Final Evaluation of the Title IV-E Waiver
Child Welfare Demonstration in New
Hampshire
Ninth Annual Child Welfare
Demonstration Projects Meeting
June 2005
Glenda Kaufman Kantor, University of New Hampshire
Bernie Bluhm, NH DCYF
State of New Hampshire Study Sample
Sites
Challenges of
NH Environment
Baseline Status of
Substance Abuse in
NH
History: Higher Incidence of
Problem Drinking NH Women Than
National Average
% Frequent Drinking in NH Women & Women Nationally
25%
20%
20%
15%
NH Women
10%
13%
14%
13%
5%
0%
1991
1995
National Median
Current Status of NH
Substance Abuse (2002)

31% Past Month Illicit Drug Use
– (18-25 yrs)– 2nd Highest in U.S.

50% Past Month Binge Alcohol Use
– (18-25 yrs)- 3rd Highest in U.S.

21% Past Month Binge Alcohol Use
– (26 yrs>) (National Average)

300 children <17 living under court order
in secure facilities due to D/A charges, related
crimes (2001)
Since 1994, less than 15% of NH CPS
assessments completed each year have
been substantiated (Founded).
Substantiation rate of NH DCYF child abuse/neglect assessments
conducted from 1994-2004.
(Founded assessments/completed assessments)
14.6%
13.5% 13.1% 13.2% 12.6%
11.7%
CY 94 CY 95
CY 96 CY 97
CY 98
10.5%
CY 99 CY 00
9.3%
10.3% 11.0% 10.5%
CY 01 CY 02
CY 03 CY 04
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
Project Design
Target Population
Credible report of suspected CA/N
 Substance Abuse Current Risk Factor
Related to CA/N
 Reside in Hillsborough Co area covered
by the Manchester/Nashua D.Os.
 No Open Case at Intake into Study
 Accessible to DCYF CPSW

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

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

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
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
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

Evaluation
Evaluation Design







Experimental Model with True Randomized
Design to Standard/Enhanced Services at 2
District Offices
Standard group received the usual services
provided by NH DCYF
Parallel Data Collection for Standard and
Enhanced
Process & Outcomes
SACWIS Data
Interviews at Baseline & Follow-up
Cost Benefit
Final Evaluation Status

Conducted 11/15/99 through 10/15/04
– 437 families eligible
212 baseline interviews (49%)
 156 follow-up interviews (74%)

Study Sample Demographics:
Primary Caregiver
Enhanced Group (n=222): Standard Group (n=215):





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


•

•
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: Child
Enhanced Group (n=222) Standard Group (n=215)



Female:
51%
Mean Age:
8 yrs.
Median:
9 yrs.
Range:
0-17 yrs.
Ethnicity:
White:
87%
Black:
6%
Latino/Hispanic: 5%
Other:
2%



Female:
51%
Mean Age:
8 yrs.
Median:
8 yrs.
Range:
0-17 yrs.
Ethnicity:
White:
89%
Black:
6%
Latino/Hispanic: 2%
Other:
3%
Maltreatment & CPS Factors
Enhanced Group (n=222) Standard Group (n=215)

CPS Factors
 CPS Factors
Prior Referrals
51%
Prior Referrals*
44%
High Risk at Entry 14%
High Risk at Entry 11%
 Type of Maltreatment
 Type of Maltreatment
Physical Abuse:
21%
Physical Abuse
25%
Phys. Abuse & Negl: 9%

Phys. Abuse & Negl. 13% 
Neglect:
56%
Neglect:
52%
Sexual Abuse:
5%
Sexual Abuse:
3%
Psychological Abuse: 2%
Psychological Abuse: 1%
Family Risk Factors
Enhanced (n=222)
 Domestic Violence:
33%
 Adult Mental Illness:
18%
 Adult Phys. Disability:
4%
 Homeless:
17%
 Incarceration (Case
Level):
32%
Standard (n=215)
 Domestic Violence:
33%
 Adult Mental Illness:
20%
 Adult Phys. Disability:
7%
 Homeless:
14%
 Incarceration (Case
Level):
28%
Child Risk Factors
Enhanced Group (n=222) Standard Group (n=215)






Mental Illness:
Phys. Disability:
Learning Disabled
6%
3%
11%
Neonatal Addiction: 2%
Severe Behavior Prob.
5%
JPPO* Involvement
at Case Level
26%






Mental Illness:
Phys. Disability:
Learning Disabled:
7%
5%
13%
1%
Neonatal Addiction:
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.
Co-Morbidity in
Interview Sample
Victimization & Trauma Hx. Of Adult
Emotional Abuse
Type Victimization
Chld. Phys. Ab.
Witness Killing
Mugged
Unwanted Sex Know
Sex ssault stranger
Sexual Assault Know
Physical Attack Know
Physical Attack Stranger
0
20
40
60
Percent of Respondents
80
Probability of Having a Substance
Dependence Disorder
100%
80%
60%
40%
20%
64%
36%
0%
Probability
High
Low
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.

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

PROCESS
EVALUATION
Implementation Challenges






Engagement of Client & Timing
Randomization of LADC Services within Sites
District Office Cultures
Different Therapist Effects
Attrition of LADC & CPSWs
Need to build consensus between co-located
systems
– Information sharing/confidentiality
– Focus on “Primary Client”
– Treatment recommendations from different points
of view
– ASFA 12 month clock vs recovery clock
LADC: Challenges
of Engagement
Challenges of Engagement
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 Families Completed SASSI
Percentage of Families Completed
SASSI by Site
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
66%
Manchester
54%
Site
Nashua
Percent of Initial Referrals Founded
by Group
Percent of Families
100%
Enhanced
Standard
50%
0%
13%
15%
Founded Dispositions
Final Founded Dispositions of Initial
Referrals by Group & Site
Percent of Families
100%
80%
60%
Enhanced
Standard
40%
20%
0%
17%
13%
Manchester
10% 17%
Nashua
Client Satisfaction w/ LADC
Manchester (n=27)
Nashua (n=19)



Overall Satisfaction
Satisfied: 52%
Overall Satisfaction by
Substantiation
– No Case Ever Opened
Satisfied: 40%
– Case Opened
Satisfied: 67%

Overall Satisfaction
Satisfied: 90%
Overall Satisfaction by
Substantiation
– No Case Ever Opened
Satisfied: 92%
– Case Opened
Satisfied: 86%
Mean Therapist Referrals for Clients
After Initial Eval. by Site:
Mental Health
Services
AA/NA
0.13
0.13
1
Women's
2
Homeless Shelter
Out-Patient
Services
0.21
0.01
3
0.4
0.19
0.07
Nashua
Manchester
0.33
4
In-Patient 0.06
Services
Domestic
Violence
1,2,3,4 statistical
significance found
between sites: ANOVA
p > .05
0.28
0.06
0.08
0.08
0.11
Social Services
0
0.1
0.2
0.3
0.4
0.5
Treatment Utilization
Treatment Utilization by Group
Mental Health
38%
Short-Term
Detox
12%
51%
16%
Short-Term In10%
6%
Patient
Long-Term InPatient
Domestic
Violence
Home Based
12%
12%
0%
Standard
20%
6%
6%
Enhanced
10%
26%
20%
30%
40%
50%
60%
LADC: Networking
LADC: Networking
Outcomes
Outcomes:
Substance Abuse &
Assessment
Preliminary Findings on System Status
1999: Substance Abuse Incidence &
Case Outcome

Review of NH Cases for 1 month= 640 Cases
 546 cases completed assessments
 Substance Abuse documented as a factor in
completed assessments =159/546 or 29%
 Proportion of substance abuse referrals
founded as cases=35/159 (22%)
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
Substantiation by High Probability of
Having a Substance Dependence
Disorder
45%
40%
35%
30%
45%
25%
20%
15%
19%
10%
5%
0%
High Probability
Low Probability
* Significant statistical difference found between substantiation: Chi Sq 9.51, 1df,p=.002
Cases opened
for continued
Caseand/or
Open
services
placement
directly
supervised or
paid by DCYF
Percentage of Cases Open on
Subsequent Referral by Group & Site
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Enhanced
Standard
48%
46%
40%
20%
Manchester
Nashua
*Significant statistical difference found between groups within Manchester: Chi Sq. 1-Sided p (.036) > .05
Subsequent Referrals* by Group
% CASES FOUNDED ON SUBSEQUENT
REFERRALS
MEAN # SUBSEQUENT REFERRALS
Enhanced
(n= 228)
Standard
(n= 219)
46%
49%
1.04
1.20
*Referral: Report to NH DCYF based on a suspicion of child
abuse or neglect. All NH citizens are mandated reporters.
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
# OF FAM. RECEIVING IN-HOME
SERVICES W/ A VOLUNTARY/B-CASE
Enhanced Standard
12%
0.14
2
16%
0.16
0
* “In home services” means services paid for and/or supervised by DCYF in
founded cases after due process was provided or afforded. 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/ Children in KIN
CARE
FOSTER CARE
% FAM. ANY FOSTER CARE
MEAN # Child Placements for FAM
W/ FOSTER CARE Placements
OTHER OHP
% FAM. ANY OHP
MEAN # FAM W/ Children in OHP
22%
0.41
16%
0.24
63%
1.78
62%
2.72
26%
0.82
28%
0.68
Mean Number of Children in Placement per
Family by Group & Site
3
# of Children
2.5
2
2.13
1.5
1
1.90
1.67
1.94
0.5
0
Manchester
Nashua
Enhanced
Standard
Mean # of days in placement
Mean length of placement (days) per
child in placement by group & site
350
300
250
200
150
319
250
234
281
Enhanced
Standard
100
50
0
Manchester
Nashua
Site
Mean Number of Placements per
Child in Placement by Group & Site
5
4.5
# of Placements
4
3.5
3
Enhanced
2.5
1.5
Standard
3.04
2
2.53
1.91
1
2.21
0.5
0
Manchester
Nashua
Percentage of Families with TPR by Group
100%
% of Families
80%
60%
Enhanced
Standard
40%
20%
18.0%
0%
10.0%
Percentage of Families with TPR by
Group & Site
50%
45%
% of Families
40%
35%
30%
25%
Standard
20%
Enhanced
23%
15%
10%
5%
12% 12%
8%
0%
Manchester
Nashua
Mean Length to TPR by Group
900
800
# of Days
700
600
500
400
300
200
100
0
692
807
Enhanced
Standard
ADULT OUTCOMES
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. hospitalization
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: Reports on Partner
% Partner 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
% Hard Drug Hx
W1
W2
Enhanced
Standard
39%
36%
40%
32%
29%
35%
53%
42%
43%
44%
47%
48%
W1 & W2 Parent Outcomes:
Interview Sample, Self Reports
Enhanced Standard
% Employed FT
W1
32%
W2
38%
%Enrolled Educ/Voc. Program
W2
28%
32%
24%*
16%
Child Outcomes
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
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%
Cost Analysis
Project First Step: Comparison of costs by group.
$1,200,000.00
$1,000,000.00
$800,000.00
$600,000.00
$400,000.00
$200,000.00
10
-1
2
01 /99
-0
3
04 /00
-0
6
07 /00
-0
9
10 /00
-1
2
01 /00
-0
3
04 /01
-0
6
07 /01
-0
9
10 /01
-1
2
01 /01
-0
3
04 /02
-0
6
07 /02
-0
10 9/0
-1 2
2/
0
1 2
-3
/0
4 3
-6
/
7 03
-9
10 /0
- 3
1 12/
03
4/ 3/3
1 1/
- 6 04
7/ / 3
0
1
10 - 9 / 04
/1 /3
- 1 0/0
2/ 4
31
/0
4
$-
CUMULATIVE (CUM.) CTRL. - GROSS TOTAL (X 0.5 (B7c(e)))
CUM. EXPER. GRP. CNL - GROSS TOTAL
EX. Group + LADC
Shortfall EXPER. GRP. EXPEND. IN EXC. OF CNL - FFP TOTAL
(B7d(e)) $280,000.00 (IV-E funds)
IV: Cost-Benefit Analysis
- Costs to date $1,569,065.00
- Major funding streams Title IV-E
Project First Step: Comparison of costs by group.
$1,200,000.00
$1,000,000.00
$800,000.00
$600,000.00
$400,000.00
$200,000.00
10
-1
2
01 /99
-0
3
04 /00
-0
6
07 /00
-0
9
10 /00
-1
2
01 /00
-0
3
04 /01
-0
6
07 /01
-0
9
10 /01
-1
2
01 /01
-0
3
04 /02
-0
6
07 /02
-0
10 9/0
-1 2
2/
0
1 2
-3
/0
4 3
-6
/
7 03
10 9/0
-1 3
1 2/
- 03
4/ 3/3
1 1/
- 6 04
7/ / 3
1 0
10 - 9 / 04
/1 /3
- 1 0/0
2/ 4
31
/0
4
$-
CUMULATIVE (CUM.) CTRL. - GROSS TOTAL (X 0.5 (B7c(e)))
CUM. EXPER. GRP. CNL - GROSS TOTAL
What Contributed to Higher
Costs?
Few differences between standard and
enhanced
 Prior referrals significantly higher
among enhanced high cost group
 JPPO referrals significantly greater
among enhanced high cost group
 More child mental health problems
identified at intake for enhanced group

Cost Benefits Analysis by Group
Including LADC Costs
Avg.
Cost/Child1
Savings –
Child Not
Removed2
Savings –
Kin Care3
Total Avg.
Cost/Child
Total Avg.
Savings5
4
Enhanced
$23,709
$23,709
$5,952
$23,709
$29,660
Standard
$20,951
$20,951
$4,920
$20,951
$25,871
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
LADC: Closing
Finale: LADAC clip