1. 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 Putting the Pieces Together 1 st National Conference on Substance Abuse, Child Welfare and the Dependency Courts Marriott Inner Harbor Hotel Baltimore, MD July 14 & 15, 2004 Joseph Ryan, Ph.d. University of Illinois at Urbana-Champaign Rosie Gianforte, LCSW Illinois Department of Children and Family Services

2. 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. 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. 4 The Recovery Coach

5. 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 20 - 25 clients per Recovery Coach

6. 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. 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.What additional factors help explain family reunification?

8. 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. 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. 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 Cumulative Totals as of December 31, 2003 ControlDemonstrationTotal Families273665938 Parents3348311,165 Children5271,2171,744

11. 11 A comparison of demographic characteristics reveals that the random assignment created equivalent groups. Evaluation of the Demonstration Parent CharacteristicsDemoControl African American80%82% White12% Unemployed70%65% Previous Substance Exposed Infant63%64% Age of Youngest Parent32.432.0 Primary Drug Cocaine37% Primary Drug Heroin26%25% Primary Drug Alcohol21%22%

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

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

14. 14 Question 3: Family Reunification & Permanence Group Assignment by Permanency Status (child level) The difference between the proportion of children returning home is statistically significant, p<.01 Living Arrangement TypeControlDemonstration Home of Parent41 (8%)143 (12%) Home of Adoptive Parent32 (6%)76 (6%) Subsidized Guardianship10 (2%)24 (2%) Permanency Totals83 (16%)243 (20%)

15. 15 Question 4: Additional Factors Although families are accessing services more quickly, and participating in treatment at higher rates the likelihood of family reunification is still quite low. So why are so few children returning home? What additional factors might help us understand reunification? It’s possible that many of these families are experiencing problems in addition to substance abuse. We focus on three: Domestic Violence, Housing, and Mental Health We also focus on the service response to these problems: forms completed by caseworkers, AODA treatment providers, and recovery coaches (limited to families in the demonstration group).

16. 16 Multiple Problems and Service Response 53% of families report Domestic Violence 72% of families report difficulties with Housing 51% of families report Mental Health problems 29% of families report experiencing all three of these problems Exploring the Service Response Of those reporting a problem with domestic violence 53% received no domestic violence services Of those reporting a problem with housing, 52% received no housing services Of those reporting mental health problems, 42% received no mental health services

17. 17 Multiple Problems and Service Response So despite the high participation in substance abuse treatment programs – a substantial proportion of families are not receiving services for other co-occurring issues Does Service Response Make a Difference? We developed a proportional measure of service response. Rather than a yes/no measure, we look at the number of times a problem was reported and the number of times services were provided to address that specific problem. Range from 0 (no services provided),.50 (services were provided 50% of the time) and 1 (services were provided each time the problem was reported in a particular quarter).

18. 18 Multiple Problems and Service Response So – Does Service Response Make a Difference? Service response does make a difference – and it seems to matter most if multiple problem areas are addressed. That is, families experiencing all three problems benefit most when all three problem areas are addressed. And this relationship is linear. That is, the more consistent the response, the more likely families are to achieve reunification. This is true for mental health and domestic violence. For example, families with mental health problems in the high response category – 16% achieved reunification – those in the low or no service response category – 9% achieved reunification. There was no relationship with the provision of housing services.

19. 19 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.  Multiple Problems- A substantial proportion of families are simultaneously experiencing multiple problems. Nearly half of these families are not receiving services intended to address these specific problems. The families that are not receiving a comprehensive service response are less likely to achieve family reunification.

20. 20 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)?  It’s important to revisit and test the underlying assumptions that support interventions for substance abusing caretakers in the child welfare system. Interventions that target substance abusing caretakers in the child welfare system must address families problems beyond the scope of substance abuse. The assumption that moving these families into treatment more quickly – and increasing rates of treatment participation – to increase family reunification might be necessary but not sufficient. Many of these families are experiencing a wide range of problems. The families that receive more comprehensive services are more likely to achieve family reunification.