š Foundational Treatment Model
Substance Use Support Services utilizes the same foundational TBRIĀ® model as our T3C Basic Foster Family Home Support Services package, enhanced with recovery-oriented interventions for youth with substance use disorders.
For comprehensive information about the core TBRIĀ® principles, implementation strategies, education plans, and foundational practices, please refer to:
All staff and caregivers working with children in the Substance Use package must complete training in the foundational TBRIĀ® model plus 4-hour substance abuse awareness training.
š©ŗ Recovery-Oriented Service Model
Substance Use Support Services is distinctly designed for youth with DSM-5 substance-related and addictive disorder diagnoses or documented problematic substance use:
- Non-punitive approach - treats addiction as disease, not moral failing
- Relapse is treatment issue - requiring adjustment, not punishment
- Substance-free environment with secured medications
- Drug screening as clinical tool - not punitive measure
Purpose: Provide trauma-informed, recovery-supportive care that addresses both substance use and underlying trauma while building healthy relationships as protective factors.
1. Treatment Model Framework and Structure
Our Child Placing Agency implements Trust-Based Relational InterventionĀ® (TBRIĀ®) as our primary treatment model, enhanced with recovery-oriented interventions for providing the T3C Substance Use Support Services. TBRI provides the evidence-based, trauma-informed foundation while incorporating specialized recovery practices for children and youth with DSM-5 substance-related and addictive disorder diagnoses or documented problematic substance use requiring specialized monitoring and support.
The selection of TBRI enhanced with recovery-oriented approaches recognizes that substance use in foster youth is often rooted in trauma and attachment disruptions. Research consistently demonstrates that effective substance use treatment for adolescents must address underlying trauma while building healthy relationships as protective factors against continued use.
Youth with substance use disorders still experience trauma responses and need the same trauma-informed, relational care provided in all our foster homes. All core TBRIĀ® principles remain fully applicable with recovery enhancements:
- Connecting Principles: Building trust and healthy relationships that model substance-free connections
- Empowering Principles: Addressing physiological needs complicated by substance use including sleep, nutrition, and regulation
- Correcting Principles: Non-punitive recovery response with trigger identification and coping skill development
The difference is in the additional recovery-specific enhancements layered onto the TBRIĀ® foundation to address substance use while healing relational trauma.
Core TBRIĀ® Principles with Recovery Enhancements
The enhanced TBRI framework maintains three interconnected principles adapted for children and youth with substance use disorders:
Recovery-Supportive Relationships
- ā¢Therapeutic communication avoiding shame and judgment
- ā¢Relationship building modeling healthy, substance-free connections
- ā¢Engagement approaches maintaining connection during relapse
- ā¢Daily check-ins monitoring emotional state and recovery progress
- ā¢Connection maintained through challenges without enabling
Physical Regulation and Recovery Support
- ā¢Addressing physiological needs complicated by substance use
- ā¢Sleep regulation support for substance-related disruption
- ā¢Nutritional planning addressing substance-related deficits
- ā¢Sensory accommodations for post-acute withdrawal
- ā¢MAT coordination when clinically appropriate
- ā¢Substance-free environment with secured medications
Non-Punitive Recovery Response
- ā¢Positive Behavioral Interventions and Supports (PBIS)
- ā¢Relapse viewed as treatment issue, not punishment trigger
- ā¢Trigger identification and coping skill development
- ā¢Natural consequences with therapeutic support
- ā¢Drug screening as clinical tool, not punitive measure
- ā¢Recovery-focused skill building at developmental level
Staffing Structure
| Position | Ratio/Requirement | SU-Specific Role |
|---|---|---|
| Treatment Director | Required | Supervises Licensed Therapist; oversees recovery treatment coordination |
| Licensed Therapists | 1:14 ratio | Substance use treatment coordination; weekly individual therapy (minimum) |
| Behavior Support Specialists | 1:15 ratio | Behavioral interventions; trigger management; coping skill development |
| Case Managers | 1:15 ratio | Service coordination; STAR Health navigation; recovery resource connection |
| Crisis Management Staff | 1:25 ratio | 24/7 crisis response; relapse intervention support |
| Aftercare Case Manager | 1:25 ratio | Post-discharge recovery support and monitoring |
| SU Foster Parents | 35-hour pre-service + 4-hour SU training | TBRIĀ® implementation; substance-free environment maintenance; recovery support |
Critical for Substance Use population
Youth with substance use disorders are at elevated risk for human trafficking. Our model incorporates specialized protections and monitoring.
ā¢ Universal trafficking screening at admission
ā¢ Regular reassessment during placement
ā¢ Recognition of trafficking-SU connection
ā¢ Documentation of risk indicators
ā¢ Staff trafficking awareness training
ā¢ Foster parent trafficking recognition
ā¢ Safety planning protocols
ā¢ Response procedures
ā¢ Immediate reporting protocols
ā¢ Coordination with law enforcement
ā¢ Victim services coordination
ā¢ Trauma-informed response
2. Meeting Custom Physical, Emotional, Social, and Spiritual Well-being Needs
Our recovery-enhanced TBRI model addresses all domains of well-being with specialized attention to the unique challenges faced by youth with substance use disorders:
Unique physical challenges requiring careful management
- Comprehensive health assessments including substance use history
- Substance use assessment within 30 days of admission
- Medication administration with attention to abuse potential
- Medication-Assisted Treatment (MAT) coordination when appropriate
- Sleep hygiene programs addressing substance-related disruption
- Physical activity as therapeutic intervention and relapse prevention
- Nutritional planning addressing substance-related deficits
- STAR Health coordination for specialized services
Complex intersection of trauma, mental health, and substance use
- Daily mood monitoring with attention to triggers
- Crisis safety planning including relapse prevention
- Emotion regulation skill training
- Trauma-informed interventions addressing root causes
- Therapeutic outlets (journaling, arts, physical activity)
- CANS assessment every 90 days
- Coping skill development for managing triggers
- Weekly individual therapy with SU-qualified provider (minimum)
Structured recovery-supportive connections
- Evidence-based social skills training
- Supported peer interactions in recovery-supportive environments
- Family therapy addressing family system impacts of substance use
- School collaboration with attention to academic impacts
- Connection to age-appropriate recovery community resources
- Healthy relationship modeling
- Peer recovery support connections when appropriate
Spiritual growth and meaning-making in recovery
- Values development supporting recovery identity
- Cultural identity support and exploration
- Inclusion in faith communities when desired
- Meaning-making opportunities consistent with recovery
- Hope and purpose cultivation
- Connection to recovery community values
3. Evidence and Data Informing Treatment Model Selection
California Evidence-Based Clearinghouse for Child Welfare (CEBC) Rating:
TBRIĀ® Caregiver Training is rated as a "Promising Practice" based on scientific research showing improved outcomes for children who experienced trauma, abuse, and neglect.
Research Foundation:
The integration of TBRI with recovery-oriented interventions is supported by substantial evidence demonstrating improved outcomes when trauma is addressed concurrently with substance use treatment.
Key Research Findings
- Adolescent substance use treatment outcomes improve significantly when trauma is addressed concurrently
- Family-based treatment models demonstrate superior outcomes for adolescent substance use
- Non-punitive approaches to relapse reduce shame and increase treatment engagement
- Healthy relationships serve as primary protective factors against substance use in adolescents
- Medication-Assisted Treatment, when clinically appropriate, improves outcomes for opioid and alcohol use disorders
Quality Monitoring
Our Continuous Quality Improvement process ensures effective recovery-oriented service delivery through:
- CANS assessments every 90 days with recovery progress tracking
- Regular review of recovery milestones and treatment engagement
- Substance use treatment coordination effectiveness monitoring
- Drug screening patterns reviewed as clinical indicators
- Relapse response protocol adherence tracking
- Post-discharge recovery stability monitoring (30/60/90 days)
4. Trauma-Informed Approach for Children Who Have Experienced Abuse and Neglect
Youth with substance use disorders have often experienced significant trauma. Our trauma-informed approach recognizes that substance use is frequently an attempt to cope with or self-medicate trauma symptoms.
- ā¢ CANS 3.0 serves as primary assessment tool
- ā¢ Comprehensive substance use assessment within 30 days
- ā¢ Treatment planning addresses both trauma and substance use
- ā¢ Recognition that SU may be self-medication for trauma
- ā¢ Regular reassessment guiding treatment adjustments
- ā¢ 4-hour substance abuse awareness training (minimum)
- ā¢ Understanding addiction as disease
- ā¢ Recognition of signs and relapse warning signs
- ā¢ Non-punitive recovery-supportive response strategies
- ā¢ 24/7 consultation availability
- ā¢ Weekly individual therapy with SU-qualified provider
- ā¢ Substance use treatment per clinical recommendation
- ā¢ Family therapy addressing system impacts
- ā¢ Connection to recovery community resources
- ā¢ MAT coordination when appropriate
5. Appropriateness of the Treatment Model for T3C Substance Use Support Services
Service Package Alignment
Our enhanced TBRI model directly addresses each requirement specified in the T3C Substance Use Support Services package:
| T3C Requirement | Our Implementation |
|---|---|
| Regular individual therapy | Weekly individual therapy with SU-qualified provider (minimum) |
| Substance use assessment | Comprehensive assessment within 30 days of admission |
| Service planning every 90 days | CANS-informed reviews with clinical team; recovery progress tracked |
| 24/7 crisis response | On-call clinical staff with TBRI and SU training; relapse response protocols |
| Evidence-informed treatment | TBRI enhanced with recovery-oriented interventions |
| STAR Health coordination | Dedicated staff for service navigation and recovery support coordination |
| Drug screening protocols | Screening as clinical tool (non-punitive); results inform treatment |
| Substance-free environment | Foster home requirements verified; medication security protocols |
Short-Term (3-6 months):
- Treatment engagement established
- Reduced substance use frequency
- Reduced crisis incidents
- CANS score improvement
- School stabilization
- Coping skill development
Long-Term (12-18 months):
- Sustained recovery
- Placement stability (85%+)
- Reduced or eliminated substance use
- Successful transition to Basic Services when appropriate
- Community recovery connections maintained
- Family relationships improved
Through this TBRIĀ®-based, recovery-enhanced approach to Substance Use Support Services, we provide youth with the trauma-informed, relational care they need while addressing substance use through non-punitive, recovery-oriented interventions. The integration ensures children and youth receive comprehensive substance use support while maintaining the relational foundation essential for lasting recovery.
TBRIĀ® is a registered trademark of the Karyn Purvis Institute of Child Development at Texas Christian University
"A home is in the heart of every child."
Last Revised: December 10, 2025