1. Findings from the Illinois IV-E AODA Waiver
Children and Family
Research Center
Findings from the Illinois IV-E AODA Waiver
State Liaison Officers’ Grantee Meeting
Portland, OR
April 17, 2007
Presenter:
Ms. Rosie Gianforte, LCSW
Illinois Department of Children and Family Services

2. Illinois IV-E AODA Waiver Demonstration
The Illinois Department of Children and Family Services received approval from the U.S. Department of Health and Human Services (HHS) beginning in April 2000 to waive certain restrictions on the use of federal IV-B and IV-E funds to facilitate the demonstration of new approaches to the delivery of child welfare services.
The waiver allows the Department to provide enhanced alcohol and other drug abuse services to DCFS involved placement families in the Cook County catchment area.

3. Impact of AODA on DCFS Court Cases GAO Report 1998
74% of Cook County DCFS cases had 1 or more parent required to get AOD treatment
82% of mothers AOD histories greater than 5 years (41% > 10 years)
> 80% were primary heroin or cocaine abusers
Child welfare agencies had limited familiarity with AODA resources making admissions low
Judges reported permanency decisions delayed due to lack of information on treatment progress

4. Foundations of the Waiver Project – Built on Existing Relationships
Existing DASA/DCFS Initiative Services, 1995
Full range of treatment services
Expedited assessment and admission
Removal of barriers to treatment, I.e. childcare and transportation
Juvenile Court Assessment Project, 1999
On site assessment services at Juvenile Court
Standardized assessment (DSM IV-R & ASAM)
Same day referral to treatment
Provide courts assessment results

5. Illinois IV-E AODA Waiver Project Goals
Increase the number of AODA impacted foster care children that are safely reunified
Decrease the length of time it takes for safe reunification of AODA foster care cases
Increase the number of cases and the speed at which AODA impacted cases are moved to a permanency decision
Increase the number of DCFS involved individuals referred to AODA that remain in treatment for at least 90 days
Reduce the number of subsequent oral reports (SOR) of child abuse and neglect

6. Eligibility and Random Assignment
Just extended the number of days for eligibility to 180 days from TC
Random assignment conducted based on the agency/team servicing the parent.

7. Recovery Coach Role Contracted through an independent agency (TASC)
Recovery Coaches:
Assist the parent(s) in obtaining AODA treatment services and negotiating departmental and judicial requirements associated with AODA recovery and permanency planning
Work in collaboration with the Child Welfare worker, AODA treatment provider and extended family members to bridge service gaps
Provide specialized outreach, intensive AODA case management & support services throughout the life of the case, before, during, and after treatment & reunification

8. Specific Recovery Coach Interventions
Coordinate AOD planning efforts, arrange staffings, participate in family meetings
Provide ongoing assertive outreach and re-engagement efforts, i.e.…transportation to initial intake appointment
Assist in removing any barriers in engaging, retaining and re-engaging parents who have discontinued treatment
Provide ongoing assessments to evaluate the need for mental health, parenting, housing, domestic violence and family support services
Urinalysis testing
Standardized, regular (monthly) reporting to worker & the courts

9. The Recovery Coach Organization Chart

10. The Recovery Coach Profile
Recovery Coach Credentials:
Certified Alcohol & Drug Counselors (CADC)
Certified Assessment & Referral Specialists (CARS)
Some experience in Child Welfare
Bachelor Level Degree – Human Services Field
Supervised by Master Level Degree with Child Welfare & Substance Abuse Experience
Caseloads: Average clients

11. Evaluation of the Demonstration
Eligibility: (1) foster care cases opened after April 2000, and (2) parents must be assessed at the Juvenile Court Assessment Program (JCAP) within 90 days of the temporary custody hearing
Assignment: Substance abusing caregivers were randomly assigned to either the control (regular services) or demonstration group
Treatment: Parents in the demonstration group received regular services plus intensive case management in the form of a Recovery Coach

12. Evaluation of the Demonstration
Research Questions
Are parents in the demonstration group more likely to access AODA treatment services compared with parents in the control group?
Do parents in the demonstration group access AODA treatment services more quickly compared with parents in the control group?
Are families in the demonstration group more likely to achieve family reunification and/or permanence compared with families in the control group?
Are families in the demonstration group less likely to be associated with subsequent reports of maltreatment?
Is the waiver demonstration cost neutral?

13. Evaluation of the Demonstration Parent Characteristics
As of June 30, 2006, 496 parents in control group (790 children) and 1,347 parents in the demonstration group (1,894 children).
Parent Characteristics
Demo
Control
African American
83%
80%
White
11%
14%
Unemployed
75%
72%
Previous Substance Exposed Infant
66%
64%
Age of Youngest Parent 35 36
Primary Drug Cocaine
36%
35%
Primary Drug Heroin
24%
Primary Drug Alcohol
18%
19%

14. Treatment Participation Control = 52% Demonstration = 71%
Data from three sources: caseworkers, AODA treatment providers and recovery coaches

15. Time to First Treatment Episode

16. Family Reunification & Permanence
Group Assignment by Permanency Status (child level) as of June 2005
Living Arrangement Type
Control
Demonstration
Home of Parent
105 (13%)
298 (17%)
Home of Adoptive Parent
131 (17%)
309 (16%)
Subsidized Guardianship
61 (7.2%)
132 (7%)
Permanency Totals
297 (37%)
739 (40%)
The difference between the proportion of children returning home is
statistically significant

17. Time to Family Reunification

18. Subsequent Reports of Maltreatment
Group Assignment Subsequent Reports totals
No Yes
Control 255 (70%) 111 (30%) 366
Demonstration 706 (75%) 237 (25%) 943
Totals 961 (73%) 348 (27%) 1309 (100%)
The difference between the proportion of subsequent reports between the Control and Demo groups is statistically significant.
As of June 2005
14% vs. 19% if we included all subsequent SEIs…..ones that occur only days after entering the demonstration waiver.

19. Subsequent Substance Exposed Infants (SEI)
Group Assignment Subsequent SEI totals
No Yes
Control 210 (80%) 51 (20%) 261
Demonstration 579 (86%) 91 (14%) 670
Totals 789 (85%) 142 (15%) 931 (100%)
The difference between the proportion of subsequent SEI births between the Control and Demo groups is statistically significant.
As of June 2005
14% vs. 19% if we included all subsequent SEIs…..ones that occur only days after entering the demonstration waiver.

20. Cost Neutrality

21. Additional Findings of Interest
Domestic Violence 30%
Mental Health 40%
Housing 56%
Reunification
Substance Abuse
Treatment
Recovery Coach

22. Problems indicated by Caseworker
Enter page title here!
Co-occurring Problems and Reunification
The Problems and the Progress are Important
Problems indicated by Caseworker
Not Reunified
Reunified
Totals
Substance abuse only
79%
21% 8%
One additional problem
89%
11%
30%
Two additional problems
88%
12%
35%
Three additional problems
27%
100%

23. Co-occurring Problems and Reunification
The Problems and the Progress are Important
Problem Area
% progress
Not Reunified
Reunified
Substance Abuse
Complete
18%
74%
26%
Substantial
24%
87%
13%
Reasonable effort
15%
91% 9%
Unsatisfactory
43%
93% 7%
Domestic Violence
75%
25%
76%
90%
10%
58%
95% 5%

24. Co-occurring Problems and Reunification
The Problems and the Progress are Important
Problem Area
% progress
Not Reunified
Reunified
Housing
Complete
10%
69%
31%
Substantial
13%
83%
17%
Reasonable effort
22%
88%
12%
Unsatisfactory
55%
93% 7%
Mental Health 5%
58%
42%
18%
20%
92% 8%
56%

25. Findings from Multivariate Models
Families unable to make sufficient progress in SA are 42% less likely to achieve reunification
Families unable to make sufficient progress in DV are 53% less likely to achieve reunification
Families unable to make sufficient progress in MH are 39% less likely to achieve reunification
No significant effect associate with housing

26. Conclusions:
Families involved with the AODA waiver report a variety of co-occurring problems.
These problems decrease the likelihood of reunification.
Yet – when progress is achieved – the likelihood of achieving family reunification is significantly increased – especially with regard to MH and DV.
IV-E Extension: Integrated service model designed to increase treatment access and reunification targeting services to specific problem areas such as Domestic Violence, Mental Health and Housing.

27. Lessons Learned Outreach and early engagement are critical
Data systems and data collection aren’t exciting but they can be invaluable
The job of project awareness is never done
Seemingly unimportant factors can kill the project

28. Lessons Learned (continued)
Juvenile Court Assessment Program (JCAP) – the project’s “secret weapon”
Evolution of Recovery Coaches from generalists to more specialized roles
Importance of Recovery Coach’s independence
Stability through the process
Ally for the parent
Driving force for system collaboration

29. Project Extension-Cook County
Focus on co-occurring problems
Housing – provide housing resources and advocates to assist in securing safe homes.
Mental health – Implement a MH screen to assist in securing necessary services to address needs.
Domestic violence – collaborate with case worker to identify needs and secure appropriate services.
Stabilize families in drug free housing
Transition to subsidized and independent
Education/vocational supports to recovery

30. Project Extension-Downstate
Expansion to 2 downstate counties
Assessment & Recovery Coach services to less urban less centralized setting
Integrate drug court model into process
Confront methamphetamine abuse and production in rural populations

31. DCFS Contacts: Sam Gillespie – AODA Services Manager
Rosie Gianforte – IV-E AODA Coordinator