February 2005

Grant Results

SUMMARY

From 2001 to 2003, Mary R. Haack, Ph.D., explored the role of nursing in the family court system in Newark, N.J., and the juvenile court system in Baltimore.

The project focused on the role of nursing in assessing the developmental, mental and reproductive health needs as well as case management needs of families involved in these court systems.

Haack began the project while an associate professor at the Rutgers College of Nursing and continued her research after moving to the University of Maryland-Baltimore.

Key Results

  • Rutgers nursing faculty and judges and court personnel, trained approximately 550 court personnel, nursing and law school students and faculty, and others on family health needs
  • Selected a parent training program for use in Newark
  • Planned a new course for nurses on the court system and the role of nurses
  • Developed a plan for a computerized case management system for parents and children involved in the child welfare and court system.

Funding
The Robert Wood Johnson Foundation (RWJF) provided two grants totaling $49,824 for this project.

 See Grant Detail & Contact Information
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THE PROBLEM

Sixty to eighty percent of the 1 million substantiated cases of child abuse nationwide are estimated to involve parental substance abuse, according to researchers at Rutgers University. Most of these children are placed in foster care. Decisions regarding child custody — reunification with their parents or termination of parental rights — must be made within 12 to 18 months of foster care placement, according to the 1997 federal Adoption and Safe Families Act.

With the long-standing health care disparities in Newark, N.J., and Baltimore (e.g., high rates of infant mortality and sickness and high rates of HIV and substance abuse), and high child welfare case loads, few families can access services (primarily substance abuse and mental health) that enable them to meet the requirements for reunification with their child or children.

Mary Haack, Ph.D., while an associate professor at the Rutgers College of Nursing, conducted RWJF-funded research on the resources available for drug-exposed infants and their families (Grant ID# 021920). She found that 13 percent of pregnant women who needed substance abuse treatment received it, and those who received treatment did so through the family court system.

Haack also worked on two projects funded by the U.S. Department of Health and Human Services Substance Abuse and Mental Health Administration's Center for Substance Abuse Prevention to develop drug courts in Kansas City (Mo.), Manhattan (New York City) and Miami (1998–2000); and to select and implement an evidence-based family intervention for parents charged with child abuse and neglect in the New Jersey Superior Court System (1999–2002).

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THE PROJECT

Haack worked to explore and define the role of nursing in assisting the family court system in Newark, N.J., and the juvenile court system in Baltimore (which handles child abuse and neglect cases involving parents who use substances). The project focused on the role of nursing in assessing the developmental, mental and reproductive health needs, and the case management needs, of families involved in these court systems.

Haack had originally planned to focus only on Newark, but after she moved to the University of Maryland - Baltimore in 2002, she expanded the project to include Baltimore.

The project was comprised of:

  1. Multidisciplinary training on family health needs for family court personnel and nursing and law school students and faculty.
  2. Consensus building with court personnel about effective nursing interventions.
  3. Development of a plan for a computerized case management system for family court.

Project staff did not develop written assessment, referral and intervention procedures as planned due to a lack of time and funds. RWJF funds also partially supported the 2003 National Conference on Children & Adolescents.

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RESULTS

This project accomplished the following:

  • Rutgers nursing faculty and judges and court personnel, provided formal and informal training on family health needs and related issues for approximately 350 nursing and law faculty and students, and judges and court staff in Newark, N.J. For example, a judge from Miami's family drug court conducted a formal training session for Rutgers nursing and law school faculty and students, and judges and staff from the Newark family court. Court personnel served as guest lecturers in Rutgers nursing classes. Graduate nursing students did clinical training in the Newark family court. Topics covered included: therapeutic jurisprudence (planning and delivering health services for people involved with the court system), evidence-based family interventions, dual diagnosis (people with both an alcohol or drug problem and an emotional/psychiatric problem), family planning, Medicaid coverage for families in court and legal issues related to child abuse and neglect.
  • Three Newark court personnel and three Rutgers nursing school faculty used consensus-building activities to select a program to assist children and families involved with the Newark family courts. Court personnel and Rutgers School of Nursing faculty held five consensus-building meetings in which they chose the 14-week evidence-based Strengthening Families Program to implement (see the Appendix for a description of the program). Under a separate grant to Haack from the Center for Substance Abuse Prevention, Rutgers nursing faculty and students implemented the program for parents charged with child abuse and neglect in 39 families in Newark in 2002.
  • Haack moderated a panel at the 2003 National Conference on Children and Adolescents to train court personnel, health care professionals and others on "Links Between Academia, the Community and the Courts" (June 11–13, 2003, in Baltimore). Approximately 200 court personnel, health care professionals and others attended.
  • Two Baltimore court personnel and four University of Maryland School of Nursing faculty formed a planning committee for a new nursing course, "Therapeutic Jurisprudence." The course provides an overview of the workings of the court system in Baltimore as a template for all judicial settings. Topics to be covered include the following: the structure and function of the court system, health professionals' role in the court and issues for families involved in family court. Judges will serve as guest lecturers.
  • Project staff developed a plan for a computerized case management system to track and follow parents and children involved in the child welfare and court system. Computerized case management integrates data from inside and outside the court system. Outside data could include health or mental health status, history of illnesses, progress in treatment, availability of a treatment bed, immunization records and living situation. The system connects the family through a voice interactive telephone.

Conclusion

The project director reported the following conclusion to RWJF:

  • There is a clear role for nurses in working with the family court system to address the health care needs of children and parents. Nurses can provide case management, prevention and treatment services (mental health and primary care services) to underserved children and families involved in the family court system.

Communications

The 2003 National Conference on Children and Adolescents, held in Baltimore in June 2003, included a session on the role of nursing in the courts. Haack's work was highlighted in a cover article in the University of Maryland School of Nursing's Pulse magazine. See the Bibliography for details.

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LESSONS LEARNED

  1. People from different fields can overcome misperceptions and work together successfully. In order for this project to succeed, nurses and court system personnel both had to overcome their initial stereotypes and misconceptions about each other. To foster collaboration, project staff held a conference on dispelling stereotypes and identifying opportunities to work together. (Project Director)
  2. When working with people in different fields, it is important to establish credibility. The nurses involved in this project worked closely with judges and other court personnel to establish their credibility, including educating court personnel about the ways in which nurses can address the problems families in their courts face. (Project Director)

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AFTER THE GRANT

Haack is co-investigator on a grant from the RWJF National Program Substance Abuse Policy Research Program to study online counseling and Internet use among family drug court participants (ID# 041106); the Substance Abuse Policy Research Program provides support for investigators to conduct policy research on projects directed at helping the country reduce the harm caused by substance abuse. See Grant Results.

The University of Maryland will offer the "Therapeutic Jurisprudence" course beginning in Spring 2005. Haack and her colleagues are also developing a course on assessing and treating adolescents in the juvenile justice system, with funding from the federal Health Resources and Services Administration; and field-testing a screening tool to identify the health care needs of girls in the juvenile justice system, with other funding.

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GRANT DETAILS & CONTACT INFORMATION

Project

Assessment of the Role of Nursing Care Services for Newark Family Court

Grantee

Rutgers, The State University, College of Nursing (Piscataway,  NJ)

  • Amount: $ 7,294
    Dates: October 2001 to June 2002
    ID#:  043048

Grantee

University of Maryland, Baltimore, School of Nursing (Baltimore,  MD)

  • Amount: $ 42,530
    Dates: October 2002 to September 2003
    ID#:  046685

Contact

Mary R. Haack, Ph.D., R.N., F.A.A.N.
(410) 706-1501
mhaac001@son.umaryland.edu

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

The Strengthening Families Program

The Strengthening Families Program is designed to increase resilience and reduce risk factors for substance abuse, depression, violence and aggression, delinquency and school failure in high-risk, 6–12-year old children and their parents. The program includes three courses — Parent Skills Training, Children's Skills Training and Family Life Skills Training — taught in 14 two-hour periods. In the first hour of each session, parents and children participate in separate classes. Parents learn to increase desired behaviors in children by using attention and rewards, clear communication, effective discipline, substance use education, problem solving and limit setting. Children learn effective communication, understanding feelings, coping with anger and criticism, stress management, social skills, problem solving, resisting peer pressure, consequences of substance use and compliance with parental rules. During the second hour, families practice structured family activities, therapeutic child play, family meetings, communication skills, effective discipline, reinforcing positive behaviors in each other and jointly planning family activities.

Many federal agencies recognize the Strengthening Families Program as an exemplary, research-based family model. Positive results from more than 15 independent research replications demonstrate that the program is robust and effective in increasing assets and protective factors by improving family relationships, parenting skills and improving youths' social and life skills.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

"Strengthening Drug-Impacted Families — Research in Action." Pulse — University of Maryland School of Nursing, 13 (Fall 2002/Winter 2003), 5–8, 2003. Also available online.

Alemi F, Haack MR, Nemes S and Weissman L. "Statistical Definition of Relapse: Case of Family Drug Court." Addictive Behaviors, 29(4): 685–698, 2004. Abstract available online.

Alemi F, Haack MR, Harge A, Dill R, and Benson L. "Engaging Client's Family and Friends in Online Counseling." Journal of Addictions Nursing, 16: 47–55, 2005.

Haack MR, Alemi F, Nemes S, Harge A and Burda-Cohee C. "Facilitating Self-Management of Substance Use Disorders with Online Counseling: A Pilot Study." Journal of Addictions Nursing, 16: 41–46, 2005.

Haack MR, Alemi F, Nemes S and Cohen JB. "Experience with Family Drug Courts in Three Cities." Substance Abuse, 25(4): 17–25, 2004. Abstract available online.

Presentations and Testimony

Mary R. Haack, "Women and Children: Casualties of the War on Drugs," 29th Annual AMERSA Conference, 2004. Go online for a link to the file.

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Report prepared by: Mary Ann Scheirer
Report prepared by: Lori De Milto
Reviewed by: Lori De Milto
Reviewed by: Molly McKaughan
Program Officer: Victor A. Capoccia

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