Parental Substance Abuse & Child Maltreatment
Evaluation Results From
Project First Step: New Hampshire’s
IV-E Waiver Demonstration
NCSACW First National Conference on Substance Abuse, Child
Welfare and the Dependency Court
July 2004
Bernie Bluhm, NH DCYF
Glenda Kaufman Kantor
Family Research Lab, CCRC, UNH
Barriers to effective treatment
Limited services
Wait lists for in-patient and out-patient
Focus on the substance abuse recovery
doesn’t address family and parenting
issues
Client Minimization
Readiness to Change
Co-Morbidity
Original project
assumptions

Better initial risk & safety
assessments by CPS.
 Direct
assessment/counseling
available to the family.
 Interventions to address
child maltreatment in the
context of the substance
abuse
 Eventual decrease in child’s
stay in temp. foster care.
New Hampshire Health &
Human Services, Division for
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,
2000-2004
Initial selection at Intake
Call
Received
Screened
Out
Intake
Assessment
Credible
Report: No
Identified
Substance
Abuse
Credible
Report +
Identified
Substance
Abuse
Family Research Lab

Involved in client selection
CPS Intake
screens in
eligible family
FRL staff makes
random assignment to
standard/ enhanced
groups, takes client id
info
Group assignment noted when family
is referred to targeted district office for
CPS assessment
Enhanced Services
Consult with L.A.D.A.C. and supervisor
 CPS + consultant meet with family

Goal for Enhanced Services
In CPS cases involving parental
substance abuse
– Better assessments of safety for children
– Better plans for children in placement
– Less frequent/shorter periods of time in foster
care
– Improved permanency plans
– Costs for children in temporary
foster care may decrease
Benefits to the community
Strengthened ties between the
Treatment community & the CPS office
 Education for the Treatment providers
about substance abuse treatment needs
in CPS cases
 Additional outreach resource

For people awaiting treatment
Individual counseling
On-going contact with counselor
– Treatment Window extended 60 days
– Treatment Provider connections
For families receiving services
Consultant participates in case planning
 Keep focus on parent issues
 Include parenting in treatment goals
 Aftercare with focus on parenting

Benefits to CPS during
assessment
Regular Consultation
 Preliminary screening (SASSI) of
parental substance abuse
 Impact of parental substance abuse on
safety and risk of harm to children
 Recommendations for
services and treatment

“[The Counselor’s] involvement provides all
concerned with a better understanding of what is
needed, what has been provided, how receptive
parents are, what has or has not been
accomplished. This is done in a way that seems
entirely consistent with the legal protections
accorded patients in substance abuse programs.
… To a large extent, I think this is a matter of much
better coordination between the folks who treat
substance abuse and the folks who protect
children. I do think the project is providing better
outcomes for the children and their parents, by
making necessary info more readily available.”
Communication from NH DCYF attorney, on Project
First Step, 6/2003
Benefits for CPS cases when
children are in out-of-home care
Comprehensive assessment with DX
 Assistance with goal specific case
planning
 Continued consultation
 Recommendations for
parents and children

Current Evaluation Status

Since 11/15/99…
– 437 families eligible
 212 baseline interviews (49%)
 151 follow-up interviews (73%)
– 132 SA assessments of Enhanced clients
by LADACs (59%)
Percentage of Families Completed
SASSI by Site
Percentage of Families Completed
SASSI
100%
90%
80%
70%
60%
50%
66%
Manchester
40%
54%
30%
20%
10%
0%
Site
Nashua
Status of SA Assessment among
Enhanced Clients

Enhanced Clients assessed = 132 (59% of
total assigned)
 Equivalent to engagement of client/ or an
overestimate?
 36% HI DEF .
– True extent of engageability or readiness to
change may be more like a third of clients (those
assessed and not minimizing). (1/2 x 2/3=1/3 all
clients engageable )
– May be the first time anyone has confronted them
with assertions of SA.
Study Sample Characteristics:
Trauma & Co-Morbidity
Co-Morbidity





1/3 of those assessed by SA consultants fall
in “High Prob.” range of Substance
Dependence Disorder
45% of “high-prob” have a prior diagnosis of
mental illness.
Within interview sample, 45% of “high prob.”
have clinical levels of depression
16% prior hx of mental illness was
documented in initial record data.
Evaluation interviews reveal 45% Clinically
Depressed using CESD measure.
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

Victimization & Trauma Hx. Of Adult
Type Victimization
Emotional Abuse
Chld. Phys. Ab.
Witness Killing
Mugged
Unwanted Sex Know
Sex Assault stranger
Sexual Assault Know
Physical Attack Know
Physical Attack Stranger
0
20
40
Percent of Respondents
60
80
Alcohol Abuse History in Initial CPS
Referrals (Interview Sample)
 40% of respondents reported drinking 4 >
drinks at a time.
 1/3> of partners had a history of
binge/bender drinking patterns & a history of
aggressive behavior when drinking.
Avg. MAST score= 2.2 (range 0-11)
 40% attended AA
 41% fights while drinking
 22% arrested for DUI
 28% prior RX history for drinking problem
Respondents’ Past Year Drug Use (N=139)
Type of Drug Used
Marijuana
Amphetamines
Barbiturates
Tranquilizers
Cocaine or Crack
Heroin
0
4
8
12
16
20
24
Percent of Respondents that Have Used
28
Dispositions
Preliminary Outcomes by Group
Enhanced
(n=222)
1.8%
Standard
(n=215)
5.1%
Unfounded Closed
86.5%
84.6%
Founded New Case (Court)/ BCase w/ Services
11.3%
9.3%
Incomplete
0.0%
0.9%
Unfounded, Voluntary Case
Opened
0.5%
0.0%
Founded Problem Resolved
Preliminary Outcomes of Initial Referrals by Group & Site
Founded-Problem Resolved
Manchester
Nashua
B Case Opened, Founded
Manchester
Nashua
DCYF Founded, Court Dismissed
Manchester
Nashua
Unfounded, Voluntary Services
Manchester
Nashua
Founded-New Case Opened
Manchester
Nashua
Unfounded-Closed
Manchester
Nashua
Enhanced
(n=222)
Standard
(n=215)
0.9%
2.6%
5.4%
4.8%
4.7%
0.9%
0.9%
1.9%
0.0%
0.9%
0.9%
1.0%
0.9%
0.0%
0.0%
0.0%
11.3%
6.0%
6.3%
9.6%
82.1%
89.7%
85.6%
81.7%
Percent of Initial Referrals Founded
by Group
Percent of Families
100%
Enhanced
50%
0%
Standard
13.1%
14.6%
Founded Dispositions
Final Founded Dispositions of Initial
Referrals by Group & Site
Percent of Families
100%
80%
60%
Enhanced
Standard
40%
20%
0%
17.1% 12.7%
9.5% 16.5%
Manchester
Nashua
Correct Assignment of Subsequent
Referrals by Group & Site
100%
90%
80%
70%
60%
99.1%
92.6%
88.6%
78.3%
Enhanced
Standard
50%
40%
30%
20%
10%
0%
Manchester
Nashua
Percentage of Cases Ever Open by
Group & Site
Percentage of Cases Opened
100%
90%
80%
70%
60%
Enhanced
Standard
50%
40%
30%
20%
10%
22.2%
19.3%
23.8%
19.3%
0%
Manchester
Nashua
Percentage of Cases Open on
Subsequent Referral by Group
100%
90%
80%
% of Cases
70%
60%
Enhanced
50%
Standard
40%
30%
20%
10%
0%
41.7%
46.8%
Subsequent Referrals by Group
Enhanced
(n= 228)
Standard
(n= 219)
ANY SUBSEQUENT REFERRALS
MEAN # SUBSEQUENT REFERRALS (“0”
INCLUDED)
42.5%
0.94
45.2%
1.03
% & # CASES OPENED ON SUBSEQUENT
REFERRALS
7.0% (16)
9.13% (20)
% & # SUBSEQUENT REFERRALS
FOUNDED
11% (34)
14.6% (43)
Subsequent Referrals by Group & Site
Enhanced
Standard
Manchester
Nashua
Manchester
Nashua
ANY SUBSQ. REFERRALS
MEAN # SUBSQ.
REFERRALS,
(“0” INCLUDED)
45.4%
0.95
40.0%
0.93
44.7%
1.08
45.7%
0.98
% & # CASES OPENED ON
SUBSQ. REFERRALS
4.6%
(5)
9.2%
(11)
8.8%
(10)
9.5%
(10)
% & # SUBSQ. REFERRALS
FOUNDED
8.3%
(13)
13.6%
(21)
14.9%
(21)
14.3%
(22)
Characteristics of
Child Placements
In-Home Services for Families with
Cases by Group
IN-HOME SERVICES*
% FAM. ANY IN-HOME SERVICE
MEAN # FAM W/ IN-HOME SERVICE
(“0” INCLUDED)
# OF FAM. RECEIVING IN-HOME
SERVICES W/ A VOLUNTARY/B-CASE
Enhanced Standard
12.5%
0.15
12.8%
0.13
2
0
* There are 8 families, in which one child received In-Home Services and was not
removed, but another child within that same family was removed.
Out of Home Placement (OHP)
Types by Group
Enhanced Standard
KIN CARE
% FAM. ANY KIN CARE
MEAN # FAM. W/ KIN CARE
(“O” INCLUDED)
FOSTER CARE
% FAM. ANY FOSTER CARE
MEAN # FAM W/ FOSTER CARE
(“0” INCLUDED)
OTHER OHP
% FAM. ANY OHP
MEAN # FAM W/ OHP
(“0” INCLUDED)
18.7%
0.30
17.0%
0.21
58.3%
1.67
63.8%
2.72
22.9%
0.77
25.5%
0.68
Mean Number of Days in Placement
per Family (Includes all Children) by
Group & Site
1200
Mean # of Days
1000
1057.1
800
941.6
600
825.9
1040.9
Standard
400
200
0
Manchester
Enhanced
Nashua
Mean # of Days in Placement per
Family (Includes all Children) by
LADAC Engaged Groups & Site
1200
Mean # of Days
1000
1057.1
800
600
941.6
900.5
Standard
1039.6
1043.7
400
200
266.5
0
Manchester
Nashua
Enhanced w/
SASSI
Enhanced w/
No SASSI
Mean Number of Placements per
Family by Group & Site
10
Mean # of Placements
9
8
7
6
Standard
5
4
Enhanced
6.29
3
2
3.94
4.61
3.56
1
0
Manchester
Nashua
Mean Number of Placements per Family
by LADAC Engaged Groups & Site
7
Mean # of Placements
6
5
6.29
4
3
4.2
Standard
Enhanced w/ SASSI
Enhanced w/ No SASSI
2
1
5
4.61
2
2.83
0
Manchester
Nashua
Mean Number of Children in
Placement per Family by LADAC
Engaged Groups & Site
3
# of Children
2.5
2
1.5
1
2.14
2
Standard
1.94 1.92 1.83
1.47
0.5
0
Manchester
Nashua
Enhanced w/ SASSI
Enhanced w/ No SASSI
Percentage of Families with Children
in Placement by LADAC Engaged
Groups & Site
% of Families in Placement
100%
90%
80%
70%
60%
50%
40%
30%
20%
Standard
63.6%
71.4%
66.7%
72.0%
75.0%
75.0%
10%
0%
Manchester
Nashua
Enhanced w/ SASSI
Enhanced w/ No SASSI
Mean Number of Placements per
Child in Placement by LADAC
Engaged Groups & Site
5
4.5
# of Placements
4
3.5
3
Standard
2.5
2
1.5
Enhanced w/ SASSI
3
Enhanced w/ No SASSI
2.63
1
0.5
2.39
2.05
1.65
1
0
Manchester
Nashua
Percentage of Families with TPR by Group
100%
% of Families
80%
60%
Enhanced
Standard
40%
20%
0%
16.7%
8.5%
Percentage of Families with TPR by
Group & Site
25%
% of Families
20%
20.8%
15%
Enhanced
Standard
10%
12.5%
5%
9.1%
8.0%
0%
Manchester
Nashua
Mean Length to TPR by Group
800
700
# of Days
600
500
400
300
200
100
0
682.3
783
Enhanced
Standard
Mean Length to TPR by Group & Site
1000
900
800
998
# of Days
700
600
500
400
600.33
300
Enhanced
Standard
731.4
568
200
100
0
Manchester
Nashua
Child Outcomes
Preliminary Child Outcomes
for Index Children ages 4-17
 CBCL Scores (Caregiver Reports):
 Mean problem scores decreased for all
subscales, among both Enhanced and
Standard Groups
 Children in Enhanced Groups had greater
declines in 5 of 8 problem categories:
–
–
–
–
–
Anxiety & Depression
Withdrawn/Depressed
Somatic Problems
Attention Problems
Aggressive Behavior
Cost Neutrality
Population measured includes all children
involved in “Founded/Open” Cases
Total children in open cases, by
group and quarter.
Standard Open
2/
03
-1
/0
3
10
-6
4
2/
02
-1
/0
2
10
04
-0
6
/0
1
09
-1
2
/0
1
04
-0
6
/0
0
10
-1
2
/0
0
-0
6
04
10
-1
2
/9
9
120
100
80
60
40
20
0
Enhanced/Open
Enhanced/Standard group costs
-1
2/
03
10
-6
/0
3
4
10
-1
2/
99
04
-0
6/
00
10
-1
2/
00
04
-0
6/
01
09
-1
2/
01
04
-0
6/
02
10
-1
2/
02
$700,000.00
$600,000.00
$500,000.00
$400,000.00
$300,000.00
$200,000.00
$100,000.00
$-
CUMULATIVE (CUM.) CTRL. - GROSS TOTAL
CUM. EXPER. GRP. CNL - GROSS TOTAL
Treatment Utilization
& Caretaker
Outcomes
Wave 2 Counseling & Treatment
Utilization Ever-Open Cases:
Interview Sample
Referral
Made
Attended
>1X
Counseling
Standard
Enhanced
70% (7/10)
86% (6/7)
63% ( 12/19) 67% (8/12)
Substance
Abuse RX
Standard
Enhanced
40% (4/10)
59% (10/17)
%Referrals
Completed/
Ongoing RX
50% (5/10)
67% (8/12)
100% (4/4)
30% (3/10)
88% (10/17) 50% (5/10)
W1 & W2 RX Utilization by Groups:
Interview Sample, Self Reports
Enhanced
% Resp. attend AA
W1 (ever)
W2 (past yr.)
% Resp. help for drinking
W1 (ever)
W2 (past yr.)
% Resp. hosp. for
drinking
W1 (ever)
W2 (past yr.)
Standard
40% (45/112) 43% (43/100)
69% (19/28) 45% (10/22)
25% (28/112) 32% (32/100)
48% (11/23) 43% (6/14)
16% (18/112) 18% (18/100)
27% (4/15)
11% (1/9)
W1 & W2 RX Utilization by Groups:
Interview Sample, R. Reports on Partner
% Part. attend AA
W1 (ever)
W2 (past yr.)
% Part. help for drinking
W1 (ever)
W2 (past yr.)
% Part. hosp. for drinking
W1 (ever)
W2 (past yr.)
Enhanced
Standard
31% (20/65)
62% (8/13)
44% (25/57)
46% (6/13)
25% (16/64)
25% (2/8)
22% (12/65)
43% (6/10)
16% (9/64)
27% (4/15)
18% (8/54)
11% (1/9)
W1 & W2 Parent Outcomes:
Interview Sample, Self Reports
% Clinically Depressed
W1
W2
% Heavy Drinking
W1
W2
% Past Year Hard Drug Use
W1
W2
Enhanced
Standard
38.2%
34.2
43.8%
34.4
27%
33%
53%
44%
45%
16%
55%
19%
W1 & W2 Parent Outcomes:
Interview Sample, Self Reports
Enhanced Standard
% Employed FT
W1
33.3%
W2
39.7
%Enrolled Educ/Voc. Program
W2
28.2%
30.3%
25.7%*
16.2%*
Next Steps
 Apply First Step model to additional district
offices
– Via IV-E waiver model, or
– Alternate funding source
 Develop statewide protocol that addresses
co-occurrence of child maltreatment &
substance abuse
 Engage in training/awareness building among
essential partners
Parental Substance Abuse and Child
Maltreatment: Evaluation Results From
Project First Step
Thank You for
your advocacy
and service!