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Findings from the Illinois IV-E AODA Waiver

C hildren and F amily. Research Center. Findings from the Illinois IV-E AODA Waiver. State Liaison Officers’ Grantee Meeting Portland, OR April 17, 2007 Presenter: Ms. Rosie Gianforte, LCSW Illinois Department of Children and Family Services.

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Findings from the Illinois IV-E AODA Waiver

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  1. ChildrenandFamily Research Center Findings from the Illinois IV-E AODA Waiver State Liaison Officers’ Grantee Meeting Portland, OR April 17, 2007 Presenter: Ms. Rosie Gianforte, LCSW Illinois Department of Children and Family Services

  2. Illinois IV-E AODA Waiver Demonstration • The Illinois Department of Children and Family Services received approval from the U.S. Department of Health and Human Services (HHS) beginning in April 2000 to waive certain restrictions on the use of federal IV-B and IV-E funds to facilitate the demonstration of new approaches to the delivery of child welfare services. • The waiver allows the Department to provide enhanced alcohol and other drug abuse services to DCFS involved placement families in the Cook County catchment area.

  3. Impact of AODA on DCFS Court CasesGAO Report 1998 • 74% of Cook County DCFS cases had 1 or more parent required to get AOD treatment • 82% of mothers AOD histories greater than 5 years (41% > 10 years) • > 80% were primary heroin or cocaine abusers • Child welfare agencies had limited familiarity with AODA resources making admissions low • Judges reported permanency decisions delayed due to lack of information on treatment progress

  4. Foundations of the Waiver Project – Built on Existing Relationships • Existing DASA/DCFS Initiative Services, 1995 • Full range of treatment services • Expedited assessment and admission • Removal of barriers to treatment, I.e. childcare and transportation • Juvenile Court Assessment Project, 1999 • On site assessment services at Juvenile Court • Standardized assessment (DSM IV-R & ASAM) • Same day referral to treatment • Provide courts assessment results

  5. Illinois IV-E AODA Waiver Project Goals • Increase the number of AODA impacted foster care children that are safely reunified • Decrease the length of time it takes for safe reunification of AODA foster care cases • Increase the number of cases and the speed at which AODA impacted cases are moved to a permanency decision • Increase the number of DCFS involved individuals referred to AODA that remain in treatment for at least 90 days • Reduce the number of subsequent oral reports (SOR) of child abuse and neglect

  6. Eligibility and Random Assignment Just extended the number of days for eligibility to 180 days from TC Random assignment conducted based on the agency/team servicing the parent.

  7. Recovery Coach Role • Contracted through an independent agency (TASC) • Recovery Coaches: • Assist the parent(s) in obtaining AODA treatment services and negotiating departmental and judicial requirements associated with AODA recovery and permanency planning • Work in collaboration with the Child Welfare worker, AODA treatment provider and extended family members to bridge service gaps • Provide specialized outreach, intensive AODA case management & support services throughout the life of the case, before, during, and after treatment & reunification

  8. Specific Recovery Coach Interventions • Coordinate AOD planning efforts, arrange staffings, participate in family meetings • Provide ongoing assertive outreach and re-engagement efforts, i.e.…transportation to initial intake appointment • Assist in removing any barriers in engaging, retaining and re-engaging parents who have discontinued treatment • Provide ongoing assessments to evaluate the need for mental health, parenting, housing, domestic violence and family support services • Urinalysis testing • Standardized, regular (monthly) reporting to worker & the courts

  9. The Recovery Coach Organization Chart

  10. The Recovery Coach Profile • Recovery Coach Credentials: • Certified Alcohol & Drug Counselors (CADC) • Certified Assessment & Referral Specialists (CARS) • Some experience in Child Welfare • Bachelor Level Degree – Human Services Field • Supervised by Master Level Degree with Child Welfare & Substance Abuse Experience • Caseloads: Average 20 - 25 clients

  11. Evaluation of the Demonstration Eligibility: (1) foster care cases opened after April 2000, and (2) parents must be assessed at the Juvenile Court Assessment Program (JCAP) within 90 days of the temporary custody hearing Assignment: Substance abusing caregivers were randomly assigned to either the control (regular services) or demonstration group Treatment: Parents in the demonstration group received regular services plus intensive case management in the form of a Recovery Coach

  12. Evaluation of the Demonstration Research Questions • Are parents in the demonstration group more likely to access AODA treatment services compared with parents in the control group? • Do parents in the demonstration group access AODA treatment services more quickly compared with parents in the control group? • Are families in the demonstration group more likely to achieve family reunification and/or permanence compared with families in the control group? • Are families in the demonstration group less likely to be associated with subsequent reports of maltreatment? • Is the waiver demonstration cost neutral?

  13. Evaluation of the Demonstration As of June 30, 2006, 496 parents in control group (790 children) and 1,347 parents in the demonstration group (1,894 children).

  14. Treatment Participation Control = 52% Demonstration = 71% Data from three sources: caseworkers, AODA treatment providers and recovery coaches

  15. Time to First Treatment Episode

  16. Family Reunification & Permanence Group Assignment by Permanency Status (child level) as of June 2005 The difference between the proportion of children returning home is statistically significant

  17. Time to Family Reunification

  18. Subsequent Reports of Maltreatment Group Assignment Subsequent Reports totals No Yes Control 255 (70%) 111 (30%) 366 Demonstration 706 (75%) 237 (25%) 943 Totals 961 (73%) 348 (27%) 1309 (100%) The difference between the proportion of subsequent reports between the Control and Demo groups is statistically significant. As of June 2005

  19. Subsequent Substance Exposed Infants (SEI) Group Assignment Subsequent SEI totals No Yes Control 210 (80%) 51 (20%) 261 Demonstration 579 (86%) 91 (14%) 670 Totals 789 (85%) 142 (15%) 931 (100%) The difference between the proportion of subsequent SEI births between the Control and Demo groups is statistically significant. As of June 2005

  20. Cost Neutrality

  21. Additional Findings of Interest Domestic Violence 30% Mental Health 40% Housing 56% Reunification Substance Abuse Treatment Recovery Coach

  22. Enter page title here! • Co-occurring Problems and Reunification • The Problems and the Progress are Important

  23. Co-occurring Problems and Reunification The Problemsand the Progress are Important

  24. Co-occurring Problems and Reunification The Problemsand the Progressare Important

  25. Findings from Multivariate Models • Families unable to make sufficient progress in SA are 42% less likely to achieve reunification • Families unable to make sufficient progress in DV are 53% less likely to achieve reunification • Families unable to make sufficient progress in MH are 39% less likely to achieve reunification • No significant effect associate with housing

  26. Conclusions: • Families involved with the AODA waiver report a variety of co-occurring problems. • These problems decrease the likelihood of reunification. • Yet – when progress is achieved – the likelihood of achieving family reunification is significantly increased – especially with regard to MH and DV. • IV-E Extension: Integrated service model designed to increase treatment access and reunification targeting services to specific problem areas such as Domestic Violence, Mental Health and Housing.

  27. Lessons Learned • Outreach and early engagement are critical • Data systems and data collection aren’t exciting but they can be invaluable • The job of project awareness is never done • Seemingly unimportant factors can kill the project

  28. Lessons Learned (continued) • Juvenile Court Assessment Program (JCAP) – the project’s “secret weapon” • Evolution of Recovery Coaches from generalists to more specialized roles • Importance of Recovery Coach’s independence • Stability through the process • Ally for the parent • Driving force for system collaboration

  29. Project Extension-Cook County • Focus on co-occurring problems • Housing – provide housing resources and advocates to assist in securing safe homes. • Mental health – Implement a MH screen to assist in securing necessary services to address needs. • Domestic violence – collaborate with case worker to identify needs and secure appropriate services. • Stabilize families in drug free housing • Transition to subsidized and independent • Education/vocational supports to recovery

  30. Project Extension-Downstate • Expansion to 2 downstate counties • Assessment & Recovery Coach services to less urban less centralized setting • Integrate drug court model into process • Confront methamphetamine abuse and production in rural populations

  31. DCFS Contacts: • Sam Gillespie – AODA Services Manager • sam.gillespie@illinois.gov; 312-814-5483 • Rosie Gianforte – IV-E AODA Coordinator • rosie.gianforte@illinois.gov; 312-814-2440

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