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Parental Substance Abuse & Child Maltreatment Evaluation Results From Project First Step: New Hampshire’s IV-E Waiver Demonstration. NCSACW First National Conference on Substance Abuse, Child Welfare and the Dependency Court July 2004. Barriers to effective treatment. Limited services - PowerPoint PPT Presentation
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Parental Substance Abuse & Child Parental Substance Abuse & Child MaltreatmentMaltreatment
Evaluation Results From Evaluation Results From Project First Step: New Hampshire’s Project First Step: New Hampshire’s
IV-E Waiver DemonstrationIV-E Waiver Demonstration
NCSACW First National Conference on Substance Abuse, NCSACW First National Conference on Substance Abuse, Child Welfare and the Dependency CourtChild Welfare and the Dependency Court
July 2004July 2004
Barriers to effective treatmentBarriers to effective treatment
Limited servicesWait lists for in-patient and out-patient
Focus on the substance abuse recovery doesn’t address family and parenting issues
Client MinimizationReadiness to ChangeCo-Morbidity
Original project Original project assumptionsassumptions
Better initial risk & safety assessments by CPS.
Direct assessment/counseling available to the family.
Interventions to address child maltreatment in the context of the substance abuse
Eventual decrease in child’s stay in temp. foster care.
New Hampshire Health & Human Services, Division for Children, Youth & families
Vision Statement
We envision a state in which every child lives in a nurturing family and plays and goes to school in communities that are safe and cherish children.
Mission Statement
We are dedicated to assisting families in the protection, development, permanency,
and well-being of their children and
the communities in which they live.
DCYF Comprehensive
Child & Family Services Plan, 2000-2004
Initial selection at IntakeInitial selection at Intake
Call Received
Intake Assessment
Credible Report + Identified Substance Abuse
Screened Out
Credible Report: No Identified Substance Abuse
Family Research LabFamily Research Lab
Involved in client selection
CPS Intake screens in eligible family
FRL staff makes random assignment to standard/ enhanced groups, takes client id info
Group assignment noted when family is referred to targeted district office for CPS assessment
Enhanced ServicesEnhanced Services
Consult with L.A.D.A.C. and supervisorCPS + consultant meet with family
Goal for Enhanced ServicesGoal for Enhanced Services
In CPS cases involving parental substance abuse– Better assessments of safety for children– Better plans for children in placement– Less frequent/shorter periods of time in foster
care– Improved permanency plans– Costs for children in temporary
foster care may decrease
Benefits to the communityBenefits to the community
Strengthened ties between the Treatment community & the CPS office
Education for the Treatment providers about substance abuse treatment needs in CPS cases
Additional outreach resource
For people awaiting treatmentFor people awaiting treatment
Individual counselingOn-going contact with counselor
– Treatment Window extended 60 days– Treatment Provider connections
For families receiving servicesFor families receiving services
Consultant participates in case planningKeep focus on parent issuesInclude parenting in treatment goalsAftercare with focus on parenting
Benefits to CPS during Benefits to CPS during assessmentassessment
Regular Consultation Preliminary screening (SASSI) of
parental substance abuseImpact of parental substance abuse on
safety and risk of harm to childrenRecommendations for
services and treatment
“[The Counselor’s] involvement provides all concerned with a better understanding of what is needed, what has been provided, how receptive parents are, what has or has not been accomplished. This is done in a way that seems entirely consistent with the legal protections accorded patients in substance abuse programs. … To a large extent, I think this is a matter of much better coordination between the folks who treat substance abuse and the folks who protect children. I do think the project is providing better outcomes for the children and their parents, by making necessary info more readily available.”
Communication from NH DCYF attorney, on Project First Step, 6/2003
Benefits for CPS cases when Benefits for CPS cases when children are in out-of-home carechildren are in out-of-home care
Comprehensive assessment with DXAssistance with goal specific case
planningContinued consultationRecommendations for
parents and children
Current Evaluation StatusCurrent Evaluation Status
Since 11/15/99…– 437 families eligible
212 baseline interviews (49%) 151 follow-up interviews (73%)
– 132 SA assessments of Enhanced clients by LADACs (59%)
Percentage of Families Completed Percentage of Families Completed SASSI by SiteSASSI by Site
66%
54%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Pe
rce
nta
ge
of
Fa
mili
es
Co
mp
lete
d
SA
SS
I
Site
Manchester
Nashua
Status of SA Assessment among Status of SA Assessment among Enhanced ClientsEnhanced Clients
Enhanced Clients assessed = 132 (59% of total assigned)
Equivalent to engagement of client/ or an overestimate?
36% HI DEF . – True extent of engageability or readiness to change
may be more like a third of clients (those assessed and not minimizing). (1/2 x 2/3=1/3 all clients engageable )
– May be the first time anyone has confronted them with assertions of SA.
Study Sample Characteristics: Study Sample Characteristics: Trauma & Co-MorbidityTrauma & Co-Morbidity
Co-MorbidityCo-Morbidity
1/3 of those assessed by SA consultants fall in “High Prob.” range of Substance Dependence Disorder
45% of “high-prob” have a prior diagnosis of mental illness.
Within interview sample, 45% of “high prob.” have clinical levels of depression
16% prior hx of mental illness was documented in initial record data.
Evaluation interviews reveal 45% Clinically Depressed using CESD measure.
Domestic Violence in Initial CPS Domestic Violence in Initial CPS Study ReferralsStudy Referrals
Over half (58%) had a prior Order of Protection at some time
Over 1/3 report DV in current year19% got a protective order on current
partner in the past
Victimization & Trauma Hx. Of AdultVictimization & Trauma Hx. Of Adult
0 20 40 60 80
Physical Attack Stranger
Physical Attack Know
Sexual Assault Know
Sex Assault stranger
Unwanted Sex Know
Mugged
Witness Killing
Chld. Phys. Ab.
Emotional Abuse
Ty
pe
Vic
tim
iza
tio
n
Percent of Respondents
Alcohol Abuse History in Initial CPS Alcohol Abuse History in Initial CPS Referrals (Interview Sample)Referrals (Interview Sample)
40% of respondents reported drinking 4 > drinks at a time. 1/3> of partners had a history of binge/bender drinking
patterns & a history of aggressive behavior when drinking. Avg. MAST score= 2.2 (range 0-11)
40% attended AA 41% fights while drinking 22% arrested for DUI 28% prior RX history for drinking problem
Respondents’ Past Year Drug Use Respondents’ Past Year Drug Use (N=139)(N=139)
0 4 8 12 16 20 24 28
Heroin
Cocaine or Crack
Tranquilizers
Barbiturates
Amphetamines
Marijuana
Ty
pe
of
Dru
g U
se
d
Percent of Respondents that Have Used
DispositionsDispositions
Preliminary Outcomes by GroupPreliminary Outcomes by Group
Enhanced
(n=222)
Standard
(n=215)
Founded Problem Resolved 1.8% 5.1%
Unfounded Closed 86.5% 84.6%
Founded New Case (Court)/ B-Case w/ Services
11.3% 9.3%
Incomplete 0.0% 0.9%
Unfounded, Voluntary Case Opened
0.5% 0.0%
Preliminary Outcomes of Initial Referrals by Group & SitePreliminary Outcomes of Initial Referrals by Group & SiteEnhanced
(n=222) Standard(n=215)
Founded-Problem Resolved Manchester Nashua
0.9%2.6%
5.4%4.8%
B Case Opened, Founded Manchester Nashua
4.7%0.9%
0.9%1.9%
DCYF Founded, Court Dismissed Manchester Nashua
0.0%0.9%
0.9%1.0%
Unfounded, Voluntary Services Manchester Nashua
0.9%0.0%
0.0%0.0%
Founded-New Case Opened Manchester Nashua
11.3%6.0%
6.3%9.6%
Unfounded-Closed Manchester Nashua
82.1%89.7%
85.6%81.7%
Percent of Initial Referrals Founded Percent of Initial Referrals Founded by Groupby Group
13.1% 14.6%0%
50%
100%
Pe
rce
nt
of
Fa
mil
ies
Founded Dispositions
Enhanced
Standard
Final Founded Dispositions of Initial Final Founded Dispositions of Initial Referrals by Group & SiteReferrals by Group & Site
17.1% 12.7% 9.5% 16.5%0%
20%
40%
60%
80%
100%
Pe
rce
nt
of
Fa
mili
es
Manchester Nashua
Enhanced
Standard
Correct Assignment of Subsequent Correct Assignment of Subsequent Referrals by Group & SiteReferrals by Group & Site
92.6%
99.1%
78.3%
88.6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Manchester Nashua
Enhanced
Standard
Percentage of Cases Ever Open by Percentage of Cases Ever Open by Group & SiteGroup & Site
22.2%19.3% 19.3%
23.8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Pe
rce
nta
ge
of
Ca
se
s O
pe
ne
d
Manchester Nashua
Enhanced
Standard
Percentage of Cases Open on Percentage of Cases Open on Subsequent Referral by GroupSubsequent Referral by Group
41.7% 46.8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% o
f C
as
es
Enhanced
Standard
Enhanced
(n= 228)
Standard
(n= 219)
ANY SUBSEQUENT REFERRALS
MEAN # SUBSEQUENT REFERRALS (“0” INCLUDED)
42.5%
0.94
45.2%
1.03
% & # CASES OPENED ON SUBSEQUENT REFERRALS
7.0% (16) 9.13% (20)
% & # SUBSEQUENT REFERRALS FOUNDED
11% (34) 14.6% (43)
Subsequent Referrals by GroupSubsequent Referrals by Group
Subsequent Referrals by Group & SiteSubsequent Referrals by Group & Site
Enhanced Standard
Manchester Nashua Manchester Nashua
ANY SUBSQ. REFERRALS
MEAN # SUBSQ. REFERRALS,
(“0” INCLUDED)
45.4%
0.95
40.0%
0.93
44.7%
1.08
45.7%
0.98
% & # CASES OPENED ON SUBSQ. REFERRALS
4.6%
(5)
9.2%
(11)
8.8%
(10)
9.5%
(10)% & # SUBSQ. REFERRALS FOUNDED
8.3%
(13)
13.6% (21)
14.9%
(21)
14.3% (22)
Characteristics of Characteristics of Child PlacementsChild Placements
In-Home Services for Families with In-Home Services for Families with Cases by GroupCases by Group
IN-HOME SERVICES* Enhanced Standard
% FAM. ANY IN-HOME SERVICE
MEAN # FAM W/ IN-HOME SERVICE
(“0” INCLUDED)
# OF FAM. RECEIVING IN-HOME SERVICES W/ A VOLUNTARY/B-CASE
12.5%
0.15
2
12.8%
0.13
0
* There are 8 families, in which one child received In-Home Services and was not removed, but another child within that same family was removed.
Out of Home Placement (OHP) Out of Home Placement (OHP) Types by GroupTypes by Group
Enhanced Standard
KIN CARE % FAM. ANY KIN CARE MEAN # FAM. W/ KIN CARE (“O” INCLUDED)
18.7%0.30
17.0%0.21
FOSTER CARE % FAM. ANY FOSTER CARE MEAN # FAM W/ FOSTER CARE (“0” INCLUDED)
58.3%1.67
63.8%2.72
OTHER OHP % FAM. ANY OHP MEAN # FAM W/ OHP (“0” INCLUDED)
22.9%0.77
25.5%0.68
Mean Number of Days in Placement Mean Number of Days in Placement per Family (Includes all Children) by per Family (Includes all Children) by
Group & SiteGroup & Site
825.9941.6 1040.9
1057.1
0
200
400
600
800
1000
1200
Me
an
# o
f D
ay
s
Manchester Nashua
Enhanced
Standard
Mean # of Days in Placement per Mean # of Days in Placement per Family (Includes all Children) by Family (Includes all Children) by LADAC Engaged Groups & SiteLADAC Engaged Groups & Site
941.6
900.5
266.5
1057.1
1039.6
1043.7
0
200
400
600
800
1000
1200
Me
an
# o
f D
ay
s
Manchester Nashua
Standard
Enhanced w/SASSI
Enhanced w/No SASSI
Mean Number of Placements per Mean Number of Placements per Family by Group & SiteFamily by Group & Site
6.29
3.94 4.613.56
0
1
2
3
4
5
6
7
8
9
10
Me
an
# o
f P
lac
em
en
ts
Manchester Nashua
Standard
Enhanced
Mean Number of Placements per Family Mean Number of Placements per Family by LADAC Engaged Groups & Siteby LADAC Engaged Groups & Site
6.29
4.2
2
4.61
2.83
5
0
1
2
3
4
5
6
7
Me
an
# o
f P
lac
em
en
ts
Manchester Nashua
Standard
Enhanced w/ SASSI
Enhanced w/ No SASSI
Mean Number of Children in Mean Number of Children in Placement per Family by LADAC Placement per Family by LADAC
Engaged Groups & SiteEngaged Groups & Site
2.14
1.47
2 1.94 1.92 1.83
0
0.5
1
1.5
2
2.5
3
# o
f C
hild
ren
Manchester Nashua
Standard
Enhanced w/ SASSI
Enhanced w/ No SASSI
Percentage of Families with Children Percentage of Families with Children in Placement by LADAC Engaged in Placement by LADAC Engaged
Groups & SiteGroups & Site
63.6%
71.4%
66.7%
72.0%
75.0%
75.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% o
f F
am
ilie
s in
Pla
ce
me
nt
Manchester Nashua
Standard
Enhanced w/ SASSI
Enhanced w/ No SASSI
Mean Number of Placements per Mean Number of Placements per Child in Placement by LADAC Child in Placement by LADAC
Engaged Groups & SiteEngaged Groups & Site
32.63
1
2.051.65
2.39
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
# o
f P
lac
em
en
ts
Manchester Nashua
Standard
Enhanced w/ SASSI
Enhanced w/ No SASSI
Percentage of Families with TPR by GroupPercentage of Families with TPR by Group
16.7% 8.5%0%
20%
40%
60%
80%
100%
% o
f F
am
ilie
s
Enhanced
Standard
Percentage of Families with TPR by Percentage of Families with TPR by Group & SiteGroup & Site
12.5%
9.1%
20.8%
8.0%
0%
5%
10%
15%
20%
25%
% o
f F
am
ilie
s
Manchester Nashua
Enhanced
Standard
Mean Length to TPR by GroupMean Length to TPR by Group
682.3 783
0
100
200
300
400
500
600
700
800
# o
f D
ay
s
Enhanced
Standard
Mean Length to TPR by Group & SiteMean Length to TPR by Group & Site
600.33
998
731.4568
0
100
200
300
400
500
600
700
800
900
1000
# o
f D
ay
s
Manchester Nashua
Enhanced
Standard
Child OutcomesChild Outcomes
Preliminary Child Outcomes Preliminary Child Outcomes for Index Children ages 4-17for Index Children ages 4-17
CBCL Scores (Caregiver Reports): Mean problem scores decreased for all
subscales, among both Enhanced and Standard Groups
Children in Enhanced Groups had greater declines in 5 of 8 problem categories: – Anxiety & Depression– Withdrawn/Depressed– Somatic Problems– Attention Problems– Aggressive Behavior
Cost NeutralityCost Neutrality
Population measured includes all children Population measured includes all children involved in “Founded/Open” Casesinvolved in “Founded/Open” Cases
Total children in open cases, by group and quarter.
020406080
100120
Standard Open Enhanced/Open
Enhanced/Standard group costs
$-$100,000.00$200,000.00$300,000.00$400,000.00$500,000.00$600,000.00$700,000.00
CUMULATIVE (CUM.) CTRL. - GROSS TOTAL
CUM. EXPER. GRP. CNL - GROSS TOTAL
Treatment Utilization Treatment Utilization & Caretaker & Caretaker OutcomesOutcomes
Wave 2 Counseling & Treatment Wave 2 Counseling & Treatment Utilization Ever-Open Cases: Utilization Ever-Open Cases:
Interview SampleInterview Sample
Referral Made
Attended >1X
%Referrals Completed/
Ongoing RX
Counseling
Standard Enhanced
70% (7/10)
63% ( 12/19)
86% (6/7)
67% (8/12)
50% (5/10)
67% (8/12)
Substance Abuse RX
Standard
Enhanced40% (4/10)
59% (10/17)
100% (4/4)
88% (10/17)
30% (3/10)
50% (5/10)
W1 & W2 RX Utilization by Groups: W1 & W2 RX Utilization by Groups: Interview Sample, Self ReportsInterview Sample, Self Reports
Enhanced Standard
% Resp. attend AA
W1 (ever)
W2 (past yr.)
40% (45/112)
69% (19/28)
43% (43/100)
45% (10/22)
% Resp. help for drinking
W1 (ever)
W2 (past yr.)
25% (28/112)
48% (11/23)
32% (32/100)
43% (6/14)
% Resp. hosp. for drinking
W1 (ever)
W2 (past yr.)16% (18/112)
27% (4/15)
18% (18/100)
11% (1/9)
W1 & W2 RX Utilization by Groups: W1 & W2 RX Utilization by Groups: Interview Sample, R. Reports on PartnerInterview Sample, R. Reports on Partner
Enhanced Standard
% Part. attend AA
W1 (ever)
W2 (past yr.)
31% (20/65)
62% (8/13)
44% (25/57)
46% (6/13)
% Part. help for drinking
W1 (ever)
W2 (past yr.)
25% (16/64)
25% (2/8)
22% (12/65)
43% (6/10)
% Part. hosp. for drinking
W1 (ever)
W2 (past yr.)
16% (9/64)
27% (4/15)
18% (8/54)
11% (1/9)
W1 & W2 Parent Outcomes: W1 & W2 Parent Outcomes: Interview Sample, Self ReportsInterview Sample, Self Reports
Enhanced Standard
% Clinically Depressed
W1
W2
38.2%
34.2
43.8%
34.4
% Heavy Drinking
W1
W2
27%
33%
53%
44%
% Past Year Hard Drug Use
W1
W2
45%
16%
55%
19%
W1 & W2 Parent Outcomes:W1 & W2 Parent Outcomes: Interview Sample, Self ReportsInterview Sample, Self Reports
Enhanced Standard
% Employed FT
W1
W2
33.3%
39.7
30.3%
25.7%*
%Enrolled Educ/Voc. Program
W2 28.2% 16.2%*
Next StepsNext Steps
Apply First Step model to additional district offices– Via IV-E waiver model, or– Alternate funding source
Develop statewide protocol that addresses co-occurrence of child maltreatment & substance abuse
Engage in training/awareness building among essential partners
Parental Substance Abuse and Child Parental Substance Abuse and Child Maltreatment: Evaluation Results From Maltreatment: Evaluation Results From
Project First StepProject First Step
Thank You for your advocacy
and service!