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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, parents assigned to the experimental group work with a child welfare worker, as well as an addiction Recovery Coach, who ensures that clients receive addiction treatment in addition to 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 addiction, health, and social problems.
Services research in addiction treatment reveals clients often experience a significant need-services gap when there is a disparity between the services clients say they need and those they receive. Research indicates that when clients receive the services they need, child welfare outcomes improve. This study under Illinois Title IV-E Waiver Demonstration assesses the longitudinal effects of need-service gaps on child welfare reunification outcomes.
Methods
The study sample was selected from substance-involved parents in the Illinois AODA Title IV-E Waiver Demonstration from 2011-2013. Participants had a positive screen for substance use and were assigned to the experimental group (n=200). Intervention length varied from one month to 11 months with 52 (26%) parents reunified with their children and 148 (74%) parents not achieving reunification. Recovery Coaches reported service need and receipt monthly. When clients received a service they self-identified as needing, this was indicated as a matched service received. When clients did not receive a service they needed, this was indicated as an unmatched service.
Results
The average intervention length is 4.3 months for reunified parents and 4.1 months for non-reunified parents. On average, reunified parents received more matched services (0.6 vs. 0.5) and fewer unmatched services (2.3 vs. 2.6) compared with non-reunified parents. Longitudinal analysis revealed two major findings: (1) reunified parents have 21.9% (p=0.027) more matched services compare with the non-reunified parents, and (2) reunified parents have 11.8% (p=0.012) fewer unmatched services compared with non-reunified parents. Analyses controlled for the period and random subject effects.
Conclusions and Implications
This longitudinal analysis reveals that the need-service gap plays an important role in child welfare outcomes for substance-involved parents. Although parents in the experimental group have higher rates of reunification compared to those in the control group, still more than three-fourths of parents did not reunify with their children after the intervention. Results suggest that substance-involved parents are more likely to reunify with their children when they receive more services matched to needs and fewer services unmatched to needs across the intervention period. As the evidence base grows concerning the development of effective models for integrating primary care, behavioral health, and social services, this longitudinal study provides evidence of the value of closing the need-service gap by delivering matched services to improve child welfare outcome for substance-involved parents.