Home > Programs & Funding > Profiles of the Title IV-E Child Welfare Waiver Demonstration Projects > Illinois - Services for Caregivers with Substance Use Disorders - Phase I

Illinois

Demonstration Type:	Services for Caregivers with Substance Use Disorders - Phase I1
Approval Date:	September 29, 1999
Implementation Date:	April 28, 2000
Completion Date:	December 31, 20062
Interim Evaluation Report Date:	May 16, 2003
Final Evaluation Report Date:	January 2006

Target Population

Illinois' substance abuse demonstration targeted parents assessed as having problems with drug or alcohol abuse and whose children were removed from the home. Specifically, the demonstration's target population included custodial parents of children who entered placement on or after April 28, 2000, in Chicago and suburban Cook County. The parents of infants testing positive for substance exposure were also included in the target population. The children of eligible parents were able to receive services through the demonstration regardless of their title IV-E-eligibility status.

Jurisdiction

The project was implemented in Cook County, Illinois.

Intervention

The Illinois Alcohol and Other Drug Abuse (AODA) demonstration sought to improve child safety and permanency outcomes, as well as caregiver functioning, treatment adherence, and well-being, by providing enhanced alcohol and other drug abuse treatment services to substance-affected families in the Illinois child welfare system. Specifically, the Illinois AODA demonstration focused on the recovery of caregivers who were not in treatment at the time of their children's placement into foster care. The intervention involved providing intensive case management and supportive services to (1) improve treatment participation and retention rates, (2) facilitate the reunification of parents with their children, (3) improve the timeliness of decisions regarding other permanency options, and (4) reduce subsequent reports of maltreatment. To qualify for the demonstration, parents in substance-affected families were referred to the Juvenile Court Assessment Program (JCAP) at the time of their temporary custody hearing or at any time within 90 days of that hearing.

JCAP staff conducted an assessment and referred parents to treatment if necessary. In addition to receiving traditional child welfare and substance abuse treatment services, experimental group participants received multiple services from outreach workers known as "Recovery Coaches," including the following:

• Immediate Engagement: A Recovery Coach liaison was stationed at the JCAP office in Juvenile Court to facilitate and expedite an initial engagement session immediately following the AODA assessment conducted by JCAP staff.
• Treatment Access: Recovery Coaches often transported parents to the initial intake appointment to ensure attendance and treatment accessibility.
• Coordination and Collaboration: Recovery Coaches maintained regular contact with the AODA treatment agency and child welfare worker by arranging interagency staff meetings, attending administrative case reviews, and being available for court appearances.
• Clinical Assessment: Recovery Coaches ensured the completion of a comprehensive range of assessments, including the AODA assessment.
• Benefits Identification and Advocacy: Recovery Coaches assisted parents in obtaining entitlement or other program resources for which the family was eligible, and in meeting the responsibilities and mandates associated with these benefits.
• Service Planning: The parent and the Recovery Coach mutually developed a plan to prioritize issues identified during the clinical assessment, the benefit determination process, and through other assessments.
• Outreach: Recovery Coaches made home visits to enrolled caregivers as well as visits to AODA treatment facilities.
• Case Management: A Recovery Coach was assigned to a parent throughout and beyond the treatment process to ensure that parents remained actively engaged in aftercare and recovery support activities.
• Drug Testing: Recovery Coaches had access to random urine toxicology testing to monitor a parent's compliance with program requirements.
• Permanency Assessment and Recommendations: In addition to monthly progress reports, a licensed psychiatrist met with the client and prepared a Permanency Assessment and Recommendation Report for the Recovery Coach and caseworker. This report outlined the parent's progress in treatment and recovery, and provided an assessment of the child's safety if the child were to return to the parent's custody.

Recovery Coaches made strenuous efforts to engage clients who had never participated in substance abuse treatment. On average, 60 outreach attempts were made before a Recovery Coach considered discontinuing services to an experimental group caregiver. In addition, efforts to re-establish contact were made for six consecutive months if a client became difficult to engage or was otherwise hard to reach.

Evaluation Design

The evaluation of the State's demonstration included process, outcome, and cost-effectiveness components. The outcome evaluation was designed to test whether Recovery Coach services had a positive effect on the drug-recovery process and on key child welfare outcomes. To this end, Illinois used a two-stage random assignment process in which child welfare agencies and caseworker teams were first randomly assigned to experimental or control groups, after which parents were randomly assigned to agencies in the control group or experimental groups. Parents assigned to agencies serving the control group received traditional substance abuse services that were available prior to the waiver demonstration. Parents assigned to agencies serving the experimental group received these standard services plus the services of a Recovery Coach.

Sample Size

As of September 30, 2006, 1,892 parents were enrolled in the demonstration. Of these, 506 (27 percent) were randomly assigned to the control group and 1,386 (73 percent) were assigned to the experimental group. The State's evaluation focused on outcomes among families assigned to the AODA demonstration between April 2000 and June 2004. During that period, 366 parents of 569 children were assigned to the control group and 943 parents of 1,367 children were assigned to the experimental group.

Data Collection

Data on clients' substance abuse treatment participation came from the State's Treatment Record and Continuing Care System (TRACCS), which included surveys completed by child welfare workers, Recovery Coaches, and substance abuse treatment providers.³ Additional service data came from the Department's Automated Reporting and Tracking System (DARTS), which provided service dates and levels of care.⁴

Evaluation Findings

Process Evaluation

1. Assessments and Referrals for Substance Abuse Treatment: Thirty-five percent of referrals to JCAP originated from a temporary custody hearing. Judges, court personnel, and child welfare workers refered clients to JCAP for two main reasons: (1) to determine the appropriate level of care and arrange an intake appointment for clients with substance abuse problems, and (2) to rule out the presence of a substance abuse issue. As of June 30, 2004, a total of 1,309 caregivers had completed a JCAP assessment. Of these, 422 gave informed consent to share their substance abuse treatment data for the State's evaluation of its AODA waiver. Of these 422 caregivers, 101 were assigned to the control group and 321 to the experimental group.
2. Treatment Access, Participation, and Completion Rates: Overall, the AODA demonstration did not significantly increase access to substance abuse treatment services. According to data available in DARTS, caregivers in the experimental group were somewhat more likely to access substance abuse services (84 percent) compared with those in the control group (77 percent), although this difference was not statistically significant. However, experimental group caregivers did access treatment services more quickly than caregivers in the control group. On average, experimental group caregivers accessed treatment services within 74 days compared with 108 days for control group caregivers, a statistically significant difference.
   
   Although no difference was found in levels of initial access to substance abuse treatment services, the AODA demonstration did have significant positive effects on treatment participation and completion rates. According to data available through the TRACCS database, 71 percent of experimental group caregivers actively participated in treatment compared with 52 percent of control group caregivers, a statistically significant difference. In addition, 43 percent of experimental group caregivers completed at least one entire treatment episode compared with 23 percent of caregivers in the control group, a statistically significant difference. Overall, 22 percent of experimental group caregivers completed all recommended levels of treatment.
   
   The State's evaluators identified several variables that were significantly correlated with the likelihood of treatment completion, including age, employment status, and the caregiver's primary drug of choice. For example, alcohol users were 71 percent more likely to complete treatment than heroin users, while unemployed caregivers were 30 percent less likely than employed caregivers to complete treatment. Age was also a significant predictor of treatment completion, with older caregivers more likely to finish treatment than younger caregivers.

Outcome Evaluation

Illinois' AODA demonstration achieved moderate success in improving permanency and safety outcomes for the children of caregivers in the experimental group. Specifically, Illinois' final evaluation reported the following significant findings:

1. Re-allegations of Child Abuse/Neglect: Children in families with access to enhanced services experienced lower rates of subsequent maltreatment. Overall, caregivers in the experimental group were significantly less likely to have a subsequent allegation of maltreatment (25 percent) than caregivers in the control group (30 percent). In addition, mothers in the experimental group were significantly less likely to have a subsequent substance-exposed infant (SEI) allegation (13.6 percent) than mothers in the control group (19.5 percent). On a related note, caregivers who completed substance abuse treatment were significantly less likely to have subsequent SEIs (7.9 percent) than caregivers who did not complete treatment (18.8 percent).
2. Permanency Rates: Children in the experimental group were slightly more likely to achieve reunification compared with children in the control group. Overall, 15.5 percent of children in the experimental group were reunified compared with 11.6 percent of control group children, a small but statistically significant difference.
3. Placement Duration: Access to enhanced AODA services was significantly correlated with reduced lengths of stay in out-of-home placement. On average, children in the experimental group who were reunified spent 522 days in out-of-home placement compared with 707 days for reunified children in the control group.

Although many experimental group families were engaged in or completed substance abuse treatment, overall reunification rates remained low. The State's Final Evaluation Report described several co-occurring problems experienced by both experimental and control group families that affected the probability of reunification, including problems with housing (56 percent), mental health issues (40 percent), and domestic violence (30 percent). The presence of major life problems beyond substance abuse had a statistically significant effect on the likelihood of reunification, with 21 percent of families in which substance abuse was identified as the only major life problem achieving reunification, compared with 11 percent of families dealing with one additional problem. Overall, 62 percent of families enrolled in the demonstration were experiencing at least three major life problems simultaneously. The State's final report noted that future AODA initiatives will be greatly improved by incorporating treatment strategies specifically designed to address a range of co-occurring problems beyond substance abuse.

Web Links

The Illinois AODA January 2006 Final Evaluation Report is available at the following Web site: http://cfrcwww.social.uiuc.edu/pubs/pdf.files/AODA.01.06.pdf. (PDF - 563 KB)

¹ This is one of three Illinois Child Welfare Demonstration Projects. The evaluation findings reported in this profile are limited to the five years of the original title IV-E waiver and are based on information submitted by the State as of January 2006. Back

² Phase I of the Illinois Substance Abuse Demonstration was scheduled to end April 2005, but it continued to operate through December 2006 under a series of short-term extensions. On January 1, 2007, approval for a five-year extension was granted, marking the onset of Phase II of the Illinois Substance Abuse Demonstration. Back

³ Overall, 81 percent of TRACCS forms were completed and returned by Child Welfare Workers and Recovery Coaches, while treatment providers completed 63 percent of their TRACCS forms. Back

⁴ Most data contained in the State's final evaluation report run through June 30, 2005; in a few instances, data running only through December 31, 2004 were available. Back

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