Children and Family
Research Center
Integrating Substance Abuse Treatment and
Child Welfare Services: Findings from the Illinois
AODA Waiver Demonstration
First National Conference on Substance Abuse, Child Welfare
and the Dependency Court
Baltimore, MD
July 14 - 15, 2004
Rosie Gianforte & Joseph Ryan
School of Social1Work
TM
University of Illinois at Urbana-Champaign
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Overview
of AODA
Waiver
Foundations of the Waiver Project – Building on Existing
Relationships
• Existing OASA/DCFS Initiative Services – 1995
 Full range of treatment services
 Expedited assessment and admission
• Juvenile Court Assessment Project – 1999
 On site assessment services at Juvenile Court
 Standardized assessment (DSM-R & ASAM)
 Same day referral to treatment
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Overview
of AODA
Waiver
Primary Objectives of Illinois AODA Waiver: Increase
timely access to substance abuse treatment and thus speed
up time to family reunification
How Can this be Accomplished: Recovery Coaches
• Contracted through an independent agency (TASC)
• Works in collaboration with caseworker; not a replacement
• Assigned to family for the life of a case
Before, during, and after treatment & reunification
• Provide ongoing assertive outreach, engagement, and re-engagement
• Coordinate AOD planning efforts
• Standardized, regular (monthly) reporting to worker
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The Recovery Coach
Recovery Coach Staffing Pattern
Four Teams
Program Administrator
Clinical Supervisor
Recovery Recovery Recovery Recovery
Coach
Coach
Coach
Coach
Tracker
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The Recovery Coach
• 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 per Recovery Coach
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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
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Evaluation of the Demonstration
Research Questions
1. Are parents in the demonstration group more likely to
access AODA treatment services compared with parents in
the control group?
2. Do parents in the demonstration group access AODA
treatment services more quickly compared with parents in
the control group?
3. Are families in the demonstration group more likely to
achieve family reunification and/or permanence compared
with families in the control group?
4. Is the demonstration cost neutral?
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Evaluation of the Demonstration
Data Sources
1. IDCFS Integrated Database: placement, permanency
and child safety
2. Juvenile Court Assessment Program (JCAP):
substance abuse assessment, substance abuse history,
variety of demographic information (e.g. employment,
living arrangements)
3. Department’s Automated Reporting & Tracking
System (DARTS): managed by OASA, includes service
intake date, termination date, level of care, and reason
for service closing
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Evaluation of the Demonstration
Data Sources Continued
4. Treatment Record and Continuing Care System
(TRACCS) Monthly and quarterly progress completed by
caseworkers, treatment providers and recovery coaches
5. Treatment Alternatives for Safe Communities (TASC)
Quarterly reports completed with point in time treatment
progress, visitation and case status
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Evaluation of the Demonstration
Sample: April 2000 – December 2003
As of December 31, 2003, a total of 938 families, 1,165 parents
and 1,774 children were enrolled in the Illinois AODA
waiver. The following is a breakdown by group assignment.
Cumulative Totals as of December 31, 2003
Control
Demonstration
Total
Families
273
665
938
Parents
334
831
1,165
Children
527
1,217
1,744
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Evaluation of the Demonstration
Sample: April 2000 – December 2003
A comparison of demographic characteristics reveals that the
random assignment created equivalent groups.
Parent Characteristics
Demo
Control
African American
80%
82%
White
12%
12%
Unemployed
70%
65%
Previous Substance Exposed Infant
63%
64%
Age of Youngest Parent
32.4
32.0
Primary Drug Cocaine
37%
37%
Primary Drug Heroin
26%
25%
Primary Drug Alcohol
21%
22%
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Question 1: Treatment Access
Control = 46%
Demonstration = 70%
Data from three sources: caseworkers, AODA treatment providers and recovery coaches
70%
60%
Control
50%
Demo
40%
30%
20%
10%
0%
Participated
in Tx
Never in Tx
Unknown No Record
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Question 2: Time to First Treatment Episode
Data from DARTS, limited to parents with signed consent
Time between First Treatment Episode and JCAP Assessment
percent accessing services
1
0.9
control
0.8
demonstration
0.7
50% in
100 days
0.6
0.5
0.4
0.3
50% in
40 days
0.2
0.1
0
0
30 60 90 120 150 180 210 240 270 300 330 360 390 420 450 480 510 540 570
time in days
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Question 3: Family Reunification & Permanence
Group Assignment by Permanency Status (child level)
Living Arrangement Type
Control
Demonstration
Home of Parent
33 (6%)
122 (10%)
Home of Adoptive Parent
24 (5%)
67 (6%)
Subsidized Guardianship
10 (2%)
18 (2%)
67 (13%)
207 (17%)
Permanency Totals
The difference between the proportion of child achieving family reunification is statistically
significant, p<.05
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Question 4: Cost Neutrality
Recovery Coach efforts to engage parents in drug treatment increase the chances
for recovery and reunification or provides grounds for expedited TPR and
adoption which are less costly than long-term foster care.
The cumulative per child IV-E expenditures in the cost neutrality group through
September 30, 2003 was $9,805.82
As of 9/30/03, the actual IV-E cost in the demonstration group was $22,207,203
and the calculated cost was $23,551,558 which is a cost savings to the state
of $981,910.
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Summary of Findings
 Access to Services – parents in the demonstration group were more
likely to access substance abuse services as compared with parents in
the control group
 Time to Service Access – parents in the demonstration group
accessed substance abuse services more quickly as compared with
parents in the control group
 Family Reunification – children in the demonstration group were
more likely to achieve family reunification as compared with children in
the control group.
 Cost Neutrality – the demonstration project is generating savings to
the State that can be reinvested toward child welfare related activities.
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EnterImplications
page title
Questions,
andhere!
Future Research
 Although the use of Recovery Coaches increases reunification rates, these
rates are still quite low.
 This raises important questions related to timelines to permanency and
recovery. Can families recover from serious addiction problems within the
time specified to achieve permanence (many families in for multiple years)?
 We need to investigate the child-parent visitation status for parents having
completed substance abuse treatment. Identify other possible systemic
family issues interfering with unsupervised visitation – or even reunification being granted to parents. The majority of parents that have completed
treatment have yet to achieve reunification. Why – and what might this say
about some of the underlying assumptions of substance abuse treatment – or
access to substance abuse treatment?
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