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Final Evaluation of the Title IV-E Waiver Child Welfare Demonstration in New Hampshire

Final Evaluation of the Title IV-E Waiver Child Welfare Demonstration in New Hampshire. Ninth Annual Child Welfare Demonstration Projects Meeting June 2005 Glenda Kaufman Kantor, University of New Hampshire Bernie Bluhm, NH DCYF. State of New Hampshire Study Sample Sites.

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Final Evaluation of the Title IV-E Waiver Child Welfare Demonstration in New Hampshire

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  1. Final Evaluation of the Title IV-E Waiver Child Welfare Demonstration in New Hampshire Ninth Annual Child Welfare Demonstration Projects Meeting June 2005 Glenda Kaufman Kantor, University of New Hampshire Bernie Bluhm, NH DCYF

  2. State of New Hampshire Study Sample Sites

  3. Challenges of NH Environment

  4. Baseline Status of Substance Abuse in NH

  5. History: Higher Incidence of Problem Drinking NH Women Than National Average

  6. Current Status of NH Substance Abuse (2002) • 31% Past Month Illicit Drug Use • (18-25 yrs)– 2nd Highest in U.S. • 50% Past Month Binge Alcohol Use • (18-25 yrs)- 3rd Highest in U.S. • 21% Past Month Binge Alcohol Use • (26 yrs>) (National Average) • 300 children <17 living under court order in secure facilities due to D/A charges, related crimes (2001)

  7. Since 1994, less than 15% of NH CPS assessments completed each year have been substantiated (Founded).

  8. Key Project Aims • Identify & Address Parental Substance Abuse Problems co-occurring with suspected child abuse or neglect. • Better Decision-Making about Safety • Reduce Substance Abuse Risk Behaviors of Parents • Fewer Subsequent Founded Referrals • Prevent or Shorten Placement of Children in Foster Care • Improve Stability and Adjustment of Children • Cost Neutrality/Savings of Project

  9. Project Design

  10. Target Population • Credible report of suspected CA/N • Substance Abuse Current Risk Factor Related to CA/N • Reside in Hillsborough Co area covered by the Manchester/Nashua D.Os. • No Open Case at Intake into Study • Accessible to DCYF CPSW

  11. LADC Role • Engage Client at Time of Assessment of Allegation • Immediate Screening & Assessment by LADC • Immediate individual treatment for AODA • Immediate and ongoing consultation for CPSW

  12. For people awaiting treatment • Individual counseling • On-going contact with counselor • Treatment window extended 60 days from CPS assessment or case closure • Treatment provider connections

  13. For Families Receiving Services • Consultant participates in case planning • Keep focus on parent issues • Include parenting in treatment goals • Aftercare with focus on parenting • Support to relative caregivers

  14. 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

  15. 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

  16. Evaluation

  17. Evaluation Design • Experimental Model with True Randomized Design to Standard/Enhanced Services at 2 District Offices • Standard group received the usual services provided by NH DCYF • Parallel Data Collection for Standard and Enhanced • Process & Outcomes • SACWIS Data • Interviews at Baseline & Follow-up • Cost Benefit

  18. Final Evaluation Status • Conducted 11/15/99 through 10/15/04 • 437 families eligible • 212 baseline interviews (49%) • 156 follow-up interviews (74%)

  19. Enhanced Group (n=222): Mean Age: 33 Years % White: 92% Any Employment: 59% Relationship of Alleged Perp. to Child Bio. Mother 69% Mean Family Size Total Adults: 1.83 Total Children: 2.80 Standard Group (n=215): Mean Age: 33 Years % White: 90% Any Employment: 63% Relationship of Alleged Perp. to Child Bio. Mother: 72% Mean Family Size Total Adults: 1.85 Total Children: 2.84 Study Sample Demographics: Primary Caregiver

  20. Enhanced Group (n=222) Female: 51% Mean Age: 8 yrs. Median: 9 yrs. Range: 0-17 yrs. Ethnicity: White: 87% Black: 6% Latino/Hispanic: 5% Other: 2% Standard Group (n=215) Female: 51% Mean Age: 8 yrs. Median: 8 yrs. Range: 0-17 yrs. Ethnicity: White: 89% Black: 6% Latino/Hispanic: 2% Other: 3% Study Sample Demographics: Child

  21. Enhanced Group (n=222) CPS FactorsPrior Referrals* 44% High Risk at Entry 11% Type of Maltreatment Physical Abuse 25% Phys. Abuse & Negl. 13% Neglect: 52% Sexual Abuse: 3% Psychological Abuse: 1% Standard Group (n=215) CPS Factors Prior Referrals 51% High Risk at Entry 14% Type of Maltreatment Physical Abuse: 21% Phys. Abuse & Negl: 9% Neglect: 56% Sexual Abuse: 5% Psychological Abuse: 2% Maltreatment & CPS Factors

  22. Enhanced (n=222) Domestic Violence: 33% Adult Mental Illness: 18% Adult Phys. Disability: 4% Homeless: 17% Incarceration (Case Level): 32% Standard (n=215) Domestic Violence: 33% Adult Mental Illness: 20% Adult Phys. Disability: 7% Homeless: 14% Incarceration (Case Level): 28% Family Risk Factors

  23. Enhanced Group (n=222) Mental Illness: 6% Phys. Disability: 3% Learning Disabled 11% Neonatal Addiction: 2% Severe Behavior Prob. 5% JPPO* Involvement at Case Level 26% Standard Group (n=215) Mental Illness: 7% Phys. Disability: 5% Learning Disabled: 13% Neonatal Addiction: 1% Severe Behavior Prob. 9% JPPO* Involvement at Case Level 24% Child Risk Factors * DHHS Division for Juvenile Justice Services Juvenile Probation & Parole Officers, involved due to child status offenses or delinquency.

  24. Co-Morbidity in Interview Sample

  25. Victimization & Trauma Hx. Of Adult

  26. Probability of Having a Substance Dependence Disorder

  27. Co-Morbidity • 45% of “high-probability” have prior diagnosis of mental illness. • 45% of “high probability” have clinical levels of depression • 18% prior hx of mental illness documented in initial record data. • 45% Clinically Depressed using CESD measure.

  28. 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

  29. PROCESS EVALUATION

  30. Implementation Challenges • Engagement of Client & Timing • Randomization of LADC Services within Sites • District Office Cultures • Different Therapist Effects • Attrition of LADC & CPSWs • Need to build consensus between co-located systems • Information sharing/confidentiality • Focus on “Primary Client” • Treatment recommendations from different points of view • ASFA 12 month clock vs recovery clock

  31. LADC: Challenges of Engagement

  32. Challenges of Engagement

  33. Correct Assignment of Subsequent Referrals by Group & Site

  34. Percentage of Families Completed SASSI by Site

  35. Percent of Initial Referrals Founded by Group

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

  37. Manchester (n=27) Overall Satisfaction Satisfied: 52% Overall Satisfaction by Substantiation No Case Ever OpenedSatisfied: 40% Case Opened Satisfied: 67% Nashua (n=19) Overall Satisfaction Satisfied: 90% Overall Satisfaction by Substantiation No Case Ever OpenedSatisfied: 92% Case Opened Satisfied: 86% Client Satisfaction w/ LADC

  38. Mean Therapist Referrals for Clients After Initial Eval. by Site: 1 2 3 4 1,2,3,4 statistical significance found between sites: ANOVA p > .05

  39. Treatment Utilization

  40. Treatment Utilization by Group

  41. LADC: Networking

  42. LADC: Networking

  43. Outcomes

  44. Outcomes: Substance Abuse & Assessment

  45. Preliminary Findings on System Status 1999: Substance Abuse Incidence & Case Outcome • Review of NH Cases for 1 month= 640 Cases • 546 cases completed assessments • Substance Abuse documented as a factor in completed assessments =159/546 or 29% • Proportion of substance abuse referrals founded as cases=35/159 (22%)

  46. Project First Step:Substance Abuse as a Factor in Completed Assessments • 1999: Substance Abuse documented as a factor in completed assessments • 159/546 or 29% • 2004:Substance Abuse documented as a factor in completed assessments • 66% of Enhanced Group*** • 47% of Standard Group

  47. Substantiation by High Probability of Having a Substance Dependence Disorder Cases opened for continued services and/or placement directly supervised or paid by DCYF * Significant statistical difference found between substantiation: Chi Sq 9.51, 1df,p=.002

  48. Percentage of Cases Open on Subsequent Referral by Group & Site *Significant statistical difference found between groups within Manchester: Chi Sq. 1-Sided p (.036) > .05

  49. Subsequent Referrals* by Group *Referral: Report to NH DCYF based on a suspicion of child abuse or neglect. All NH citizens are mandated reporters.

  50. Characteristics of Child Placements

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