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Policy and Practice Options Related to Exit Issues Experimenting and Improving the Recovery Coach Model Joseph P. Ryan, Ph.D. Working Conference on Race and Child Welfare Cambridge, MA January 29, 2011. Background of Title IV-E AODA Demonstration.

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slide1

Policy and Practice Options Related to Exit Issues

Experimenting and Improving the Recovery Coach Model

Joseph P. Ryan, Ph.D.

Working Conference on Race and Child Welfare

Cambridge, MA January 29, 2011

background of title iv e aoda demonstration
Background of Title IV-E AODA Demonstration
  • 74% of foster care cases in Cook County had at least one parent required to get AOD treatment (GAO, 1998)
  • Parents had long term struggles with substance abuse problems (41% > 10 years)
  • Child welfare agencies had limited familiarity with AODA resources and few treatment slots - resulting in low admissions
  • Judges reported permanency decisions delayed due to lack of information on treatment progress
  • Low reunification rates, 14% of SEIs reunified after 7 years (Budde & Harden, 2003)
illinois aoda waiver project goals
Illinois AODA Waiver Project Goals

Increase family reunification and adoption

Decrease the time to family reunification and permanency

Increase treatment access and retention for AODA families

Increase permanency without increasing risk of subsequent maltreatment

  • How would these goals be accomplished? RECOVERY COACHES
    • Assist the parent 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
experimental design random assignment
Experimental Design (Random Assignment)

Conducted by JCAP

TC

AODA

assessment

Control Group

Demo Group

Child Welfare Case

Manager

Recovery Coach with

Child Welfare Case

Manager

slide5

64% of those screened are indicated for SA

43% of all TCs associated with SA

No difference by race

primary drug of choice
Primary Drug of Choice

Random assignment procedures worked to create equivalent groups

subsequent reports of maltreatment
Subsequent Reports of Maltreatment

Changes to

21% v. 15%

after 3 years

slide10

Permanency significantly Increases.

Yet substantial proportion of youth remain in care after 5 years.

47% control vs. 35% demonstration

experimental design random assignment1
Experimental Design (Random Assignment)

Time Lag

66% within 1 month

18% within 2 months

16% 3+ months

Conducted by JCAP

TC

AODA

assessment

Control Group

Demo Group

Child Welfare Case

Manager

Recovery Coach with

Child Welfare Case

Manager

slide14

Early Engagement is Critical to Treatment Success

  • Timely access is important to both treatment completion and family reunification (Green et al 2007)
  • Who are the families associated with the longest lag times?
    • No race or age effects
    • No group assignment effects
    • Single fathers increased lag (46% v. 66% vs. 75% within month)
    • Families with mental health issues increased lag (only 59% within month)
  • Cox regression models indicate both main effects and significant interactions between group assignment and timing of JCAP assessment
  • Group assignment by reunification by timing of assessment
    • Early Engagement (1 month) Control 21% vs. Experimental 30%
    • Moderate Engagement (2 months) Control 23% v. Experimental 20%
    • Delayed Engagement (3 + months) Control 21% v. Experimental 20%
slide15

17%

8%

slide16

11%

6%

slide17

6%

4%

slide18

Summary of Findings and Implications

  • Substance abuse indicated in 43% of temporary custodies
  • The Recovery Coach model increases reunification and adoption
  • Substantial proportion of youth remain in long term care (5 year follow up)
  • African American youth at increased risk of long term care
  • There exists a significant delay between TC and assessment
  • Only 66% of caregivers are screened for substance abuse within 30 days of TC
  • 16% experience at least a 3 month gap between TC and assessment
  • There is a clear need to speed up the entire process, drop predetermined LOS
  • Complex problems require innovation solutions – waivers provide opportunities for innovative approaches and rigorous evaluations