Child Welfare & Substance Abuse

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Many families struggle with both child maltreatment and substance abuse problems. The Rocky Mountain Quality Improvement Center (RMQIC) was initiated to assist and evaluate efforts to strengthen families dealing with those issues.

The Rocky Mountain Quality Improvement Center

Purpose and Focus

The Rocky Mountain Quality Improvement Center (RMQIC) was funded by the Children's Bureau from 2002 through 2006, and work continued well into 2007. The RMQIC initially sought to improve the quality of Child Protective Services work by assessing the needs of its region, increasing capacity among those who serve the region's most vulnerable children, and identifying, sponsoring and evaluating innovative programs.

To these ends and with the guidance of its Advisory Committee, the RMQIC conducted an intensive series of information-gathering activities during its first year to determine its focus; and through literature searches, focus groups and interviews, the RMQIC found that the most serious gaps in service and knowledge, and the most serious challenges faced by child welfare practitioners, arose from substance abuse among parents.

Implementation

The RMQIC issued a request for applications and ultimately funded four highly diverse projects: two government-based projects in Idaho and two community-based projects in Colorado. These projects implemented, conducted and evaluated their service models for three years. The findings from these projects have taught us much about implementation and startup of new projects, patterns of substance abuse and recovery, and the importance of and barriers to collaboration across disciplines to coordinate the array of services many families need to become strong and nurturing.

The professionals who created and conducted these projects continue to work in the area of substance abuse treatment and family strengthening and build upon the work they did as part of the RMQIC.

Findings

Four programs were conducted; 265 families were served beyond the initial stages of enrollment; outcomes in child safety, permanency and well-being proved modestly encouraging; and elements or all four programs have been incorporated into general practice. Although the notion of collaborative service to families was certainly not unique to RMQIC, an awareness of the need for collaboration gained momentum in the various service communities during the time of RMQIC's operation. The experience of RMQIC reinforced that awareness for stakeholders and professionals involved in RMQIC and, through the various challenges to collaboration, provided valuable lessons to be applied in the future.

The projects produced a rich body of work detailing their practice and outcomes. The RMQIC findings are reported in detail in the products from the individual sites, the articles in Volume 21.3-4 of our journalProtecting Children, and in the final report submitted by the RMQIC staff (available upon request).

The following summary emphasizes lessons learned and recommendations for future project implementation and research.

Services Delivered By the Subgrantees

Funding and Intensive Case Management

The substance abuse and maltreatment reports showed up highest for the Ada County (Idaho) Familial Violence Court (FVC), which distinguished itself among the RMQIC projects as having a funded case coordinator providing intensive case management from within the court system. The fact that FVC funded the case coordinator and services received meant that access to substance abuse treatment and other services was not hampered by funding complications, as it was in other programs. FVC's rate of treatment entry among those found to have substance abuse issues at intake was 64 percent. Similarly, the Denver Indian Family Resource Center (DIFRC) also reported a high rate of treatment (76 percent) while the project staff at DIFRC treated two participants in-house and referred the rest outside. They worked to facilitate Medicaid and other forms of funding for their clients.

Intensity of Services

The Curriculum for Mothers in the Recovering Together Program (RTP) (Cortez, Colo.) has drawn much praise from readers and community members for its richness and warmth, as has the accompanying children's curriculum (the success of which, unfortunately, has eluded measurement). Members of the substance abuse community in Cortez have acknowledged that gender-specific treatments are promising, and that more attention needs to be paid to families of substance-abusing clients. Substance abuse treatment professionals suggest that the curricula developed by RTP be used not instead of, but in addition to, more traditional or more intensive outpatient treatment; that is, after the parent has completed one of the more traditional treatment programs. The project, however, used the curriculum alone and reported that the sobriety outcomes, when compared to other outpatient treatments, were as good as traditional programs, cost less, and supported mothers to stay in their community. In addition, the children received support and educational information.

Use of Staff Time and Resources

Although findings broken down by region within the Idaho Pre-Treatment Program (PTP) were not presented, the use of substance abuse liaisons (SALs) within the offices of the Child Protective Services agencies has produced some discussion and systemic change which merits addressing.

  • The presence of SALs in Child Protective Services offices provided immediate availability of specialized expertise of frontline workers. In at least one of the regions in Idaho, the regional director reported that he is considering the use of other specialized liaisons, for health and mental health, as well.
  • Geographic distribution: In the most sparsely populated of the regions, the SAL found herself expending much of her time allotment on travel among offices. While limited resources may make this inevitable, care should be taken to find a way to reduce travel time for these specialists (e.g., having part-time staff located in other offices).

Kinship Placement and Service

Although services to extended families were beyond the scope of these projects, the issues surrounding engagement of family merit some attention:

  • DIFRC, given the emphasis on family and kin in its mission, cited moving children from foster care to kin placement among its successes. Unfortunately, it was beyond the scope of our research plan to examine closely the ways in which progress toward substance-abuse abstinence among parents may affect the quality of their relationship with their children who may be placed with grandparents or other kin; such subtleties might well be examined in future research.
  • Likewise, adapting the Phase I of RTP to serve or include relatives who care for children of substance-abusing parents was a model adjustment that this project would like to test in the future.

Health and Co-Occurring Problems

As with many programs and initiatives, the rate of attrition remained moderately high, though better than other studies, as can be seen from the "levels of engagement" findings. The RMQIC has constituted one part of a larger movement to consider substance abuse when responding to issues of child maltreatment. Colorado's Protocol - Improving Services to Families: Strategies for Substance Abuse Treatment, Child Welfare, and Dependency Court -- A Guide for Counties, Service Providers and Judicial Districts in Colorado issued a model encompassing the courts, child protection and substance abuse. Recent thinking, however, is evolving beyond this triangle. Substance abuse is coming to be seen as one of a number of co-occurring issues that need to be addressed. Foremost among these issues are health and mental health.

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