Taking FDTC to Scale: System Change or Pilot Projects? Pilot Projects? Sid Gardner, MPA Honorable Nicolette Pach Sharon DiPirro-Beard, LMFT NADCP June 2010 4940 Irvine Blvd, Suite 202 Irvine, CA 92620 (714) 505-3525 [email protected]A Program of the Substance Abuse and Mental Health Services Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment and the Administration on Children, Youth and Families Children’s Bureau Children’s Bureau Office on Child Abuse and Neglect
Transcript
Taking FDTC to Scale:System Change or
Pilot Projects?Pilot Projects?
Sid Gardner, MPAHonorable Nicolette Pach
Sharon DiPirro-Beard, LMFT
NADCP June 2010
4940 Irvine Blvd, Suite 202Irvine, CA 92620(714) 505-3525
Substance Abuse and Mental Health ServicesSubstance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
and the
Administration on Children, Youth and FamiliesChildren’s Bureau
TEXT PAGE
Children’s BureauOffice on Child Abuse and Neglect
•Dependency mattersS i li d t i
•Dependency mattersR t
Family Drug Court (FDC) Models
INTEGRATED DUAL TRACKPARALLEL
•Dependency matters•Recovery management•Same court, same judicial officer
•Specialized court services offered before noncompliance occurs•Compliance reviews and recovery management heard by specialized court officer
•Recovery management•Same court, same judicial officer during initial phase•Noncompliant case transferred to specialized judicial officer
(e.g., Santa Clara, Reno,
Suffolk)
DUAL TRACK
(e.g., San Diego)
(e.g., Sacramento)
Common Ingredients of Family Drug Courts
System of identifying familiesSystem of identifying families
Earlier access to assessment and treatment servicesEarlier access to assessment and treatment services
Increased management of recovery services and complianceIncreased management of recovery services and compliance
Consistent responses to participant behaviorConsistent responses to participant behaviorConsistent responses to participant behaviorConsistent responses to participant behavior
FDCs have shown they can improve treatment and child welfare outcomes
• Increase in reunification rates
• Decrease in re-entry into foster care rates
• Decrease in recurrence of maltreatment
FDCs encounter both Scale and Scope challenges
• Scale: to what extent can FDCs respond to the full f t t t d th hild lfrange of treatment needs among the child welfare
population—as opposed to remaining small “boutique courts”?
• Scope: to what extent can FDCs respond to the full range of co-occurring needs among the child welfare population—mental illness, family violence, family p p y yincome and employment issues, developmental delays?
Current Scale: do we know?
• In most states with multiple FDCs, the average size i d 50 li tis under 50 clients
• A few larger FDCs may serve as many as 400-500 clients annually in large counties
• The lack of a national data base and in-depth data in most states on FDC scale means there is no accurate total of FDC clientsaccurate total of FDC clients
The Project vs the System
• Some FDCs focus so heavily upon their project that they become isolated from the larger child welfare s stem hich res lts insystem which results in:
– Inability to track impact on the larger system
– Inability to develop to a large enough scale to impact the larger system
• Isolation from the larger child welfare system results g yin:
– Continued marginalization for the families affected by parental substance use
The Project vs the System
The lack of Integrated or Coordinated Data and Information systems results in:
Insufficient in depth documentation of treatment• Insufficient in-depth documentation of treatment and child welfare outcomes to enable evaluation of scale issues over time
• Lack of comparison between FDC child welfare outcomes within the entire child welfare caseload
• Lack of accurate data on caseload overlap among hild lf t t t t l h lth hildchild welfare, treatment, mental health, child
development, and other agencies
• Inability to determine if FDC results able to “move the needle” in the larger child welfare system
Barriers to Going to Scale
• Judges’ preferences for manageable caseloads and project-level scale
• The time requirements of intensive client case management
• Lukewarm buy-ins from child welfare and treatment agencies, resulting in low referrals or screened-out clients due to narrowed eligibility requirements
• A desire to retain fidelity to an FDC model that may not have been developed at scale
• An inability to sustain funding for an FDC model beyond the level of a single project
Barriers to Going to Scale
• Lack of resources or ability to redirect resources.
• Historically, lack of National FDC Standards and Performance Standards
– Few States have FDC Standards
• Limited National Data on the number of FDC clients, and FDC outcomes.
• Limited Technical Assistance (TA) available to FDCs
Barriers to Expanding FDC Scope
• Judges’ preferences in engaging with other systems
• Other agencies’ resistance to coordination with a caseload defined by child welfare
• Clarity in roles and responsibilities
– Assessment of substance use disorders
– Referral to treatment
– Coordination of Services (MH, Housing, VocationCoordination of Services (MH, Housing, Vocation Ed, etc.)
• Gaps in Resources
So how did the big ones get so big?
• Judicial leadership in convening interagency players and tracking outcomes over time
• Child welfare and treatment agency buy-in based on recognition that FDCs could directly improve their own outcomes
• Data systems and case management tracking that focused on both the FDC project and the larger systemsystem
• Annual evaluations that included cost offset data powerful enough to convince policy leaders to expand FDCs
Judicial Leadership
• Advocate for systems change
• Engage child welfare directorg g
• Engage treatment directly and through contract process
• Support community investment in systemic change
• Speak out in public
• FDC as the laboratory for change
M k il bl f h i i• Make resources available from the inception
ChangingThe System
Getting Better at Getting Along: Four Stages of Collaboration
ChangingThe Rules
The System
Shared DataUniversal ScreeningSh d C l
FDC Project
Better Outcomes for Children and Families
InformationExchange
JointProjects
Sid Gardner, 1996Beyond Collaboration to Results
Shared Case Plans
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Moving From A Project
While many FDCs are able to “collaborate” at the level of the FDC “project,” the ingredients for real s stems change ma not et be presentsystems change may not yet be present:
• Shared Outcomes
• Universal substance abuse screening for all parents involved with child welfare
• Universal child maltreatment screening for parents involved in substance abuse treatment
• Joint (SA/CW) Case Planning and Monitoring
• Shared Data Systems
The Remaining Challenges
Will information system upgrades enable tracking the answers to….
1. Can FDCs define their client mix to include a significant segment of the CW population needing treatment?
2 Can FDCs work closely enough with other2. Can FDCs work closely enough with other agencies to provide needed services for co-occurring problems?
The Remaining Challenges
Will information system upgrades enable tracking the answers to….
3. Are the results of FDCs significant enough to make an impact on national goals for child welfare and treatment outcomes?
• Expanding timely access to effective treatment
• Reducing out of home care
Ensuring timely decisions about child safety and• Ensuring timely decisions about child safety and permanency?
4. Can FDCs reduce out of home care costs?
FDC Elements as a Template for System Wide Practice
• Earlier pre-court utilization of collaborative relationshipsrelationships
• Multi disciplinary teams
• Resource linkages
• Facilitated access to services
• Case Management/Recovery Specialist
• Communication protocols
Sacramento County Dependency Drug Court:
A St d i PA Study in Progress
Sacramento County’s Comprehensive Reform
1. Comprehensive Cross-System Joint T i iTraining
2. Substance Abuse Treatment System of Care3. Early Intervention Specialists4. Recovery Management Specialists (STARS)5. Dependency Drug Court6. Early Intervention Drug Court (EIFDC)
Sacramento County Dependency Drug Court Model
Level 1DDC
Hearings30
Days60
Days90
Days
Level 3Monthly Hearings
180 DaysGraduation
Jurisdiction& Disposition
Hearings
Detention Hearing
Child in Custody
Level 2
Weekly or Bi-Weekly Hearings
ReviewHearings at 6Mo Intervals
PermanencyHearing at
12 Mos
Referral to Treatment
g
STARSVoluntary
Participation
STARSCourt OrderedParticipation
Early Intervention Specialist (EIS) Assessment &Referral to STARS
Court Ordered to
STARS & 90 Days of DDC
Mo Intervals 12 Mos
Shared Data Systems: Data Sources
Measured outcomes are arrived at through the culmination of data from:
• Preliminary Assessments
• California Outcomes Measurement System (CalOMS; the CA version of NOMS)
• Child Welfare Services/Case Management System (CWS/CMS; SACWIS in other States)
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• Home Court and Dependency Drug Court
• STARS Intake and Twice Monthly reports
Shared Data Systems:Matching Records
• From the 19 digit CWS/CMS identifier a 10 digit id tifi f t i t ti ll t d
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identifier for parents is automatically generated through an extract run from CWS/CMS, which creates a text file that is sent to ADS
• The Drug Court Coordinator matches the 10 digit identifiers with parents that have appeared for STARS and DDC services.
– If any identifiers cannot be matched, the identifiers are sent back to STARS for more information
Shared Data Systems: Matching Records
• At intake, STARS creates a 10 digit Unique P ti i t ID f t i i STARS/DDCParticipant ID for parents receiving STARS/DDC services
– This 10 digit identifier is the same format of what would be entered in CalOMS and generated by CWS/CMS
• ADS matches the 10 digit ID from CMS/CMS with the
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ADS matches the 10 digit ID from CMS/CMS with the STARS/DDC database on the parents
Shared Data Systems:Data Extraction
• The 10 digit Parent Identifier is matched to CalOMS Unique Participant ID to extract treatment data
Treatment data is onl e tracted for a cohort of data
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• Treatment data is only extracted for a cohort of data. CFF Evaluator sends a “cohort” list to ADS, plus alternate IDs for aliases. ADS imports data into an Excel database and sends data to the CFF Evaluator.
• CWS/CMS Special Projects page, Project Start Date is used to extract and send placement reports to CFF f C/S Sfor children whose parents entered DDC/STARS
Shared Data Systems: Analysis
• The CCF contracted Evaluator combines treatment d t STARS i t k d t i thl t d tdata, STARS intake and twice-monthly report data, and child placement data into an Excel database for SPSS analyses
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Shared Data Systems:Confidentiality
• Release of information names all agencies involved i th DDC/STARS t
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in the DDC/STARS team
– County Council reviewed and approved the form
• Data utilizes Unique Identifiers, and does not include identifying information (e.g. names)
• Data shared and transmitted for evaluation is encrypted and password protected
Evaluation Findings: Parents and Children in the Evaluation
36 36 36
18 Mos
36
36 Mos
36 Mos 12
Mos
Mos Mos Mos Mos
Source: CWS/CMSComp Parents = 111 Children = 173 DDC Parents = 2,873 Children = 4,400
Evaluation Findings: Re-Entry to Foster Care Rates
Comp n=173; DDC n=2817 Source: CFSR, CWS/CMS
Evaluation Findings: Re-Entry to Foster Care Rates Over Time
Comp n=173; DDC n=2817 Source: CFSR, CWS/CMS
Evaluation Findings: Recurrence of Maltreatment Rates
Comp n=173; DDC n=2817 Source: CFSR, CWS/CMS
24 MONTH COST SAVINGS DUE TO INCREASED REUNIFICATION
What would have happened regarding out of home care costs in the absence of DDC?
27.2% - Reunification rate for comparison childrenp49.6% - Reunification rate for DDC children= 766 fewer DDC children would have reunified
33.1 - Average months in out-of-home care for comparison children8.98 - Average months to reunification for DDC children= 24.12 months that DDC kids would have spent in 24.12 months that DDC kids would have spent in out of home care (OHC)
$1,828.92 – Out of home care cost per month
766 x 24.12 x 1,828.92 =$33,790,979 Total Savings in OHC Costs
Sacramento County Comprehensive Funding Model
Making the case for expanded funding
• Sacramento went beyond project-level scale by y p j yconvincing county policy leaders that the FDC had achieved better results than a comparison group and genuine cost offsets
• It took a strong information system, data analysis, and an evaluation team to compile that evidence of impact
• Resources follow from results—and it takes resources to prove results
Sacramento County Comprehensive Funding Model
Sacramento County Services Costs
• STARS salary and administrative costs
• Substance abuse treatment services, both residential and outpatient
• Mental health treatment services
• Dependency drug court salary, travel and training
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Sacramento County Comprehensive Funding Model
Sacramento County Funding Streams
• Tobacco Litigation Settlement (TLS)g ( )
• State General Funds
• County Child Protective Services(CPS)
• Substance Abuse Prevention and Treatment (SAPT) Block Grant
• Perinatal Service Network
C lWORK (C lif i i f TANF)• CalWORKs (California version of TANF)
• Comprehensive Drug Court Implementation (CDCI) money (i.e. Drug Court State Grants)
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Sacramento County Comprehensive Funding Model
State CWS General Funds• State CWS funding is 50% Federal, 35% State and g
15% County
– Federal funding is Title IV-E, Title IV-B, Title 20, etc.• The County’s quarterly time study documents the
reimbursable activities of caseworkers to claim IV-E eligible cases and activities
• Activities govern whether IV-E and IV-B can be drawn down
– Each activity has a different Federal, State and County funding ratio
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Sacramento County Comprehensive Funding Model
State CWS General Funds
• In CWS, there is a IV-B allocation, but not to draw for a specific activity. It helps to lower costs for services.
• Certain activities, including services provided to parents, are not claimable for Title IV-E
• STARS is not a IV-E eligible activity because it is a “service” to the parentse ce to t e pa e t
• The County includes STARS in their budget, but not as a IV-E eligible activity
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Resources
To obtain a FREE copy, please visit:
SAMHSA National Clearinghouse for Alcohol and Drug
Information
www.ncsacw.samhsa./fil /SAFERRgov/files/SAFERR
C i t thComing soon to the National Center on Substance Abuse and Child Welfare
website!
To obtain a FREE copy, please visit:
SAMHSA National Clearinghouse for Alcohol and Drug
Information
www.samhsa.gov/shin
C i t thComing soon to the National Center on Substance Abuse and Child Welfare
website!
To obtain a FREE copy, please visit:
SAMHSA N ti lSAMHSA National Clearinghouse for Alcohol and Drug
I have completed the tutorial training, and utilized the information to help educate new child protective service workers. The information is very useful, understandable, and very specific to the issues and concerns that child welfare workers will encounter, and how these should be handled.
-Direct Service Provider
Online Training
On-Line Training
• Training specific for Child Welfare, Substance Abuse or Legal ProfessionalsAbuse, or Legal Professionals
• Available at no cost
• Upon completion of the tutorial:
• Certificate awarded
• CEUs and CLEs are available
• To access, please visit:
• http://www.ncsacw.samhsa.gov/
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NEW! Child Welfare Training Toolkit
6 modules, each containing a:
•Trainer Script•PowerPoint Presentation•Handouts
•Case Vignettes
A il bl t NOAvailable at NO CHARGE!
http://www.ncsacw.samhsa.gov/training/def
ault.aspx
Levels of Technical Assistance
Level One:
Information and Sharing of Models
Level Two:
Expert Consultation and
Research
Level Three:
Development of Issue‐ Specific
Products
Level Four:
Strategic Planning, Training Resources and Facilitation
TEXT PAGE
16 States3 Tribes1 County
53 Grantees10 Pre‐IDTA
314 requests 410 requests 1349 requests
September 2001 through February 2010 49
National Center on Substance Abuse and Child Welfare
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