Addressing Substance Use Disorders Among Families Involved with the Child Welfare System: A Cross-Agency Collaboration

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Community Burden Study

Provider/Stakeholder Interview Guide

Introduction

1. To start, please tell me about yourself. For what type of agency or organization do you work?

1. How long have you worked for this organization?

2. Briefly, what are your primary roles and responsibilities?

3. How long have you worked in this field?

Priority Substance Use Issues

Now, I’d like to talk briefly about the kinds of substance use challenges that people in your community are struggling with.

2. From your perspective, how severe of a problem is the opioid epidemic in your county?

   1. [If not a priority issue] What would you say are the priority substance use issues in your county?

Probe cocaine, crack, meth, amphetamine, hashish use, etc.

2. To what extent, if at all, do some agencies and organizations perceive [the opioid epidemic, this drug use issue] as taking resources away from other essential programs? Please describe.

Probe: Is there fatigue within the county from dealing with the opioid crisis? Please explain.

3. [High drug mortality burden counties] A few years ago, statistics showed that drug mortality is higher in your county relative to other counties in your state. Do you agree or disagree with this? Why?

   1. Are there particular conditions or risk factors——that you believe have led to high rates of opioid misuse in your county? Please describe.

Probe for conditions such as economic conditions, unemployment, service provider shortage, health care worker shortage, etc.

4. [Low drug mortality burden counties] A few years ago, statistics showed that drug mortality is lower in your county relative to other counties in your state. Do you agree or disagree with this? Why?

   1. Are there particular factors that you believe have helped to prevent opioid misuse in your county? Please describe.

Probe for conditions such as economic conditions, good policing, employment, lack of easy availability of drugs, service provider availability, etc.

Children’s Exposure to ACEs

1. ACEs List

• Physical abuse or neglect

• Emotional abuse or neglect

• Sexual abuse

• Substance misuse within the household

• Household mental illness

• Intimate partner violence

• Mother treated violently

• Parental separation or divorce

• Incarcerated household member

Next, I’d like to talk about how [the opioid epidemic, drug use] is affecting families in your county, including whether children are being exposed to violence or adverse childhood experiences as a result of a parent’s opioid/drug use. [Show ACEs list] Adverse childhood experiences, or ACEs, are stressful or traumatic events, including abuse and neglect. As shown on this card, ACEs also may include household challenges, such as witnessing domestic violence or growing up with family members who have substance use disorders.

5. In your experience working with families, how has [the opioid epidemic, drug use] affected families and children in your county?

Probe family separations, children’s exposure to violence and ACEs, neglect, issues at school, etc.

Available Programs and Services

I’d like to turn now to talk about the programs and services in your county that are available to help families affected by [the opioid epidemic, drug use]. These may be provided by your agency or other agencies or organizations within the county. We’ll focus on substance use services first, and then talk about other programs and services.

6. What substance use programs or services are available to the families your agency/organization supports?

Probe substance use treatment providers, detox facilities, community-based programs, medication assisted treatment (MAT), needle exchange programs, support groups, etc.

1. What key factors—particularly funding—help keep these programs running?

Probe grant funding, partnerships, MOUs, grant-funded FTEs, staff who champion the program, community support, Medicaid or insurance reimbursement for services, etc.

2. What are the barriers or challenges to these programs or services?

Probe barriers to family access, not covered by Medicaid or private insurance, staffing issues, etc.

3. What additional funding or resources are needed to continue these programs or services in the future?

7. What other related programs or services are available to families affected by opioid/substance use in your county as provided by your agency/?

Probe parenting classes, respite care, support groups, family or children’s programs, etc.

1. What key factors—particularly funding—help keep these programs running?

Probe grant funding, partnerships, MOUs, grant-funded FTEs, staff who champion the program, community support, Medicaid or insurance reimbursement for services, etc.

2. What are the barriers or challenges to these programs or services?

Probe barriers to family access, not covered by Medicaid or private insurance, staffing issues, etc.

3. What additional funding or resources are needed to continue these programs or services in the future?

8. What support, if any, is your county receiving through federal and/or state programs? Please describe. These might include programs or policies that exist on a state or federal level rather than a local level such as needle exchange programs, opioid prescription monitoring programs.

   1. How well are these programs working?

9. Are there gaps in programs or services within your county for families affected by [the opioid epidemic, drug use]? If so, please describe.

   1. How would you prioritize addressing these gaps? Which gaps represent the highest need and therefore, should be addressed first?

10. Within your county, is there perceived stigma around the [the opioid epidemic, drug use] that might deter the individuals and parents who need services from seeking them? Please describe.

Partnerships

Next I’d like to talk with you about how agencies and organizations in your county are working together to address [the opioid epidemic, drug use issues] and children’s exposure to violence and ACEs.

11. What, if any, formal collaborations or partnerships are occurring in your county to address [the opioid epidemic, drug use] and prevent adverse childhood experiences? Please describe.

Probe coalitions, collaboratives, committees, cross-agency programs or funding streams, Naloxone distribution, etc.

1. Who are the partners in this collaboration?

2. To the best of your knowledge, what have the partners accomplished through this collaboration to date?

Policies

Before we finish, I have a few more questions for you about federal and state programs and the impact of state and local policies on efforts to address [the opioid epidemic, drug use].

12. How do state and local policies affect the availability of services for families affected by [the opioid epidemic, drug use] in your county?

1. What about the delivery and accessibility of these services?

2. Are there certain policies that work against each other? For example, the need for naloxone or other treatments, but the requirement that parents must be substance free before reunification can occur?

13. In your opinion, what else is needed within your county to address the [the opioid epidemic, drug use] and prevent children’s exposure to violence and ACEs?

Closing

Thank you for taking the time to speak to me today. Those are all of the questions I have for you. Is there anything else you’d like to add to our discussion before we end?

Community Burden Substudy – Provider/Stakeholder Guide 3