Project First Step: Approaches to Co-occurrence of Child Maltreatment & Substance Abuse in New Hampshire Natl. Conference on Substance Abuse, Child Welfare & the Courts Jan Glenda Kaufman Kantor, UNH, Bernie Bluhm, NH DCYF

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, NH DHHS, Children, Youth, & Families

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

Project design Abuse/Neglect reports to the most populous Co in NH (2 Offices). Substance Abuse ID’d as Current Risk Factor LADC services provided up front, prior to substantiation/placement. Random selection: Control/Exp groups maintained for five yrs.

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

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

Evaluation Design Experimental Model with True Randomized Design to Standard/Enhanced Services at 2 District Offices “Enhanced Group”: LADC + CPS “Standard Group”: Received the usual services provided by NH DCYF UNH-FRL Eval. Team – Conducted confidential interviews with parents in both groups. – Analyzed case records, SACWIS data, LADC records. – Process & Outcomes data Cost Benefit (In terms of IV-E Dollars)

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

Study Sample Demographics: Primary Caregiver 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

Maltreatment & CPS Factors Enhanced Group (n=222) CPS Factors Prior 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%

Co-Morbidity in Interview Sample

Victimization & Trauma Hx. Of Adult

Probability of Having a Substance Dependence Disorder SASSI)

Association Between Partners’ Substance Abuse Patterns 70% of women reporting heavy alcohol use, reported similar heavy use by partners (p<.01) Intimate partners’ drug use is significantly correlated (p<.001) Heavy drinking women are significantly more likely to have partners who use illicit drugs (p=.06)

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

Outcomes

Outcomes: Substance Abuse & Assessment

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

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

Women’s Treatment Utilization by Groups (Interview Sample) EnhancedStandard % Attend AA T1 (ever) T2 (past yr.) 41% (40/97) 66% (19/29) 45% (39/87) 44% (10/23) % Help for drinking T1 (ever) T2 (past yr.) 24% (23/97) 48% (11/23) 32% (32/100) 43% (6/14) % Hospitalization for drinking T1 (ever) T2 (past yr.) 16% (15/97) 28% (4/14) 18% (18/100) 11% (1/9)

Treatment Utilization by Group

ADULT OUTCOMES

Women’s Education & Employment by Group ( Interview Sample, Self Reports ) EnhancedStandard % Employed FT T1 T2 30% 38% 28% 24%* %Enrolled Educ./Voc. Program T228%17%

Case (Child Safety) Outcomes

Percentage of Cases Founded (Substantiated) on Subsequent Referral by Group & Site *Significant statistical difference found between groups within Site A: Chi Sq. p <.05

Out of Home Placement (OHP) Types by Group EnhancedStandard KIN CARE % FAM. ANY KIN CARE MEAN # FAM. W/ Children in KIN CARE 22% % 0.24 FOSTER CARE % FAM. ANY FOSTER CARE MEAN # Child Placements for FAM. W/ FOSTER CARE Placements 63% % 2.72

Mean Number of Placements per Child in Placement by Group & Site

Mean Length to TPR by Group

Child Outcomes

Child Outcomes for Index Children ages 4-17 Children in Enhanced Groups had greater declines in 7 of 8 problem categories: –Anxiety & Depression –Withdrawn/Depressed –Somatic Problems –Attention Problems –Aggressive Behavior

Child School & Health Outcomes Enhanced Group – Repeated Grade* 10% – Academic/Other School Problems 39% – MD concerns re: health 11% Standard Group – Repeated Grade* 29% – Academic/Other School Problems 43% – MD concerns re: health 14%

Conclusions Key Outcomes – Significant Effects of Assessment – Strengths of Effects Diminished by Site Differences – More Long-Term Substance Abuse Treatment of Adults – Child Safety Outcomes: fewer subsequent founded reports, more stability, decrease in time to TPR – Improved Well Being for Adults & Children

First Step Program: Post IV-E Waiver Demo March 2005 Two largest district offices (Manchester & Nashua) composing 25% of the statewide caseload of abuse/neglect assessments. Additional region (Central NH) to be added, increasing First Step to 33% of statewide caseload.

Funding considerations: PSSF & CAPTA

First Step Program: Post IV-E Waiver Demo Local child protection supervisor links LADC and CPSW when: – Child Abuse/Neglect report approved for face:face assessment (Investigation) + – Parental substance abuse id’d as a factor. LADC involved as: – CPSW consult, – AODA Assessment, Treatment, Case Management

Based on two month snapshot, Manchester: Nov-Dec 2006

Overview of Treatment Recommendations LADC provides direct treatment and case management: Goal is community based treatment

NH Dept. of Health & Human Services Children, Youth, & Families Thank You! University of New Hampshire Family Research Lab