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

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

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. 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,

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

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

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

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

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

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

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

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

“[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

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

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%)

Percentage of Families Completed SASSI by Site

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.

Study Sample Characteristics: Trauma & Co-Morbidity

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.

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

Victimization & Trauma Hx. Of Adult

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

Respondents’ Past Year Drug Use (N=139)

Dispositions

Preliminary Outcomes by Group Enhanced (n=222) Standard (n=215) Founded Problem Resolved1.8%5.1% Unfounded Closed86.5%84.6% Founded New Case (Court)/ B- Case w/ Services 11.3%9.3% Incomplete0.0%0.9% Unfounded, Voluntary Case Opened 0.5%0.0%

Preliminary Outcomes of Initial Referrals by Group & Site Enhanced (n=222) Standard (n=215) Founded-Problem Resolved Manchester Nashua 0.9% 2.6% 5.4% 4.8% B Case Opened, Founded Manchester Nashua 4.7% 0.9% 1.9% DCYF Founded, Court Dismissed Manchester Nashua 0.0% 0.9% 1.0% Unfounded, Voluntary Services Manchester Nashua 0.9% 0.0% Founded-New Case Opened Manchester Nashua 11.3% 6.0% 6.3% 9.6% Unfounded-Closed Manchester Nashua 82.1% 89.7% 85.6% 81.7%

Percent of Initial Referrals Founded by Group

Final Founded Dispositions of Initial Referrals by Group & Site

Correct Assignment of Subsequent Referrals by Group & Site

Percentage of Cases Ever Open by Group & Site

Percentage of Cases Open on Subsequent Referral by Group

Enhanced (n= 228) Standard (n= 219) ANY SUBSEQUENT REFERRALS MEAN # SUBSEQUENT REFERRALS (“0” INCLUDED) 42.5% % 1.03 % & # CASES OPENED ON SUBSEQUENT REFERRALS 7.0% (16)9.13% (20) % & # SUBSEQUENT REFERRALS FOUNDED 11% (34)14.6% (43) Subsequent Referrals by Group

Subsequent Referrals by Group & Site EnhancedStandard ManchesterNashuaManchesterNashua ANY SUBSQ. REFERRALS MEAN # SUBSQ. REFERRALS, (“0” INCLUDED) 45.4% % % % 0.98 % & # CASES OPENED ON SUBSQ. REFERRALS 4.6% (5) 9.2% (11) 8.8% (10) 9.5% (10) % & # SUBSQ. REFERRALS FOUNDED 8.3% (13) 13.6% (21) 14.9% (21) 14.3% (22)

Characteristics of Child Placements

In-Home Services for Families with Cases by Group IN-HOME SERVICES*EnhancedStandard % FAM. ANY IN-HOME SERVICE MEAN # FAM W/ IN-HOME SERVICE (“0” INCLUDED) # OF FAM. RECEIVING IN-HOME SERVICES W/ A VOLUNTARY/B-CASE 12.5% % * 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.

Out of Home Placement (OHP) Types by Group EnhancedStandard KIN CARE % FAM. ANY KIN CARE MEAN # FAM. W/ KIN CARE (“O” INCLUDED) 18.7% % 0.21 FOSTER CARE % FAM. ANY FOSTER CARE MEAN # FAM W/ FOSTER CARE (“0” INCLUDED) 58.3% % 2.72 OTHER OHP % FAM. ANY OHP MEAN # FAM W/ OHP (“0” INCLUDED) 22.9% % 0.68

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

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

Mean Number of Placements per Family by Group & Site

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

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

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

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

Percentage of Families with TPR by Group

Percentage of Families with TPR by Group & Site

Mean Length to TPR by Group

Mean Length to TPR by Group & Site

Child Outcomes

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

Cost Neutrality

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

Treatment Utilization & Caretaker Outcomes

Wave 2 Counseling & Treatment Utilization Ever-Open Cases: Interview Sample Referral Made Attended >1X %Referrals Completed/ Ongoing RX Counseling Standard Enhanced 70% (7/10) 63% ( 12/19) 86% (6/7) 67% (8/12) 50% (5/10) 67% (8/12) Substance Abuse RX Standard Enhanced 40% (4/10) 59% (10/17) 100% (4/4) 88% (10/17) 30% (3/10) 50% (5/10)

W1 & W2 RX Utilization by Groups: Interview Sample, Self Reports EnhancedStandard % Resp. attend AA W1 (ever) W2 (past yr.) 40% (45/112) 69% (19/28) 43% (43/100) 45% (10/22) % Resp. help for drinking W1 (ever) W2 (past yr.) 25% (28/112) 48% (11/23) 32% (32/100) 43% (6/14) % Resp. hosp. for drinking W1 (ever) W2 (past yr.) 16% (18/112) 27% (4/15) 18% (18/100) 11% (1/9)

W1 & W2 RX Utilization by Groups: Interview Sample, R. Reports on Partner EnhancedStandard % Part. attend AA W1 (ever) W2 (past yr.) 31% (20/65) 62% (8/13) 44% (25/57) 46% (6/13) % Part. help for drinking W1 (ever) W2 (past yr.) 25% (16/64) 25% (2/8) 22% (12/65) 43% (6/10) % Part. hosp. for drinking W1 (ever) W2 (past yr.) 16% (9/64) 27% (4/15) 18% (8/54) 11% (1/9)

W1 & W2 Parent Outcomes: Interview Sample, Self Reports EnhancedStandard % Clinically Depressed W1 W2 38.2% % 34.4 % Heavy Drinking W1 W2 27% 33% 53% 44% % Past Year Hard Drug Use W1 W2 45% 16% 55% 19%

W1 & W2 Parent Outcomes: Interview Sample, Self Reports EnhancedStandard % Employed FT W1 W2 33.3% % 25.7%* %Enrolled Educ/Voc. Program W228.2%16.2%*

Next Steps Apply First Step model to additional district offices –Via IV-E waiver model, or –Alternate funding source Develop statewide protocol that addresses co-occurrence of child maltreatment & substance abuse Engage in training/awareness building among essential partners

Parental Substance Abuse and Child Maltreatment: Evaluation Results From Project First Step Thank You for your advocacy and service!