Substance Abuse Services for Youth in Florida: A Guide for Families

(1)

Substance Abuse Services for Youth

in Florida: A Guide for Families

March 2009

(2)

(3)

Disclaimer: Please note that many people have reviewed this guide for accuracy at the time of publication. Remember, though, contact information, laws and agency policies can change at any time. It is always a good idea to request copies of current policies and rules from the agencies with whom you are working.

(5)

Dear Parent,

If you learn your child is abusing drugs, you must act. Finding someone to treat your child’s substance abuse problem is just as important taking care of his or her physical well-being. If your child has a broken bone, you go to an emergency room. But what if he or she is using or abusing alcohol or other drugs? Where do you go?

A common complaint from parents is that they are frustrated in trying to obtain services from the systems that treat both substance abuse and mental health problems. This can be very complicated and confusing. This guidebook has been created to assist you in accessing substance abuse services for your child in Florida.

The guidebook is a one-stop resource for parents. It is written for parents, but it is our hope that family members, community organizations, schools, and healthcare providers will also use the information. This guidebook maps all the different parts of the system (both public and private) and how they connect. We have included warning signs and symptoms of substance use;

assessment and treatment options for substance abuse problems; and descriptions of different types of services providers and services that can help parents.

Remember, you are providing important support for your child. Take care of yourself mentally and physically. Do not become frustrated; seek help. The resources in this guidebook have proven effective.

The system for

children’s substance

abuse services can be

complex and confusing.

Navigating through

it can be difficult,

time consuming, and

stressful . This guide

can help.

(6)

1

(7)

Chapter One: Introduction

Rarely can we turn on the TV or read the headlines today without hearing about someone in trouble with alcohol or other drugs. Young people are particularly at risk for experimenting with them. Yet we know that alcohol and drug use interferes with important learning and growth that take place during the teenage years. Alcohol and drug abuse can affect a youth’s ability to make good decisions. It can lead to health, school, developmental, legal, and family problems.

The reasons youth use drugs are as different as the kids themselves. Some try alcohol and/or drugs to feel good, i.e., to be part of a group, to feel happier or be more at ease. Others may use drugs to cope with bad feelings, such as boredom, loneliness or sadness. They may be exposed to drugs by friends and may be curious about their effects. Sometimes drug use is happening in the family with an older brother or sister, or perhaps a parent. Drugs are more widely available to youth than most adults realize.

For instance, the 2008 Florida Youth Substance Abuse Survey (of 91,471 Florida students in grades 6-12) showed 53.2% reported that they have used alcohol in their lifetime and 29.8% reported using it in the last 30 days. More than one in five (21.5%) Florida high school students reported one or more occasions of binge drinking (defined as the consumption of five or more drinks in a row) in the last two weeks. Marijuana use within the last thirty days was reported by 11.1%. Youth who use alcohol and other drugs often have a mental or emotional problem as well, which sometimes appears even before the drug use begins.

Despite the widespread use of alcohol and other drugs by youth, most parents think “not my kid.” What would you do if you thought your child might be involved? Where would you go? What could you expect?

Purpose of this Publication

This guidebook is written to help you answer these questions. While there are no immediate, guaranteed solutions, there is much that you as a parent can do. Study after study has shown that parents are the most important influence in a teen’s decision to use or not use drugs. Please note that whenever drugs are mentioned throughout this guidebook, it is important to remember that this includes alcohol, the most frequently used drug by teens. The time to act is now if you suspect or know that your child is using drugs.

This guidebook will help you to:

• Identify some signs and symptoms of alcohol and drug use • Learn tips for talking to your child

• Become familiar with places to go for help • Understand what types of help is available • Learn how you can be part of your child’s care

• Understand you and your child’s rights and responsibilities • Review the most common payment methods

The flow chart on the following pages will assist you in thinking through some of the action steps you will take in seeking help for your child and where to go in

1

(8)

8 | Substance Abuse Services for Youth in Florida: A Guide for Families Are you concerned that

your child may be abusing alcohol or other drugs?

Talk to your child. Ask questions that may help you to determine if you should be concerned. Are you still worried?

Continue the positive things that you are doing. Remain watchful for signs or symptoms of a problem. Help your child to make healthy choices.

If no services are

recommended, continue positive parenting, seek healthy social support for yourself and your child and re-assess if negative changes create new concerns.

Talk to others who know your child such as teachers, coaches, doctors, clergy and other parents. Do they agree that there may be a problem?

Does the assessment recommend services other than substance abuse treatment, such as family counseling or mental health services?

Decide as a family if you will enroll in these services. If the assessment agency has not provided specific information, call 211 to find services.

Review the treatment recommendation as a family. Decide if you will seek treatment at this time. Do you want to enroll your child in substance abuse treatment? (See page 29).

Get a professional

assessment of your child’s situation. (See page 18). Use the DCF Adolescent

Substance Abuse Treatment Directory as a resource.

Does the assessment recommend substance abuse treatment?

A Quick Guide to Making Decisions – Is Treatment Needed?

YES YES YES NO NO NO YES YES YES YES

(9)

If you want to enroll your child in treatment, do you know where to find it?

Do you know if your child is eligible to receive services at the agency you have identified treatment?

Use the Adolescent

Treatment Directory to find

an agency in your area or call 211 to help you find appropriate services. treatment, do you know where to find it?

If a treatment slot is not available at this time, ask to be put on a wait list. Find out if there are services available to wait list clients. If so, enroll in those services.

If the wait will be long, ask for a referral to an alternative appropriate agency or service. Continue to seek community and social support for your child and family.

If your child is eligible for services, do you know how much services cost and how you will pay for services?

Call the agency or agencies you have selected and ask about your child’s eligibility. Be prepared to answer questions about the treatment recommendation, where you live and your income.

If you know your child is eligible and you have a way to pay for services, call to see if a treatment slot is available. See the boxes below for what to do next.

If a treatment slot is available, set up an appointment for an intake visit. Make sure you know what documentation and records you need to bring with you to this appointment.

A Quick Guide to Making Decisions – When Treatment is Necessary

See the chart on pages 36–37 for ways to pay for treatment. NO NO YES NO YES YES NO YES YES YES YES

(10)

(11)

Chapter Two: Know Your Child

How will you know if your child is using alcohol or drugs? It may not be easy to tell, since changes in youth are expected as they approach the teen years. Knowing your child and the kinds of things that may indicate drug use will help. While none of these confirm your child is using, you may want to know what’s causing them.

Talking to Your Child

The first step is often the hardest. Admitting to yourself that your child may be using alcohol or drugs can be frightening. The thought of talking to your child about potential drug use can be even scarier. Parents may also feel guilty or responsible. What’s important to remember now is that there are many reasons why kids use drugs. It is never too early or too late to take action. Parents are the most important part of a child’s life and your actions from this point on can make a difference. Always consider seeking professional advice for yourself. There is no need for you to confront this alone.

Before you engage your child in a conversation, you’ll need to prepare yourself. Go for a walk, sit where you can’t be disturbed, and think. Reflect on the facts of the situation. Try to avoid negative feelings of anger and betrayal - as they won’t be useful to you in this conversation and may result in your child tuning out. Organize your thoughts. Decide what you want to say.

Tips for Talking

First, learn what you can about alcohol and drugs. Many of the resources in Appendix A of this guidebook will direct you to places where this information is available for parents.

Find a time to talk with your child when you are calm and know what you want to say. Arrange for some privacy. Ensure there is enough uninterrupted time for the discussion. Tell your child what you have seen and how you feel about it. Be specific about what you have noticed that makes you think he or she may be using alcohol or other drugs. Explain why this concerns you. Try to find out what is going on and encourage your child to talk about alcohol or

Signs and Symptoms

There may be sudden changes in the way your child acts, such as:

• Increased secrecy about activities • Unusual outbursts of temper • Withdrawal from the family • Lying or stealing

There may be changes in the way your child sounds or looks, such as:

• Slurred speech or lack of coordination

• Major weight loss or gain

• Different clothing, particularly those with drug messages

There may be changes in your child’s social or school activities, such as:

• Skipping school • Drop in grades

• Loss of interest in previous activities • Change in friends

You may find things that may be related to alcohol or drug use, such as:

• Rolling papers, pipes, clips, etc. • Lighter fluid, gasoline cans, etc.,

sometimes with paper bags or rags • Bottles of eye drops (may be used to

cover up blood shot eyes) • Missing bottles of alcohol or

prescription drugs from the home

(12)

After presenting the facts as you see them, ask your child for his/her response to the information you’ve presented. Listen. Hear what your child is saying. You can show your attentiveness by simply repeating or “reflecting” what your child has said or by saying it back in your own words. This will make sure that you truly understand what s/he is trying to tell you. Listen!

Be prepared for your child to deny using alcohol or drugs. Even if your child admits it, s/he may not think there is a “problem.” Discuss what the rules are in your family about drug or alcohol use and that you will enforce these. You can also share that there will be a continuing conversation about this and that you may want to talk to a professional. Leave the door open for the child to talk to you at any time in the future.

The resources in Appendix A also include websites that have information about teenage drug use and give additional tips about how to talk to your child.

What if My Child Doesn’t Want Help?

Chances are your child will not think or admit s/he needs help. The question for you as a parent becomes: How can you get your child the help once you believe s/he needs it?

You must be firm about the importance of an assessment and/or recommended treatment. Substance abuse professionals who work with youth are prepared to counsel kids who may not yet recognize a problem. You may want to contact a substance abuse program and get some advice on what you can say and do before you speak with your child.

Sometimes a young person may continue to refuse to attend or participate in substance abuse services. Under a Florida law called the Marchman Act

(Chapter 397, Florida Statutes) there are some special circumstances when a youth can be taken involuntarily for assessment and/or treatment. The special circumstances include the requirements that the youth is substance impaired as evidenced by:

1. has lost the power of self-control with respect to substance use; and either

2. (a) has harmed, threatened to or attempted to harm him or herself or others, or

(b) needs substance abuse services but is so impaired by the use of substances that he/she cannot recognize the need or make a rational decision to get services; however, refusal to get services does not necessarily show evidence of a lack of judgment.

The process used to enforce the Marchman Act varies in each county. In some counties, the family contacts an agency that provides substance abuse services for assistance in filing a Petition for Involuntary Assessment and Stabilization with the court. In the other counties, the probate office at the courthouse is the first point of contact.

Once a petition for assessment has been filed, the Court will determine if your child needs to be immediately picked up for assessment without a hearing (an Ex Parte order), or will set a hearing date and time. If a hearing is conducted, all parties will have the opportunity to advise the judge of the need for the assessment and the resources available to complete it.

(13)

If the judge finds that there is enough evidence to meet the requirements for involuntary assessment, your child will be ordered to attend an appointment with a substance abuse counselor in an outpatient office-type setting. The judge could also direct your child to be placed into a secure facility such as a Juvenile Addictions Receiving Facility (if one is available in your area). During your child’s stay in this safe and secure environment, s/he will receive a physical exam, in detailed substance abuse assessment, and supportive counseling every day. The assessment is usually completed within seventy-two (72) hours.

The goal of the assessment is to provide you and your child a recommendation for treatment and a referral for follow-up care. In most cases, the counselor can make an appointment with a treatment provider during the assessment, and can answer questions regarding his or her recommendations. The counselor’s duty is to ensure that your child is placed in the “least-restrictive setting” to receive care. This may be an outpatient program, day-treatment setting, or a residential facility. Finally, the counselor will determine if the youth is willing to enter the program on a voluntary basis, or if another Marchman Act court hearing will be necessary to ensure your child follows through with the recommended treatment.

Based upon the results of the assessment and the determination that the youth will not voluntarily enter treatment, a Marchman Act Petition for Involuntary Treatment can be filed by the parent or a designated representative of the treatment facility (or the counselor) who completed the assessment. A court hearing will be held, and everyone involved in the case will have a chance to discuss the findings of the assessment and the appropriate treatment program. The judge will then make a

determination whether your child should be court ordered to attend treatment.

The Marchman Act court process is not a criminal proceeding but is designed to ensure your child understands the seriousness of his or her need for treatment and complies with the court order. If your child fails to obey the Order for Treatment, an Order to Show Cause as to why he or she has not followed the court order is filed with the court and s/he can be held responsible under the law. The court’s order can be reviewed and renewed within sixty (60) days in order to make certain your child completes the program.

Key Terms

Assessment: A professional review

of a child’s and family’s needs that is done when they first seek services from a provider. The assessment of the child includes a review of physical and mental health, substance use history, developmental history, school history and performance, family situation, and behavior in the community.

Diagnosis: The identification and

labeling of a disorder or disease based on its signs and symptoms.

Treatment: A set of activities

carried out by properly trained and certified professionals that can help to reduce or eliminate the abusive use of alcohol and drugs.

Marchman Act: A law under the

Florida Statutes (Chapter 397) that enables family members to obtain help for a loved one who is unwilling to seek substance abuse services voluntarily.

(14)

(15)

Chapter Three: Taking the First Step

Getting Advice from Others

You may want to talk to other people who can offer support and information on where to get help. There are various resources available to you at this point.

Sometimes it is helpful to talk to other families who have had the same experience. This may be someone you know. Knowing that you are not alone and how others have sought help can be very encouraging. Many communities have self help groups for families such as Alanon and Narcanon. You can check your phone book for listings of these or Alcoholics Anonymous or Narcotic Anonymous hotlines for meeting locations and times.

You may want to talk to your child’s doctor. A doctor can also examine your child and perhaps order a drug test that can screen for the recent presence of certain drugs in the urine. The doctor may also be able to recommend a substance abuse professional or program where you can take your child for an assessment.

Consider talking to your child’s school counselor. School counselors often know if there are specialists in the school system that can help decide if a referral for a substance abuse or mental health assessment is needed. School counselors also often know where you can take your child for assessment and treatment within the community. Some schools have services that take place in the school for youth who may have a substance or mental health problem. You can ask your child’s school counselor if there are services like this in your child’s school.

You may want to call your local office of the Florida Department of Children and Families (DCF) Substance Abuse Office. They will be able to tell you about publicly funded facilities or how to access private care.

Getting an Assessment

When you or others decide that your child may need help, the next step is getting your child an assessment. The assessment provides explanations of your child’s problems as well as recommendations for strategies to treat them. During an assessment, the substance abuse professional will talk with your child and the family, and sometimes others (i.e., probation officers or teachers) in order to collect current and background information. This should include asking if your child has any specific cultural or physical needs that should be considered. The substance abuse professional doing the assessment may want your child to complete other tests or questionnaires. All information will be used to determine if your child is having any problems that need treatment. The initial assessment usually takes from one to two hours.

The substance abuse professional will make recommendations to you and your child once the assessment is completed. These recommendations may include the need for further assessment and/ or treatment and the places where treatment may be available.

(16)

Types of Assessments

Some of the most common types of assessments for a substance abuse and/or co-existing mental health problem, and the type of professional who typically provides them are described in the following table.

Sometimes an assessment will include a urine drug screen. A urine sample can be tested to detect if certain drugs are present in the urine. Not all drugs can be detected in urine and each drug can only be detected for a certain period of time. Urine drug testing does not tell how often the drug has been used.

Blood testing for alcohol and other drugs is rarely performed. It occurs most often in cases of arrests for “driving under the influence” or in hospitals in emergency situations.

Mental Health Problems

Young people can have mental, emotional, and behavioral problems. Mental health disorders, sometimes called “emotional disorders,” are medical conditions that can disrupt a child’s mood, thinking, feelings, and ability to interact with and relate to others in his or her life. For the majority of children, a change in mood, feelings, and behavior is a natural part of child development. However, when these changes begin to impact a child’s ability to function on a daily basis, a mental health disorder may be the cause of these changes. If this is the case, the child may need mental healthcare.

If you suspect that your child has a mental health issue, it may be hard to know when to seek help. If you observe some of the following symptoms, it may be time to talk to your child’s doctor about your child’s symptoms:

• Extreme anxiety or worry • Constant hyperactivity

Purpose

Collects current information and background information in order to determine the need for substance abuse and mental health treatment

Determines the need for medical assistance to withdraw from alcohol or drugs; conducts a routine medical exam

Assesses mental and emotional problems; provides a diagnosis and treatment recommendations, including any medications

Type of Assessment

Psychosocial

Medical

Psychiatric

Who Does It

Substance Abuse Professional (Bachelor or Master degree) Mental Health Professional (Bachelor, Master or Doctoral degree)

Social Worker (Bachelor of Social Work, Master of Social Work or Licensed Clinical Social Worker) Physician (Medical Doctor-MD) Physician Assistant (PA)

Advanced Registered Nurse Practitioner (ARNP)

(17)

• Appearing distracted when others try to interact with him or her • Constant nightmares

• Frequent anger, aggression, or disobedience

• Constant temper tantrums that cannot be explained • Significant changes in eating or sleeping habits • Significant change in performance at school • Inability to handle daily stresses or problems

• Constant complaining about physical problems (for example, stomachaches or headaches)

• Acting withdrawn or depressed • Self-injurious behaviors

Drug or alcohol use may also be a sign of other mental health issues. Some children use substances as a way to control mental health symptoms—a form of self-medicating without the use of (and sometimes the stigma of) prescription medications. If you think that your child may have a problem with drugs or alcohol, you may need to think about other mental health issues as well.

Trying to figure out if a mental health problem is affecting your child is not easy and requires the expertise of a doctor, such as a psychiatrist or a pediatrician, or a mental health professional. These professionals can evaluate the child and determine if he or she has a mental health issue. Specially designed interview and assessment tools are used to evaluate a person for mental health disorders. The person conducting the assessment bases the diagnosis on the person’s report of symptoms, and his or her observation of the person’s attitudes and behavior. The physician or mental health professional then determines if the person’s symptoms and degree of disability point to a diagnosis of a specific disorder.

If a mental health problem is identified, it too should be treated. Experts agree that both substance abuse and mental health should be addressed at the same time. Not doing so is likely to result in treatment failure. The substance abuse professional may refer your child to a psychiatrist for evaluation. Parental permission is required

TIP

If your child’s behavior

concerns you, write down

how he or she acts each

day—specific signs or

symptoms, how often they

happen , in what context

they happen , when you first

noticed them, and any other

concerns you have.

This will be a big help

when you talk to your

child’s doctor or mental

health specialist. It is also

a good habit to get into for

the future. If your child is

diagnosed with a mental

health disorder, your

records can be very helpful

in charting his or her

symptoms and response to

treatment over time.

(18)

in most cases in order for your child to receive medication for mental or

behavior problems. A description of common mental disorders among children and adolescents can be found in Appendix B.

Where to Get an Assessment

Substance abuse assessment and treatment services are offered primarily in two types of systems: publicly funded services, which families must qualify for, and services covered by a family’s private insurance.

There are programs that are mostly funded by state and public dollars. Because these programs receive public funding, they cannot deny services to individuals solely based on a person’s inability to pay. You may want to contact your local publicly funded substance abuse program or community mental health center if you have limited income or financial resources.

There are several ways you can access information about where to go for an assessment.

• Dial 211 for information and referral provided by Florida Alliance of Information and

Referral Services which provides assistance to approximately 75% of Florida’s population. • Look in the Yellow Pages of your local telephone

book which will list alcohol and drug treatment programs.

• Call the Florida Department of Children and Families’ Substance Abuse and Mental Health Office that serves your county. See listing in Appendix C.

• Obtain a copy of Florida’s best source of information for publicly funded adolescent substance abuse programs - the Directory of DCF Funded Adolescent Substance Abuse Treatment Programs in Florida 2008. This Directory was developed to assist parents, families, professionals, and individuals in locating services for Florida youth. Any of the providers listed in this directory, by county, will be happy to answer your questions about the various services they provide.

Privately funded services can be obtained from both agencies and individuals, with families paying a fee. Since privately funded services do not receive public funding, they are more costly to the people who receive them. If you have insurance, it may pay for some of the costs, depending upon your policy. For details about payment options, please see Chapter Seven, Paying for Services.

(19)

(20)

(21)

Chapter Four: When Emergencies Happen

Emergencies and crisis situations happen and sometimes cannot be avoided. Crisis situations are filled with high levels of stress, anxiety, and fear. Your best bet is to remain calm and realize your child needs your help and support.

1 _{Crisis Stabilization Services}_{– These services are residential acute care services}

that are provided on a 24-hour, 7-day a week basis. The services involve brief, intensive residential treatment to meet the needs of individuals who are experiencing acute crises and who, in the absence of a suitable, alternative, would need inpatient psychiatric hospitalization. Each county in Florida either has such a facility, usually called a Crisis Stabilization Unit (CSU), or contracts with a facility to serve people from that respective county. Several counties may contract with a facility to provide this service.

If your Child is Arrested

Many youth who are involved with alcohol or drugs come to the attention of the juvenile justice system since the use of these substances are illegal. The juvenile justice system includes a range of services provided under the Florida Department of Juvenile Justice to youth who break the law. There are different points of contact a youth may have within the juvenile justice system where a potential substance abuse or mental health problem may be identified.

When a minor is taken into custody by a police officer for a law violation, the officer will determine whether the child can be released to the family

Where to Get Help

• Call 911

• Hospital Emergency Room • Mental Health Crisis Stabilization

Units1

• Police

• Call 211

• Pediatrician or other physician • Substance Abuse or Mental

Health provider or agency • Community Organization (call

your local DCF office as shown in Appendix C for the number)

• Pediatrician or other physician • Substance Abuse or Mental

Health provider or agency • School

• Family or friend

• Community Organization (call your local DCF office as shown in Appendix C for the number)

Your Child’s Situation

• Your child is showing severe, out of control behavior.

• Your child may be a threat to self or others.

• You are frightened. • There has been a major

change in your child’s behavior.

• Your child seems unable to function without help. • You feel unable to cope

with the situation or help your child.

• There has been a mild to moderate change in your child’s behavior.

• You are worried, but not alarmed.

When to Get Help

Immediately (emergency) 48-72 hours (urgent) Soon (a routine evaluation)

4

(22)

detention. Detention screening is done in a Juvenile Assessment Center or by a Department of Juvenile Justice on-call screener. A child may be detained in a residential Department of Juvenile Justice Detention facility or placed on home detention. A Juvenile Probation Officer (JPO) will be notified of the law violation and will then conduct an intake interview with the child and family to gather information and develop a plan to address the offense. The Juvenile Probation Officer’s assessment and plan to address the offense is then sent as a recommendation to the State’s Attorney’s Office, who makes the final decision.

The plan takes into consideration things like previous arrests, the nature of the offense, and the risk the child presents to the community. The recommendation may be to place the child in a program and divert them from the juvenile court system or file a petition for the child to appear in court. Youth who appear in court for a delinquent offense may be court ordered to attend a diversion program, placed on probation, and/or committed to a residential commitment program.

All youth who are arrested for a law violation in Florida are screened for

potential alcohol, drug and/or mental health problems. The substance abuse and mental health screening occurs after the arrest and may be done in a Juvenile Assessment Center or by an on-call detention screener. Screening may also be done when youth are placed in a detention center or by a Juvenile Probation Officer during the intake interview. This screening for substance abuse and mental health occurs as part of an instrument called the Positive Action Change Tool. A referral for a full assessment will be made if any screening indicates a potential substance abuse or mental health problem.

What if a Judge says Your Child Has a Problem?

An assessment that confirms a substance abuse and/or mental health problem will make recommendations for the type of services and may include a specific program where these services are available. Recommendations for treatment may be given to the Juvenile Judge who will hear your child’s case. Based on these, the judge may court order your child to attend a particular program.

If a judge commits your child to the Department of Juvenile Justice, the Department will decide where your child will be sent. Youth being considered for commitment to a Department of Juvenile Justice residential facility must receive a comprehensive evaluation, which includes mental health and

substance abuse, prior to placement. The residential commitment facility should address any identified needs for substance abuse or mental health services.

What if the School says Your Child had Drugs?

Schools in Florida have a “zero tolerance” policy regarding the possession of alcohol and drugs at school. Youth found to have alcohol, tobacco or drugs at school may be expelled, suspended or referred to an alternative program, depending upon the policy in that school district. Should this happen to your child, it is important to ask the school any questions that you have about the incident. Find out what options there are for your child’s continued education or how to get help. Ask about an appeals process if you disagree with the decisions that are made about your child. You can also contact the Florida Department of Education Office of Safe Schools at (850) 245-0416 for more information.

(23)

Hospitalization

Emergency situations involving alcohol or drugs usually occurs in medical emergency situations, i.e., an overdose. Call 911 if you suspect that your child has overdosed. If you know what your child has taken or find bottles or pills, take these with you to the emergency room. The emergency room will medically evaluate your child. Once your child’s immediate condition has been stabilized, the hospital may admit your child to the hospital for further observation, transfer your child directly to a substance abuse facility, or release your child to the family with follow-up recommendations.

Keeping Track of Information

You will likely interact with many people while seeking assistance for your child. Even though you may have others who coordinate specific aspects of your child’s care, you are the primary coordinator of all your child’s services. Keeping careful records will help you as well as all of your child’s providers.

Having information readily available will allow you to quickly provide a complete and accurate picture of your child to physicians, counselors, teachers, and others. It is well worth the effort.

Here are some tips for getting organized:

• Keep all originals in a safe place in your home file and place only copies in your notebook.

• Fasten all records securely in a three-ring notebook. This will keep the pages from getting separated and out of order should the notebook fall.

• If the notebook becomes too big, transfer items not needed into your home files. Clean out the home files as needed.

• Keep a log or summary of the records contained in the notebook.

• If you have many records, separate them in a way that makes sense to you. Consider filing them in sections based on type of records or filing them in chronological order. You might have separate files for school reports, medical assessments, and treatment plans. For example, you might want to organize your folders this way:

• Birth certificate • Immunization records

• Doctors’ reports • Specialists’ reports

• Legal documents • School tests and assessments

• Reports for any prior care for substance abuse or mental health problems

• Write any personal notes on a copy of the record or a blank sheet of paper. • Keep a phone log with the name of the person you spoke with, date of the

call and summary of conversation. This will help you keep track of important events, conversations and future appointments.

• If your child is on any medications, keep a list of medications including dosage changes, start date, and discontinue date. Be sure to note any adverse

(24)

(25)

Chapter Five: Privacy of Information

Protecting Your Privacy

Your child has a right to confidentiality throughout the entire process of referral, assessment and treatment. Confidentiality means that personal

information obtained during the process of seeking or receiving substance abuse services cannot be shared without the written permission of the person receiving services. Permission to release information must be in writing and be specific about who can receive information, the type of information to be shared and how the information will be used.

There are a few situations where information can be released without the person’s consent. Even then there are often restrictions on how much and what type of information can be given or how it can be used. Confidentiality and its limitations should be explained to your child during the initial contact with a service provider.

Mandated Reporting Requirements

One of the exceptions to confidentiality occurs when a professional is told or suspects that a child has been abused or neglected. The professional in this situation is required by law to report this suspicion to Child Protective Services. Child Protective Services will then be responsible for following up on the report.

Special Rules for Youth Seeking Alcohol/Drug Treatment

Florida law gives minors the right to seek and receive substance abuse

prevention and treatment services without parental consent (meaning, on their own). For this reason, your child will be asked to sign consent forms in order for information to be shared about their treatment. This includes information that will be shared with parents and family members.

Protected Health Information

The federal government has a law called the Health Insurance Portability and Accountability Act of 1996 (HIPAA) which requires that “personal health information” be private. Your child’s “personal health information” will be kept in records at the office or agency where you get services. This information cannot be given to others without written permission from the child if he or she is 18 years or older. Your written permission is needed if you are the guardian of a child younger than 18 years.

When you first go to the professional or agency for help, they will ask you to sign a form giving permission for the agency to use or share your information. The form says you give permission for the personal health information to be shared with others for two purposes: 1) to get help from another professional who is needed; or, 2) in order for the office to send a bill to your insurance company, or to the Medicaid or Healthy Kids plan.

(26)

26 | Substance Abuse Services for Youth in Florida: A Guide for Families Other reasons that the personal health information could be given to others include:

• To study what works, in order to improve services (for research). In this case, your child’s name would not be shown. Only summaries would be published. • Because a judge or court asked for

the information.

• To protect public health, for example, if your child had a disease that others could get. • For government agencies to

review the work of this office, to insure that they are doing a good job and spending money wisely. • When there is concern about

abuse or neglect of a child.

Your family’s personal health information cannot be given to employers. It cannot be used or shared for sales calls or advertising.

It is important that you give the health professional or agency all the information they need to help your child. They may ask you to sign a form giving permission for them to get old records so they can see your child’s past medical history.

If you think your privacy is not respected, you may file a complaint. Contact the Department of Health Inspector General at 850-245-4141. You can learn more about your rights at: www.hhs.gov/ocr/hipaa. This is a web site for the federal government. State rights to privacy may be stricter.

Privacy is an expectation

and a right.

Here are your rights under the law: • You can expect to have both

written information and conversations kept private and confidential.

• You have the right to be told what the office’s policies are about privacy and keeping personal health information confidential. This information should be in writing.

• You have the right to get a copy of your child’s medical record or personal health information. You have the right to review it and to correct it if it is wrong or incomplete.

• You have the right to know who has used or shared your personal health information, and for what purpose. Generally the purposes will be for treatment, payment, or for office operations.

• You can ask to be called or have mail sent to another place other than your home.

• You can ask that information not be shared if it is not required for it to be used or shared.

(27)

(28)

(29)

Chapter Six: Understanding Treatment

There are many successful treatments for substance abuse and dependence. Treatment includes drug or alcohol rehabilitation, which provides strategies for coping with the desire to use alcohol or drugs, teaches ways to avoid drugs, and prevents a return to use (called relapse), and helps the person to deal with relapse if it occurs. Treatment also allows the person’s body to get over any physical dependence to the substance.

There are many different methods that are used to provide counseling for your child and your family. Individual, group, and family counseling are suggested forms of treatment. Depending on your child’s situation, he or she may need different levels of care. Treatment for substance abuse may also

include additional services such as education, peer support, and continuing care. Medications may be prescribed by a psychiatrist, who will continue to monitor your child while they are on them to assess their effects. Within Florida, a child 13 years old or older can receive mental health and substance abuse assessment services or individual and counseling, or other forms of verbal counseling from qualified agencies and professionals without parental consent.

Types of Services

Placement in a particular type of treatment is based on the results of the assessment. These placements are often guided by nationally recognized guidelines. If your child has any special cultural or physical needs, these should be considered in the placement recommendation.

An array of services is usually available.

Medical services involve a range of care depending upon individual needs:

• Detoxification centers provide medical withdrawal from addicting drugs in a residential or outpatient setting. • Crisis stabilization units provide assessment and stabilization of a mental or emotional crisis, including suicide risk.

• Routine medical care offers nursing assessments, physical exams and prescribes medications to treat physical conditions, if indicated.

• Psychiatric services provide assessment, diagnosis, and prescribe and monitor medications for mental conditions, if indicated.

Outpatient services consist of individual, group or family counseling in an office setting once or twice a week. Some programs are more

Types of Counseling

Services

Individual counseling takes

place one-on-one with just the counselor and the client.

Group counseling is where

a small group of youth meet regularly to talk, interact, and discuss problems with each other and the counselor. This setting gives youth a chance to talk about problems and get feedback from others who are experiencing similar problems.

Family counseling is used

to treat family problems and address the impact that an alcohol, drug or mental health problem has on the family. The counselor considers the family, not the individual, as the unit of treatment and emphasizes relationships and communication patterns between people as the focus of work to be done in treatment.

(30)

intensive outpatient programs that provide individual, group or family counseling and educational services several hours per week. In some cases, outpatient counseling services are conducted in the home.

Residential services are programs that are staff supervised twenty-four hours a day, seven days a week, and offer a variety of counseling, educational, recreational, case management, and support services. Residential programs can be short term (one month), intermediate (three to six months) or long term (more than six months).

Peer support services are typically offered as self help groups. The most

widely available support groups for people receiving treatment for substance abuse are 12 step groups such as Alcoholics Anonymous or Narcotics

Anonymous. For family members, peer support groups are usually Al-Anon or Alateen.

Case management services are activities that are handled by a counselor or case manager that link your child or family to other services that are needed. Some examples might be scheduling an appointment with a psychiatrist or an employment counselor.

Educational services help you and your child learn more about your child’s specific problems as well as new skills. When a child develops a substance abuse problem or a mental health issue, the child, parents, and other family members need specific information about what is happening—the diagnosis, the meaning of specific symptoms, what is known about the causes, effects, and implications of the problems. It includes information on how to recognize signs of relapse, so that the child can get necessary treatment before it happens. It also involves teaching coping strategies and problem-solving skills to parents and other family members to help them deal more effectively with the child.

Continuing care or aftercare services focus on maintaining changes made while in treatment. These may include going to continuing care groups, participating in peer support groups, or relapse prevention counseling. When parents, families, professionals, and adolescents are seeking treatment for substance abuse or substance dependence it can be challenging to determine if outpatient treatment is sufficient or if more intensive treatment is needed. When more intensive care is needed outside of the home, treatment choices may be limited and may not be available in all counties due to higher operational costs. Distance to treatment and cost for treatment can create challenges that influence treatment choices.

Finding Quality Care

Programs that hold themselves out to the public as substance abuse prevention and treatment services in Florida must be licensed by the Florida Department of Children and Families. This applies to programs that are publicly and privately funded. Licensure means that a program must meet various health, safety, and client care standards. Programs that are licensed are reviewed by the Department of Children and Families to ensure they meet these standards.

In addition to licensing, programs may choose to be accredited by a national accreditation organization. Accreditation involves additional standards of care

(31)

and adds another layer to the assurance of quality services within a program. Programs that receive accreditation are reviewed by the accrediting body to ensure they meet those accreditation standards.

Programs are required to post their license within each program area. Programs that are also accredited also post notices of their accreditation within their facilities. In addition, many programs cite licensure and accreditation status on their brochure or program information materials.

Substance abuse counselors who work in licensed programs may choose to obtain licensure under the Department of Health (in areas listed below) as individuals or certification as addiction professionals. If the substance abuse counselor is not individually licensed or certified, the standards require that they be clinically supervised by someone who is either licensed under the Department of Health or certified as an addiction professional.

Individuals in independent private practice who provide substance abuse and mental health services must be licensed individually. An individual must meet certain education, experience and competency requirements in order to be licensed. Individuals in Florida who provide these services are licensed by the Florida Department of Heath, Division of Medical Quality Assurance. Examples of the types of licenses held by individuals who treat mental heath and substance abuse problems include:

• Physician • Psychiatrist • Psychologist

• Mental Health Counselor • Social Worker

• Marriage and Family Counselor

What to Expect During Treatment

A plan of care, or treatment plan, is developed when your child begins a program. You and your child will participate with the counselor and other treatment team members in the development of this plan. The plan will identify what problems will be addressed, what services will be applied to these problems, and what the expected result is for each problem. The plan will also specify how often and for how long your

TIP: There are some questions you may want to ask before your child enrolls in a program. Some things to consider are:

• Is the program and/or individual counselor licensed or certified? • Do the program and/or individual

have experience with youth who have substance abuse or mental health problems?

• What are the costs and what is my financial responsibility? • What types of counseling will be

provided for my child?

• How will the family be included in the treatment?

• What kind of information will I be given and how often?

• What are the major program rules/expectations? How are violations handled?

• Does the program offer

medications as part of treatment, if appropriate?

• What happens when my child’s treatment is complete?

• What success have you achieved in treating youth?

• What are your measurable program outcomes?

(32)

Your child will be expected to follow this treatment plan and review it

periodically with the counselor, making agreed upon changes when necessary. This includes attending and participating in counseling and other activities as scheduled. There may be other expectations for your child’s behavior, such as coming to counseling sessions sober and not being in possession of drugs, including alcohol. You and your child should be informed about these expectations at the beginning of treatment. If your child does not attend treatment regularly, it will not work.

It is widely accepted that families are a critical part of a child’s treatment. Programs and individuals who work with youth know this and involve families in the treatment process in a number of ways. Families in most cases will be expected to arrange for transportation for their child to and from appointments. In some cases, families will be asked to attend activities specifically designed for families. You will want to ask in what ways you will be involved in your child’s care. The following are examples of the types of activities that may be expected for family members:

Communication: Families should expect to be in regular contact with treatment providers to receive information about their child’s progress. Families need to know the kind of information that will be shared with them, consistent with confidentiality regulations. Counselors often want to hear your observations as well as anything that could impact on your child’s treatment.

Family Counseling: Some programs provide family counseling where parents and their child meet with counselors to improve communications and relationships within your individual family.

Family Visitation: Residential programs usually offer times during the week when families can visit their child at the program. Your child may be

allowed to come home for periods of time, depending on treatment progress and the length of the program.

If there is another family member in the home that also has a problem with alcohol or drugs, including a parent, this will have a significant impact on your child’s substance abuse treatment. Discuss this immediately with your child’s counselor if this is happening in your family.

Signs that Treatment is Working

There are various signs that your child is getting better. In general, the things that led you to suspect that your child was involved with drugs and/or alcohol to begin with will start to disappear. You may also notice changes for the better in your child’s attitude and appearance. Your child’s attendance and grades in school may improve. Your child may start getting along better with other family members at home.

You may request a meeting with your child’s counselor or program to get their view of your child’s progress. The counselor can share information, within the boundaries of your child’s confidentiality. While there are many signs that treatment is working, only your child knows for sure whether or not they have truly made changes and will work to maintain them once treatment is over.

(33)

Maintaining Treatment Successes

All of the available information based on years of studies indicates that treatment works. It especially works while the person is active in treatment. Most youth do complete the treatment program. However, it is hard to maintain changes for most people once treatment is completed. Old temptations will still be there and it is not unusual for youth and adults to stumble and return to using substances – to relapse.

Relapse is not unusual and because of this, substance abuse professionals develop a plan to prevent relapses with your child. This plan includes what to do if a relapse occurs. Usually this involves re-contacting a substance abuse professional or program as early in the relapse as possible. A relapse may result in a return to medical services, counseling, continuing care or self help groups, depending on the extent and nature of the relapse. Continuation in some type of support or aftercare services after completing the primary course of treatment is also important to help prevent relapse and maintain treatment gains.

Family healing and the rebuilding of trust is a delicate process. If your child has completed treatment, he or she has worked hard to begin making the needed changes in their life. As your child continues to show the ability to maintain these changes, they will slowly begin to regain your trust. It is important to remember that many of the painful things that occurred in the past were related to your child’s alcohol and drug use. Although the past doesn’t go away, it is helpful to stay focused on the present and to allow your child to be the person they are now and are becoming.

(34)

7

(35)

Chapter Seven: Paying for Services

Once you know that your child needs treatment, you may be concerned about how you can pay for the services that are needed. You might think that you would need to pay for services yourself or have private health insurance to cover the cost of care. This is not the case.

In Florida, there are many different types of insurance and subsidy programs that can help you afford the care that your child needs. In addition, many programs offer “sliding scale” payment, which means that cost depends on how much you can afford to pay. Florida’s publicly funded treatment programs cannot turn anyone away due to an inability to pay. Since there are limited slots in these public programs, there may be a waiting period for your child to enter treatment.

Payment Terminology

Depending on the severity of your child’s problems and your own financial situation, you may need to use a combination of programs in order to pay for care. It is important to be familiar with the key terms below.

Medicaid is a state and federally funded program that provides health care coverage for certain low-income individuals who meet requirements related to age, disability or condition of pregnancy. In Florida, the Agency for Health Care Administration (AHCA) develops and carries out policies related to the Medicaid program. The Florida Department of Children and Families determines eligibility for low-income children and family programs and the institutional care program.

Managed Care is the process by which Medicaid controls the costs of its services. Medicaid has three types of managed care:

1. Medicaid HMOs (health maintenance organizations) are private managed care insurance companies that have contracts with the state of Florida to provide health care for eligible recipients.

2. MediPass is a state administered primary care case management program that provides health care for eligible recipients.

3. Provider Service Network (PSN) is operated by health care providers who offer integrated systems of health care to eligible recipients. Only a limited number of Florida counties have PSNs.

Florida Healthy Kids is a program that helps thousands of uninsured children in the state of Florida gain access to affordable, quality health care. Healthy Kids combines local, state, federal and family funds to pay premiums to commercial health plans who assume the insurance risk. The program is one of four components of the Florida KidCare program and covers children ages five through eighteen who are uninsured and not eligible for Medicaid or the Children’s Medical Services Network. Healthy Kids is unique because it is designed to provide affordable access to health insurance coverage for working families for whom the payment of the full premium would be out of reach.

Private Health Insurance is usually obtained through an employer, but is also available for purchase on an individual basis. Your insurance policy is essentially a contract between you and the insurance company. The contract can be renewable yearly or monthly. The type and amount of health care costs that will be covered by the health plan are specified in advance in the member contract or an evidence of coverage guidebook.

(36)

Florida Healthy Kids Uninsured children ages 5 through 18; other programs under Florida KidCare are available for children from birth through age 18 as well. Subsidized coverage for children up to 200% Federal Poverty Levels Non-subsidized coverage for those over 200% FPL There is a monthly premium payment for overall coverage (most families pay $15 or $20 per month for coverage). $5 office co-payment for outpatient ser

vices

To be eligible for subsidized coverage, a child must be a US Citizen or qualified non-citizen Families can apply online at www

.floridakidcare.org or call

1-888-540-KIDS and request an application be mailed to them. Applications take 6-8 weeks to process; coverage starts the first of the month following approval AND receipt of the first month’

s premium

payment. A child may also be required to see a primar

y care

physician first for a referral for specialty ser

vices.

Inpatient Ser

vices: 7 days

per contract year for medical detoxification; 30 days residential ser

vices

Outpatient Ser

vices: 40 visits

per contract year

.

Yes, a child has to be uninsured to be enrolled in and eligible for the Healthy Kids program. Child must use designated providers within their managed care plan’

s network; the

managed care plans var

y

by county

.

Questions Who is eligible? What are the income limits? (What if I own a house/car?) What does it cost to get substance abuse assessment and treatment ser

vices?

Do I have to be a legal resident to be eligible for ser

vices?

Where can I go to apply for benefits under this payor? How long does it take to be able to receive ser

vices?

What types of ser

vices

are available as benefits? (related to substance abuse issues) What if we have health insurance... will this affect our ser

vices?

How and where do I/my child go to receive these ser

vices?

Medicaid Eligibility is determined by the Department of Children and Families (DCF) or the Social Security Administration. DCF determines Medicaid eligibility for: • Low income families with children • Children only • Pregnant women • Non-citizens with medical emergencies • Aged and/or disabled individuals not currently receiving Supplemental Security Income (SSI). Social Security Administration determines eligibility for anyone who is: aged (age 65 or older); blind; or disabled. Eligibility is determined by the Department of Children and Families or the Social Security Administration. Income limits are set by these two entities and var

y with eligibility group.

Please see these websites for details. • Department of Children and Families, Office of Economic Self Sufficiency http://www

.dcf.state.fl.us/ess/

• Social Security Administration: http://www

.ssa.gov/

Rates are dependent on the type of assessment and treatment that the recipient is receiving. Some providers have a nominal co-pay of $3 (or less) per day

.

Yes. Again, eligibility is determined by the Department of Children and Family

.

http://www

.myflorida.com/accessflorida/

This will var

y depending upon the number of

providers in their area, and the availability of appointments within each provider

.

Outpatient Substance Abuse ser

vices: • individual/family therapy • assessments • group counseling, • treatment planning; • peer recover y support • after care ser vices

• methadone or buprenorphine administration Medicaid is the last payor to be used. Therefore, if you have 3rd party insurance the provider must bill your primar

y insurance first. Once payment or

denial of payment is determined the provider can submit reimbursement from the Agency for any unpaid ser

vices. The Agency will determine if the

claim is eligible for reimbursement based on: the ser

vice provided, the payment made by the primar

y

insurer and the amount that Medicaid reimburses for that ser

vice.

There are several agencies that provide these ser

vices. Please contact your local AHCA office for

information (listings of the Medicaid offices can be found in Appendix D). Florida Department of Children and Families (DCF), Substance Abuse Office Individuals with family incomes that are less than 250% of the federal poverty level. Fees are assessed based on sliding scale – the higher the income, the more the client is responsible to pay

.

Family income determinations include salar

y/hourly wage and benefits

such as Supplemental Security Income (SSI)*, disability

, retirement,

TANF**, etc. for the client’

s household and for most state supported

ser

vices, based on the Federal Poverty Level guidelines.

* Supplemental Security Income (SSI) is a federal program that makes monthly payments to people with low income who are age 65 or older or are blind or have a disability

.

** T

emporar

y Assistance for Needy Families (T

ANF) is a federal program

that provides states with funds that replace the former welfare systems. TANF funds are provided directly to needy families, used to promote work and education, promote family planning, or be used to encourage two parent families. State statutes governing substance abuse require a share of cost from the consumer

, based on the family’

s ability to pay

. Providers under contract

with DCF are required to develop a Sliding Fee Scale in accordance with the Federal Poverty Level. Ser

vices can cost as little as a few dollars from

the client per ser

vice. The state absorbs the majority of the costs for a

wide range of ser

vices.

State funding is allocated to local communities based on population; therefore, most areas of the state have additional requirements of residency due to local match funds. Because state resour

ces are limited,

providers have designated ser

vice areas for individuals and families

residing in specific communities. Exceptions can be granted depending on cir

cumstances of the client/family

.

The local DCF Substance Abuse and Mental Health Program Offices maintain a list of contracted ser

vice providers and can provide a list of

options. Many communities have a central intake process, an agency that determines eligibility and provides an assessment of ser

vice needs.

The more intensive ser

vices generally have longer wait times due to

limited capacity (residential treatment) – few days to a few weeks (some as long as a month). Interim ser

vices such as case management and

counseling ser

vices are available until a bed becomes available. Less

intensive ser

vices (outpatient) can be same day or same week.

The department pur

chases a wide range of prevention, detoxification,

treatment, and support ser

vices for individuals and families affected by

substance abuse. Families with health insurance have a greater number of options. They can go anywhere the insurance is accepted. The department has limited resour

ces, and in most cases, only pur

chases a portion of a provider’

s

ser

vice capacity

.

Any provider that is licensed by the department has been thoroughly reviewed and is continuously monitored. For state or federally supported programs, the local SAMH Program Office (see Appendix C) or 211 can direct individuals to the most appropriate agency

.

Payors for Childr

en’

s Substance Abuse T

reatment Comparison Chart

36 | Substance Abuse Ser

vices for Y

Substance Abuse Services for Youth in Florida: A Guide for Families