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Illinois

Demonstration Type:	Services for Caregivers with Substance Use Disorders – Phase II1
Approved:	January 1, 2007
Implemented:	January 1, 2007
Expected Completion:	December 31, 2011
Interim Evaluation Report Expected:	August 31, 2009
Final Evaluation Report Expected:	June 30, 2011

Target Population

The long-term extension of the Illinois Alcohol and Other Drug Abuse (AODA) demonstration targets custodial parents whose children enter out-of-home placement on or after January 1, 2007.  This includes custodial parents who deliver infants testing positive for substance exposure.  To qualify for assignment to the demonstration, a custodial parent must have completed a comprehensive substance abuse assessment within 180 days of a temporary custody hearing.  Eligible families may receive services through the demonstration regardless of their title IV-E eligibility status. 

Jurisdiction

Implementation continues in Cook County, Illinois.  In addition, the long-term extension is expanding the scope of the demonstration to eligible caregivers and children residing in the downstate rural counties of Madison and St. Clair.

Intervention

Under its long-term waiver extension, Illinois is continuing the key service components of the Recovery Coach Program (RCP) implemented under its original waiver demonstration.  Primary RCP services will continue to include clinical assessment and identification, recovery plan development, intensive outreach and engagement to facilitate parents’ treatment participation and recovery, random urinalyses, and ongoing follow-up with reunified families to promote and sustain parents’ recovery and ensure child safety.

In addition to these original services, Illinois is expanding the scope of its long-term waiver extension to include several new service components.  The impetus behind the expansion of Illinois’ waiver arose in part from findings from the evaluation of the State’s original substance abuse demonstration.²  The research revealed that multiple co-occurring problems beyond substance abuse had significant negative effects on the likelihood of achieving reunification.  Primary barriers to reunification included domestic violence, mental health issues, and inadequate housing.  Thus, even in cases in which intensive RCP services had resolved addiction issues, family reunification often remained unlikely due to the presence of these or other co-occurring problems.

Together, the original and new services available to enrolled families under the State’s long-term waiver extension are referred to as the “enhanced RCP model.”  New core service components include the following:

• Housing Resources:  The enhanced RCP model promotes increased access to housing-related resources.  Recovery Coaches assist enrolled families in determining whether they qualify for housing assistance through DCFS and help custodial caregivers complete any necessary paperwork.  In addition, Recovery Coaches work with enrolled families to identify and procure housing resources through local government programs.
  
  
• Mental Health Services: In addition to standard Recovery Coach services, the State’s enhanced RCP model employs specialized “Mental Health Recovery Coaches” with experience serving parents with dual diagnoses of mental illness and a substance use disorder.  Mental Health Recovery Coaches focus on the special needs of this population by providing initial screenings and referrals, assisting parents in accessing services through the State’s mental health service system, and through direct communication with mental health service providers.
  
  
• Domestic Violence Services:  Enhanced domestic violence services include improved procedures to assess the safety and well-being of enrolled parents and increased domestic violence training for Recovery Coaches.  Training topics include recognizing the risk factors of domestic violence, appropriate responses to domestic violence, and the identification of services for both victims and perpetrators. 

Evaluation Design

The evaluation of the State’s long-term waiver extension includes process and outcome components, as well as a cost study.  An experimental research design with random assignment is being implemented in all three counties that are participating in the demonstration.  The sampling plan in Cook County incorporates a two-stage random assignment process whereby (1) DCFS casework teams and private child welfare agencies are stratified by size and randomly assigned to an experimental or control group, and (2) parents are then randomly assigned to agencies or casework teams in the experimental or control groups.  In Madison and St. Clair counties, parents are assigned to DCFS casework teams and private child welfare agencies and are randomly assigned when caseworkers log into a special Web site developed and maintained by the State’s evaluation team. In all three counties, parents undergo random assignment immediately after completion of their initial clinical assessment.  Those parents assigned to the control group receive traditional child welfare services with access to standard substance abuse services, while parents assigned to the experimental group receive these standard services in addition to enhanced RCP services.

Sample Size

Based on initial estimates of the population of caregivers potentially eligible for enhanced waiver services, Illinois has proposed a 3:2 assignment ratio in Madison and St. Clair Counties, for a total estimated sample size of 400 cases (240 experimental and 160 control) in each county.  In Cook County, the State has proposed a 5:2 assignment ratio with a total estimated sample size of 1500 cases (1,070 experimental and 430 control).

Data Collection

Illinois’ evaluation utilizes data from multiple sources, including the State’s SACWIS, the Treatment Record and Continuing Care System (TRACCS), the Division of Alcoholism and Substance Abuse (DASA), Departmental Automated Reporting and Tracking System (DARTS), and child welfare agency case records.

Process Evaluation

The State’s process evaluation analyzes how demonstration services are implemented for experimental group cases and identifies how these services differ from those received by control group families.  Specific areas of study include the organizational aspects of the demonstration; the number and type of staff involved in implementation; the type and array of services received by families; the role of the courts in the demonstration; barriers encountered during implementation and strategies to address these challenges; and contextual factors, such as social, economic and political forces, that affect the implementation and effectiveness of the demonstration. 

Outcome Evaluation

The State’s outcome evaluation compares the experimental and control groups for statistically significant differences in treatment access and completion; permanency rates, especially reunification; placement duration; and child safety.  Specific outcome measures of interest include the following:

• Number and proportion of parents who are referred to substance abuse treatment
• Mean/median length of time between treatment referral and treatment entry
• Number and proportion of parents who enroll in a substance abuse treatment program
• Mean/median length of enrollment in substance abuse treatment
• Number and proportion of parents who complete substance abuse treatment
• Mean/median length of time spent by enrolled children in out-of-home placement
• Number and proportion of children who are reunified with their custodial parents, enter guardianship, or are adopted
• Number and proportion of children with a subsequent alleged and/or substantiated maltreatment report
• Number and proportion of parents who give birth to a substance-exposed infant, and the average number of such births per parent

Cost Study

The cost component of the evaluation examines the costs of enhanced services received by families in the experimental group, and then compares these costs with those of standard services received by control group families.  In addition, the cost analysis includes an examination of the use of key funding sources, including Federal sources such as titles IV-A, IV-B, IV-E and XIX of the Social Security Act, as well as State and local funds.  Where feasible, a cost-effectiveness analysis is being conducted to identify costs per successful outcome for the experimental and control groups.  This analysis may be conducted using one or more key outcomes in which a statistically significant difference between the experimental and control groups is identified.

Evaluation Findings

Evaluation findings are pending continued implementation of Illinois’ Phase II substance abuse waiver demonstration.

¹This is one of two Illinois child welfare demonstration projects currently in operation. Back

²See the profile for Illinois’ Phase I waiver for a detailed review of evaluation findings from its original substance abuse demonstration. Back

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