Project First Step: Approaches to Co-occurrence of Child Maltreatment & Substance Abuse in New Hampshire

1. Project First Step: Approaches to Co-occurrence of Child Maltreatment & Substance Abuse in New Hampshire Natl. Conference on Substance Abuse, Child Welfare & the Courts Jan. 2007 Glenda Kaufman Kantor, UNH, Bernie Bluhm, NH DCYF Glenda.Kantor@unh.edu bbluhm@dhhs.state.nh.us

2. NH DHHS, Children, Youth, & Families Vision Statement We envision a state in which every child lives in a nurturing family and plays and goes to school in communities that are safe and cherish children. Mission Statement We are dedicated to assisting families in the protection, development, permanency, and well-being of their children and the communities in which they live. DCYF Comprehensive Child & Family Services Plan, 2004-2009

3. 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

4. Project design • Abuse/Neglect reports to the most populous Co in NH (2 Offices). • Substance Abuse ID’d as Current Risk Factor • LADC services provided up front, prior to substantiation/placement. • Random selection: Control/Exp groups maintained for five yrs.

5. 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

6. 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

7. Evaluation Design • Experimental Model with True Randomized Design to Standard/Enhanced Services at 2 District Offices • “Enhanced Group”: LADC + CPS • “Standard Group”: Received the usual services provided by NH DCYF • UNH-FRL Eval. Team • Conducted confidential interviews with parents in both groups. • Analyzed case records, SACWIS data, LADC records. • Process & Outcomes data • Cost Benefit (In terms of IV-E Dollars)

8. Final Evaluation Status • Conducted 11/15/99 through 10/15/04 • 437 families eligible • 212 baseline interviews (49%) • 156 follow-up interviews (74%)

9. 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

10. 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

11. Co-Morbidity in Interview Sample

12. Victimization & Trauma Hx. Of Adult

13. Probability of Having a Substance Dependence Disorder SASSI)

14. Association Between Partners’ Substance Abuse Patterns • 70% of women reporting heavy alcohol use, reported similar heavy use by partners (p<.01) • Intimate partners’ drug use is significantly correlated (p<.001) • Heavy drinking women are significantly more likely to have partners who use illicit drugs (p=.06)

15. 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

16. Outcomes

17. Outcomes: Substance Abuse & Assessment

18. Outcomes: Substance Abuse & Assessment

19. 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

20. 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

21. Women’s Treatment Utilization by Groups (Interview Sample)

22. Treatment Utilization by Group

23. ADULT OUTCOMES

24. Women’s Education & Employment by Group(Interview Sample, Self Reports)

25. Case (Child Safety) Outcomes

26. Percentage of Cases Founded (Substantiated) on Subsequent Referral by Group & Site *Significant statistical difference found between groups within Site A: Chi Sq. p < .05

27. Out of Home Placement (OHP) Types by Group

28. Mean Number of Placements per Child in Placement by Group & Site

29. Mean Length to TPR by Group

30. Child Outcomes

31. 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

32. 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

33. 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

34. First Step Program:Post IV-E Waiver DemoMarch 2005 • Two largest district offices (Manchester & Nashua) composing 25% of the statewide caseload of abuse/neglect assessments. • Additional region (Central NH) to be added, increasing First Step to 33% of statewide caseload.

35. Funding considerations: PSSF & CAPTA

36. First Step Program:Post IV-E Waiver Demo • Local child protection supervisor links LADC and CPSW when: • Child Abuse/Neglect report approved for face:face assessment (Investigation) + • Parental substance abuse id’d as a factor. • LADC involved as: • CPSW consult, • AODA Assessment, Treatment, Case Management

37. Based on two month snapshot, Manchester: Nov-Dec 2006

39. Overview of Treatment Recommendations LADC provides direct treatment and case management: Goal is community based treatment

40. NH Dept. of Health & Human ServicesChildren, Youth, & Families University of New Hampshire Family Research Lab Thank You!