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Children and

Family Research Center

University of Illinois at Urbana-Champaign

School of Social WorkTM

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 14 - 15, 2004Rosie Gianforte & Joseph Ryan

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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

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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

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The Recovery Coach

R eco v ery C o a ch S ta ffin g P a tternF o u r T ea m s

R e c o v e ryC o a c h

R e c o v e ryC o a c h

R e c o v e ryC o a c h

R e c o v e ryC o a c h

T ra c k e r

C l in ic a l S u p e rv is o r

P ro g ra m A d m in is tr a to r

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The Recovery Coach

• Recovery Coach Credentials:Certified Alcohol & Drug Counselors (CADC)Certified Assessment & Referral Specialists (CARS)Some experience in Child WelfareBachelor Level Degree – Human Services FieldSupervised by Master Level Degree with Child Welfare

& Substance Abuse Experience

• Caseloads:Average 20 - 25 clients per Recovery Coach

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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

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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?

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Evaluation of the Demonstration

Data Sources1. IDCFS Integrated Database: placement,

permanency and child safety2. 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

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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

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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

Control Demonstration Total

Families 273 665 938

Parents 334 831 1,165

Children 527 1,217 1,744

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A comparison of demographic characteristics reveals that the random assignment created

equivalent groups.

Evaluation of the Demonstration

Sample: April 2000 – December 2003

Parent Characteristics Demo Control

African American 80% 82%

White 12% 12%

Unemployed 70% 65%

Previous Substance Exposed Infant 63% 64%

Age of Youngest Parent 32.4 32.0

Primary Drug Cocaine 37% 37%

Primary Drug Heroin 26% 25%

Primary Drug Alcohol 21% 22%

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Question 1: Treatment Access

0%

10%

20%

30%

40%

50%

60%

70%

Participatedin Tx

Never in Tx Unknown -No Record

Control

Demo

Control = 46% Demonstration = 70%Data from three sources: caseworkers, AODA treatment providers and recovery coaches

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Question 2: Time to First Treatment Episode

Data from DARTS, limited to parents with signed consent

Time between First Treatment Episode and JCAP Assessment

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

0 30 60 90 120 150 180 210 240 270 300 330 360 390 420 450 480 510 540 570

time in days

perc

ent a

cces

sing

ser

vice

s

control

demonstration50% in 100 days

50% in 40 days

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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 Type Control Demonstration

Home of Parent 33 (6%) 122 (10%)

Home of Adoptive Parent 24 (5%) 67 (6%)

Subsidized Guardianship 10 (2%) 18 (2%)

Permanency Totals 67 (13%) 207 (17%)

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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 $9,805.82

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.

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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.

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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?