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Final Evaluation of the Title IV-E Waiver Child Welfare Demonstration in New Hampshire. Ninth Annual Child Welfare Demonstration Projects Meeting June 2005 Glenda Kaufman Kantor, University of New Hampshire Bernie Bluhm, NH DCYF. State of New Hampshire Study Sample Sites.

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slide1

Final Evaluation of the Title IV-E Waiver Child Welfare Demonstration in New Hampshire

Ninth Annual Child Welfare

Demonstration Projects Meeting

June 2005

Glenda Kaufman Kantor, University of New Hampshire

Bernie Bluhm, NH DCYF

current status of nh substance abuse 2002
Current Status of NH Substance Abuse (2002)
  • 31% Past Month Illicit Drug Use
    • (18-25 yrs)– 2nd Highest in U.S.
  • 50% Past Month Binge Alcohol Use
    • (18-25 yrs)- 3rd Highest in U.S.
  • 21% Past Month Binge Alcohol Use
    • (26 yrs>) (National Average)
  • 300 children <17 living under court order in secure facilities due to D/A charges, related crimes (2001)
slide7

Since 1994, less than 15% of NH CPS assessments completed each year have been substantiated (Founded).

key project aims
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
target population
Target Population
  • Credible report of suspected CA/N
  • Substance Abuse Current Risk Factor Related to CA/N
  • Reside in Hillsborough Co area covered by the Manchester/Nashua D.Os.
  • No Open Case at Intake into Study
  • Accessible to DCYF CPSW
ladc role
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
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
for families receiving services
For Families Receiving Services
  • Consultant participates in case planning
  • Keep focus on parent issues
  • Include parenting in treatment goals
  • Aftercare with focus on parenting
  • Support to relative caregivers
benefits to cps during assessment
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
benefits for cps cases when children are in out of home care
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
evaluation design
Evaluation Design
  • Experimental Model with True Randomized Design to Standard/Enhanced Services at 2 District Offices
  • Standard group received the usual services provided by NH DCYF
  • Parallel Data Collection for Standard and Enhanced
  • Process & Outcomes
  • SACWIS Data
  • Interviews at Baseline & Follow-up
  • Cost Benefit
final evaluation status
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

Study Sample Demographics: Primary Caregiver
study sample demographics child
Enhanced Group (n=222)

Female: 51%

Mean Age: 8 yrs. Median: 9 yrs. Range: 0-17 yrs.

Ethnicity: White: 87% Black: 6% Latino/Hispanic: 5% Other: 2%

Standard Group (n=215)

Female: 51%

Mean Age: 8 yrs. Median: 8 yrs. Range: 0-17 yrs.

Ethnicity: White: 89% Black: 6% Latino/Hispanic: 2% Other: 3%

Study Sample Demographics: Child
maltreatment cps factors
Enhanced Group (n=222)

CPS FactorsPrior 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%

Maltreatment & CPS Factors
family risk factors
Enhanced (n=222)

Domestic Violence: 33%

Adult Mental Illness: 18%

Adult Phys. Disability: 4%

Homeless: 17%

Incarceration (Case Level): 32%

Standard (n=215)

Domestic Violence: 33%

Adult Mental Illness: 20%

Adult Phys. Disability: 7%

Homeless: 14%

Incarceration (Case Level): 28%

Family Risk Factors
child risk factors
Enhanced Group (n=222)

Mental Illness: 6%

Phys. Disability: 3%

Learning Disabled 11%

Neonatal Addiction: 2%

Severe Behavior Prob. 5%

JPPO* Involvement

at Case Level 26%

Standard Group (n=215)

Mental Illness: 7%

Phys. Disability: 5%

Learning Disabled: 13%

Neonatal Addiction: 1%

Severe Behavior Prob. 9%

JPPO* Involvement at

Case Level 24%

Child Risk Factors

* DHHS Division for Juvenile Justice Services Juvenile Probation & Parole Officers, involved due to child status offenses or delinquency.

co morbidity
Co-Morbidity
  • 45% of “high-probability” have prior diagnosis of mental illness.
  • 45% of “high probability” have clinical levels of depression
  • 18% prior hx of mental illness documented in initial record data.
  • 45% Clinically Depressed using CESD measure.
domestic violence in initial cps study referrals
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
implementation challenges
Implementation Challenges
  • Engagement of Client & Timing
  • Randomization of LADC Services within Sites
  • District Office Cultures
  • Different Therapist Effects
  • Attrition of LADC & CPSWs
  • Need to build consensus between co-located systems
    • Information sharing/confidentiality
    • Focus on “Primary Client”
    • Treatment recommendations from different points of view
    • ASFA 12 month clock vs recovery clock
client satisfaction w ladc
Manchester (n=27)

Overall Satisfaction Satisfied: 52%

Overall Satisfaction by Substantiation

No Case Ever OpenedSatisfied: 40%

Case Opened Satisfied: 67%

Nashua (n=19)

Overall Satisfaction Satisfied: 90%

Overall Satisfaction by Substantiation

No Case Ever OpenedSatisfied: 92%

Case Opened Satisfied: 86%

Client Satisfaction w/ LADC
mean therapist referrals for clients after initial eval by site
Mean Therapist Referrals for Clients After Initial Eval. by Site:

1

2

3

4

1,2,3,4 statistical significance found between sites: ANOVA p > .05

preliminary findings on system status 1999 substance abuse incidence case outcome
Preliminary Findings on System Status 1999: Substance Abuse Incidence & Case Outcome
  • Review of NH Cases for 1 month= 640 Cases
  • 546 cases completed assessments
  • Substance Abuse documented as a factor in completed assessments =159/546 or 29%
  • Proportion of substance abuse referrals founded as cases=35/159 (22%)
project first step substance abuse as a factor in completed assessments
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
Substantiation by High Probability of Having a Substance Dependence Disorder

Cases opened for continued services and/or placement directly supervised or paid by DCYF

* Significant statistical difference found between substantiation: Chi Sq 9.51, 1df,p=.002

percentage of cases open on subsequent referral by group site
Percentage of Cases Open on Subsequent Referral by Group & Site

*Significant statistical difference found between groups within Manchester: Chi Sq. 1-Sided p (.036) > .05

subsequent referrals by group
Subsequent Referrals* by Group

*Referral: Report to NH DCYF based on a suspicion of child abuse or neglect. All NH citizens are mandated reporters.

in home services for families with cases by group
In-Home Services for Families with Cases by Group

* “In home services” means services paid for and/or supervised by DCYF in founded cases after due process was provided or afforded. 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.

child outcomes for index children ages 4 17
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%

Child School & Health Outcomes
slide69

IV: Cost-Benefit Analysis

      - Costs to date $1,569,065.00      

- Major funding streams Title IV-E

what contributed to higher costs
What Contributed to Higher Costs?
  • Few differences between standard and enhanced
  • Prior referrals significantly higher among enhanced high cost group
  • JPPO referrals significantly greater among enhanced high cost group
  • More child mental health problems identified at intake for enhanced group
conclusions
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