Multi-System Families in Illinois

1. Multi-System Families in Illinois Robert M. Goerge January 27, 2010 Illinois Child Welfare Data Summit: 1st Annual Leadership Summit

2. The Multi-System Family Study • Overview and highlights • Approach • Findings • Future directions

3. Overview Study rationale • The State believes that a small number of families in Illinois use a large portion of the State’s service resources. • If the State could understand where these families are and what services they are using, the State could provide more adequate and efficient services. Major problems identified for study • Mental health service, claimed through Medicaid • Substance abuse treatment, claimed through Medicaid • Adult incarceration • Juvenile incarceration • Foster care

4. Definitions Definition of a “family” • Households whose members were recipients of Food Stamps, TANF grants or were eligible for Medicaid, or whose members were involved in a DCFS case Definition of a “problem” • An instance of mental health service, substance abuse treatment, adult incarceration, juvenile incarceration, or foster care placement. Definition of a “Multi-System Family” • A family whose members had at least two different types of problems (e.g. adult incarceration and substance abuse)

5. Highlights of Findings • 23 percent of the sample were Multi-System Families (MSFs) • Multi-System Families accounted for 63 percent of the total number of problems • 1 in 15 households with children are a MSF • Mental health service is very common in Multi-System Families

6. Families with multiple problems Families with one problem Families with no problems Multi-System Families Account for a Large Proportion of the Problems and Expenditures

7. Chapin Hall Multi-service dataset Chapin Hall Linked Separate Program Data across Illinois Departments Children and Family Services CANTS child abuse and neglect and CYCIS foster care records 1977-2008 Healthcare and Family Services Mental health and substance abuse Medicaid paid claims from 1994-2008* Human Services Individuals who were members in cases with women ages 18-45 who were food stamp recipients in 2007 or 2008 Corrections Adult and juvenile admissions and exits from 1990-2008 *No adult claims prior to 1995

8. Not all Agency Records were Linked to Families The smallest proportion of records included is that of adult incarceration where the population is predominantly male.

9. Mental Health Service was the Most Common Problem (Total number of problems=465,036)* 220,878 *The total number of problems (465,036) exceeds the total number of families with problems (285,722) because some families have multiple problems.

10. Mental Health Services were Common, Especially among Families with Multiple Problems Families with one or more problems Families with multiple problems Did not receive mental health service Did not receive mental health service Received mental health service Received mental health service 100% = 285,722 families 100% = 114,355 families

11. MSFsreceiving mental health service (94%) MSFsreceiving substance abuse treatment (60%) 58% of multi-problem families had both Many MSFs received both Mental Health Service and Substance Abuse Treatment Co-incidence of mental health service and foster care Co-incidence of mental health service and substance abuse treatment MSFsreceiving mental health service (94%) MSFswith member in foster care (53%) 49% of multi-problem families had both Mental health service and foster care was also a common combination. 100% = 114,355 families

12. ManyMSFsreceived Inpatient andOutpatient Mental Health Service and Substance Abuse Treatment 54% of families receiving any mental health service received both inpatient and outpatient services. 57,663 = 54% 107,755 42% of families receiving any substance abuse treatment received both inpatient and outpatient services. 28,940 = 42% 68,486 *Inpatient and outpatient treatment may have been received by different individuals within the same family.

13. Incarceration, Substance Abuse Treatment, and Foster Care were also Common in Multi-System Families *The percentages in the “Percent of All Families” column do not total 100% because families with no problems are not included. **The percentages in the “Percent of Families with Multiple Problems” columns do not total 100% because families with multiple problems are counted once for each problem they have.

14. DCFS incidence findings For foster care, roughly 2/3 of all new placements into foster care in calendar 2008 were from multi-system families 30 percent of the children in families with indicated investigations during FY2008 were from multi-system families

15. Abuse and Neglect and Violent Injuries often go Hand-in-hand in Multi-System Families (TotalMSFs= 114,355) 41% of Multi-System Families had both abuse or neglect findings and an instance of violent injury (46,444) 49% ofMSFshad an instance of violent injury (55,471) 73% ofMSFshad an abuse or neglect finding (83,944) Violent injury incidents correspond to Medicaid paid claims for CCS codes for injury due to violence and those ICD-9 codes that were found to be highly indicative of abuse, neglect or violence.

16. In all Counties,MSFswith Abuse/Neglect Finding were more likely to have a Member with an Episode of Juvenile Incarceration (N=490,128)* 3,834 3,151 614 594 Abuse / Neglect Finding** No Abuse / Neglect Finding *Of the 502,165 families in the sample, only 490,128 had county of residence recorded. **The family member incarcerated is not necessarily the same member responsible for the abuse or neglect.

17. Multi-System Families: Future Research Directions Potential research area Benefit Multi-problem families by neighborhood Recent problems Individual vs. family problems Magnitude of problems Additional service problems • Identifying neighborhoods with high concentrations of problems • Discovering the problems that may have the greatest impact on the current state of the family • Revealing whether single individuals account for multiple problems within a family or whether several family members encounter problems • Delineating between families that have had few service spells versus families with multiple service spells. • Estimating the cost of providing state services to multi-problem families. • Asthma/chronic conditions • Additional mental health service and substance abuse treatment from DHS

21. Identifying Multi-System Families Family 1 DHS: Cases with women age 18-45 who received food stamps in 2007-2008 DHS Supercases: Cases with members in common merged DCFS Supercases: Cases with members in common merged DHS-DCFS Families DCFS: All cases Julie Kyle Julie Kyle Julie Kyle Gillian Henry Gillian Henry Gillian Henry Bill Alice Opal Clarice Alice Bill Bill Alice Alice Bill Bill Clarice Clarice Nancy Nancy Opal Alice Frank Opal Frank Frank Nancy Clarice Frank Alice Frank 3 4 2 2 1 Family with no problems Julie Kyle Family with one problem Gillian Henry Substance abuse treatment Bill Foster care Multi-problem family (family with 4 unique problems) Alice Nancy Foster care Frank Incarceration Opal Clarice Juvenile detention Substance abuse treatment Case Creation Steps Select cases by criteria Link individuals within agencies Link cases across agencies Link service records to families 1 2 3 4