Intensive Case Management for Substance Abusing Mothers in Child Welfare: Timing Matters

Introduction: Alcohol and other drug abuse are major problems for child welfare systems. Substance abuse compromises appropriate parenting practices and increases the risk of child maltreatment. It is estimated that one half of children taken into foster care are removed from families with drug/alcohol problems. Because untreated substance abuse delays reunification, children removed from such families tend to remain in care for extended stays. Since 2000, Illinois has been experimenting with an intensive case management model (recovery coaches) to help speed up the recovery process and help increase the likelihood of reunification. This approach has proven successful, yet the effects are relatively small. The purpose of the current study is to investigate if the effects of the case management intervention vary by the timing of the contact between mothers and recovery coaches. We focus specifically on the time between temporary custody and random assignment to either the control (services as usual) or experimental group (recovery coach).

Methods and Results: This study utilizes an experimental design, as substance abusing parents are randomly assigned to either the control (services as usual) or experimental (intensive case management in the form of a recovery coach) groups. Analyses were based on survey and administrative data including survey and administrative data collected at initial screening, through caseworker assessment of treatment progress and through official reports of reunification. The sample includes 1,200 women (78% African American) from Chicago, Illinois.

Results: In the current study, only 50% of the mothers are screened and randomly assigned within seven days of the temporary custody hearing. More than two months lapse for 34% of substance abusing mothers. After three years, approximately 24% achieve reunification. There is a small difference when comparing the overall experimental (26%) and control groups (22%). Yet, when the timing of assignment and first contact are considered, the effects associated with the intervention increase. Specifically, for families assigned and making contact within the first week subsequent to temporary custody, 32% of mothers in the experimental group achieve reunification as compared with only 21% in the control group. This effect remains in multivariate models even after controlling for other important covariates (Exp(B) = 1.58, p<.05).

Conclusions: Substance abusing families present major challenges for child welfare systems. Once in the system, substance abusing families consume significant resources as the chances for the termination of parental rights remains high and the odd of reunification remain low. In response, many states are experimental with innovative strategies to improve important child welfare and treatment related outcomes. The findings from the current study clearly indicate that timing matters. Mothers who are connected with intensive case management services quickly (within a week of temporary custody) are significantly more likely to achieve family reunification. The challenge now involves determining (1) how to get parents to the temporary custody hearings, and (2) how to best engage families in a timely manner. Implications suggest that intensive case management works, but as time passes, the likelihood of success decreases.