19.24 Family Treatment Court

Georgia State Seal

Georgia Division of Family and Children Services
Child Welfare Policy Manual

Chapter:

(19) Case Management

Policy Title:

Family Treatment Court

Policy Number:

19.24

Previous Policy Number(s):

N/A

Effective Date:

November 2023

Manual Transmittal:

2023-03

Codes/References

O.C.G.A. § 15-11-2 Definitions
O.C.G.A. § 15-11-30 Rights and Duties of Legal Custodian
O.C.G.A. § 15-11-70 Family Treatment Court Division
O.C.G.A. § 15-11-101 Medical and Psychological Evaluation Orders When Investigating Child Abuse and Neglect
O.C.G.A. § 15-11-212(f) Disposition of Dependent Child
O.C.G.A. § 19-7-5 Reporting of Child Abuse
O.C.G.A. § 49-5-8 Powers and Duties of Department of Human Services
O.C.G.A. § 49-5-41 Persons and Agencies Permitted to Access Records
45 CFR Parts 1355.38(a)(5), 1356.21(b)(3)(i), 1356.21(d), 1356.21(k), and 1356.67
Title IV-E of the Social Security Act §§ 471(a)(15)(D), 472(a)(1), and 472(f)
Child Abuse Prevention and Treatment Act (CAPTA)
Public Law (PL) 104-191 Health Insurance Portability and Accountability Act (HIPAA) of 1996
J.J. v. Ledbetter-Release of Information of Confidential Records

Requirements

The Division of Family and Children Services (DFCS) will:

  1. In accordance with the Family Treatment Court Standards by the Council of Accountability Court Judges of Georgia (see Forms and Tools: Section XI Family Drug Court Standards):

    1. Protect children’s health and safety;

    2. Ensure the well-being of the children;

    3. Ensure that children and their parents receive necessary services in addition to substance abuse treatment;

    4. Assist in identifying potential participants and refer them to Family Treatment Court (FTC);

    5. Inform the team immediately (within 24 hours) of any significant changes in the needs of children and parents as well as to attend and participate as an active, engaged member of the team in all staffings and required hearings.

    6. Abide by the mission, goals, eligibility criteria, operating procedures, performance measures, orientation, drug testing, and program structure guidelines for the applicable FTC jurisdiction.

    Each FTC jurisdiction establishes a Memorandum of Understanding (MOU) with the relevant agencies in their area outlining each agency’s role, responsibilities, duties, and tasks.

  2. Provide case management services in partnership with legal jurisdictions that use the FTC model to address issues of child dependency related to parent/guardian/legal custodian substance and alcohol use.

    A Family Treatment Court is not available in every juvenile court jurisdiction. Refer to cacj.georgia.gov/family-treatment-courts to determine if your jurisdiction has a Family Treatment Court.

  3. Conduct a comprehensive assessment to determine:

    1. Whether the parents/guardian/legal custodian and/or other adult household members’ substance or alcohol use impacts family functioning and child safety throughout the life of the case (see policy 19.26 Case Management: Case Management Involving Substance Abuse or Use).

    2. The appropriateness of filing a dependency complaint based on a comprehensive assessment of the family’s functioning and child safety.

  4. Identify whether parents/guardians/legal custodian with moderate to high risk substance or alcohol use needs meet the minimum eligibility criteria for FTC participation (refer to the MOU in the applicable FTC jurisdiction) including:

    1. A pending dependency petition or open Permanency case.

    2. Parent/guardian/legal custodian substance or alcohol use as a contributing factor to child maltreatment.

    3. Parent/guardian/legal custodian agreement to participate in FTC.

    No potential participant shall be excluded on the basis of sex, race, color, religion, creed, age, national origin, ancestry, pregnancy, marital status or parental status, sexual orientation, or disability.

  5. File a dependency complaint/petition in the juvenile court within the appropriate jurisdiction in consultation with the Special Assistant Attorney General (SAAG) and recommend FTC services for families impacted by parent/guardian/legal custodian substance use and dependency concerns.

    If there is an existing dependency action before the court such as a protective order or open foster care case, it may not be necessary to file a new dependency complaint/petition for FTC. County staff should consult with their SAAG to determine whether to file an amendment to the existing dependency action, as appropriate.

  6. Discuss with eligible parents/caregivers the benefits and requirements of FTC participation, including that it is voluntary.

  7. Ensure, in partnership with the FTC team, the following occurs:

    1. A referral for a substance or alcohol use assessment for parents/caregivers or other adult household members is conducted by appropriately trained and qualified professional staff using standardized assessment tools.

    2. A referral for culturally and evidence-based substance or alcohol use treatment for parents/caregivers or other adult household members is conducted by appropriately trained and qualified professional staff.

    3. A “warm hand-off” is used to connect the parent/guardian/legal custodian or other adult household members with service providers. When a warm hand-off is not possible, work with the parent/guardian/legal custodian to identify a responsible party to assist him/her with making and keeping appointments. Confirm that the responsible party has agreed to assist (see Practice Guidance: Warm Hand-off).

    4. The creation of coordinated substance and alcohol use disorder treatment plans and case plans for parents/guardians/legal custodians, children and/or other household members that is supported through court order which includes, as appropriate:

      1. Clinical treatment when the assessment indicates the need for clinical treatment interventions (i.e. detoxification, crisis intervention, treatment planning, substance use counseling and education, prenatal care, medical care, mental health services and pharmacotherapy).

      2. Clinical supportive services (i.e. life skills training, parenting and child development education, employment readiness, housing support, legal services).

      3. Community supportive services (i.e. childcare, transportation, Temporary Assistance to Needy Families (TANF), vocational and education services, and connections to faith-based organizations).

    5. The development and implementation of a Plan of Safe Care for families with infants identified as being affected by substance use (illegal and/or legal); or withdrawal symptoms resulting from prenatal drug exposure; or a Fetal Alcohol Spectrum Disorder (FASD) in accordance with policy 19.27 Case Management: Developing the Plan of Safe Care for Infants Prenatally Exposed to Substances or a Fetal Alcohol Spectrum Disorder (FASD).

    6. The coordination of drug screens to assess/monitor progress and recovery goals:

      1. The drug screen can be used as a tool to initiate a discussion with parents/guardians/legal custodians regarding positive screens and how that fits in with their goals, retaining or regaining custody of their children, and re-evaluating the treatment and case plans to make adjustments to enable the caregiver to overcome a lapse or relapse. Also refer to Practice Guidance: Obtaining Drug Screens for Parents/Caregivers in Treatment in policy 19.25 Case Management: Drug Screens.

      2. Parents/guardians/legal custodians in Medication Assisted Treatment (MAT) programs will have positive drug screens for the medications used to treat the alcohol or substance use disorder (see Practice Guidance: Commonly Used Medications for Medication Assisted Treatment and Forms and Tools: Know Your Rights: Rights for Individuals on Medication Assisted Treatment).

    7. The commencement of treatment services occurs within 30 days of a parent/guardian/legal custodian being determined eligible for the program unless documentation includes a compelling reason that treatment could not begin (i.e., incarceration, illness, lack of a provider, etc.) and the plan to ensure family safety and well-being.

      DFCS staff must initiate any services needed to address child safety and well-being concerns until the commencement of services through FTC.

    8. A celebration of the parents/guardians/legal custodians’ progress towards their recovery goals.

  8. Refer infants prenatally exposed and other children in the home under the age of three to Children 1st/Babies Can’t Wait for a developmental screening in accordance with policy 19.28 Case Management: Children 1st and Babies Can’t Wait.

  9. Provide to the FTC, upon request, access to all records relevant to the treatment of the parent/guardian/legal custodian participating in the FTC as authorized by state and federal law (see policies 2.6 Information Management: Confidentiality/Safeguarding Information and 2.5 Information Management: Health Insurance Portability and Accountability Act).

  10. Obtain and review copies of the following and upload to Georgia SHINES External Documentation within 72 hours of receipt:

    1. The standard FTC Agreement form signed by the parent/guardian/legal custodian

    2. The court order from each hearing

    3. Screening, assessment and diagnosis of substance/alcohol use disorder records

    4. Treatment records

  11. Support parent(s)/caregivers in their recovery efforts and monitor their FTC participation, including follow up with service providers to verify the parent’s/caregiver’s progress or lack of progress towards recovery goals.

  12. Incorporate applicable assessments and court orders into the case plan.

  13. Provide all case management activities needed to mitigate child safety concerns and make reasonable efforts to prevent removal, reunify the child or finalize the permanency plan throughout the oversight of the FTC (see policy 9.5 Eligibility: Reasonable Efforts and Practice Guidance: Reasonable Efforts).

  14. Adhere to confidentiality and HIPAA provisions outlined in policies 2.6 Information Management: Confidentiality/Safeguarding Information and 2.5 Information Management: Health Insurance Portability and Accountability Act. Obtain a signed Authorization for Release of Information (ROI) to facilitate sharing of information with others, when applicable.

Procedures

Social Services Case Manager

  1. Initiate a staffing with the Social Services Supervisor (SSS) to:

    1. Discuss the dependency issues in the case assessment due to parent/guardian/legal custodian substance or alcohol use.

    2. Discuss the eligibility for referral to the FTC within the appropriate jurisdiction. Consult with other DFCS county offices when providing case management services across county lines.

    3. Complete the DFCS internal Family Treatment Court (FTC) Screening Form in Georgia SHINES (see Job Aid in Georgia SHINES).

  2. In consultation with the SAAG, initiate the dependency action recommending FTC for the parent/guardian/legal custodian in accordance with policy 17.1 Legal: The Juvenile Court Process.

  3. Engage the parent/guardian/legal custodian to build consensus regarding participation in FTC:

    1. Discuss that DFCS filed a petition for dependency due to child safety concerns related to alcohol and substance abuse and that FTC was recommended.

    2. Inform him/her of the behavioral and environmental indicators that support FTC participation (see Practice Guidance: Observing and Documenting Behavioral and Environmental Indicators of Substance Abuse in policy 19.26 Case Management: Case Management Involving Substance Abuse or Use).

    3. Explain the purpose and process of FTC.

    4. Explain that the FTC team makes the final decision for acceptance into the program.

    5. Provide full disclosure regarding FTC participation (see Practice Guidance: Full Disclosure / Informed Consent), including:

      1. The parent’s/caregiver’s right to receive counsel from an attorney prior to admittance to the FTC and signing the standard FTC agreement form.

      2. The requirement for judicial monitoring, weekly or bi-weekly court hearings, drug screens, etc.;

      3. Participation is voluntary;

      4. The implications of not participating; and

      5. The benefits of participation in supporting their treatment and recovery (i.e., wraparound services, retaining or regaining of child custody).

    6. If consensus cannot be reached with the parent/guardian/legal custodian regarding the need for and benefits of FTC:

      1. Explore the reason for declining participation.

      2. Explore any fears and anxiety regarding the FTC (i.e. fear of the child being removed, etc.). Refer to Practice Guidance: Enhancing Caregiver Motivation and Responding to Parent/Caregiver Resistance in policy 19.26 Case Management: Case Management Involving Substance Abuse or Use for strategies to engage the parent/guardian/legal custodian.

  4. Consult with the FTC team after the dependency complaint/petition has been filed with the court regarding the next steps for screening, assessments, and referrals for the parent/guardian/legal custodian and other household members, in accordance with the FTC MOU or policies for the FTC jurisdiction.

  5. If the parent/guardian/legal custodian is accepted into the FTC:

    1. Discuss with the parent/guardian/legal custodian what he/she feel is needed to successfully achieve long-term recovery and how services through FTC can support their goals.

    2. Coordinate service provision with the FTC team.

    3. Participate in court hearings and FTC Team meetings.

    4. Update the case plan to incorporate outcomes and tasks related to the services being provided through FTC that address parent/guardian/legal custodian recovery, child safety, permanency and wellbeing.

    Parents/caregivers may request a formal hearing if terminated from FTC.

  6. If the parent/guardian/legal custodian is not accepted or declines participation:

    1. Engage him/her to explore fears, ambivalence, etc., if the parent/guardian/legal custodian declines treatment.

    2. Discuss with him/her the benefits of participation in the FTC and other related services to mitigate safety threats to the child(ren) and to promote a lifestyle in recovery for the entire family.

    3. Consult with the SSS regarding the impact on case assessment, case planning, assessing progress in treatment and recovery, and/or legal requirements.

    4. Refer to another substance use disorder program and any other services needed in accordance with policy 19.26 Case Management: Case Management Involving Substance Abuse or Use and 19.17: Case Management: Service Provision.

  7. Obtain and review the following:

    1. The standard FTC agreement form signed by the parent/guardian/legal custodian;

    2. The court order from each hearing;

    3. The screening and assessment of alcohol use disorder/substance use disorder records;

    4. Drug screens in accordance with policy 19.25 Case Management: Drug Screens;

    5. Treatment records;

  8. Support the parent/guardian/legal custodian and family in their recovery efforts and monitor participation and progress:

    1. Participate in all court hearings and FTC team meetings.

    2. Observe for behavioral and environmental changes during purposeful contacts (see policies 5.2 Investigation: Purposeful Contacts During an Investigation, 6.2 Special Investigations: Purposeful Contacts in Special Investigations, 8.2 Family Preservation Services: Purposeful Contacts with Families Receiving Family Preservation Services, and 10.18 Foster Care: Purposeful Contacts in Foster Care).

    3. Gather and assess information from collateral contacts regarding behavioral changes in accordance with policy 19.16 Case Management: Collateral Contacts.

    4. Verify the parent’s/caregiver’s progress or lack of progress towards recovery goals with service providers (see policy 19.17 Case Management: Service Provision).

    5. Discuss with the parent/guardian/legal custodian the progress made towards recovery goals.

    6. Address any barriers to successful completions of the FTC with the parent/guardian/legal custodian as well as with the FTC program staff.

  9. Conduct a supervisory staffing to discuss next steps when a parent/guardian/legal custodian fails to complete FTC and dependency issues remain.

  10. Document case management activities in Georgia SHINES within 72 hours of occurrence, including uploading documents into External Documentation.

  11. Follow provisions for case closing outlined in policy 19.26 Case Management: Case Management Involving Substance Abuse or Use prior to closing the case.

Social Services Supervisor

  1. Conduct a staffing with the SSCM to:

    1. Discuss the dependency issues in the case assessment due to parent/guardian/legal custodian substance or alcohol use.

    2. Discuss the eligibility for referral to the FTC within the appropriate jurisdiction. Consult with other DFCS county offices when providing case management services across county lines.

    3. Complete the DFCS internal FTC Screening Form in Georgia SHINES to determine if the parent/guardian/legal custodian meets the criteria for FTC.

  2. In conjunction with the SSCM, consult with the SAAG to file the dependency complaint, ensuring to review the complaint and that it is filed timely.

  3. Ensure the SSCM conduct reasonable efforts to prevent removal, reunify families, and finalize permanency occurs throughout the parent’s/caregiver’s participation in FTC.

  4. Discuss with the SSCM strategies to motivate parents’/caregivers’ FTC participation.

  5. Discuss with the SSCM the impact on case assessment, case planning, assessing progress in treatment and recovery, and/or legal requirements, when parents/caregivers decline to participate in the FTC process or do not complete the process.

  6. Ensure DFCS participation in all court hearings and FTC team meetings.

  7. Review all screening and assessment forms related to the parent’s/caregiver’s substance or alcohol use and ensure that recommendations and modifications are incorporated into the case plan.

  8. Review all court orders.

  9. Ensure that all FTC related activities are documented in Georgia SHINES within 72 hours of receipt, including uploading documents received into External Documentation.

  10. Ensure the SSCM adheres to policy 19.26 Case Management: Case Management Involving Substance Abuse or Use prior to approval to close the case.

Practice Guidance

FTCs[1] are a collaborative effort of the court, child welfare, substance use disorder treatment systems, and community partners. No single system or set of workers has the authority, capacity, resources, or skills to respond to the array of challenges faced by families affected by substance use disorders, but collectively, multiple systems and agencies do have those capacities and skills. To formalize the family treatment court partnership, a MOU with each partner is developed that outlines each agency’s role, responsibilities, duties, and tasks. Agencies participating in the FTC must maintain ongoing communication with the FTC. Depending upon the FTC jurisdiction, SSCMs may be required to provide weekly reports and/or attend court hearings weekly or every two weeks. Additionally, agencies are required to participate in continuing interdisciplinary education to promote effective planning, implementation, and operations.

Family Treatment Court Division (O.C.G.A. §15-11-15)

The goal of a family treatment court division is to:

  1. Reduce alcohol or drug abuse and addiction for respondents in dependency proceedings;

  2. Improve permanency outcomes for families when dependency is based in part on alcohol or drug use and addiction;

  3. Increase the personal, familial, and societal accountability of respondents in dependency proceedings; and

  4. Promote effective intervention and use of resources among child welfare personnel, law enforcement agencies, treatment providers, community agencies, and the courts.

Family Treatment Court Services

FTC’s provide access to a continuum of alcohol, drug and other related treatment and recovery services using evidence-based treatment and practice.

  1. FTC shall provide confidentiality for both parents and children in accordance with the law.

  2. Participant involvement in FTC programs should last a minimum of 18 to 24 months.

  3. FTC’s will provide a validated assessment normed to the target population, including substance abuse and risk of recidivism/criminogenic needs.

  4. Programming shall include services for addiction and criminal risk or recidivism. These services will be Evidence-Based/Evidence-Informed and include:

    1. Group counseling

    2. Individual counseling

    3. Drug testing

  5. FTC programs should ideally provide:

    1. Family counseling

    2. Gender specific counseling

    3. Domestic violence counseling

    4. Health screening

    5. Behavioral health services

    6. Trauma-informed care and counseling

    7. Individual case management and treatment planning

    8. Parenting services

    9. Services for children

  6. Ancillary services are available to meet the needs of participants, and may include but are not limited to:

    1. Employment counseling and assistance

    2. Educational components

    3. Medical and dental care referrals and assistance

    4. Transportation

    5. Housing assistance

    6. Mentoring

    7. Alumni groups

    8. Relationship counseling

Roles of FTC Team Members[2]
TEAM MEMBER ROLE

Judge

  • Ensure the safety, permanency and well-being of children

  • Provide leadership and lead the team in development of protocols and procedures

  • Serve as the public face of the FTC

  • Ensure children and participants receive appropriate services

  • Oversee the progress of family members in treatment

  • Encourage continuous education for all staff

  • Make appropriate court orders at hearings

  • Reward successes

  • Sanction noncompliance and facilitate team discussions

The judge’s role is paramount to the success of the program. He/she must possess recognizable leadership skills as well as the capability to motivate team members and elicit buy-in from stakeholders.

Coordinator

  • Serve as the chief administrator and jointly serve as the public face of the FTC

  • Coordinate the referral process

  • Coordinate drug testing and results

  • Develop and communicate agendas and provide notification of special meetings and dates

  • Schedule and facilitate clinical staffing and pre-court staffing

  • Participate with all team members in the development of the forms for cases in the FTC

  • Act as liaison between parents, attorneys, treatment providers and others

  • Monitor the provision of services (including adherence to best and Evidence-Based Practices (EBP) in the delivery of case management services, behavioral modification [sanctions and incentives], treatment dosage and responsiveness, and model fidelity)

  • Maintain case files and keep appropriate and current case files

  • Collect weekly progress information/prepare a consolidated weekly progress update on participants reporting for court

  • Assist in identification and enrollment of potential participants

  • Report on state and federal grants

  • Coordinate additional services for participants

SAAG

  • Represent DFCS at staffings and hearings

  • Prepare and file necessary pleadings

  • Participate as an active, engaged member of the team

Child Attorney

  • Represent children served by FTC at staffings and required hearings

  • Prepare for and file necessary pleadings

  • Participate as an active, engaged member of the team

Parent Attorney

  • Represent parent participants at staffing and required hearings

  • Prepare and file necessary pleadings

  • Participate as an active, engaged member of the team

CASA / Child Advocate

  • Advocate for the best interests of the children served by FTC at staffings and hearings

  • Participate as an active, engaged member of the team

DFCS Representative (SSCM)

  • Protect children’s health and safety and ensure their well-being

  • Ensure that children and their parents receive necessary services in addition to SATP

  • Assist in identifying potential participants and refer them to FTC

  • Inform the team immediately of any significant changes in the needs of children and parents

  • Attend and participate as an active, engaged member of the team in all staffings and required hearings

Treatment Provider

  • Provide the parent with the appropriate level of treatment to address their substance abuse and criminogenic needs (determined by evaluation and assessment)

  • Bring the parents’ treatment needs to the attention of the team

  • Provide the services to address the needs of parents or make appropriate referrals

  • Provide weekly progress notes to the FTC in a timely manner

  • Provide random, observed drug and alcohol testing

  • Provide a discharge plan for the parent and all parties involved

  • Ensure adequate supervision, coaching and oversight practices to ensure model fidelity for EBP’s

  • Provide regular feedback to the team regarding program integrity elements.

Community Policing Representative / Surveillance Officer

  • Report observations made during random home visits

  • Report observations regarding the children and the home environment

  • Conduct random, observed drug screens

  • Report results of drug tests and any information deemed relevant to the family’s continued success

FTC Case Manager

(When available and funded)

  • Serve as the mandated official that ensures the parent is following the court order and program rules

  • Conduct case management reviews as deemed appropriate by the team

  • Correspond with DFCS regarding case plans and parent’s progress

  • Attend court hearings and reviews

  • Maintain client files

  • Coordinate drug testing and results

  • Correspond with any pertinent community resources related to the parents’ case

Warm Hand-off

Alcohol and substances cause significant changes in brain chemistry, which can affect a person’s mood, thinking, behavior and perception, making it difficult for them to follow through on scheduling and keeping appointments. Therefore, it is essential that the SSCM assist or identify a responsible party to assist the caregiver with making and keeping appointments.

The SSCM is responsible for disclosing all significant information about FTC to parents/caregivers including the implications of participation. The SSCM should also explain that the benefits of participating are to assist him/her with evaluating their physical, psychological and social well-being, as well as, evaluating progress in substance use treatment and recovery services. When discussing FTC participation, the SSCM should avoid using statements that can perceived as coercive or punitive. Individuals have the right to choose whether to participate in FTC. Three conditions must be met before a decision can be considered fully informed:

  1. Capacity: The parent/guardian/legal custodian can make rational decisions.

  2. Comprehension: Information must be provided in a way that the parent/guardian/legal custodian understands, including language and words the parent/guardian/legal custodian understands. The parent/guardian/legal custodian should be asked to repeat her/his understanding of the information, so it is assured things were fully understood and fill in whatever gaps exist.

  3. Voluntariness: Implies that the parent/guardian/legal custodian is free to make this choice and is acting without any coercion.

Reasonable Efforts

A parent’s/caregiver’s enrollment and participation in the FTC does not relieve DFCS of its legal responsibility to make reasonable efforts throughout case management to prevent removal, reunify families, and to finalize permanency. Due diligence in the provision of individualized services goes beyond referral and requires support of the parent/guardian/legal custodian and family, monitoring engagement, adjustment of services as needed, and constant communication between provider and SSCM. At each dependency hearing, the SSCM will be required to testify to reasonable efforts made. It is essential that case management activities continue throughout the oversight of the treatment court. The parent/guardian/legal custodian and family should only benefit from the collaboration of systems designed to connect accountability with treatment. Refer to policy 9.5 Eligibility: Reasonable Efforts for additional information.

Commonly Used Medications for Medication Assisted Treatment

MAT[3] encompasses treatment for drug and alcohol addiction with other medications and psychotherapies.

Medications for Alcohol Dependence Medications for Opioid Dependence

  1. Naltrexone: (ReVia®, Vivitrol®, Depade®)

  2. Disulfiram: (Antabuse®)

  3. Acamprosate: (Campral®)

  1. Methadone: Methadose®, Dolophine®[4]

  2. Buprenorphine: (Suboxone® and Subutex®)

  3. Naltrexone: (ReVia®, Vivitrol®, Depade®)

4. Drug Enforcement Administration Office of Diversion Control Drug & Chemical Evaluation Section (2014 March). Methadone. Available from www.deadiversion.usdoj.gov/drug_chem_info/methadone/methadone.pdf

Forms and Tools

Know Your Rights: Rights for Individuals on Medication Assisted Treatment
Section XI Family Drug Court Standards
The Effects of Substance Abuse on Behavior and Parenting

1. National Center on Substance Abuse and Child Welfare (2015). Guidance to States: Recommendations for Developing Family Drug Court Guidelines. Children and Family Futures, 2015. Retrieved from ncsacw.acf.hhs.gov.
2. Council of Accountability Court Judges. (2020, July). Family Treatment Court Standards. (Available from cacj.georgia.gov/media/3951/download.)
3. Attorneys at the Legal Action Center authored, Know Your Rights: Rights for Individuals on Medication Assisted Treatment. HHS Publication No. (SMA) 09-4449. Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 2009.