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Findings from the Illinois
IV-E AODA Waiver
State Liaison Officers’ Grantee Meeting
Portland, ORApril 17, 2007
Presenter:Ms. Rosie Gianforte, LCSWIllinois Department of Children and Family Services
Children and
Family Research Center
Illinois IV-E AODA Waiver Illinois IV-E AODA Waiver DemonstrationDemonstration 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.
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
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
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
Eligibility and Random Assignment
IV -E A O DA P ro ject
C ontro l G roupD C F S se rv ices
(5 0 0 clie n ts)
Dem o G roupD C F S se rv ices
w o rk in tan d e m w ithR e co ve ry C oa ch (1 ,0 0 0 clie n ts)
J C A P A ss es m entC o n du c ted w ith in 9 0 da ys o f TC
C o o k C o u n ty C a se
Tem porary C us tody granted to DC FS
Random assignment conducted based on the agency/team servicing the parent.
Just extended the number of days for eligibility to 180 days from TC
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
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
The Recovery Coach Organization Chart
Four Team s
S enior R ecoveryC oach
R ecoveryC oach
R ecoveryC oach
R ecoveryC oach
T racker
C linica l S upervisor
P rogram A dminis tra tor
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 20 - 25 clients
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
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. Are families in the demonstration group less likely to be associated with subsequent reports of maltreatment?
5. Is the waiver demonstration cost neutral?
As of June 30, 2006, 496 parents in control group (790 children) and 1,347 parents in the demonstration group (1,894 children).
Evaluation of the Demonstration
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% 24%
Primary Drug Alcohol 18% 19%
Treatment Participation
0%
10%
20%
30%
40%
50%
60%
70%
80%
Participatedin Tx
Never in Tx Unknown -No Record
Control
Demo
Control = 52% Demonstration = 71%Data from three sources: caseworkers, AODA treatment providers and recovery coaches
Time to First Treatment Episode
Time to First Substance Abuse Service (DARTS), June 2005 (caregiver level)
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
0 30 60 90 120 150 180 210 240 270 300 330 360 390 420 450 480 510 540 570 600 630 660 690
days between jcap and first substance abuse services
pro
po
rtio
n r
eu
nif
ied
control
demonstration
70% after 11 months
70% after 4 months
Family Reunification & Permanence
Group Assignment by Permanency Status (child level) as of June 2005
The difference between the proportion of children returning home is statistically significant
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%)
Time to Family Reunification
Time to Reunification (Home of Parent), June 2005 (child level)
0
0.1
0.2
0 30 60 90 120 150 180 210 240 270 300 330 360 390 420 450 480 510 540 570 600 630 660 690
days between jcap and family reunification
pro
po
rtio
n r
eu
nif
ied
control
demonstration
9% at 18 months
4% at 18 months
Subsequent Reports of Maltreatment
Group Assignment Subsequent Reportstotals
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
Subsequent Substance Exposed Infants (SEI)
Group Assignment Subsequent SEItotals
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
Cost Neutrality
$(9,322.21)
$1,344,355.34
$3,920,816.37
$5,615,534.57
$5,021,917.77
$(1,000,000.00)
$-
$1,000,000.00
$2,000,000.00
$3,000,000.00
$4,000,000.00
$5,000,000.00
$6,000,000.00
Sep. '02 Sep. '03 Sep. '04 Sep. '05 Sep. '06
Total IV-E AODA Claim savings/loss: Includes all foster care and adoption claims as of September 2006
Additional Findings of Interest
Substance Abuse
Housing 56%
Mental Health 40%
Treatment Reunification
Domestic Violence 30%
Recovery Coach
Enter page title here!Co-occurring Problems and Reunification
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
89% 11% 27%
Totals 88% 12% 100%
The Problems and the Progress are Important
Co-occurring Problems and Reunification
The Problems and the Progress are ImportantProblem Area % progress Not
Reunified Reunifie
d
Substance Abuse
Complete 18% 74% 26%
Substantial 24% 87% 13%
Reasonable effort 15% 91% 9%
Unsatisfactory 43% 93% 7%
Domestic Violence
Complete 15% 75% 25%
Substantial 9% 76% 24%
Reasonable effort 18% 90% 10%
Unsatisfactory 58% 95% 5%
Co-occurring Problems and Reunification
The Problems and the Progress are ImportantProblem Area % progress Not Reunified Reunifie
d
Housing
Complete 10% 69% 31%
Substantial 13% 83% 17%
Reasonable effort 22% 88% 12%
Unsatisfactory 55% 93% 7%
Mental Health
Complete 5% 58% 42%
Substantial 18% 88% 13%
Reasonable effort 20% 92% 8%
Unsatisfactory 56% 93% 7%
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
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.
Conclusions:
Lessons Learned
Outreach and early engagement are criticalData systems and data collection aren’t exciting but they can be invaluableThe job of project awareness is never doneSeemingly unimportant factors can kill the project
Lessons Learned (continued)
Juvenile Court Assessment Program (JCAP) – the project’s “secret weapon”Evolution of Recovery Coaches from generalists to more specialized rolesImportance of Recovery Coach’s independence Stability through the process Ally for the parent Driving force for system collaboration
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
Project Extension-Downstate
Expansion to 2 downstate counties Assessment & Recovery Coach services to less urban less centralized settingIntegrate drug court model into processConfront methamphetamine abuse and production in rural populations
DCFS Contacts:
Sam Gillespie – AODA Services Manager [email protected]; 312-814-5483
Rosie Gianforte – IV-E AODA Coordinator [email protected]; 312-814-
2440
