“It’s All About the Data” The Interface of Evaluation, Program Development, and Partnership to Address Substance Abuse and Reduce Child Abuse and Neglect

Introductions Pat Mangan, Birth & Beyond Program Manager, Sacramento County Department of Health and Human Services Michele McGibbon, LPC Consulting Associates, Inc.

Agenda Program Model: What is Birth & Beyond? Who Does Birth & Beyond Serve? Success Reducing Child Abuse & Neglect Need for Substance Abuse Services Relationship between CAN & Substance Abuse Integrating Substance Abuse Services (partners) Use of First 5-funded Substance Abuse Services Challenges & Lessons Learned

Program Model: What is Birth & Beyond

Historical Context 1997Tragedies precipitate prevention Sacramento County Board of Supervisors authorizes Family Support Collaborative Department of Health and Human Services (DHHS) leadership 1999/00 Birth & Beyond (B&B) begins, with evaluation contract 2002 First 5 funding and FRC expansion Decline in Child Protective Services (CPS) reports for B&B families 2004First 5 funding and focus on substance abuse 2005Child deaths reduced, credit to B&B

What is Birth & Beyond? Home visiting, ABC/CalSAHF & HFA Integrated Team Case Management: Multi-Disciplinary Teams Center-based services: 8 Family Resource Centers (target neighborhoods) Capacity for 1,600 home visiting families (10 home visitors x 20 families x 8 sites) FRC classes, workshops, community development Parent involvement and leadership Participatory Evaluation & Quality Assurance

Multi-Disciplinary Team In Home Services Family Resource Center Systematic Screening and Assessment Intensive Home Visiting Center Based Services Intensive Training and Supervision Caseloads Limits Multi-disciplinary Team BIRTH & BEYOND PROGRAM COMPONENTS Evaluation & Quality Assurance

How the Evaluation Supports Birth & Beyond Participatory evaluation since program began Logic models and capacity building Database and monthly census, outcomes Reports to funding sources Troubleshooting and trends analysis Quality Assurance and Model Fidelity “It’s All About the Data;” training and technical support Analysis of CPS Outcomes

Who Does Birth & Beyond Serve?

Family Demographics 2,183 families had an open home visitation case at least one day during the year (7/1/05 – 6/30/06). Families had 4,340 children; 75 percent of children were age 0-5 Birth & Beyond strives to serve the entire community, seeks culturally & linguistically representative staff. 49% Hispanic; 19% African American; 16% Caucasian; 6% Asian/Pacific Islanders

Family Demographics B&B serves many first time parents who are young single parents, mostly young women. 73% under the age of 30; 24% between 30 and 39; 3% are 40 years or older 40% never married; 39% married; 14% live with a partner 44% have less than a high school diploma; 30% high school diploma or GED; 22% have education beyond high school.

Top 10 Outcomes Decreased Child Abuse and Neglect Immunizations Breastfeeding Health Screenings Improved Employment Readiness Child Development Knowledge of School Enrollment Improved Parenting Skills Environmental & Home Safety Prenatal Care

Success Reducing Child Abuse and Neglect

CPS Follow Up Study: Approach Annual follow-up Selection criteria: ≥90 days, ≥6 home visits, ≥ 300 minutes of direct service, closed cases 300 in 2001; 1,472 in 2002; 1,839 in 2003; 1,863 in 2004 & 2,410 in : differentiated between abuse & neglect; introduced more comprehensive demographic & risk analysis 2005: introduced matched sample comparison group of families with less than a minimum level of service

CPS Outcomes ,410 (closed) families

Need for Substance Abuse Services

Modified CAGE replaced the AUDIT and the DAST in 2003 to identify substance abuse risk. 2,913 families completed one or more Modified CAGE assessments between 7/1/03 – 9/30/06 Modified CAGE is completed at intake and every 6 months thereafter 15%(428 families ) responded "yes" to one or more questions on at least one Modified CAGE, indicating a risk of substance abuse

Modified CAGE 2,913 families completed one or more Modified CAGE assessments between 7/1/03 – 9/30/06 15% (428 families) responded "yes" to one or more questions C= cut down A= annoyed G= guilty E= eye opener

Relationship Between Child Abuse and Neglect and Substance Abuse

CAGE CPS 24% of families with a substantiated CPS record showed risk 8% of families with no CPS record showed risk on the Modified CAGE

Integrating Substance Abuse Services through Partnerships

Interface with Substance Abuse Providers Funding support from First 5 Providers: County AOD and Community Agency (Bridges) AOD representation on Multi-Disciplinary Teams AOD Pre-Treatment Groups/Classes at FRCs Referrals for Motivational Interviews Philosophy of “Any Door to Services” Offer Anonymous groups (AA, NA) at FRCs

Any Door to Services

Sample Referral Form

Challenges and Lessons Learned

Challenges CULTURE SHIFT: Adding a new component in addition to Parenting Support required staff education and support. Program staff need time and support to buy into providing neighborhood-based Pre-Treatment Groups. Difficult to gather follow-up information from providers about treatment and/or aftercare services. There can be a stigma on the classes until a family actually attends; there can be a challenge getting families to attend the first few meetings. However, many families are consistent after the first few sessions. Families do not always utilize referrals.

Lessons Learned Families will engage with Pre-Treatment Groups offered in a Family Resource Center. Offering Play Care is critical for families’ attendance. Program has highlighted need for more intensive (residential) community-based treatment services, especially that allow children. Evaluation can demonstrate the link between the risk of substance abuse and the risk of child abuse and neglect.

Questions & Future Contacts Pat Mangan, Birth & Beyond Program Manager, Sacramento County Department of Health and Human Services Michele McGibbon, LPC Consulting Associates, Inc.