Transcript Findings From the Illinois AODA IV-E Waiver

Children and Family
Research Center
Findings from the Illinois
IV-E AODA Waiver
State Liaison Officers’ Grantee Meeting
Portland, OR
April 17, 2007
Presenter:
Ms. Rosie Gianforte, LCSW
Illinois Department of Children and Family Services
Illinois IV-E AODA Waiver Demonstration
 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
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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

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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 AODA Project
Temporary Custody granted to DCFS
JCAP Assesment
Conducted within 90 days of TC
Cook County Case
Control Group
DCFS services
(500 clients)
Just extended the
number of days for
eligibility to 180 days
from TC
Demo Group
DCFS services
work in tandem with
Recovery Coach (1,000 clients)
Random assignment conducted based on the agency/team
servicing the parent.
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,
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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 reengaging 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 Teams
Program Administrator
Clinical Supervisor
Senior Recovery
Coach
Recovery
Coach
Recovery
Coach
Recovery
Coach
Tracker
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?
Evaluation of the Demonstration
As of June 30, 2006, 496 parents in control group (790 children)
and 1,347 parents in the demonstration group (1,894
children).
Parent Characteristics
Demo
Control
African American
83%
80%
White
11%
14%
Unemployed
75%
72%
Previous Substance Exposed Infant
66%
64%
35
36
Primary Drug Cocaine
36%
35%
Primary Drug Heroin
24%
24%
Primary Drug Alcohol
18%
19%
Age of Youngest Parent
Treatment Participation
Control = 52%
Demonstration = 71%
Data from three sources: caseworkers, AODA treatment providers and recovery coaches
80%
70%
Control
60%
Demo
50%
40%
30%
20%
10%
0%
Participated
in Tx
Never in Tx
Unknown No Record
Time to First Treatment Episode
Time to First Substance Abuse Service (DARTS), June 2005 (caregiver level)
1
0.9
70% after
4 months
0.8
proportion reunified
0.7
70% after
11 months
0.6
0.5
0.4
0.3
control
demonstration
0.2
0.1
0
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
Family Reunification & Permanence
Group Assignment by Permanency Status (child level) as of June 2005
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%)
297 (37%)
739 (40%)
Permanency Totals
The difference between the proportion of children returning home is
statistically significant
Time to Family Reunification
Time to Reunification (Home of Parent), June 2005 (child level)
0.2
control
proportion reunified
demonstration
9% at
18 months
0.1
4% at
18 months
0
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 betw een jcap and fam ily reunification
Subsequent Reports of Maltreatment
Group Assignment
Subsequent Reports
totals
No
Yes
Control
255 (70%)
111 (30%)
366
Demonstration
706 (75%)
237 (25%)
943
348 (27%)
1309 (100%)
Totals 961 (73%)
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 SEI
totals
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

Total IV-E AODA Claim savings/loss: Includes all foster care
and adoption claims as of September 2006
$5,615,534.57
$6,000,000.00
$5,021,917.77
$5,000,000.00
$3,920,816.37
$4,000,000.00
$3,000,000.00
$1,344,355.34
$2,000,000.00
$1,000,000.00
$(9,322.21)
$$(1,000,000.00)
Sep. '02
Sep. '03
Sep. '04
Sep. '05
Sep. '06
Additional Findings of Interest
Domestic Violence 30%
Mental Health 40%
Housing 56%
Substance Abuse
Treatment
Recovery Coach
Reunification
Enter
pageProblems
title here!
Co-occurring
and Reunification
The Problems and the Progress are Important
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%
Co-occurring Problems and Reunification
The Problems and the Progress are Important
Problem Area
% progress
Not Reunified
Reunified
Complete
18%
74%
26%
Substantial
24%
87%
13%
Reasonable effort
15%
91%
9%
Unsatisfactory
43%
93%
7%
Complete
15%
75%
25%
Substantial
9%
76%
24%
Reasonable effort
18%
90%
10%
Unsatisfactory
58%
95%
5%
Substance Abuse
Domestic Violence
Co-occurring Problems and Reunification
The Problems and the Progress are Important
Problem Area
% progress
Not Reunified
Reunified
Complete
10%
69%
31%
Substantial
13%
83%
17%
Reasonable effort
22%
88%
12%
Unsatisfactory
55%
93%
7%
Complete
5%
58%
42%
Substantial
18%
88%
13%
Reasonable effort
20%
92%
8%
Unsatisfactory
56%
93%
7%
Housing
Mental Health
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
Conclusions:
 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.
Lessons Learned
Outreach and early engagement are
critical
Data systems and data collection aren’t
exciting but they can be invaluable
The job of project awareness is never
done
Seemingly 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 roles
Importance of Recovery Coach’s
independence
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Stability through the process
Ally for the parent
Driving force for system collaboration
Project Extension-Cook County
Focus on co-occurring problems
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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
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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 setting
Integrate drug court model into process
Confront methamphetamine abuse and
production in rural populations
DCFS Contacts:
Sam Gillespie – AODA Services Manager
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[email protected]; 312-814-5483
Rosie Gianforte – IV-E AODA
Coordinator
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[email protected]; 312-814-2440