Implementing a

Family-Centered
Approach
For Families Affected by Substance Use Disorders
and Involved With Child Welfare Services

MODULE
Collaboration To Support Family-Centered 3
Practices at the County and State Level

Substance Abuse and Mental Health

Services Administration
This Technical Assistance Tool was developed by the National Center on Substance Abuse and Child Welfare (NCSACW). NCSACW is
a technical assistance resource center jointly funded by the Substance Abuse and Mental Health Services Administration (SAMHSA)
and the Children’s Bureau (CB), Administration on Children, Youth and Families (ACYF), U.S. Department of Health and Human
Services. Points of view or opinions expressed in this guide are those of the authors and do not necessarily represent the official
position or policies of SAMHSA or ACYF.

National Center on Substance Abuse and Child Welfare

MODULE 3

Collaboration To Support Family-Centered

Practices at the County and State Level

Substance use disorders (SUDs) affect the entire family—they About This Module
can interfere with a parent’s ability to take care of and bond This final module highlights the state- and local-level
with a child and can disrupt family health and well-being. leadership and collaboration required to successfully
Traditional SUD treatment focuses on the individual, despite implement the family-centered practice lessons
evidence that parents and children are most effectively presented in Module 2. It describes collaborative efforts
served through a family-centered treatment approach. A and policy-level activities such as priority setting, data
family-centered approach to SUD treatment provides a collection and evaluation, tapping existing and new
comprehensive array of clinical treatment and related support funding streams, and other collaborative strategies
services that meet the needs of each member in the family, to ensure the implementation and sustainability of
not only the individual requesting care. The Family First a family-centered approach.
Prevention Services Act (FFPSA) offers a historic opportunity
for child welfare agencies and their SUD and mental health
treatment partners to expand and enhance family-centered
NCSACW recognizes that a family-centered approach
interventions.
extends well beyond the SUD treatment system, the child
To help communities move toward family-centered care, the welfare system, the courts, and mental health services, and
National Center on Substance Abuse and Child Welfare includes all other agencies and individuals that interact with
(NCSACW) prepared a series of companion modules on and serve families. The work of all partners must reflect an
implementing a family-centered approach. This series is understanding and responsiveness to the fact that parents
designed for state, county, and agency-level collaborative and children live within the context of a larger family system
partners that are working together to improve systems, and that families exist within the context of their community
services, and outcomes for children and families affected by and culture. The cultural influences of race, ethnicity, religion,
SUDs. The modules include: geography, and customs are considerations that must be
prioritized when implementing a family-centered approach.
§ Module 1: Overview of a Family-Centered Approach
and Its Effectiveness NCSACW strives to improve family recovery, safety, and
stability by advancing best practices and collaboration among
§ Module 2: On the Ground—Family-Centered Practice
agencies, organizations, and courts working with families
§ Module 3: Collaboration To Support Family-Centered affected by substance use and co-occurring mental health
Practices at the County and State Level disorders and child abuse or neglect. For more information
about this module or assistance with implementing
a family-centered approach, visit the NCSACW webpage
or email us at ncsacw@[Link].

1 Module 3
 The Importance of State and Local Leadership
State and local leaders who plan, oversee, and fund SUD § Conducting a needs assessment for family-centered
treatment services ensure that services meet the needs services and identifying any gap between current treatment
of the persons to be served. A family-centered approach services and need for family-centered treatment services.
that addresses the needs of each member in the family
has demonstrated positive outcomes. SUD treatment has § Reviewing the available funding opportunities for
historically been underfunded and much of the available family-centered treatment, both within treatment funding
funding is categorical (i.e., focused on specific populations streams and those allocated to non-treatment agencies
or evolving priorities). Transitioning traditional services to a whose support is essential for serving children and
family-centered approach requires collaboration between families affected by SUDs.
key state and local partners and a commitment to review Collaboration among state and local agencies requires
and potentially redirect available resources. Identifying a leadership, clearly specified tasks, and agreement on what
champion to direct and oversee this process increases the results can be achieved with a specified level of resources
likelihood of success. allocated across agencies. In states where counties and other
State and local policymakers have a critical role in making local entities have major implementation roles, achieving
decisions about the scale (the number of those served effective collaboration requires building in an active,
compared to the need) and scope (the breadth and type of sustained role for these local agencies and leaders.
services delivered) of family-centered treatment services. Successful providers of a family-centered approach emphasize
They are responsible for: that, whenever possible, they include state agency
partners from the start of their efforts to move toward
§ Recognizing and prioritizing family-centered treatment as family-centered treatment.
more effective than adult-only treatment.

National Center on Substance Abuse and Child Welfare 2

 Determining the Scale and Scope of a
Family-Centered Approach in Treatment
It is important to determine the scale and scope of the in the child welfare system. Courts need to understand the
transition from traditional services to family-centered available data on the effectiveness of treatment programs
treatment. The scale of a family-centered approach involves to which they refer clients, since those agencies’ impact
the number of children and parents who can be served. determines courts’ decisions about reunification or removal
Scope is concerned with the array of services that reinforce and termination of parental rights.
and sustain the initial benefits of a family-centered approach,
including access to services that reflect the family’s race, The transition to a family-centered approach can be done
ethnicity, religion, geography, customs, and other incrementally rather than be viewed as “all or nothing.”
special needs. Collaboration across all partner agencies is ideal but can
also be done on a smaller scale. For example, a treatment
To plan for scale and scope of a family-centered approach, agency can work with the local child welfare agency to begin
policymakers need to include agencies whose resources and providing family-centered treatment to a group of shared
expertise can support and reinforce SUD treatment clients or begin sharing information and coordinating
providers, such as home visiting, mental health treatment, services for the adults and children in the family. While
developmental services, early intervention services, the goal may be to change all traditional treatment to
parenting skills education, and early childhood education. family-centered treatment across the system, new practices
Child welfare agencies can provide both prevention and can be implemented on a smaller scale as a starting point.
intervention supportive services for families

Priority Setting
One of the most challenging tasks of collaboration is setting Priority-setting as a collaborative task requires consensus to
priorities. Priorities respond to the needs of clients with ensure that resources—both new funding and redirected,
specific characteristics such as foster care status, prenatal existing funding—are targeted on the most effective programs
exposure, single-parenting, or trauma histories. Priorities and families with the greatest needs. Collaborative meetings
also take geography into account, recognizing the special avoid the tendency to focus primarily on what agencies are
needs of dense urban areas as well as those of rural and doing, concentrating instead on the more important focus of
tribal populations. To move forward with implementing or whether children and families are doing better. That emphasis
expanding a family-centered approach, policymakers and on accountability for results rather than merely tracking
collaborative partners agree to make it a priority. agency activities is an important shift, enabling partners to
answer the critical questions of what works, for which
clients, compared to our baseline results for those clients
with current approaches.

3 Module 3
 Data Collection and Evaluation
Collaborative teams review available data on a regular basis agencies. Each collaborative partner has its own way of
and use this information to make adjustments in service collecting data and its own screening and assessment tools.
approaches, to assess for cultural responsiveness, and to Some agencies may have high-quality data on the costs of
support ongoing funding. In the absence of a shared data and their current services, while others may not yet collect cost
evaluation system, partners work toward sharing data that is or cost-offset data in depth. Developing a shared data and
available. It is beneficial to document what data will be shared evaluation system also requires funding. Collaborative teams
and establish a regular process for the review of data and any have succeeded in seeking additional funding for evaluation
available evaluation. through partnerships with local or regional universities
and research agencies. The credibility of these agencies’
This task of developing consensus among collaborative evaluation capacity can assist in securing the additional funds
partners on how to measure progress against baselines needed for improved analysis and evaluation.
requires a data sharing and evaluation system across

National Center on Substance Abuse and Child Welfare 4

 Funding a Family-Centered Approach
Collaborative teams start with developing an inventory cost savings was approximately $5,000 to $13,000 per family,
of all available funding sources to understand available which was calculated by factoring in the investment costs and
and upcoming funding. Teams can request each of the the value of the outcomes produced (Marlowe & Carey, 2012).
collaborative partners to list the funding streams that support
its portion of the project and those that might be available Funding Streams
in the future. Funding from non-treatment agencies to serve Funding available to support family-centered treatment can
the whole family can be included in the funding inventory and be drawn from both federal treatment funding streams and a
can be sought and negotiated with each of these agencies wider network of allied services from other public and
and its funding sources. Santa Clara County (n.d.) in California private sources. The Dennis et al. (2008) publication, Funding
developed a funding matrix, which teams may customize and Family-Centered Treatment for Women With Substance
use as a template in their own communities. Use Disorders, provides a description of the various funding
sources that can be used. Funding sources include Substance
Costs of Family-Centered Treatment Abuse Block Grant, Medicaid, the Mental Health Block Grant,
The exact cost of implementing family-centered treatment Social Services Block Grants, and other sources, including
is hard to quantify as it is not a one-size-fits-all approach the newly available substance use disorder portion of the
and the actual service array is unique to each community. In FFPSA Title IV-E funding (Substance Abuse and Mental
addition to differences in cost across treatment modalities, Health Services Administration, 2012; Woodward, 2015).
there are variable expenses associated with service delivery, Some exemplary family-centered treatment providers
such as the range and intensity of services and the length of have negotiated with accountable care organizations
stay in services. to enable reimbursement for some components of
family-centered treatment.

SHIELDS for Families (Los Angeles, CA) is a large-scale There are four types of federal and state programs
organization that offers a comprehensive continuum of (Hayes et al., 2004):
SUD treatment services ranging from early intervention
to residential treatment programs. The total cost across § Entitlement programs – Open-ended, uncapped
multiple agencies is approximately $25,000, which is appropriations that provide funding to serve all children
shared by SHIELDS’ collaborating partner service agencies and families that meet the program’s eligibility criteria (e.g.,
(California Child Welfare Co-Investment Partnership, 2017; Medicaid, Title IV-E).
SHIELDS for Families, n.d.). Formula (or block) grants – Capped appropriations that
§
provide a fixed amount of funding to states or localities
based on established formulas, which vary from grant to
Family treatment courts (FTC) are a promising model to
grant and generally require a state match. Formulas are
implement family-centered treatment and provide evidence
usually tied to population characteristics (e.g., Substance
of cost savings to other systems and the community. FTCs
Abuse Prevention and Treatment Block Grants, Temporary
are juvenile dependency or family court dockets for cases of
Assistance for Needy Families [TANF]).
child abuse or neglect in which parental substance use, and
often co-occurring mental health disorders, is a contributing § Discretionary grants – Capped appropriations for specific
factor (Center for Children and Family Futures & National project grants awarded on the basis of competitive
Association of Drug Court Professionals, 2019). FTCs use a applications. Growing numbers of discretionary grant
collaborative, family-centered treatment approach to address programs (e.g., Head Start) require collaborative efforts by
the complex needs of families and have achieved promising a consortium of community agencies and organizations.
results in child safety and permanency, parental recovery, and
family well-being outcomes (Bruns et al., 2012; Green et al., § Direct payments – Capped appropriations that support
2007; Lloyd, 2015; Zhang et al., 2019). Across three studies direct financial assistance to individual beneficiaries who
that examined the cost-effectiveness of FTCs (Burrus et al., satisfy eligibility requirements (e.g., Supplemental Security
2008; Carey et al., 2010a, 2010b), program costs ranged from Income [SSI], Section 8 housing).
approximately $7,000 to $14,000 per family. The average net

5 Module 3
State Variability in Funding treatment. States that expanded Medicaid may have options
States’ capacity to transition to family-centered treatment that non-expansion states may lack. States that prioritize
may be affected by prior policy regarding health and mental treatment clients in their home visiting programs or early
health coverages for treatment; decisions to accept or reject care and education slots may be able to link these programs
Medicaid expansion; the role of managed care entities; to treatment more effectively than others that lack such
state laws and definitions of child risk and safety; and state priorities. Understanding the landscape of funding options
investments in early childhood development and maternal can guide selection of those services that may be critical
and child health. first steps toward more comprehensive family-centered
treatment programs.
State funding allocations and policy may determine which
collaborative partners are most likely to respond to SUD
treatment providers’ efforts to enhance family-centered

National Center on Substance Abuse and Child Welfare 6

 Strategies To Negotiate Shared Implementation
and Sustainability
SUD treatment providers at state and local levels that are § Working with community-based agencies, such as family
seeking resources for a family-centered approach will need resource centers, whose staff can play important roles in
to negotiate with external agencies and organizations. providing staffing for peer recovery support and advocacy
Sometimes state agencies can lead this process, while in for additional funding for a treatment agency.
other cases local agencies will need to negotiate with each
other in a process that may take time and patience. § Agreeing upon a level of improvement in baseline
outcomes for which partner agencies would share credit,
Some of the strategies that have proven effective in to the extent that their resources have contributed to
negotiations for shared implementation and sustainability of those results.
a family-centered approach across agencies include:
§ Agreeing that potential partner agencies help identify
§ Clarifying how many children and families in SUD treatment shared clients during the intake process by collecting
providers’ caseloads may now or in the future be clients of relevant data that is helpful to all collaborative partners.
other agencies. The risk factors documented for children
in families affected by SUDs are substantial, and some § Compiling data on which clients may be screened out
agencies may recognize how much they share these current or find access difficult to potential partner agencies and
and prospective clients. developing plans to reduce such barriers to access for
children and parents.
§ Exercising entitlements of the children of parents in
family-centered programs, such as the need for Some of these strategies may be more appropriate than
developmental screening under the Individuals with others, and tailoring approaches to external, non-treatment
Disabilities Education Act for children under 3 in the child agencies’ needs and goals is a critical task in negotiating for
welfare system, or the priority for children with special the resources needed to add ingredients that enhance a
needs in Head Start programs. family-centered approach.

§ Seeking state legislation that establishes a priority or

presumptive eligibility for children whose parents are in Some exemplary providers of a family-centered approach
SUD treatment. have reviewed their clients’ need for and access to income
and work supports such as Supplemental Nutrition
§ Responding to media attention to agency performance
Assistance Program; TANF; Special Supplemental Nutrition
with an opportunity for such agencies to demonstrate how
Program for Women, Infants, and Children; housing
effectively they are working with partners in achieving
assistance programs; and home visiting. These providers
their tasks.
have negotiated agreements with the agencies that
§ Developing joint proposals for external funding, which provide these services when necessary to stabilize families
may be more successful if an interagency application is in family-centered treatment and aftercare.
made rather than a single agency seeking funding for its
own operations.

7 Module 3
 Collaborative Policy Tasks
Collaborative partnerships also need to complete State, local, agency, and community leaders seeking to
state- and local-level policy tasks to expand and sustain implement a system-wide family-centered approach will
a family-centered approach, including: likely need to do so in an incremental manner. Continuing
to collaborate with key partners, share and review data,
§ Developing interagency agreements for client-level data and inventory available funding can lead to the necessary
sharing across agencies involved in family-centered policy changes and implementation of more family-centered
treatment to monitor treatment enrollment and completion approaches, which result in better outcomes for the
data as well as other benchmarks of parents’ and families’ individuals, families, and communities served.
stability. Partners agree upon the performance measures
and outcomes to assess the effectiveness of family-centered
services. Partnerships develop a dashboard of shared data
for partners to regularly review and to inform needed The FFPSA provides a new arena for moving toward
adjustments to services that promote positive equitable a family-centered approach. With child welfare IV-E
outcomes for families. funding available for approved prevention and treatment
programs, a multi-agency approach to wide scope and
§ Creating data-informed estimates of the levels of need broader scale is possible.
for family-centered programs and a projection of the
For additional information on FFPSA:
gap between need and current levels of available
family-centered services. Data are at a level of detail that § Review the Children’s Bureau Title IV-E Prevention
spotlight racial and ethnic characteristics and informs Program webpage.
decisions about responding to disproportionate needs and
§ Review the Summary FFPSA Federal Guidance Program
services, including any relevant disparities between
Instructions and Information Memoranda.
treatment completers and those who dropped out.
§ Access the Children’s Bureau Regional Office that is
§ Implementing a diverse collaborative governance structure linked to your state.
that includes senior leadership from each partner agency,
§ Access Planning Title IV-E Prevention Services: A Toolkit
middle managers who implement programs and changes,
for States.
front-line staff, and consumers. This governance structure
ensures consistent oversight, commitment to shared vision The FFPSA toolkit specific to the SUD treatment provisions
and goals, and sustainability of the initiative. includes five key steps toward using the new legislation
and funding information is available here (Children and
§ Developing interagency agreements that delineate the
Family Futures et al., 2020).
levels of family-centered services to be funded with
resources from multiple agencies. Partnerships can The toolkit has details on how to explore what approved
complete an inventory of funding sources to review and family-focused practices can be funded by FFPSA.
update regularly to aid with this policy task.

§ Developing interagency agreements that promote annual

reporting of data and results to leadership to ensure the
sharing of positive outcomes and promote the expansion
and sustainability of services.

§ Creating state-level incentives and requirements for

expanded local collaboration, such as among health
providers and early intervention services, or among early
care and education systems and treatment providers whose
clients need childcare onsite or closely linked to treatment.

National Center on Substance Abuse and Child Welfare 8

 Take Action—Next Steps

§ Prioritize a family-centered approach as

a goal for SUD treatment.

§ Assess the need based on review of current

treatment approaches to families.

§ Review current funding streams and

potential new funding that could increase
or redirect resources needed for
family-centered program expansion.

§ Negotiate with partner agencies

whose support is essential to providing
a family-centered approach.

9 Module 3
 References
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& Murphy, J. K. (2012). Effects of a multidisciplinary W. (2007). How effective are family treatment drug
family treatment drug court on child and family courts? Outcomes from a four-site national study.
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Hayes, C. D., Flynn, M.J., & Stebbins, H. (2004). Strategic
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National Center on Substance Abuse and Child Welfare 10