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NC Department of Health and Human Services Division of Mental Health, Developmental Disabilities, and Substance Abuse Services

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Work First / Child Protective Services Substance Abuse Initiative

In 1997 the North Carolina General Assembly enacted General Statute 108A-29.1, Substance Abuse Treatment Required: Drug Testing for Work First Program Recipients and General Statute 108A-25, Exemption from limitations for individuals convicted of certain drug-related felonies. These two laws are the basis for the current North Carolina Work First/ Child Protective Services (CPS) Substance Abuse Initiative. The Initiative is intended to provide early identification of individuals applying for public assistance who may be experiencing substance use problems that act as a barrier to self-sufficiency. Furthermore, the identification assists in connecting the individuals to substance abuse treatment, so that sustained self- sufficiency is likely and benefits the family.

Initiative Orientation (ppt)

In 2001, the Work First/CPS Substance Abuse Initiative was expanded in two ways. The first allows for voluntary mental health screenings of the Work First applicants and subsequent connection to mental health treatment if indicated. The second expansion allows for Work First/CPS Substance Abuse Initiative services to the families whose CPS cases have been substantiated or found in need of services with an indication of substance abuse. The expansion to include a population who may experience mental health issues as barriers to self sufficiency and a population whose possible addiction is jeopardizing their family, results in more individuals and families receiving necessary treatment for recovery.

The North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH/DD/SAS) holds a Memorandum of Agreement with the North Carolina Division of Social Services (DSS) for the joint management of this Initiative. The joint responsibilities include developing and providing training for county DSS's and the LME's along with their contracted providers regarding Work First and substance abuse. Each Division is to provide technical assistance to county DSS's and LME's and providers regarding the program development of the Initiative.

Connecting Individuals and Families to Treatment

It is required that local Memorandums of Agreement exist between the Local Management Entity (LME) and the county DSS to establish procedures surrounding the services of a Work First/Child Protective Services Qualified Professional in Substance Abuse (WF/CPS QPSA).  Its purpose is to facilitate appropriate substance abuse services and mental health services to the following eligible populations:

  • Work First applicants and recipients
  • Class H or I Controlled Substance Felons applying for Work First assistance and/or food stamps
  • Non-custodial parents and/or families with income at or below 200% of federal poverty guidelines (The eligibility status of this population is based on inclusion of this population in the county Work First Plan)
  • Parent(s)/caretakers who have a substantiated or in need of services finding that involves substance abuse.

Work First DSS state policy (WFB 104) states thatmicrosoft image the county DSS is responsible for administering the two substance abuse verbal screening tools to all Work First applicants prior to completion of the application. The first tool is the Alcohol Use Disorder Identification Test or AUDIT. The second tool is the Drug Abuse Screening Test, or DAST-10. Both are standardized instruments intended as a brief verbal screening to be used by non-substance abuse professionals. An additional tool used in identifying substance abuse issues is the Behavioral Health Indicator Checklist. This is useful in that it is based on observation by the DSS worker, rather than self-report of the applicant. The Behavioral Health Indicator Checklist is intended to be used if both verbal screening tools do not reveal a substance abuse issue. According to DSS policy, the applicant who hits a threshold on one of the three tools will be referred to the Qualified Professional in Substance Abuse (QPSA) for a substance abuse assessment. If an applicant has agreed to the voluntary mental health screening, the Emotional Health Inventory is utilized by the DSS Work First staff. If a mental health issue is indicated, a referral to the QPSA for follow up, will take place.

Individuals that have an H or I controlled substance felony are eligible to apply for Work First or Food Stamp benefits 6 months post release from custody or 6 months post conviction, if they have no additional controlled substance related charges. These individuals are automatically referred to the QPSA for a substance abuse assessment on the basis of their particular felony history per G.S 108A-25and DSS Food and Nutrition Services Policy 290.

Individuals that have substantiated CPS cases or are found in need of CPS services may be referred to the QPSA for a substance abuse assessment and referral for treatment services. The individuals referred from CPS to the QPSA are not subject to the AUDIT and DAST-10 verbal screening tools, as those are specific to the Work First universal screening process, within DSS.

The LME is responsible under G.S.108A-29.1 for administering the assessment and treatment aspect of the law. The QPSA is contracted by the LME to provide the assessment and care coordination services under the Initiative. Each LME receives Federal Substance Abuse Prevention and Treatment Block Grant funds that support 1-4 full time positions, depending on the average number of TANF applicants per county.

The QPSA performs a substance abuse assessment that includes the Substance Use Disorders Diagnostic Schedule IV (SUDDS IV) tool. The SUDDS IV is a standardized substance abuse interview tool that provides key information that corresponds to the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders,(DSM-IV-TR). If the assessment indicates a substance abuse disorder, the individual is referred to the appropriate level of substance abuse treatment. The level of substance abuse treatment is dependent on the need of the individual. At this juncture, the substance abuse treatment becomes part of the individual's DSS Work First Mutual Responsibility Agreement (MRA). As a part of the MRA, the individual must participate in substance abuse treatment in order to receive the Work First benefits. The H or I Controlled Substance Felon must engage in treatment in order to maintain eligibility for FNS benefits.

The QPSA has responsibilities beyond the assessment that support individuals and families participation in treatment, when indicated. The QPSA and the DSS case manager jointly develop a plan for the family to ensure success.  The QPSA is in the key role of coordinating with the DSS case manager to address common barriers to substance abuse treatment such as lack of transportation and child care. The QPSA provides training to DSS staff on salient issues related to substance abuse. Such trainings increase the capacity of the DSS workers’ effectiveness in screening and working with substance abusing individuals. The QPSA is available to the DSS workers for individual case consultation, further supporting effective work with those possibly struggling with addiction. Tracking the provision of and participation in treatment services by the QPSA contributes to the adherence of the MRA. The QPSA and DSS case manager are both responsible to ensure consistent communication regarding the status of the individual's compliance with the MRA or required treatment. The QPSA’s regular participation in DSS meetings concerning mutual consumers assists both entities in supporting the goals of the Initiative.

What is a Qualified Professional in Substance Abuse (QPSA)?

See Staff Definitions

Accountability of Initiative

microsoft imageMonitoring of the Initiative occurs annually at the state level of both the LME's management of the Initiative and of the individual cases. The LME's are responsible for local monitoring of the community providers that have been contracted for the QPSA positions. The LME is responsible for submitting quarterly reports to DMH/DD/SAS. These reports reflect the numbers of individuals who have had assessments completed, delineated by referral source or cause (Work First, CPS, H& I felon). The number of individuals that a QPSA is coordinating services for, per quarter, is also reflected on this report.  

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