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Illinois 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 and a Recovery Coach, who ensures that clients receive substance use disorder treatment as well as a range of health and social services. Parents in the control group work only with a child welfare worker and receive standard child welfare services, with limited 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 receive. Research also indicates that when clients receive the services they need, child welfare outcomes improve. This study is the first study under Illinois Title IV-E Waiver Demonstration to assess the longitudinal effects of need-service gaps on child welfare outcomes.
Methods
The study sample was selected from substance-involved parents in the Illinois AODA Title IV-E Waiver Demonstration experimental group during the year 2010-2013, n=309. The intervention length varies from 1 to 12 assessment periods.After the intervention, 75 (24.3%) parents were reunified with their children and 234 (75.7%) parents were not reunified with their children. Recovery Coaches report the services need and receipt monthly. When clients did not receive a service they need, we marked as one need-service gap.
Results
On average, reunified parents had longer intervention length (6.1 vs. 5.3 assessment period) and less need-service gap (2.4 vs. 3.3) than non-reunified parents. Longitudinal analysis revealed two major findings: (1) the expected rate of the need-service gap was not significantly different between reunified and non-reunified parents when controlled for time and covariates, and (2) after accounting for the group by time effect, starts from the third assessment period, the expected need-service gap was significantly less for reunified parents than for non-reunified parents. Furthermore, the difference between the two groups increased over time. For example, the reunified parents’ expected need-service gap was 21.5% (p=0.039) lower in the third assessment period and 51.6% (p=0.001) lower in the tenth assessment period compared to non-reunified parents after controlling for random subject effects.
Conclusions and Implications
This longitudinal analysis reveals that need-service gap plays an import role in child welfare outcomes for substance-involved parents. According to the analysis, substance-involved parents are more likely to reunify with their children when they have fewer unmatched needs across the intervention period. This longitudinal study provides evidence that closing need-service gaps by delivering matched services to promote the child welfare outcomes for substance-involved parents provides more positive outcomes, providing evidence essential to development of effective models for integrating health, behavioral health, and social services.