Parental Substance Abuse & Child Maltreatment Evaluation Results From

1. 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

2. Barriers to effective treatment • Limited services • Wait lists for in-patient and out-patient • Focus on the substance abuse recovery doesn’t address family and parenting issues • Client Minimization • Readiness to Change • Co-Morbidity

3. 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 Original project assumptions • 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.

4. Initial selection at Intake Intake Assessment Call Received Screened Out Credible Report: No Identified Substance Abuse Credible Report + Identified Substance Abuse

5. Family 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

6. Enhanced Services • Consult with L.A.D.A.C. and supervisor • CPS + consultant meet with family

7. Goal 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

8. Benefits 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

9. For people awaiting treatment • Individual counseling • On-going contact with counselor • Treatment Window extended 60 days • Treatment Provider connections

10. For families receiving services • Consultant participates in case planning • Keep focus on parent issues • Include parenting in treatment goals • Aftercare with focus on parenting

11. Benefits to CPS during assessment • Regular Consultation • Preliminary screening (SASSI) of parental substance abuse • Impact of parental substance abuse on safety and risk of harm to children • Recommendations for services and treatment

12. “[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

13. Benefits for CPS cases when children are in out-of-home care • Comprehensive assessment with DX • Assistance with goal specific case planning • Continued consultation • Recommendations for parents and children

14. Current 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%)

15. Percentage of Families Completed SASSI by Site

16. Status of SA Assessment among Enhanced 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.

17. Study Sample Characteristics: Trauma & Co-Morbidity

18. Co-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.

19. Domestic Violence in Initial CPS Study Referrals • Over half (58%) had a prior Order of Protection at some time • Over 1/3 report DV in current year • 19% got a protective order on current partner in the past

20. Victimization & Trauma Hx. Of Adult

21. Alcohol Abuse History in Initial CPS 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

22. Respondents’ Past Year Drug Use (N=139)

23. Dispositions

24. Preliminary Outcomes by Group

25. Preliminary Outcomes of Initial Referrals by Group & Site

26. Percent of Initial Referrals Founded by Group

27. Final Founded Dispositions of Initial Referrals by Group & Site

28. Correct Assignment of Subsequent Referrals by Group & Site

29. Percentage of Cases Ever Open by Group & Site

30. Percentage of Cases Open on Subsequent Referral by Group

31. Subsequent Referrals by Group

32. Subsequent Referrals by Group & Site

33. Characteristics of Child Placements

34. In-Home Services for Families with Cases by Group * 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.

35. Out of Home Placement (OHP) Types by Group

36. Mean Number of Days in Placement per Family (Includes all Children) by Group & Site

37. Mean # of Days in Placement per Family (Includes all Children) by LADAC Engaged Groups & Site

38. Mean Number of Placements per Family by Group & Site

39. Mean Number of Placements per Family by LADAC Engaged Groups & Site

40. Mean Number of Children in Placement per Family by LADAC Engaged Groups & Site

41. Percentage of Families with Children in Placement by LADAC Engaged Groups & Site

42. Mean Number of Placements per Child in Placement by LADAC Engaged Groups & Site

43. Percentage of Families with TPR by Group

44. Percentage of Families with TPR by Group & Site

45. Mean Length to TPR by Group

46. Mean Length to TPR by Group & Site

47. Child Outcomes

48. Preliminary Child Outcomes for 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

49. Cost Neutrality

50. Population measured includes all children involved in “Founded/Open” Cases