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| Demonstration Type: | Services for Caregivers with Substance Use Disorders1 |
| Approved: | June 17, 1996 |
| Implemented: | July 1, 1996 |
| Expected Completion: | December 31, 2002 |
| Interim Evaluation Report Expected: | June 30, 1999 |
| Final Evaluation Report Expected: | March 27, 2002 |
Children who were in foster care or likely to enter foster care due to parental substance abuse were eligible for substance abuse services under this demonstration.
The program was implemented in all three of the State's counties.
Multi-disciplinary treatment teams were composed of a substance abuse counselor co-located with child protective services (CPS) workers in one CPS unit in each county. Substance abuse counselors accompanied CPS workers on initial home visits, and together they assessed the substance abuse problem and its affect on parenting. Counselors made referrals for treatment and stayed connected with the family throughout treatment.
The evaluation consisted of process, outcome, and cost-effectiveness components. The State assigned one substance abuse counselor in each county to work with one CPS unit in each office. Another unit in each county was selected for comparison purposes. Cases from comparison units were then matched to cases assigned to substance abuse counselors, based on the foster care placement status of children in care at the time of sample selection. The matched cases formed the comparison group. The demonstration was expected to serve 180 families per year, for a total of 960 families by February 2002.
Through the demonstration, Delaware expected to prevent or delay entry into foster care, as well as to reduce the average number of days children spent in care. According to their evaluation design, the State anticipated a reduction in the length of time in care for 50 percent of the cases with children who were placed as a result of parental substance abuse.2 In addition to tracking entry and number of days in foster care, the State planned to measure the following: the length of time between identification of a substance abuse problem and completion of an assessment and subsequent treatment plan; changes in parents’ abilities to care for their child; access to substance abuse treatment services and community resources that help the family promote safety; and child and family well-being.
Process Findings
By February 2002, Delaware had served 530 families, about 55 percent of the total expected. Delaware’s Final Evaluation Report cited early problems making referrals for substance abuse treatment as one of the reasons for this shortcoming, but noted that the referral process improved when a supervisory review to identify cases with substance abuse was instituted.
All 530 potential clients identified were offered a referral for substance abuse services. While only 3 clients refused services, only 32 percent of clients actually entered treatment.
The length of time families were served was also a contributing factor. The State reported that substance abuse counselors worked an average of nine months with each family, compared to three months as originally planned. This resulted in higher than expected caseloads for substance abuse counselors and an inability to accept new referrals. (Substance abuse counselors’ caseloads averaged 81 families statewide, more than twice as many as expected.)
One of the State's most significant problems when implementing its demonstration was the lack of appropriate external treatment programs and resources. Rather than referring caregivers to treatment programs, substance abuse counselors spent more time than expected with each caregiver. Appropriate services were particularly limited for women who required residential or intensive outpatient care. Residential treatment programs that could accept women with children or pregnant women were particularly scarce. Restricted access to treatment, caused by a lack of insurance or by restrictions placed on treatment by managed care, was also a barrier. Other barriers included a lack of training for child welfare agency caseworkers in identifying and responding to substance abuse problems, and philosophical differences between caseworkers and substance abuse counselors. For example, substance abuse counselors generally considered anything less than complete abstinence by enrolled caregivers to represent program failure, whereas child welfare workers were more concerned with the safety of the child and were more willing to tolerate some substance use.
Outcome Findings
As stated in the March 2002 Final Evaluation Report, the waiver showed some positive results. The average length of time in foster care was reduced by one-third, although this fell short of the goal of reducing the time in care by 50 percent. On average, children in the experimental group spent 204 days in foster care, compared to 294 days for children in the comparison group.
In addition, the proportion of cases with children entering foster care was lower in the experimental group (33 percent) than in the control group (40 percent). However, no statistically significant differences were found regarding length of time to achieve permanency or the percentage of closures due to case plan completion.
1Based on information submitted by the State as of October 2002. This is one of two waiver demonstration project components. Delaware has also implemented an Assisted Guardianship/Kinship Permanence component. Back
2 Analysis in Delaware’s Final Evaluation Report focused on whether or not there was a 50 percent reduction in the days in foster care. Back
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