1 C hildren and F amily Research Center University of Illinois at Urbana-Champaign School of Social Work TM Integrating Substance Abuse Treatment and Child Welfare Services: Findings from the Illinois AODA Waiver Demonstration First National Conference on Substance Abuse, Child Welfare and the Dependency Court Baltimore, MD July , 2004 Rosie Gianforte & Joseph Ryan

2 Enter page title here! Overview of AODA Waiver Foundations of the Waiver Project – Building on Existing Relationships Existing OASA/DCFS Initiative Services – 1995  Full range of treatment services  Expedited assessment and admission Juvenile Court Assessment Project – 1999  On site assessment services at Juvenile Court  Standardized assessment (DSM-R & ASAM)  Same day referral to treatment

3 Enter page title here! Overview of AODA Waiver Primary Objectives of Illinois AODA Waiver: Increase timely access to substance abuse treatment and thus speed up time to family reunification How Can this be Accomplished: Recovery Coaches Contracted through an independent agency (TASC) Works in collaboration with caseworker; not a replacement Assigned to family for the life of a case Before, during, and after treatment & reunification Provide ongoing assertive outreach, engagement, and re-engagement Coordinate AOD planning efforts Standardized, regular (monthly) reporting to worker

4 The Recovery Coach

5 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 per Recovery Coach

6 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

7 Evaluation of the Demonstration Research Questions 1.Are parents in the demonstration group more likely to access AODA treatment services compared with parents in the control group? 2.Do parents in the demonstration group access AODA treatment services more quickly compared with parents in the control group? 3.Are families in the demonstration group more likely to achieve family reunification and/or permanence compared with families in the control group? 4.Is the demonstration cost neutral?

8 Evaluation of the Demonstration Data Sources 1.IDCFS Integrated Database: placement, permanency and child safety 2.Juvenile Court Assessment Program (JCAP): substance abuse assessment, substance abuse history, variety of demographic information (e.g. employment, living arrangements) 3.Department’s Automated Reporting & Tracking System (DARTS): managed by OASA, includes service intake date, termination date, level of care, and reason for service closing

9 4.Treatment Record and Continuing Care System (TRACCS) Monthly and quarterly progress completed by caseworkers, treatment providers and recovery coaches 5.Treatment Alternatives for Safe Communities (TASC) Quarterly reports completed with point in time treatment progress, visitation and case status Evaluation of the Demonstration Data Sources Continued

10 As of December 31, 2003, a total of 938 families, 1,165 parents and 1,774 children were enrolled in the Illinois AODA waiver. The following is a breakdown by group assignment. Evaluation of the Demonstration Sample: April 2000 – December 2003 Cumulative Totals as of December 31, 2003 ControlDemonstrationTotal Families Parents ,165 Children5271,2171,744

11 A comparison of demographic characteristics reveals that the random assignment created equivalent groups. Evaluation of the Demonstration Sample: April 2000 – December 2003 Parent CharacteristicsDemoControl African American80%82% White12% Unemployed70%65% Previous Substance Exposed Infant63%64% Age of Youngest Parent Primary Drug Cocaine37% Primary Drug Heroin26%25% Primary Drug Alcohol21%22%

12 Question 1: Treatment Access Control = 46% Demonstration = 70% Data from three sources: caseworkers, AODA treatment providers and recovery coaches

13 Question 2: Time to First Treatment Episode Data from DARTS, limited to parents with signed consent

14 Question 3: Family Reunification & Permanence Group Assignment by Permanency Status (child level) The difference between the proportion of child achieving family reunification is statistically significant, p<.05 Living Arrangement TypeControlDemonstration Home of Parent33 (6%)122 (10%) Home of Adoptive Parent24 (5%)67 (6%) Subsidized Guardianship10 (2%)18 (2%) Permanency Totals67 (13%)207 (17%)

15 Question 4: Cost Neutrality Recovery Coach efforts to engage parents in drug treatment increase the chances for recovery and reunification or provides grounds for expedited TPR and adoption which are less costly than long-term foster care. The cumulative per child IV-E expenditures in the cost neutrality group through September 30, 2003 was $9, As of 9/30/03, the actual IV-E cost in the demonstration group was $22,207,203 and the calculated cost was $23,551,558 which is a cost savings to the state of $981,910.

16 Summary of Findings  Access to Services – parents in the demonstration group were more likely to access substance abuse services as compared with parents in the control group  Time to Service Access – parents in the demonstration group accessed substance abuse services more quickly as compared with parents in the control group  Family Reunification – children in the demonstration group were more likely to achieve family reunification as compared with children in the control group.  Cost Neutrality – the demonstration project is generating savings to the State that can be reinvested toward child welfare related activities.

17 Enter page title here! Questions, Implications and Future Research  Although the use of Recovery Coaches increases reunification rates, these rates are still quite low.  This raises important questions related to timelines to permanency and recovery. Can families recover from serious addiction problems within the time specified to achieve permanence (many families in for multiple years)?  We need to investigate the child-parent visitation status for parents having completed substance abuse treatment. Identify other possible systemic family issues interfering with unsupervised visitation – or even reunification - being granted to parents. The majority of parents that have completed treatment have yet to achieve reunification. Why – and what might this say about some of the underlying assumptions of substance abuse treatment – or access to substance abuse treatment?