Children's Bureau Website - Illinois - Services for Caregivers with Substance Use Disorders

Illinois

Demonstration Type:	Services for Caregivers with Substance Use Disorders - Phase II¹
Approval Date:	January 1, 2007
Implementation Date:	January 1, 2007
Expected Completion Date:	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, but is not limited to, custodial parents who deliver infants testing positive for substance exposure. To qualify for assignment to the demonstration, a custodial parent must have lost custody of their child to the State due to alcohol and other drug abuse issues and 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. Through the long-term waiver extension, the southern Illinois counties of Madison and St. Clair began implementing the demonstration on July 15, 2007.

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 include (1) clinical assessment and identification, (2) recovery plan development, (3) intensive outreach and engagement to facilitate parents' treatment participation and recovery, (4) random urinalyses, and (5) ongoing follow-up once reunified with their families to promote and sustain parents' recovery and to ensure child safety.

In addition to these original services, Illinois expanded the scope of its long-term waiver extension to include several new service components. The impetus behind this expansion 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 resolved substance misuse and 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." Every quarter, service delivery protocols are conducted with the family to assess issues of housing, mental health, and domestic violence. New core service components include the following:

Housing Resources: Recovery Coaches assist enrolled families in determining whether they qualify for housing assistance through the Department of Children and Family Services (DCFS) and assist caseworkers and help custodial caregivers to complete any necessary paperwork. In addition, Recovery Coaches work with enrolled families to identify and procure housing resources through local government and community-based programs.
Mental Health Services: Specialized Mental Health Recovery Coaches, who have experience serving parents with dual diagnoses of mental illness and a substance use disorder, provide initial screenings and referrals, assist parents in accessing services through the State's mental health service system, and communicate directly 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. In addition, Recovery Coaches receive increased domestic violence training which includes information on recognizing the risk factors of domestic violence, responding appropriately to domestic violence, and identifying services for both victims and perpetrators. Referrals are made to community-based providers for both perpetrators and victims of domestic violence.

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 then 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 is using 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) for both counties. In Cook County, the State is using a 5:2 assignment ratio with a total estimated sample size of another 1,500 cases (1,070 experimental and 430 control).

Data Collection

Illinois' evaluation utilizes data from multiple sources, including the State's SACWIS and Management and Reporting System/Child and Youth Centered Information System (MARS/CYCIS). Data pertaining to placement, permanency, and child safety will come from the DCFS's integrated database. Substance abuse assessment data will come from the Juvenile Court Assessment Program (JCAP). Subsequent to the temporary custody hearing, JCAP staff complete the AODA assessment in Cook County and Treatment Alternatives for Safe Communities (TASC) Recovery Coaches in Madison and St. Clair Counties will make initial treatment referrals. In addition to a wide variety of demographic information (e.g., employment status, living situation, public aid recipient), these assessment data will include substance abuse histories and indications of prior substance-exposed infants. Substance abuse treatment data will come from the Treatment Record and Continuing Care System. This system is managed by Caritas and includes surveys completed by child welfare workers, Recovery Coaches, and treatment providers. Additional services data will come from the Department's Automated Reporting and Tracking System. This system is managed by the Division of Alcoholism and Substance Abuse and includes service dates and levels of care. Other sources of data include interviews with caseworkers and reviews of case records. These data will supplement the administrative analyses and provide additional insights into the treatment process.

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; the implementation barriers encountered and strategies to address these challenges; and the 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; and
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

The following section summarizes evaluation findings for the period of April 2000 (implementation start date for Phase I) through December 2007, unless otherwise noted.

Process Evaluation

In Cook County, JCAP assessments have been conducted for 7,019 caregivers. Of these, 4,467 (63 percent) resulted in referrals to substance abuse treatment. The State notes that extending the eligibility window from 90 days to 180 days after the temporary custody hearing has increased the number of clients who meet the eligibility criteria for participation in the demonstration. At the end of Fiscal Year 2007, 44 percent of clients for whom substance abuse treatment was indicated met the eligibility criteria; by December 31, 2007, this proportion had increased to 53 percent.
Of the 2,175 parents who met eligibility criteria in Cook County, 1,573 (72 percent) have been assigned to the experimental group and 602 (28 percent) have been assigned to the control group.
From July 15, 2007 through December 31, 2007, 43 clients received AODA assessments in St. Clair and Madison Counties. Of these 43 clients, 37 met eligibility requirements and were enrolled in the waiver project. Of these 37 clients, 12 (32 percent) were assigned to the control group and 25 (68 percent) were assigned the experimental group.
Recovery Coaches have served 1,468 clients in the experimental group. Of the 1,468 clients, 282 are "active clients" (i.e., parents are currently in treatment, recently completed treatment, pending initial engagement into treatment, or have been in treatment but failed to complete). Of the 282 "active clients" in the experimental group, 198 are currently engaged in treatment or have completed all levels of service. Of these 198 clients, 42 (21 percent) have been engaged in treatment for more than one year and 49 (25 percent) have been engaged in services between 6 and 12 months.

Outcome Evaluation

While the overall percentage of children returning home might not seem significantly different between the experimental and control group, findings as of March 31, 2008 indicate that children in the experimental group not only are returned home more often, but also experience less time in placement between the JCAP assessment and reunification, as described in more detail below:

A total of 387 children (16 percent) in the experimental group whose cases were closed as of March 2008 had been reunified with a biological parent compared to 129 children (12 percent) in the control group. Net permanency rates (exits to reunification, adoption, and guardianship combined) for closed cases as of March 2008 were 37 percent (891 children) for the experimental group and 33 percent (347 children) for the control group. These outcomes all represent statistically significant differences between the two research groups.
As of March 2008, children in the experimental group who were reunified spent an average of 710 days in out-of-home placement compared with 968 days for reunified children in the control group, a statistically significant difference.
Of the 1,468 clients in the experimental group, Recovery Coaches discontinued services for 1,232 cases. Of these closed cases, 31 percent were classified as closed "pre-permanency," because the parent disappeared and was unreachable for six or more months. Of the remaining closed cases, 32 percent had an involuntary or voluntary termination of parental rights, 11 percent were reunified, 8 percent had their children placed in subsidized or private guardianship, and 13 percent were closed for other reasons (e.g., family moved out of state, incarceration, death).

Additional findings will become available as implementation continues.

¹ Based on information submitted by the State as of January 2008. Back

² See 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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