Integrated Service Delivery for Substance-Involved Parents in the Child Welfare System

Background and Purpose: The AODA Title IV-E Waiver Demonstration is an experimental evaluation of an integrated service program designed to bring health and social services to substance-involved parents in the child welfare system.  In this assertive case management model of service integration, experimental group parents work with a child welfare worker, as well as a Recovery Coach, who ensures that clients receive substance use disorder treatment as well as a range of health and social services. In the control group, parents work only with a child welfare worker and receive standard child welfare services, with no attention to their substance use or other health and social problems. Services research in substance use disorder treatment reveals clients often experience a significant need-services gap where there is a disparity between the services clients say they need and those they actually receive.  Research further indicates that when clients receive the services they need, child welfare outcomes improve. The AODA Parent Survey is the first study under Illinois Title IV-E Waiver Demonstration to assess the need-service gap, i.e., to ask parents what services they needed and what services they actually received.

Methods: The survey sample was drawn from the substance-involved participants in the AODA Waiver Demonstration who had a positive screen for substance use disorder during the year 2010-2015 and who had a telephone number listed in the data base, n=430 parents. Using telephone survey methodology, 54 interviews were ultimately completed (13% of the sample). Thirty-three parents were from the experimental group and 21 parents were from the control group. In both study groups, parents were asked what services they needed and received, their satisfaction with services received.

Results: Parenting training, family counseling, and transportation were most frequently cited as needed services by both the experimental and control groups. Over 80% of respondents expressed their need of these services. Of those who needed these services, only 61% received parent training, 48% received family counseling and 74% received transportation revealing a significant need-service gap. In comparison, among those who reported needing job training and housing services, only 4% who needed job training received it and only 11% who needed housing services received it indicating an even greater need-service gap. Across all service types, the need-service gap was smaller for the experimental than the control group. Overall parents in the experimental group received more services that they needed and reported greater satisfaction with their child welfare experience compared to the control group (58% vs 29%).

Conclusions and Implications: This experimental evaluation reveals that assertive case management serves as an integrated service mechanism that (1) reduces the need-service gap, (2) increases the number of health and social services received, and (3) improves the client satisfaction for substance-involved parents in the child welfare system. As the evidence base grows concerning the development of effective models for integrating health, behavioral health and social services, this experimental study provides evidence of the value of assertive case management as a mechanism of service integration.