Project First Step: Approaches to

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

• 2007 CAPTA State Liaison Meeting
• Bernie Bluhm, NH DCYF
• bbluhm_at_dhhs.state.nh.us

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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

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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

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Demonstration Project Design

• Abuse/Neglect reports to the most populous Co in
  NH (2 Offices).
• Substance Abuse IDd as Current Risk Factor
• LADC services initiated up front close to first
  faceface CPS contact.
• Random selection Control/Exp groups maintained
  for five yrs.

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LADC/Counselor Role

• Engage Client at Time of Assessment of Allegation
• Immediate Screening Assessment by LADC
• Immediate individual treatment for AODA,
  presenting MH conditions
• Joins with domestic violence specialist
• Immediate and ongoing consultation for CPSW

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For Families Receiving Services

• Consultant participates in case planning
• Keep focus on parent issues
• Include parenting in treatment goals
• Aftercare with focus on parenting
• Support to relative caregivers

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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

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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)

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Final Evaluation Status

• Conducted 11/15/99 through 10/15/04
• 437 families were involved in the demonstration
• 212 baseline interviews (49)
• 156 follow-up interviews (74)

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Study Sample Demographics Primary Caregiver

• Enhanced Group (n222)
• 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 (n215)
• 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

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Maltreatment CPS Factors

• Enhanced Group (n222)
• CPS Factors Prior 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 (n215)
• 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

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Family Risk Factors

• Enhanced (n222)
• Domestic Violence 33
• Adult Mental Illness 14
• Adult Phys. Disability 4
• Homeless 17
• Incarceration (Case Level) 32

• Standard (n215)
• Domestic Violence 33
• Adult Mental Illness 16
• Adult Phys. Disability 7
• Homeless 14
• Incarceration (Case Level) 28

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Child Risk Factors

• Enhanced Group (n222)
• Mental Illness 6
• Phys. Disability 3
• Learning Disabled
  11
• Neonatal Addiction 2
• Severe Behavior Prob.
  5
• JPPO Involvement
• at Case Level 26

• Standard Group (n215)
• Mental Illness 7
• Phys. Disability 5
• Learning Disabled
  13
• Neonatal Addiction 1
• Severe Behavior Prob.
  9
• JPPO Involvement at
• Case Level 24

DHHS Division for Juvenile Justice Services
Juvenile Probation Parole Officers, involved
due to child status offenses or delinquency.
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Co-Morbidity in Interview Sample
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Substance Abuse Factors

• At initial assessment, 36 demonstrated a high
  probability of having a substance dependence
  disorder (via modified SASSI).
• Strong association with partners substance
  abuse.
• 70 of women reporting heavy alcohol use,
  reported similar heavy use by partners (plt.01)
• Intimate partners drug use is significantly
  correlated (plt.001)
• Heavy drinking women are significantly more
  likely to have partners who use illicit drugs
  (p.06)

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Victimization Trauma Hx. Of Adult
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Domestic Violence identified 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

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Co-Morbidity

• 45 of high-probability have prior diagnosis of
  mental illness.
• 45 of high probability have clinical levels
  of depression
• 18 prior hx of mental illness documented in
  initial record data.
• 45 Clinically Depressed using CESD measure.

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Outcomes Substance Abuse Assessment
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Outcomes Substance Abuse Assessment
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Outcomes Substance Abuse Child Protection

• Identification of co-occurring substance abuse by
  CPS increased by 37 (29-66).
• Decreased repeat substantiation (significant
  decrease in site A)
• Improved Permanency Outcomes
• Increased kinship care (22 vs 16)
• Decrease in placement changes (1.78 vs 2.72)
• Increased reunification (44 vs 39)
• Less time to TPR (22.7 vs 26.5 months)

Over 50 in site A
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ADULT OUTCOMES
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Treatment Utilization by Group
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Womens Treatment Utilization by Groups
(Interview Sample)
Enhanced Standard
Attend AA T1 (ever) T2 (past yr.) 41 (40/97) 66 (19/29) 45 (39/87) 44 (10/23)
Help for drinking T1 (ever) T2 (past yr.) 24 (23/97) 48 (11/23) 32 (32/100) 43 (6/14)
Hospitalization for drinking T1 (ever) T2 (past yr.) 16 (15/97) 28 (4/14) 18 (18/100) 11 (1/9)
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Womens Education Employment by
Group(Interview Sample, Self Reports)
Enhanced Standard
Employed FT T1 T2 30 38 28 24
Enrolled Educ./Voc. Program T2 28 17
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Case (Child Safety) Outcomes
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Child Outcomes
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Child Outcomes for Index Children ages 4-17

• Children in Enhanced Groups had greater declines
  key problem categories
• Anxiety Depression
• Withdrawn/Depressed
• Somatic Problems
• Attention Problems
• Aggressive Behavior

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Child School Health Outcomes

• 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

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Conclusions

• Key Outcomes
• Improved documentation and response in
  assessments.
• More Long-Term Substance Abuse Treatment of
  Adults
• Child Safety Outcomes, including
• fewer subsequent founded reports,
• more stability,
• decrease in time to TPR
• Improved Well Being for Adults Children

• Not cost neutral strictly in terms of IV-E funding

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First Step ProgramPost 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.

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First Step ProgramPost IV-E Waiver Demo

• Local child protection supervisor links LADC and
  CPSW when
• Child Abuse/Neglect report approved for faceface
  assessment (Investigation)
• Parental substance abuse idd as a factor.
• LADC involved as
• CPSW consult,
• AODA Assessment, Treatment, Case Management

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Sustainable funding considerations PSSF CAPTA
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Overview of Treatment Recommendations
LADC provides direct treatment and case
management Goal is community based treatment
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NH Dept. of Health Human ServicesChildren,
Youth, Families
University of New Hampshire Family Research Lab
Thank You!