it has three or four Mac renewals
of their waiver where they spend title IV monies of the really big pot with NYC AF and make sure parents
get access to treatment in that way. It is working
and many places and Illinois uses
recovery coaches and some good ways. Another place around
the same time Baltimore wrote
the waiver and decided not
to implement, was Sacramento County
and they recognized that across all the
Health and Human Services every worker needed
to have information about addiction
treatment and recovery. They said about a
decade of doing what they refer to as
remedial education, because the
professions and disciplines that
were working in their HHS
department did not have the
preservice education to work with families
that were affected by substance abuse disorders. They had a very
long track record. Now, for infants
in Sacramento County that are identified
at birth with prenatal
substance exposure, it is most were that
the baby is removed. They participate in an early
intervention Family Court, get in-home services
with a lot of wraparound to make sure parents
can get to treatment and that the family’s
needs are being met all top there are
places of hope. There is a place
in New York that has had a
very big shift in the way that they
work with families, and in particular, and their family
treatment court. When we say family
centered in the family treatment court
they operationalize that to say that parents
have a voice at the table, that the needs of
parents children and extended family are
brought together to make sure
that happens. There are places where that is
definitely in play and there is
not only hope that that can happen, but there are lessons
from the sites in order to help
other jurisdictions move forward. Thank you very
much Nancy.>>I am assistant
Professor at the University of
Austin and more of a comment that question. I want to put
on the floor that one of
the realities that we have not
talked about is people are trying
to run away from culpability. That agencies,
judges and social workers are often the people who end up being
held accountable when things go wrong,
and that fear motivates a fair amount of our
inefficiencies and policies and the things that
don’t make sense. When somebody does
something wrong on these programs, we haven’t developed an understanding that it is not always
going to go exactly right the top and we don’t have
a way of developing programs and interventions
that are compassionate,
realistic, based on the
realities of people’s lives. Because that risk
is a part of of this a lot of people are
distances applies to be engaged and to do anything
different. It is when you move
away from the status quo that your
punishment outcome and I think
that is worth putting on the table.>>That is a very
good point and it is
just people, and not a full
proof system.>>Because the woman on
the other side before said if it is
against the law to deny people
access to MAT and child were
four settings, how come it happens. In addition to
social workers and judges not affecting
— understanding the nature
of addicting and the lawyers
don’t either. It is
extraordinarily frustrating because people
do have rights, but there is no way
to enforce some and no one going
to bat for them. People can file
complaints with the Department
of Justice and they can contact
the legal action Center and readable — and we will
do it for them. We have seen OCR
and DOJ intervene and right now I think they are
doing more of an educational approach, but
is a stop in the right
direction and we are trying to educate
the bar about this issue.>>Thank you for
everything you have done on this because
there are things written that are very
helpful for us to make sure judges and
attorneys no what the rights are.>>One of the things
that makes a real difference in the case and how quickly folks
get into treatment and if they have a
real chance along the timeline, whether
the parents attorneys deny
the client until you can’t
anymore. Or whether they say if you have an issue get into treatment
today and start treatment
early. That really makes a
difference and it is surrounded by safety
attorneys and their strategies and
going to a treatment case.>>It is even
my parents who have access
to MAT and over 80%
of people who have access to
methadone and Arbeit are the people who
contact our office for help.>>That is a really
good point, thank you. I am blown away by how much I
personally learned from this panel
this afternoon. I hope you
all learned an awful lot also and I think we have
seen a lot of the challenges in
the systems and kind of learned about
some of the things that don’t
work so well. Also, we did hear a
lot about things that do work and systems that are
not functioning well and have good
resources to turn to to help fix things that have not
yet been fixed. I want to
thank you all and Elizabeth
especially for sharing your
personal story. I know that is not
that easy to do. Things to all
our panelists, and also things to. (Applause)>>Thank you everyone
whole top this was our
final panel. I worked in
government for the city
of Seattle on the executive
branch of the president for 16 years of. Now I’m in an
academic institution were the best
part of it is it causes me, and I think
my colleagues, and hopefully
everyone today, you get to hear
different thoughts and ideas and it may
challenge your preconceived notions
about issues that you are facing, about how your
policies may affect people. It also causes us to rethink
traditional approaches we have perhaps taken. It is a great
opportunity for me personally to step back
and think about when you are in a
government position or bowl you are just
addressing incoming and you don’t have
a chance to sit back and read journal
articles and talk to people
who might have a different opinion
than perhaps your political
leadership may be directing you. So hopefully you can
take the information and implemented
in the future of. I want to talk about
a few of the things, next steps and Shelley
will come up with a few closing
works as well. I think a few
of the things — beams I took
away today is resources, in different ways, resources are not
always financial and they can
be personal. I also liked
the thought of we are the
epicenter of the solution. People are thinking
about this problem in such dire ways that also many people
in this room are the epicenter
of the solution when you go back
to communities of. It is about
prioritizing, saving lives, and leadership. One of the best
parts about working government is that when you are
in a position of executive branch you
can bring people together who come from
different perspectives, who may come at it from the idea
of diversion is a legal term and the first time
I talked to medical folks about what
diversion meant, it is a totally
different way of thinking about it. Diversion is a lifesaving resource full
mechanism, not an activity that may or may
not be illegal. We also talked
about drug courts and the importance
of sanctions and not applying
sanctions when that is
contract very — contrary to what we know
about addiction. At the beginning
of the day we talked about
some questions to guide the
conversation. Which changes
need to occur and I think we
have addressed and brought up a
lot of questions. Are these changes
happening. Certainly some are, certainly not enough. What does it take to bring them about. What we were hoping
to do with this project we have
at Georgetown is to begin to look
at the questions, we worked on
this report, Shelley did a lot
of lifting for this report so kudos to her. We were informed by lots and lots
of conversations and many in this room and for the next
steps we want to take the report and make it
actionable in communities. So you will be
hearing from us in the future about other
opportunities and taking these
in bunches about what are the
forms and how can we implement those on
the federal, state level and in local
communities. We will be sending
an email out asking folks to sign up
for a lives there are so
many people who you can call on to learn from and build community
around these issues. We want to have
this listserv that will
be moderated where we can help to not as technical
assistance, but provide people
with connections and information
and resources that they might
find useful. We will be sending
that out and you can sign
up for the listserv and Senate to others who may be
interested. Will have the slides
available also. This event today
has been webcast so you can also
watch it later, because I am sure you’re going
to want to. (Laughs) or you can send
it to others. There might be
someone you know who has an interest in
a particular topic that you consented
to. We really want this
to be the beginning of a discussion,
not the end. Will be following up
with each one of you and Shelley, if you want
to come up and share some
last thoughts. Thank you everyone.>>Thank you Regina and every person who signed up for
this convening and came today and is listing
at home, you are all champions in your communities. I think every person
in this room could have gotten up
here and talk about the work they are
doing, their experience, how you
are turning it into a shift that is sorely
needed. I want to encourage
the folks who are here and listen, we provided a list of
contact information . to reach out to your
colleagues who are here because we do not
need to reinvent the wheel in each community. There are lessons
to be learned from many different
areas and we should all
be in this together. The other thing
I was thinking as I was sitting
and listening, this thing should
be billed on the shoulders of movements
that have been in process for
a long time like healthcare
access, criminal justice
reform, mental health
advocacy. When we talk about
silos of systems, I want to think is
so not to think in silos of whom is, but we all want
to work together to build a
compassionate society. How can we do that and use each other
as a resource to do the hard work
that is necessary. Why don’t
we open it up for a few minutes
at the end if anyone
has comments or additional things
that you want to make an observation
about our talk about with
the group that is here. Yeah, are the microphones
gone? Comment from SOAR — floor.>>My name is Janet Brown and I am a woman
in recovery meaning I have not
used drugs or alcohol 432 is. — For 32 years. I have heard
a lot of stigma and that language
matters and rather than
saying medication assisted treatment, which I think is
further I would sizing to use the terms
medication or treatment of all upward
use disorder or for these
purposes . we don’t say someone is taking
medication or assisting
in treatment for medication for
other purposes. It will take time for us to make
that adjustment, but in many circles I travel in the. is quite
stigmatizing. Thank you for top>>Other closing
thoughts with top I, like Regina , came from years of
working in government and before that
in advocacy. We were always
putting out a fire or the crisis
of the day and to be in an
academic environment where you have time
to research, think and talk to people and convene . I
was also thinking how to use the
platform of Georgetown and medical school,
the law center, social work . and the fact that
we are here in DC to really advance
some major shifts. Interested in any other thoughts
about that as we kind of go into
this next phase of not only
implementing some things we
identified in the report, but continue to
develop this project on addiction and
public policy for top feel free
to reach off if you have thoughts, want to meet her want to chat. I thank you
everybody again for joining us and enjoy the rest of the day. Thanks. (Applause)

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