Substance Abuse Specialists in

Child Welfare Agencies and Dependency Courts

Considerations for Program Designers and Evaluators

i

Substance Abuse Specialists 

in Child Welfare Agencies 

and Dependency Courts - 

Considerations for Program Designers 

and Evaluators

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

And

Administration for Children and Families

Administration on Children, Youth and Families

Children’s Bureau
ii

Acknowledgments

This document was prepared by the National Center on Substance Abuse and Child Welfare 

(NCSACW) under Contract No. 270-027108 for the Substance Abuse and Mental Health 

Services Administration (SAMHSA) and the Administration for Children and Families (ACF), 

both within the U.S. Department of Health and Human Services (HHS). Nancy K. Young, 

Ph.D., developed the document. Sharon Amatetti, M.P.H., served as the Government Project 

Officer from SAMHSA’s Center for Substance Abuse Treatment (CSAT) and Irene Bocella, 

M.S.W., served as the Project Officer from Children’s Bureau within the Administration for 

Children and Families.

Disclaimer

The views, opinions, and content of this publication are those of the authors and do not 

necessarily reflect the views, opinions, or policies of SAMHSA or HHS. Resources listed 

in this document are not all-inclusive and inclusion in the list does not constitute an 

endorsement by SAMHSA or HHS.

Public Domain Notice

All material appearing in this document is in the public domain and may be reproduced or 

copied without the permission of SAMHSA. Citation of the source is appreciated. However, 

this publication may not be reproduced or distributed for a fee without the specific, written 

authorization of the Office of Communications, SAMHSA, HHS.

Electronic Access and Copies of Publication

This publication may be downloaded or ordered at http://www.samhsa.gov/shin. Or, please call 

SAMHSA’s Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727) (English and 

Español). 

Recommended Citation

Center for Substance Abuse Treatment. Substance Abuse Specialists in Child Welfare 

Agencies and Dependency Courts Considerations for Program Designers and Evaluators. 

HHS Pub. No. (SMA) 10-4557 Rockville, MD: Substance Abuse and Mental Health Services 

Administration, 2010.

Originating Office

Office of Program Analysis and Coordination, Center for Substance Abuse Treatment, 

Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, 

Rockville, MD 20857 

HHS Publication No. (SMA) 10-4557 
iii

CONTENTS

Introduction ..................................................................................................1

Purpose of This Paper ..................................................................................3

Programmatic and Collaborative Structures of Substance Abuse Specialist 

Programs ...................................................................................................3

Programmatic Structure 3

Collaborative Structure 4

Results 6

Endnotes 11

Appendix A: Case Studies.............................................................................12

Delaware: Substance Abuse Counselors Program...........................................15

Illinois: Recovery Coach Program ................................................................20

Massachusetts: Substance Abuse Regional Coordinators Program ....................25

New Hampshire: Project First Step ..............................................................30

Sacramento County: Early Intervention Specialists and

Specialized Treatment and Recovery Services................................................36

Washington: Substance Abuse Services Initiative ..........................................41

Table 1. Commonalities Matrix of Substance Abuse Specialist Programs .....45
iv
1

Introduction

For more than a decade, studies have suggested that a sizable majority of the 

families involved in child welfare services are affected by parental substance use 

disorders. With the passage of the Federal Adoption and Safe Families Act (ASFA, 

Public Law 105-89, 1997), the complex issues of parents with a substance use 

disorder who are involved with the child welfare system have become the focus 

of increased attention. Under ASFA, parents have limited time to comply with 

reunification requirements, including attaining and demonstrating recovery from 

their addiction and safely care for their children, or face permanent termination of 

their parental rights. Given the historical low rates of reunification and extended 

duration of foster care placements for families with substance use disorders, these 

families are likely to compose most of the families affected by this legislation.1,2

In addition, since substance abuse treatment can be a lengthy process and the 

recovery process often takes longer than is allowed under the ASFA timelines, it 

is important that substance-abusing parents be engaged in treatment as soon as 

possible. As a result, finding effective ways to address concurrent substance use 

and child maltreatment problems in families has taken on renewed importance.

Historically, a lack of coordination and collaboration has hindered the ability of 

child welfare, substance abuse treatment, and family/dependency court systems 

to support these families.3,4 Although the courts that have jurisdiction in cases of 

child abuse and/or neglect operate under various names (e.g., dependency, family, 

or juvenile), for the purposes of this paper they are referred to as dependency 

courts. The systems operate under different, even conflicting, mandates, priorities, 

timelines, and definitions of the primary parent, and each system has different 

goals and definitions of success. One of the primary emphases in discussions of how 

to best meet the needs of families affected by substance use disorders under ASFA 

has been on strengthening the collaborative relationships between the child welfare 

system, the substance abuse treatment agencies, and the courts. Coordinated 

efforts among child welfare caseworkers, treatment providers, and dependency 

courts are proposed as keys to timely access to appropriate treatment services, 

parent participation in child welfare and treatment services, and quality follow-up 

support.5,6

Models of collaborative intervention vary widely in emphasis. They include such 

innovations as co-location of substance abuse specialists in child welfare offices or 

dependency courts, dependency drug courts, joint case management and planning, 

official committees to guide collaborative efforts, wraparound services, improved 

cross-system communication protocols, and cross-agency training of staff. 

However, there are few empirical studies on the effectiveness of these collaborative 

models. Available research suggests that the collaborative process functions 

to provide a variety of supports to parents and has an important impact on 

service systems. A recent study by Green and colleagues7 found that successful 

collaboration helps to ensure that parents are not overwhelmed by the multiple 

demands and requirements of their case plans. In addition, collaboration indirectly 

supports parents by improving the ability of providers to work together on the 
2

parents’ behalf. This collaborative process includes such functions as providing a 

bigger resource base from which to offer needed services, helping providers to 

better monitor case progress, providing additional services and supports when 

parents are struggling, improving the coordination and timing of services, and 

holding providers accountable to each other. Successful collaboration has also been 

found to influence case outcomes by improving the ability of key stakeholders to 

make good decisions because of the availability of timely, comprehensive, and 

accurate information.8

To generate new knowledge about innovative and effective child welfare practices, 

Public Law 103-432 (authorized by Congress in 1994) introduced the concept 

of Federal waivers to child welfare programs. The introduction of Federal child 

welfare waivers mainly impacts Title IV-E, which is the Foster Care and Adoption 

Assistance Program. Since 1996, 17 States have implemented 25 child welfare 

waiver demonstrations. Four of those States (Delaware, New Hampshire, Illinois, 

and Maryland) were granted waivers to demonstrate new approaches to families 

with substance use disorders. Delaware co-located privately contracted substance 

abuse counselors with child protection managers in county child welfare offices. The 

substance abuse counselors were responsible for linking parents to treatment and 

for providing support services to parents while they awaited treatment. Through 

New Hampshire’s waiver demonstration, licensed substance abuse counselors 

worked with child welfare workers in an advisory and supportive capacity and used 

their skills to provide training, assessment, treatment, and case management 

services. Illinois’s demonstration focused on treatment retention and recovery for 

parents who lost custody of their children because of substance abuse disorders. 

The Illinois model incorporated a proactive intensive services model in which 

privately contracted case management specialists directly engaged families 

throughout the treatment process and provided post-treatment support. Maryland 

planned to implement a collaborative case management model in which privately 

contracted substance abuse specialists would work with child welfare workers, 

parent aides, and volunteer mentors to assess the needs of family members and to 

determine appropriate treatment options. The Maryland demonstration waiver was 

terminated before its full implementation because of various competing priorities 

and implementation issues. Table 1 at the end of the Appendix describes additional 

characteristics of the first three waiver demonstration sites, Delaware, New 

Hampshire, and Illinois.

Results from the Federal waiver demonstrations found that substance abuse-child 

welfare collaborations were most successful when backed by strong managerial 

support. Successful demonstrations were found to require careful service 

coordination and consistent communication between substance abuse specialists 

and child welfare staff. The mere co-location of substance abuse specialists in 

child welfare offices did not ensure that workers communicated about their cases. 

Successful collaboration requires the establishment of formal systems to share case 

information and to keep all staff informed about caregiver progress. In addition, 

adequate and appropriate substance abuse treatment resources need to be 

available to parents.
3

Purpose of This Paper

This paper focuses on one particular model of collaboration, the placing of 

substance abuse specialists in either child welfare offices or dependency courts. 

The purpose of co-locating substance abuse specialists is to ensure that parents are 

assessed as quickly as possible, to improve parent engagement and retention in 

treatment, to streamline entry into treatment, and to provide consultation to child 

welfare and dependency court workers.9 In addition to briefly describing substance 

abuse specialist programs and their various components, this paper includes 

findings from eight qualitative interviews of programs that place substance abuse 

specialists in child welfare offices or dependency courts. The interviews highlight 

ways in which early decisions about the program’s collaborative structure influence 

other design decisions. Understanding how design decisions are related to one 

another can help jurisdictions to systematically create substance abuse specialist 

programs that best meet their specific needs and use resources most efficiently. 

This information is intended to provide those interested in creating a substance 

abuse specialist program with valuable data on programmatic and collaborative 

structures, lessons learned about program design, problems or challenges faced 

by these programs, and how the issues were resolved. Table 1 at the end of the 

appendix includes a summary of key components of the programs.

Programmatic and Collaborative Structures of Substance 

Abuse Specialist Programs

Co-located substance abuse specialist programs vary, each having their own 

unique programmatic and collaborative structures. The programmatic structure is 

based on a variety of underlying concepts and arrangements, such as the overall 

purpose of the program, the roles and responsibilities of substance abuse specialist 

staff, and the locations and settings of the programs. The collaborative structure 

includes concepts such as the underlying values and principles guiding the program; 

funding; staff development, training, and supervision; and joint accountability, 

outcomes, and evaluation. A more detailed description of each programmatic and 

collaborative structure follows.

Programmatic Structure

Purpose of the Program

The type of substance abuse specialist program that is designed and implemented 

varies depending on its purpose. Some programs are begun with the purpose of 

building linkages and improving communication and collaboration between systems. 

Other programs hope to improve parents’ access to assessment and treatment, 

whereas others might design substance abuse specialist programs to improve the 

ability of child welfare and court staff to manage their caseloads. Some programs 

are designed with all three purposes in mind.
4

Roles and Responsibilities

The roles and responsibilities of the substance abuse specialist vary and depend 

on the purpose of the program. If the purpose is building linkages and improving 

communication and collaboration between systems, the substance abuse specialist 

often serves as a formal liaison and is responsible for building and enhancing the 

relationships between the systems. If the purpose is to improve parents’ access to 

assessment and treatment, the specialist may serve as a treatment broker or as a 

front-line service provider. If the purpose of the program is to improve the ability 

of child welfare and court staff to manage caseloads in which substance abuse is 

a factor, the substance abuse specialist may serve as an advisor about the nature 

of substance use disorders as they relate to all parents and, at times, individual 

families.

Locations and Settings

Some programs have chosen to assign a substance abuse specialist to regional 

child welfare offices, for example Connecticut’s Project SAFE (Substance Abuse 

and Family Education). This specialist, who is a child welfare employee, provides 

consultation and training to child welfare workers, as well as interventions with 

parents. Similarly, Delaware’s Title IV-E Waiver Demonstration used Title IV-E 

funds to hire substance abuse specialists in each of its three child welfare offices. 

These specialists conduct substance abuse assessments, identify treatment options, 

monitor parent treatment entry to improve retention, and provide consultation to 

child welfare workers. In contrast, some programs place substance abuse specialists 

in units within the agency for specific functions. Examples of these arrangements 

include workers placed in child welfare investigation units.

Substance abuse specialists are also located in child welfare offices or dependency 

courts as full- or part-time substance abuse 

treatment agency employees or contract staff. 

This type of connection with the substance 

abuse treatment agency can facilitate the 

service integration and treatment referral 

process. As dedicated staff, the specialists 

are the direct linkage to treatment provider 

agencies that can strengthen relationships 

with treatment providers, facilitate ongoing 

case monitoring, and maintain cross-system 

professional relationships.

Collaborative Structure

Underlying Values and Principles

Each partner enters the collaboration with its 

own perspective and particular assumptions 

about the mission and mandates of the other partners. Agencies seeking a 

partnership often have different perspectives on whether substance abusers can 

States’ experience indicates 

that successful collaboration 

requires the establishment of 

formal systems to share case 

information and to keep all 

staff informed about caregiver 

progress. Adequate and 

appropriate substance abuse 

treatment resources also need 

to be available to parents.
5

be effective parents; whether the client is the parent, child, or family; and whether 

the goal is child safety, family preservation, or economic self-sufficiency. Unless 

these differences are identified and addressed, collaborative agencies may find it 

difficult to reach agreement on issues related to the program-structured elements. 

Often the values and definitional issues, such as who is viewed as the primary 

parent, affect the ways in which staff work across agencies’ boundaries. Developing 

common principles of how the child welfare and substance abuse treatment 

agencies and staff will work together to best serve the parents in each of their 

caseloads is critical. Program designers must consider how they will secure each 

system’s buy-in to a shared set of values and principles that drive the outcomes to 

be measured.

Funding 

As jurisdictions move to create substance abuse specialist programs, professionals 

engaged in program design find that they are dealing with scarce resources. 

Contracting with a local substance abuse treatment provider may provide some 

cost efficiencies rather than having the specialist be employed by the child welfare 

agency. However, the financing strategies employed to provide the specialist 

program are often locally determined based on unique community influences. The 

strategies have included State funds, Federal child welfare and substance abuse 

treatment funds, and local investments.

Staff Development, Training, and Supervision

Child welfare, dependency court, and substance abuse treatment workers must 

address the complex needs and build on the strengths of their shared parents. 

To accomplish these goals, they need to continually improve their knowledge and 

skills through staff development and to receive ongoing interdisciplinary training 

and supervision. Conventional training in which professionals learn about their own 

roles and responsibilities without an appreciation for the cross-system roles and 

the ways to work appropriately in interdisciplinary teams may deepen any divisions 

between agency staff. Therefore, workers may participate in the cross-agency 

training program. For example, substance abuse staff may attend the child welfare 

New Worker Training. Staff supervision is also an important aspect of the programs, 

and various relationships have been implemented. Some programs have used a 

dual supervision approach with both agencies, others have contracted with service 

providers for supervision, and others use child welfare staff for supervision.

Joint Accountability, Outcomes, and Evaluation

Jointly developed outcomes are the best indicators that the agencies agree on the 

goals of their partnership and how to measure their progress toward achieving 

those goals. Agreement on accountability and outcomes means that the partners 

continue to measure their progress using their own, different measures of program 

success (e.g., treatment retention or child safety) while also agreeing to measure 

and report their collective effectiveness (e.g., family stability or reduction in reoccurrence of child neglect). The extent of focus on both the outcomes and the 

issues for data collection and monitoring varies significantly across programs.
6

Programs Interviewed

There were seven programs included in our review: (1) Connecticut’s Substance 

Abuse Specialists; (2) Massachusetts’ Substance Abuse Regional Coordinators 

Program; (3) Washington’s Substance Abuse Services Initiative; (4) Sacramento 

County’s Early Intervention Specialists and Specialized Treatment and Recovery 

Services; and, programs that were Title IV-E Waiver Demonstrations; (5) 

Delaware’s Substance Abuse Counselors Program; (6) New Hampshire’s Project 

First Step, and (7) Illinois’s Recovery Coach Program. These programs were 

selected for interviews because they are some of the Nation’s most well-established 

substance abuse specialist programs. 

Methodology

Qualitative interviews were conducted with key informants from the child welfare, 

substance abuse treatment, and dependency court systems. The key informants 

were those responsible for managing the substance abuse specialist program 

in their jurisdictions. Respondents were contacted by telephone and asked to 

participate in a 1-hour telephone interview.

The semi-structured interview was generally based on open-ended questions 

including a number of questions related to programmatic structure (i.e., purpose, 

roles and responsibilities, and locations and settings), collaborative structure 

(i.e., underlying values and principles; funding; staff development, training, and 

supervision; and joint accountability, outcomes, and evaluation), and lessons 

learned. Table 1, on page 45, provides a matrix of commonalities and differences 

among programs based on the programmatic and collaborative structures identified. 

Results

This section describes the lessons learned in the sites with substance abuse 

specialist programs that were interviewed for this paper and examines 10 key areas 

or “critical factors” in the operation of the substance abuse specialist program.

1. Training: Understanding How to Use the Specialist 

Child welfare offices and courts use the substance abuse specialist in a number 

of ways. In each program, the teams have determined the community’s specific 

needs for the program. In some sites, the specialist provides initial screening to 

all new parents and then conducts follow-up evaluations as clinically indicated; 

other systems require that all parents participate in an evaluation by the specialist. 

In at least one program, the specialist is responsible for conducting face-to-face 

evaluations only for those parents who are referred by either the court or the child 

welfare system. It is important that the child welfare and court professionals who 

interact with the specialists clearly understand and receive training on how and 

when to access the specialist’s expertise. 
7

In many sites, substance abuse specialists work closely with a multidisciplinary 

team to assist the child welfare worker and/or the court in managing parent 

cases and ensuring that parents are receiving needed resources. Specialists may 

be involved in the day-to-day communication with the parent and often serve as 

content experts in child welfare investigations. Interviewees in two sites noted the 

importance of having the same substance abuse specialist involved with parents 

throughout the length of their cases. Regardless of the way in which the specialist is 

used, it is important that each program retain the flexibility to develop the system 

that works for its local community needs. 

2. Training: Cross-Training Multisystem Staff 

Cross-training the multisystem providers (child welfare professionals, court staff, 

and substance abuse coaches and counselors) is of vital importance to the success 

of the program. Cross-training supports team building, sets the context within 

which the providers are to operate, and establishes mutual expectations. This is 

separate from training child welfare and court professionals on the mechanics of 

how to use the specific services of substance abuse specialists. Cross-training 

promotes the success of a substance abuse specialist program because all crosstrained participants agree on joint accountability, outcomes, and evaluation. All 

team members also should have an overall understanding of ASFA and how the 

deadlines affect the treatment timeline, as well as their professional role in helping 

the parent navigate the timeline successfully. Cross-training for all team members 

generally includes providing information and promoting skills to work with trauma 

and its effects on women and children, as well as providing appropriate screening, 

assessment, and access to community resources. 

3. Specialists’ Background and Expertise

In addition to their high level of commitment to the position and to the 

multidisciplinary team, the skill set and attributes of the specialist are critical to the 

success of the program. It is important that each specialist have knowledge about, 

and respect for, the child welfare system and the court, including the institutional 

history and the core values of both partners. Interviewees also recommended that 

specialists receive specific ongoing training in their field of expertise. Personal 

characteristics of a successful substance abuse specialist included having a “never 

give up” attitude, expertise in substance use and related disorders, expertise in 

children and family issues including relevant laws, close ties to the community, 

and excellent communication and follow-through skills. One difficulty noted by 

interviewees from three sites was that hiring qualified specialists can be time 

consuming.

Interviewees agreed that the placement of a substance abuse specialist should 

not be a random assignment of counselors who are sent to conduct treatment 

assessments in the child welfare office or the court. Finding the right specialist who 

has a strong background in substance use disorders and its related conditions, and 

who possesses the preferred attributes described by these seven programs, can 

make a significant impact on the success of the programs. 
8

4. Support of Leadership Across Systems

All of the seven program interviewees expressed the importance of having the 

support of top leadership across each of the agencies. Program success and 

sustainability requires that buy-in for the cross-system collaboration occur at 

all levels of each department and organization. This requirement was noted 

as especially important in the child welfare system. In most sites, the system 

administrators worked together to develop an overall framework for their staff to 

build on during program development, including a set of shared outcomes. 

In addition to the top-level agency support, program coordinators ensure that their 

department supervisors stay informed about the work and utility of the substance 

abuse specialist. Regular communication between systems can ensure that the 

leadership understands the roles and responsibilities of the staff who are carrying 

out the day-to-day activities of the program.

5. Collaborative Relationships

Interviewees also stated that it is imperative that the systems involved in 

operating and monitoring a substance abuse specialist program develop a set of 

joint values and principles to formalize and guide the collaborative relationships. 

They found these joint values and principles were essential to the ongoing 

planning and implementation of the programs. Whenever possible, there were 

formal partnerships whereby agencies and community organizations have written 

agreements to collaborate and share responsibility for ensuring that parents have 

access to needed resources.

It is crucial to involve stakeholders such as the courts, domestic violence 

counselors, and other community providers in the process as early as possible and 

to engage them in the dialogue about cross-system collaboration. Involvement 

of the different systems that are typically needed by the target population, 

including mental health treatment agencies, child care, housing, and vocational 

and educational resources, is also important. Interviewees noted that generating 

the necessary buy-in from each of the different systems to develop joint values 

and principles and to formalize collaborative relationships can be a slow process. 

However, the result of this process sets the context within which substance abuse 

specialists and other providers are to operate and be successful.

6. Space and Location of the Specialist

The multisystem program development team often decides on the space and 

location of the substance abuse specialist. In many situations, the substance 

abuse specialist is co-located in the child welfare office and strategically placed in 

a visible location. In other situations, the specialist is co-located in the court and 

has a visible presence in the child welfare office on a regular basis. One interviewee 

stressed that the host office, generally the child welfare office, must be willing 

to take deliberate steps to incorporate the specialist into the office environment. 

These steps may include introducing the specialists and clarifying their roles 
9

and responsibilities to supervisors and other staff members and disseminating 

information on how to access the services of the specialist.

7. Communication and Information-Sharing Protocols

Regular and effective communication between the substance abuse specialist, the 

child welfare staff, court staff and attorneys, and the other community providers is 

essential to the success of the program. The demands of the position should allow 

time for regular contact with other team members including time for information 

sharing through scheduled meetings, daily communication, and team building. In 

addition, clear understanding of the roles and responsibilities of the various team 

members, as well as a communication protocol, was suggested as essential for 

effective communication. 

8. Sustainable and Flexible Funding Sources 

It is important to ensure that there are adequate and reliable resources to operate 

the program and to create a strong sense of ownership in its ongoing success. 

Budgeting and sustainability planning for this type of collaboration should include 

representatives and funding from each of the systems involved. 

There is a need to ensure sufficient stability in the program funding to attract 

full-time professionals who are passionate about their investment in the 

multidisciplinary team concept and in the target population they serve. Staffing 

the substance abuse specialist positions with either short-term funding allocations 

or grants will make it difficult to attract and hire well-qualified and motivated 

personnel. In addition, funding for the program needs to be flexible and allow for 

program revisions that arise as the needs of the system change over time. 

9. Evaluation 

Interviewees noted the importance of evaluation in two key ways. First, evaluation 

is critical to understanding the successes and challenges of the substance abuse 

specialist program and allows for program revisions as needed. Second, positive 

evaluation results justify the existence of the substance abuse specialist program 

and generate continued and additional support for the program. 

Funding must include the resources needed to support data collection and outcomes 

management. Standardizing certain instruments, such as screening or evaluation, 

can reduce costs and provide valuable information necessary for a thorough 

evaluation. The evaluation of the substance abuse specialist program will provide a 

solid foundation for quality improvement and for building program sustainability.
10

10. Access to Treatment Services

Access to treatment services after the initial evaluation or assessment is a critical 

component for success. Interviewees described access as the general availability 

of appropriate treatment services in the community, and emphasized the role that 

substance abuse specialists can play in directly or indirectly facilitating parent 

screening, assessment, and engagement in services. In at least one program, 

eligibility periods for accessing the services of the specialists were extended 

from the first 90 days of the case to 6 months to allow for the establishment of 

relationships between the parent and the caseworker, and with multiple systems.

If planning and initial implementation of the substance abuse specialist program 

indicate a potential increased number of individuals accessing services, it is also 

important that treatment services have the resources and capacity to meet the 

potential increases. These treatment services also need to include ancillary services 

that address families’ needs. Table 1 summarizes the substance abuse specialist 

programs across the sites interviewed for this paper.
11

Endnotes

1 Lewis, M. A., Giovannoni, J. M., & Leake, B. (1997, June). Two-year placement 

outcomes of children removed at birth from drug-using and non drug-using mothers 

in Los Angeles. Social Work Research, 21(2), 81–90.

2 Walker, C., Zangrillo, P., & Smith, J. M. (1991). Parental drug abuse and 

African American children in foster care. Washington, DC: National Black Child 

Development Institute.

3 U.S. Department of Health and Human Services. (1999). Blending perspectives 

and building common ground: A report to Congress on substance abuse and child 

protection. Washington, DC: U.S. Government Printing Office.

4 Young, N. K., Gardner, S. L., & Dennis, K. (1998). Responding to alcohol and other 

drug problems in child welfare: Weaving together practice and policy. Washington, 

DC: CWLA Press.

5 U.S. Department of Health and Human Services. (1999). Blending perspectives 

and building common ground: A report to Congress on substance abuse and child 

protection. Washington, DC: U.S. Government Printing Office.

6 Semidei, J., Radel, L. F., & Nolan, C. (2001). Substance abuse and child welfare: 

Clear linkages and promising responses. Child Welfare, 80(2), 109–128.

7 Green, B. L., Rockhill, A., & Burrus, S. (2008). The role of inter-agency 

collaboration for substance-abusing families involved with child welfare. Child 

Welfare 87(1):29-61.

8 Green, B. L., Rockhill, A., & Burrus, S. (2008). Ibid.

9 Austin, M. J., & Osterling, K. L. (2006, January). Substance abuse interventions 

for parents involved in the child welfare system: Evidence and implications. 

Berkeley, CA: University of California at Berkeley, School of Social Welfare. 

Available online at: http://cssr.berkeley.edu/bassc/public/EvidenceForPractice4_

Substance%20Abuse_FullReport.pdf#search=’austin%20%26%20osterling%20

and%20substance%20abuse%20interventions
12

Appendix A: Case Studies

Connecticut: Substance Abuse Specialists

Background and Purpose

In 1989, a class action lawsuit [Juan F. v. O’Neill] was filed against the Connecticut 

Department of Children and Families (DCF) alleging that DCF was grossly 

underfunded and understaffed, child abuse complaints were not investigated, 

high caseloads overwhelmed social workers, and the dwindling supply of foster 

parents was underpaid and inadequately trained. Plaintiffs brought claims under 

the reasonable efforts provisions of Title IV-E, the Due Process Clause. The lawsuit 

resulted in a comprehensive consent decree in 1991 covering all areas of policy, 

management, procedures, and operation of the department’s child protective 

services.

Connecticut addressed these issues by, in part, developing and implementing 

Project SAFE (Substance Abuse and Family Education) in 1995 to improve the child 

protection system. Project SAFE provides a direct link between the child protection 

system and the adult substance abuse treatment system statewide. The program 

provides centralized intake procedures and priority access to substance abuse 

evaluations, drug screenings, and outpatient treatment services. Because of this 

collaborative program, direct-line social work staff in DCF have the ability to secure 

timely substance abuse evaluations and screenings for cases in which substance 

abuse issues are identified. 

At the time Project SAFE was created, DCF began hiring substance abuse specialists 

to serve as consultants and provide expertise and training to its social workers.

Roles and Responsibilities

Substance abuse specialists provide consultation, expertise, and training to child 

welfare workers to improve the workers’ practice and to provide brief interventions 

for families. The roles and responsibilities vary to meet the different needs of the 

population served in each area of the State. Examples of roles and responsibilities 

include (1) home visiting with child welfare workers, (2) collaborating with 

adolescent and adult treatment providers, (3) interpreting drug screening results 

for the child welfare workers, and (4) consulting with the workers about referrals to 

treatment providers. Specialists were involved in 70–80 percent of the 1,978 DCF 

neglect cases in 2006 for which substance abuse treatment was indicated.

Connecticut has been exploring Illinois’ recovery coach model as a way to better 

engage clients and provide more outreach. This exploration arises from concern 

about how to help more DCF clients engage in and complete treatment. Currently, 

child welfare workers and substance abuse specialists work together to provide 

clients with treatment referrals, but subsequent treatment entry is not ensured. 
13

Locations and Settings

Connecticut is a State-administered child welfare system comprising 15 area 

offices, divided according to towns, cities, and population clusters. Each area office 

director determines the number of substance abuse specialists needed for his or 

her area. There are eight to nine total substance abuse specialists in Connecticut. A 

specialist may serve more than one area.

In each area, the substance abuse specialist is one member of the Area Resource 

Group, a clinical team that includes a registered nurse and children’s mental health 

professionals, including at least one clinical social worker and a psychologist. 

Underlying Values and Principles

Under Project SAFE, a Memorandum of Agreement between DCF and the 

Department of Mental Health and Addiction Services (DMHAS) was developed 

that provides policy-level guidance for specialists and child welfare workers when 

working with DMHAS-funded treatment providers. Through the agreement, DCF 

clients receive assistance from the specialists and workers with gaining access to 

drug tests, evaluations, and outpatient treatment. 

On the practice level, however, philosophical differences may remain in whether 

the client is the parent, child, or family, and whether the goal is child safety, 

family preservation, or parent recovery. Because of the differing values, some 

child welfare workers avoid substance abuse specialists, whereas others have 

productive relationships with them. Successful collaborations result in child welfare 

workers and substance abuse specialists working on cases together, focused on the 

children’s needs, the family’s needs, and the parents’ treatment needs. 

Funding

Because of the consent decree, the State of Connecticut allocates funds to DCF 

to pay for 67 unionized clinical specialists with expertise in clinical social work, 

nursing, substance abuse, children’s mental health, and family and clinical 

psychology. Specialists’ salaries range from $45,000–$68,000 plus benefits 

negotiated in the collective bargaining agreement.

Substance abuse specialists are hired by DCF and are employed by the State of 

Connecticut. DCF pays the specialists from the State allocation. Specialists have the 

same job class as clinical social workers and are members of the health care union. 
14

Staff Development, Training, and Supervision

DCF State substance abuse specialists must be licensed clinical social workers 

with additional licensure or certification in alcohol and other drug counseling. 

The requirement for additional certification can be waived if the candidate has 

experience working with the substance abuse treatment system. Statewide, there is 

a shortage of licensed professionals who are qualified to fill these positions, which 

has led to DMHAS and treatment providers hiring staff without substance abuse 

credentials. 

When substance abuse specialists were first introduced in the early 1990s, child 

welfare workers and providers experienced a learning curve on how to use the 

specialists appropriately. The specialists provided cross-training to child welfare 

workers and providers to help them understand the role and functions of the 

specialists. Today, many DCF area offices view the worker, provider, and specialist 

as a “treatment team.” In addition, DCF is moving toward a model of training that 

will provide child welfare workers with an understanding of substance use disorders, 

treatment, and recovery. 

Specialists report to their respective DCF area office director, who is responsible for 

determining the specialist’s responsibilities. The DCF area office directors supervise 

the specialists, which includes providing ongoing training, coaching, improving 

knowledge and clinical skills, and providing other necessary support to improve 

clinical outcomes for children and families. Specialists are required to maintain their 

licensure and certifications. 

Joint Accountability, Outcomes, and Evaluation

Since introducing substance abuse specialists, DCF has collected activity data 

including the number, frequency, and type of consultations provided by the 

substance abuse specialists on each case. In addition, DCF collects data on triage, 

case conferencing, tracking, and case management. 

Each area office collects data at the area level. However, the data are not 

standardized and are therefore difficult to analyze on a statewide, aggregate basis. 

To address this challenge, DCF has implemented the use of the Global Assessment 

of Individual Needs - Short Screener (GAIN-SS), a standardized screening for cooccurring disorders to be conducted by child welfare workers. Substance abuse 

specialists train child welfare workers to use the GAIN-SS instrument. Recently, DCF 

began providing specialists information on the extent of GAIN-SS usage and the 

training and technical assistance needs among workers in specific area offices.

CONTACT: Peter Panzarella, Director of Substance Abuse Services

Connecticut Department of Children and Families

Phone: 860-550-6527

E-mail: peter.panzarella@po.state.ct.us
15

Delaware: Substance Abuse Counselors Program

Background and Purpose

In 1996, the U.S. Department of Health and Human Services granted the Delaware 

Department of Services for Children, Youth, and Their Families’ Division of Family 

Services (DFS) approval to implement a Title IV-E Waiver Demonstration Project. 

The purpose of Delaware’s 5-year waiver demonstration was to reduce the cost 

of out-of-home care by focusing on early identification of parental substance 

use disorders and substance abuse treatment service referrals. Before the 

demonstration project, DFS had limited access to substance abuse counselors. 

DFS applied for the waiver demonstration with the intent of using the expertise 

of substance abuse treatment counselors to reduce removals of children from the 

home or facilitate reunification of families with substance use disorders.

Although all child welfare workers received 3 days of training related to substance 

abuse, they had limited hands-on experience in working with these issues. The 

substance abuse counselors, however, were familiar with the treatment network, 

both within and outside of Delaware (e.g., Philadelphia and Maryland), had contacts 

in an array of treatment agencies, and understood the variety of programs offered 

by each agency (e.g., perinatal, methadone, and adolescent). With the support of 

the substance abuse treatment counselors, parents were provided with referrals 

that better reflected their individual and treatment needs. 

In addition, child welfare workers experienced difficulty in negotiating the managed 

care system that governs a significant portion of the substance abuse treatment 

network. One of the biggest challenges was navigating Medicaid and managed 

care preauthorization specifications regarding treatment length and coverage and 

determining which treatment agencies accepted Medicaid. The Title IV-E waiver 

provided an opportunity for DFS to use substance abuse counselors who were 

familiar with the managed care system. 

In the evaluation results, the Waiver Demonstration Project was not cost-neutral, 

nor did it demonstrate cost savings. As a result, the demonstration project was 

terminated in December 2001. Although Federal funding for the project ceased, 

DFS, substance abuse treatment agencies, child welfare workers, and courts saw 

the value in using substance abuse counselors who could assess and connect clients 

to appropriate treatment in a timely manner. The juvenile court wrote letters to DFS 

praising the expertise of counselors in helping parents to complete treatment. DFS 

also received letters from clients testifying to the positive impact the counselors 

made on their lives. As a result, DFS decided to continue the Substance Abuse 

Counselors Program using non-Federal Title IV-E sources.
16

Roles and Responsibilities

The primary roles and responsibilities of the substance abuse counselors include 

providing consultation, evaluations, referrals, linkages, and case management 

services to adult DFS clients who may have a substance use disorder. Specifically, 

the substance abuse counselors fulfill the following responsibilities:

1. Collaborate with treatment units;

2. Provide consultation services to child welfare investigation units;

3. Identify clients with suspected or documented substance use disorders;

4. Conduct home visits with the DFS social worker or on their own;

5. Refer clients with suspected or documented substance use disorders to a 

substance abuse treatment agency for an assessment;

6. Link and monitor substance abuse treatment services provided by substance 

abuse treatment agencies;

7. Provide continued support to clients while the client is engaged in 

treatment;

8. Coordinate services and case monitoring with the DFS social worker;

9. Keep DFS informed of activities and status of the client;

10. Participate in child safety decisions;

11. Participate in case conferences and jointly develop case plans with DFS;

12. Enter notes summarizing client contacts into the DFS computerized case 

management system known as FACTS (Family and Child Tracking System);

13. Conduct or arrange random urine screenings for clients as needed (to be 

determined by either the substance abuse counselor or the DFS social 

worker);

14. Testify in court as needed (if proper subpoenas have been issued); and

15. Provide quarterly “brown bag” seminars to DFS staff to cover a variety of 

timely substance abuse issues. Recently, seminar topics have included how 

to recognize whether clients may be using methamphetamine or heroin. 

Attendance is voluntary; however, many DFS staff attend because of the 

useful information provided.

DFS and treatment unit supervisors emphasize the need for the counselors to work 

flexible hours to accommodate the child welfare aspects of the case (i.e., visitations 

and home visits). Substance abuse counselors consult with an average of 15 DFS 

caseworkers and carry caseloads ranging from 26–37 families.
17

Locations and Settings

Delaware has three counties and four regional child welfare offices—one office each 

in Sussex and Kent counties and two offices in New Castle county. There is one 

substance abuse counselor assigned to each region. DFS contracts with communitybased substance abuse treatment agencies in each region to employ the substance 

abuse counselors and to provide clinical oversight. The DFS treatment program 

manager is involved in interviewing these potential substance abuse counselors. 

The substance abuse counselors are co-located in the community-based substance 

abuse treatment and agency with DFS treatment staff in each of the four regional 

DFS offices. DFS provides each substance abuse counselor with office space, a 

computer, a telephone, and a State vehicle. By co-locating the substance abuse 

counselors with DFS staff, the counselors are available either to accompany DFS 

staff on home visits and to case conferences or to provide consultation to DSF staff. 

The counselors are considered part of their respective DFS treatment units and are 

included in all unit meetings.

Underlying Values and Principles

In 1998, DFS signed a Memorandum of Understanding with Delaware Health 

and Social Services, Division of Substance Abuse and Mental Health (DSAMH), 

to ensure that every DFS client is given priority status to receive a substance 

abuse assessment. Although this arrangement was made independently of the 

demonstration project, it provided the foundation for building shared values and 

principles between agencies. 

Several aspects of the program design have helped build a shared set of values 

between child welfare and substance abuse systems. For example, new substance 

abuse counselors must complete a 6-month DFS New Worker Training protocol 

before they can carry a caseload. Through the DFS New Worker Training, the 

substance abuse counselors learn child welfare and safety issues as well as DFS 

policies and procedures. The counselors, having gone through New Worker Training, 

understand where differences in values can easily cause misunderstandings 

between the child welfare and substance abuse treatment systems. The DFS 

treatment program manager conducts trainings for all treatment agencies in the 

State on DFS’s Child Protection Registry, child welfare timeframes (Adoption and 

Safe Families Act), substance abuse, treatment, and recovery.

Funding 

DFS contracts with these substance abuse agencies to hire the certified substance 

abuse counselors. DFS transfers funds to the agencies in exchange for their 

employment, training, and supervision of counselors. Since DFS funds the 

Substance Abuse Counselors Program, DFS establishes the terms and conditions 

of contracts with the agencies. When the Title IV-E Waiver Demonstration Project 

ended, DFS reallocated funding from other treatment contracts to continue the 

Substance Abuse Counselors Program. 
18

DFS spends approximately $150,000 annually on the substance abuse counselors’ 

salaries, health insurance, Federal Insurance Contributions Act taxes, association 

dues, conference fees, and urinalysis screenings. The contracts between DFS and 

the substance abuse treatment agencies are the cost-reimbursement type. As 

such, the agencies submit invoices to DFS each month to cover monthly expenses 

incurred by the substance abuse counselors. The substance abuse counselors have 

access to a State vehicle; DFS absorbs the cost of State vehicle use. 

Staff Development, Training, and Supervision

Substance abuse counselors must maintain a current certification in drug and 

alcohol counseling (CDAC) and must receive clinical supervision by a credentialed 

supervisor. The treatment agencies that employ the counselors have their own 

desired qualifications and requirements based on the populations they serve. 

As discussed previously, new substance abuse counselors must complete the DFS 

New Worker Training protocol. The DFS treatment program manager provides 

opportunities for additional in-service training as well. All counselors must maintain 

their CDAC certification, and some treatment agencies require additional training. 

Delaware uses a dual supervision model to train and supervise counselors. The 

substance abuse treatment agencies provide a credentialed supervisor to conduct 

ongoing clinical supervision and training of the counselors. DFS provides supervision 

for the child welfare aspects of each counselor’s cases. The DFS treatment program 

manager and the DSAMH director of drug and alcohol services coordinate and 

facilitate quarterly meetings with all parties involved in the Substance Abuse 

Counselors Program (DFS, DSAMH, treatment agencies, and counselors). At the 

quarterly meetings, these parties review and discuss any systemic issues and 

concerns and develop programmatic improvement strategies. 

Joint Accountability, Outcomes, and Evaluation

Since 1996, the DFS Treatment Program Manager has collected data monthly, from 

the substance abuse counselors, summarizing their caseload and the status of each 

client. The data collected are as follows:

• 

• 

• 

• 

• 

• 

Date each case is referred by child welfare to the substance abuse counselor;

Date of the counselor’s first contact with the client;

Whether the client was referred to a treatment agency;

Whether the client attended treatment/scheduled appointments;

Duration of treatment episode;

Existence of co-occurring mental health disorders and domestic violence 

issues;
19

• 

• 

• 

• 

Whether the client was in substance abuse treatment at the time of referral;

Whether the children were placed in out-of-home care;

Identified barriers to success; and

The client’s current prognosis.

In evaluating a client’s current prognosis, the counselors select one of the following 

choices:

• 

• 

• 

• 

Excellent: Client connected to treatment, consistent negative urines, and 

improvement in functioning noted;

Good: Client attended evaluation, appears to be motivated toward treatment, 

mostly negative urines, and little improvement in functioning noted;

Fair: Client attended evaluation, little motivation toward treatment, some 

negative urines, and little improvement in functioning noted; and

Poor: Client did not attend evaluation, no motivation toward treatment, no 

negative urines, and no improvement in functioning noted.

If a counselor gives a client a prognosis of “fair” or “poor,” the counselor will 

increase efforts to engage the client through more frequent contact and potentially 

increasing the level of structure in the substance abuse treatment program for the 

parent.

DFS’s budget does not allocate money for an independent program evaluation. 

Thus, given limited evaluation resources, the first analysis of the postdemonstration project data was completed in 2006 by a graduate student/research 

assistant. The results indicated that in 2005, 24 percent of parents working with 

the substance abuse counselors completed a treatment program. Because of the 

evaluation, DFS, the treatment agencies, and the substance abuse counselors 

are developing strategies to improve the treatment retention rates among DFS 

clients. For example, peer mentors have been suggested as a possible additional 

component of the program. 

CONTACT: JoAnn Bruch, Treatment Program Manager

Division of Family Services

Delaware Department of Services for Children, Youth, and Their Families

Phone: 302-633-2690

E-mail: Joann.Bruch@state.de.us
20

Illinois: Recovery Coach Program

Background and Purpose

The Recovery Coach Program in Illinois emerged from a history of collaborative 

efforts focused on improving services for substance-affected families in child 

welfare. In 1986, the Department of Children and Family Services (DCFS) and the 

Department of Human Services (DHS), Division of Alcoholism and Substance Abuse 

(DASA), launched Project SAFE (Substance and Alcohol-Free Environment.) This 

pilot project was launched to learn whether DCFS and DASA could increase the 

number of women with substance use disorders engaged and retained in treatment 

if their unique needs, such as child care, transportation, and lack of insurance for 

treatment, were met. 

In 1998, DCFS launched a second pilot project, the Intact Family and Recovery 

Program, in Cook county. The cornerstone of the project is the collaboration 

between child welfare workers and alcohol and other drug abuse (AODA) workers 

in serving mothers of prenatally exposed infants. This collaboration allows the 

engagement of mothers into treatment immediately after the birth of their child 

with the goal of keeping the family intact. This pilot project revealed that there was 

a further need for cross-training of child welfare and AODA workers and that these 

workers needed the ability to address clients’ co-occurring issues (i.e., domestic 

violence and mental health issues). The project also revealed that clients benefited 

when they had an advocate to assist them in progressing through treatment.

When presented with an opportunity to apply for a Title IV-E Waiver Demonstration, 

DCFS believed that its experience in addressing substance abuse issues among 

child welfare clients would help the agency create and implement an effective 

waiver demonstration program. The waiver demonstration program began in April 

2000 in Cook county (Chicago and suburban areas) and continued until June 2005. 

The purpose of the waiver demonstration program in Illinois was to test a model of 

intensive case management in the form of a recovery coach. The use of a recovery 

coach was intended to increase access to substance abuse services, improve 

substance abuse treatment outcomes, shorten the length of time in out-of-home 

care for the child, and affect child welfare outcomes, including increasing rates of 

family reunification and decreasing the risk of continued maltreatment. 

At the conclusion of the demonstration program, an independent evaluator 

determined that the program met all of its intended outcomes. The program also 

provided a cost savings of $5.6 million over the 5 years of the demonstration, 

which DCFS was able to reinvest in State child welfare services. As a result, DCFS 

received a 5-year extension to expand the program into the southern, more rural, 

part of the State, including Madison and St. Clair counties. The new project began 

in December 2006 and will end in December 2011. The purpose of the current Title 

IV-E waiver project continues to be the use of a recovery coach. 
21

Roles and Responsibilities

The role of the recovery coach is to be an advocate for DCFS clients in working with 

their child welfare workers, the courts, the substance abuse treatment agencies, 

and their family members. As an advocate, the recovery coach assists the parent in 

obtaining benefits and in meeting the responsibilities and mandates related to the 

parent’s child welfare case and recovery treatment plan. Recovery coach services 

are provided for the duration of the case and may be continued for a period of time 

after the child welfare case closes. 

Recovery coaches engage DCFS clients in all activities related to the substance 

abuse aspects of a case, including comprehensive clinical assessments, service 

planning, outreach, and case management. The following paragraphs describe some 

of these activities. 

The clinical assessments focus on a variety of problem areas, such as housing, 

domestic violence, parenting, mental health, and family support needs. Recovery 

coaches also conduct urinalysis to help demonstrate to the court whether the client 

has tested negatively for substance use. 

In service planning, recovery coaches coordinate DCFS and other services. They 

also arrange for the appropriate level of care and ensure that there are no gaps in 

service.

In conducting outreach, recovery coaches work with substance-abusing families in 

their community. The coaches improve communication between the child welfare 

worker and substance abuse treatment facilities to ensure a seamless delivery 

of services. Recovery coaches also transport clients to appointments and court 

hearings, arrange and attend meetings with families and treatment providers, and 

make joint home visits with child welfare caseworkers and/or treatment agency 

staff. At least one recovery coach is always on call during evenings, weekends, 

and holidays to respond to any emergencies that may arise. Recovery coaches 

engage in information sharing with child welfare, treatment providers, and juvenile 

court personnel. The information sharing is intended to help inform permanency 

decisions. To ensure recovery, child welfare workers and treatment providers 

contact recovery coaches if they sense a client is about to relapse. 

Locations and Settings

The offices of recovery coaches are located in a Treatment Alternatives for Safe 

Communities (TASC) office, the organization initially responsible for providing 

recovery coach services to clients in the demonstration group. This office is close 

to the Cook county juvenile court, a location found to be effective, particularly if 

the recovery coach is unable to locate a client. Thus, if the client appears in court, 

Juvenile Court Assessment Project (JCAP) professionals are able to identify his 

or her recovery coach and immediately re-link the client to that recovery coach. 

Recovery coaches, however, often spend most of their time in the field.
22

Clients receiving recovery coach services meet the recovery coach liaison at JCAP 

immediately after their substance abuse assessment. DCFS contracts with Caritas, 

a central intake service organization, to perform the initial JCAP assessment, make 

a treatment recommendation, and set up an intake appointment at one of the 

treatment agencies participating in the interagency agreement between DCFS and 

DASA. 

There are four recovery coach teams that each focus on clients and/or specific 

issues (e.g., men, women, or co-occurring disorders). Each team has one 

supervisor and four to five recovery coaches and each team includes outreach 

workers, sometimes known as trackers, who are responsible for finding clients who 

have become difficult to locate at some point during the recovery process. There 

are two trackers in Cook County, and one of the team supervisors works with both 

trackers.

Underlying Values and Principles

Since 1995, DCFS has had in place a formal interagency agreement with DHS and 

DASA. Periodically, DCFS, DHS, and DASA review this interagency agreement to 

ensure that DCFS clients continue to receive priority treatment admission. DCFS 

contracts with approximately 60 private agencies (such as Catholic Charities and 

Lutheran Social Services of Illinois) to provide child welfare case management for 

about 80 percent of Illinois families with open child welfare cases. The contracts and 

interagency agreements with private agencies outline DCFS policy and procedures 

for serving substance-affected families. The agreements clearly outline procedures 

for working productively and collaboratively with child welfare workers and recovery 

coaches. In addition, the DCFS contracts with TASC and Caritas specify DCFS’ 

expectations for assessment, referral, recovery coach services, and data collection.

Funding

DCFS spends approximately $2.2 million annually on the Recovery Coach Program, 

including costs for the JCAP services, the computer-based data collection integrated 

system, and the recovery coaches. Recovery coaches receive the same benefits as 

TASC employees. Recovery coaches are required to use their own vehicle, but they 

receive the Federal rate allotment for mileage reimbursement. 

Staff Development, Training, and Supervision

Recovery coaches must be either a Certified Alcohol and Drug Counselor (CADC) 

or a Certified Assessment/Referral Specialist (CARS). Recovery coaches have 1 

year after hiring to obtain the required certification. Supervisors are required to 

have a master’s degree as well as experience in the child welfare and substance 

abuse treatment systems. Caritas and TASC are responsible for hiring, training, 

and supervising recovery coaches. DCFS contracts with TASC to provide supervision 

and training of recovery coaches. Recovery coaches are required to participate in a 

variety of DCFS and DASA trainings that cover various topics, including addiction, 

relapse prevention, the Diagnostic and Statistical Manual of Mental Disorders 
23

(Fourth Edition), the American Society of Addiction Medicine, fundamentals of 

assessment, ethics, service hours, client-tracking systems, service planning, case 

management, and counseling.

Since the first waiver project, DCFS personnel have provided training on the role 

of recovery coaches to child welfare agencies and substance abuse treatment 

providers. DCFS emphasized to child welfare agencies that the recovery coach was 

not to replace the child welfare worker, but would instead provide a bridge to the 

client and the treatment community regarding all substance-related aspects of the 

child welfare case. The intention of the training was to emphasize the expertise of 

the recovery coach in assisting the parents through the recovery process. 

In addition, the DCFS AODA Waiver coordinator provides cross-training to ensure 

collaboration between JCAP, Caritas, TASC, and other collaborating agencies. DCFS 

has also extended its training into courts to inform judges about the recovery 

process and the role of recovery coaches. 

The DCFS AODA Waiver coordinator meets monthly with supervisors from TASC, 

JCAP, and Caritas to discuss the recovery coach program and any data collection 

issues. Cross-training about the various roles in the collaboration also occurs during 

these monthly meetings.

Joint Accountability, Outcomes, and Evaluation

DCFS contracts with Caritas to coordinate a computer-based data collection 

integrated system called TRACCS (Treatment Record and Continuing Care System). 

Caritas collects data from child welfare workers, recovery coaches, and treatment 

agencies. The database includes a variety of client (e.g., demographics and 

placement history) and social service (e.g., placement records) information. 

The current waiver demonstration project requires that an independent evaluator 

determine whether the project has met its outcomes and whether the project is 

cost-neutral. The Children and Family Research Center at the University of Illinois 

at Urbana-Champaign School of Social Work analyzes the collected data to measure 

whether the following outcomes are being met: 

(1) increased rates of reunification; (2) shorter lengths of stay in foster care; (3) a 

reduction in reallegations of child abuse and neglect; and (4) higher success rates 

for completion of parental substance abuse treatment among demonstration group 

participants. According to the Center’s January 2006 evaluation report, DCFS has 

achieved its first three outcomes, with statistically significant differences between 

the control group and the demonstration group. Although no comparison was 

available for the fourth outcome, beginning in April 2004, 22 percent of clients in 

the demonstration group had completed treatment.

DCFS realized a cost savings of $5.6 million over the 5-year span of 2000–2005, 

which it reinvested in State child welfare services.
24

CONTACT: Rosie Gianforte, Alcohol and Other Drug Abuse Waiver Coordinator

Illinois Department of Children and Family Services

Phone: 312-814-2440

E-mail: Rosie.Gianforte@illinois.gov
25

Massachusetts: Substance Abuse Regional Coordinators Program

Background and Purpose

In 1998, the Massachusetts Department of Social Services (DSS) Child Welfare 

Department created a strategic plan entitled “The Project on Addressing Substance 

Abuse,” in collaboration with the Massachusetts Department of Public Health’s 

(DPH) Bureau of Substance Abuse Services (BSAS). The plan included six 

recommendations for improving substance abuse services for child welfare clients. 

One recommendation was to establish a Substance Abuse Unit to focus exclusively 

on building child welfare’s capacity and expertise in responding to substance abuse 

allegations. In 2000, DSS and DPH created and co-funded a managerial position at 

the child welfare central office. The two departments also hired the first substance 

abuse director with the agreement that DSS would be responsible for administrative 

oversight. In 2001, DSS and DPH used additional funding to create a central office 

assistant to the substance abuse director. 

From 2001–2004, the substance abuse director and the assistant were responsible 

for training, policies, and projects related to substance abuse, including drug testing 

policies and procedures. In 2004, because of budgetary constraints, DPH could no 

longer co-fund the director position. The resulting budgetary considerations for DSS 

led to staffing changes that presented an opportunity to reflect on the strengths 

and weaknesses of the Substance Abuse Unit’s activities and to configure a new 

program design and staffing plan. 

Several factors led to DSS’s continued support of the Substance Abuse Unit, including

(1) the Substance Abuse Unit had demonstrated the value of and demand for its 

services to DSS; (2) governmental leadership, including the support of the DSS 

commissioner at the time, for integration and system changes in child welfare and 

substance abuse was in place; and (3) the Massachusetts Child and Family Services 

Review, completed in fiscal year 2001, highlighted the need for DSS to improve 

substance abuse services. 

However, two issues were highlighted for program and staffing revision. First, 

standardized drug testing services provided from 2002–2004 demonstrated 

that child welfare workers needed more training and support for cases in which 

substance abuse is a factor. During this timeframe, all drug testing was provided 

at one laboratory location, and results were reported to child welfare. Child welfare 

workers, partially from a lack of knowledge about when testing is appropriate, 

were unnecessarily referring large numbers of cases for drug testing. Second, with 

responsibility for all six regions, the two-person Substance Abuse Unit struggled to 

provide services in the field. There was a need to add and reconfigure staff to allow 

the Substance Abuse Unit to provide services on a regional level. For example, each 

of the six regions had received a mental health specialist in 2001.
26

With funding from DSS, the Substance Abuse Unit created six regional positions in 

2004 and called the effort the Substance Abuse Regional Coordinators Program. The 

purpose of the program is to build child welfare’s capacity and expertise to address 

substance abuse, create linkages between child welfare and the substance abuse 

provider community, and collaborate with colleagues in mental health and domestic 

violence.

Roles and Responsibilities

The roles and responsibilities of the coordinators were developed by the DSS 

substance abuse director. In developing coordinator roles, the director wanted 

to exclude responsibilities that would involve coordinators in extensive clinical 

work, which would hinder their ability to focus on system-level change, promote 

interagency collaboration, and build caseworkers’ capacity and expertise to address 

substance abuse in their cases. Thus, case management and home visiting were 

intentionally excluded from the coordinator’s role, though the coordinators regularly 

consult and provide expertise and guidance to DSS staff regarding substance 

abuse-related cases. Coordinators also attend multidisciplinary meetings and case 

staffing to provide their expertise and to ensure that DSS workers are adequately 

supported to address substance abuse. 

Within these boundaries, DSS was intentionally broad in developing the various 

possible roles for the coordinator. Central administration wanted to give regional 

administration shared power to prioritize the various roles. Although central 

administration wanted to provide overall expertise and a common language and 

purpose among coordinators, the regional administrators could determine which 

roles would best serve the needs of the clients and caseworkers in that particular 

region. DSS also intentionally established common responsibilities between 

coordinators. For example, the substance abuse director planned to hold weekly 

meetings with all the coordinators, providing a venue for coordinators to learn from 

one another’s experiences. 

The roles and responsibilities listed in the coordinator job description are as follows:

• 

• 

• 

• 

• 

Conduct a capacity needs assessment on substance abuse for the assigned 

region and its corresponding area offices; 

Develop and implement substance abuse capacity building and action plans. 

Provide resources, support, and training to increase the level of substance 

abuse expertise in the assigned region;

Implement regional and area objectives outlined in “The Project on 

Addressing Substance Abuse,” in conjunction with regional leadership;

Provide case consultation to assigned area offices as needed;

Monitor ongoing pilot project efforts on substance abuse within assigned 

regions;
27

• 

• 

• 

• 

• 

Participate in regional and area team meetings, including continuous quality 

improvement teams, family group conferencing, and other clinical meetings;

Work with community-based substance abuse providers to establish working 

relationships between the provider and the local DSS area office. This 

work includes improving communication with the provider and developing 

protocols to improve DSS clients’ access to services and to streamline service 

provision;

Participate in regional and area interagency or community-based substance 

abuse or child welfare meetings;

Collect regional and area data on substance abuse when needed; and

Participate on regional and statewide projects and committees as needed.

DSS works with approximately 20,000 families on any given day. The coordinators 

do not work directly with families in their case consultation role, but conduct a total 

of 50–75 consultations with the child welfare worker per month.

All the coordinators have a substance abuse treatment background, which has been 

invaluable as they build relationships with treatment providers. Their treatment 

background is also a challenge for the program, because the coordinators enjoy 

and may prefer to focus on the case consultation part of their work. Although the 

coordinators understand their role in promoting system change, most do not have 

a background in building interagency relationships. They also face the challenge 

of frequent misperceptions about their role from within both DSS and BSAS. For 

example, people often assume the coordinators are to be directly involved with 

cases. When the coordinators become involved in casework, as many DSS and 

BSAS staff believe is the coordinator role, keeping system change and capacity 

building at the forefront becomes a challenge. 

Locations and Settings

Massachusetts child welfare services are State administered. DSS provides services 

through six regions and through area offices within each region. The DSS Substance 

Abuse Director works with each regional director to select the coordinator. The 

positions are known technically as regional positions (not central administrative 

office positions). There is one substance abuse coordinator for each region, working 

in his or her respective regional office while also providing services to area offices. 

Underlying Values and Principles

A joint value for interagency collaboration between DSS and DPH/BSAS predated the Substance Abuse Regional Coordinators Program. The collaboration was 

developed during the creation of the 1998 strategic plan to address substance 

abuse and continues to exist in the Massachusetts Family Recovery Collaboration 

(MFRC). MFRC is an effort launched in 2006 to develop an integrated, coordinated 
28

system of care for families in which parental substance use disorders result in the 

maltreatment and/or neglect of children or increase the risk of such maltreatment 

or neglect. Its goal is improved well-being of children and strengthened families. 

MFRC is governed by a Memorandum of Understanding between DSS, DPH/

BSAS, the Administrative Office of the Trial Court Juvenile Department, and the 

Wampanoag Tribe of Gay Head Aquinnah. The memorandum specifically explains 

joint values and principles for those involved in the MFRC collaboration.

The substance abuse director’s weekly meetings with coordinators also reinforce 

the program’s purpose and underlying values and principles. In the program’s first 

6 months, the leadership from the substance abuse director and weekly meetings 

were critical to help the coordinators form relationships with the child welfare 

workers and substance abuse treatment providers. The meetings continue to be 

important for helping the coordinators lead their regions to continue building their 

own capacity to address substance abuse. 

Funding

The Substance Abuse Unit created six regional positions in 2004. Since the 

coordinators are technically regional positions, DSS allocates State funds to 

the regions to cover the coordinators’ salaries, workspace, travel, and parking. 

The coordinators are State union positions, not funded by grants or legislative 

allocations. The DSS Substance Abuse Unit, however, does not have a program 

budget for other aspects of the program, such as purchasing equipment or funding 

conference participation. 

Staff Development, Training, and Supervision

Each coordinator is required to have at least a bachelor’s degree in human services, 

social work, or a related field. Licensed professionals are encouraged to apply. Four 

years of full-time or equivalent part-time professional experience in social work, 

social casework, health care administration, public health, program administration, 

hospital administration, or program management is also required. However, either 

a bachelor’s degree holder with 2 years of experience or a master’s degree holder 

with 1 year of experience is also qualified.

Massachusetts has filled all six positions. All have master’s degrees (one is in 

nursing, two are in social work, and two are Licensed Mental Health Counselors), 

and one has a Ph.D. It was difficult to find the right candidates for these positions 

for several reasons. These positions require professionals who are able to meet 

the relatively new challenge of working across governmental systems (including 

navigating the politics). And DSS strongly believed that the program’s success 

depended on identifying candidates who have a background in working with 

families. 
29

New coordinators participate in the 1-month-long child welfare New Worker 

Training, which is the key to understanding how child welfare operates. They 

typically receive a basic introduction to the program and job responsibilities from 

the substance abuse director. New hires also shadow experienced coordinators.

The director hosts a weekly meeting of the coordinators in which they are able to 

learn from one another’s experiences. In the initial implementation of this program, 

these weekly meetings provided coordinators with support and direction as they 

worked to become integrated into the child welfare system. They gained a mutual 

sense of belonging and trust and built relationships with substance abuse treatment 

providers. Coordinators have recently started arranging meetings between 

themselves, representatives from the child welfare offices where they work, and 

local substance abuse treatment providers to build relationships and initiate crosstraining.

Under a matrix-management model for supervision, the primary supervision for 

each coordinator is at the regional level. The DSS substance abuse director provides 

clinical supervision and technical support. Two factors may influence the supervisory 

relationships in the future. First, Massachusetts intends to hire a co-director of 

integrated practice for substance abuse and mental health, who will take over 

management of the program. Second, at the regional level, new clinical managers 

have recently been put into place, and some have substantial substance abuse 

experience. 

Joint Accountability, Outcomes, and Evaluation

The program does not track outcomes, but there are ways in which DSS is 

evaluating progress. In the weekly meetings, the substance abuse director can 

consistently gather information about coordinators’ success. The director uses the 

following indicators to determine whether the purpose of the Substance Abuse Unit 

and the Substance Abuse Regional Coordinators Program is being effectively carried 

out:

• 

• 

• 

High utilization of the coordinator by caseworkers and external providers;

Stronger linkages between child welfare and substance abuse treatment 

providers; and

Increased capacity of child welfare to address cases in which substance 

abuse is a factor.

CONTACT: Kim Bishop-Stevens, Substance Abuse Manager

Massachusetts Department of Social Services

Phone: 617-748-2049

E-mail: kim.bishop-stevens@state.ma.us
30

New Hampshire: Project First Step

Background and Purpose

During the late 1990s, New Hampshire’s Statewide Automated Child Welfare 

Information System, known as New Hampshire Bridges, documented a number of 

co-occurring issues facing child welfare clients, including substance abuse. Both the 

data and the opportunity to apply for a Title IV-E Waiver Demonstration Project led 

professionals from the New Hampshire Department of Health and Human Services 

(HHS), including representatives from the Division for Children, Youth and Families 

(DCYF) and what is now the Division of Alcohol and Drug Abuse Prevention and 

Recovery (DADAPR), to come together to determine how to better address the 

needs of families affected by substance use disorders who are involved in child 

welfare services. DCYF adapted Delaware’s Substance Abuse Counselors Program, 

also funded as a Title IV-E Waiver Demonstration (see page 15). 

In May 1998, New Hampshire DCYF received approval to run its proposed Title 

IV-E Waiver Demonstration Project, known as Project First Step. New Hampshire 

implemented its demonstration project in two of the State’s most populated district 

office areas, which serve the majority of Hillsborough county. The waiver allowed 

New Hampshire to demonstrate whether spending the funds to increase capacity 

to provide parents with substance abuse treatment could improve reunification and 

other family permanency and safety outcomes for children from substance-affected 

families. HHS involved the University of New Hampshire (UNH) Family Research 

Lab, as well as field supervisors, caseworkers, and stakeholder groups, to provide 

its expertise during the program design phase. 

Four factors influenced the demonstration project design in New Hampshire:

• 

• 

• 

Compared with many other States, the rate of substantiated child abuse and 

neglect referrals is relatively low. This factor is due, in part, to the State’s 

stringent due process requirements for substantiation of allegations of child 

abuse and neglect. New Hampshire’s Child Protection Act provides for a 

relatively long, 60-day assessment before substantiation. Substance abuse 

screening is conducted before substantiation, which has documented that 

one-fifth to one-fourth of all reports assigned for face-to-face assessments 

have an identified substance abuse issue. However, since 1996, just 10–11.5 

percent of all DCYF cases have been substantiated. Upon investigation, 

50 percent of those substantiated assessments that resulted in temporary 

removal or in-home services had parental substance abuse identified;

Although heroin use is substantial in some areas, alcohol is the primary 

substance used by clients;

New Hampshire is involved with most referrals on a short-term basis, but 

repeatedly (sometimes for a few months out of a year, over a period of 

years); and
31

• The program designers made an assumption that with children being 

removed from homes in only about 10 percent of cases, the actual number 

of children who would be traditionally eligible for Title IV-E funding in New 

Hampshire’s demonstration project would be relatively small. Most families 

would be receiving in-home services.

HHS decided to co-locate Licensed Alcohol and Drug Counselors (LADCs) in two 

Child Protective Services (CPS) district offices, one in Nashua and the other in 

Manchester. From November 1999 through December 2004, reports that DCYF 

accepted for assessment were randomly assigned to experimental (enhanced 

services) or control (standard services) groups. Child Protective Service Workers 

(CPSWs) and LADCs were mutually assigned to families in the experimental group. 

Families in the control group received standard child protection and communitybased assessment and treatment services. 

By July 2003, a total of 435 families had enrolled in the demonstration, with 222 

families in the experimental group and 213 in the control group. Children from 

families in the enhanced services group were more likely to remain with kin and had 

fewer foster care placements than children from families in the standard services 

group. Further, the average number of foster care placements for enhanced group 

children was significantly lower than the average number of similar placements for 

standard group children. Those children in the enhanced group who could not be 

safely reunified, reached the concurrent goal identified by Termination of Parental 

Rights sooner than those in the standard group. Regardless of substantiation 

of placement, children and their parents in the enhanced group demonstrated 

improved outcomes in the area of well-being.1

At the conclusion of the demonstration project, New Hampshire found that the cost 

of the enhanced LADC/CPSW services to families remained constant, so the project 

did not demonstrate savings in Title IV-E funds. Nevertheless, the addition of LADCs 

improved reunification and permanency rates and allowed the CPSWs to focus 

on all aspects of their cases by having a better connection with substance abuse 

treatment and recovery. By 2004, DCYF viewed the project as extremely important 

and genuinely believed that approaches like Project First Step were necessary to 

meet the needs of its clients. Thus, Project First Step was allowed to continue its 

efforts to increase clients’ access to quality assessment and timely treatment and to 

encourage child protection, substance abuse treatment, and community services to 

create a system of integrated services.

The demonstration had two lasting effects that contributed to the program’s 

continuation. First, families in the enhanced services group experienced improved 

kinship care as an alternative to foster care placement. In identified cases, LADCs 

worked with kinship caregivers to increase their awareness of the dynamics of 

addiction and recovery. LADCs also served as mediators between parents and 

kinship caregivers to obtain mutual support of the visitation and reunification plan. 

1 Bluhm, B. (2007). Project First Step: Approaches to co-occurrence of child maltreatment and substance abuse.

Unpublished. 1.
32

Second, these counselors were able to engage parents in the enhanced group with 

the understanding that information shared with LADCs was subject to State and 

Federal confidentiality laws. Thus, parents were more open to the notion that the 

services of the LADCs would be helpful. 

Roles and Responsibilities

During the Title IV-E demonstration, LADCs worked with CPSWs in an advisory 

and supportive capacity by providing training, assessment, treatment, and case 

management services. LADCs conducted an initial drug and alcohol assessment 

concurrently with the CPS maltreatment investigation and were involved from the 

outset in the risk and safety assessment to facilitate better decisions regarding 

child safety and out-of-home placement. LADCs could provide direct outpatient 

treatment or facilitate treatment access, thereby improving the timeliness of access 

to substance abuse treatment services and increasing the likelihood of positive 

treatment outcomes. In addition, LADCs had the option to continue working directly 

with parents for an additional 2 months after completion of the maltreatment 

assessment or CPS case opening.2

After the demonstration project concluded in 2004, DCYF expanded the duties of 

the LADCs. LADCs are now involved with all referrals in their respective district 

offices where substance abuse is indicated as a contributing factor. LADCs are 

involved as consultants with CPSWs, or they become involved directly with parents 

or caretakers when assessment and family service supervisors determine that 

substance abuse is a contributing factor to alleged or substantiated child abuse or 

neglect. If there are primary indicators of significant parent or caretaker substance 

abuse, LADCs may provide a direct substance abuse assessment and initiate 

referrals to community-based treatment. 

LADCs help CPSWs reduce such barriers as access to treatment facilities and provide 

direct individual treatment for parents or caretakers who are receptive to treatment, 

but have not yet accessed treatment. LADCs currently train CPSWs to incorporate 

substance abuse screening questions in all abuse and neglect assessments to 

helpclarify the existence or extent of substance abuse. During the assessment 

process,LADC services result in enhanced community-based family support. In 

open DCYF cases, LADCs are involved, both as substance abuse treatment case 

managers for parents and caretakers and as readily available consultants for 

CPSWs and supervisors. For cases that involve in-home services, LADCs provide 

services consistent with family preservation. For those cases in which children are 

in temporary out-of-home care, LADC services help to expedite reunification or 

placement into kinship care, consistent with services attributed to time-limited family 

reunification. 

2 Children’s Bureau. (2007, June 5). Profiles of the Child Waiver Demonstration Project: New Hampshire – Services 

for caregivers with substance use disorders. Accessed August 1, 2007, from http://www.acf.HHS.gov/programs/cb/

programs_fund/cwwaiver/2007/newhampshire.htm
33

For those situations in which the concurrent permanency plan is adoption, LADCs 

continue to be consultants in the case-planning process and to provide direct service 

to parents or caretakers if treatment resources are not available.3

Locations and Settings

In New Hampshire, the State HHS manages all child welfare and substance abuse 

services through district offices arranged by population and accessibility (e.g., ease 

of transportation). During the Title IV-E demonstration, LADCs were located in 

the Nashua and Manchester offices (one per office), serving most of Hillsborough 

County, the most populated area in New Hampshire. Today, Project First Step 

is expanding to a third office. Placing the LADCs in district offices allows LADCs 

to work directly with CPSWs in the field. DCYF would like to add more LADCs to 

increase the project’s capacity.

Underlying Values and Principles

DCYF expected ongoing, respectful discussion and disagreements between the 

LADCs and the CPSWs, particularly with regard to determining the primary 

client and the goals. There was a learning period during which CPSWs developed 

an understanding that LADCs were bound to Federal confidentiality laws and 

that certain information could or could not be shared. Over time, the nature of 

discussions surrounding each case has changed from debating whether children 

should be removed from the home to what can be done to provide clients with 

integrated treatment. CPSWs have become well-versed in treatment terminology, 

and they have come to trust that the LADCs are providing information relevant to 

the case while maintaining client confidentiality.

Funding

The demonstration project was funded by Title IV-E funds. Since 2004, DCYF has 

funded Project First Step with grants from the Promoting Safe and Stable Families 

(PSSF) program, which is supported by Title IV-B funds, and the Child Abuse 

Prevention and Treatment Act (CAPTA). A line item in DCYF’s budget allocates 

Project First Step $120,000–$150,000 per year. The funding covers salaries, 

furniture, telephones, mileage compensation, and administration. 

New Hampshire has very little State funding for early intervention and for crosstraining to promote service integration. In expanding Project First Step, district 

office staff will not want to commit energy to the learning curves necessary to 

develop such a program without knowing it will exist for at least 3–5 years. To 

expand Project First Step to areas outside Hillsborough County, for example, DCYF 

had to assure the district office new to the program that funding would be available 

for at least that long. 

3 Bluhm, B. (2007). Project First Step: Approaches to co-occurrence of child maltreatment and substance abuse.

Unpublished. 1.
34

Staff Development, Training, and Supervision

LADCs are certified to provide substance abuse counseling and mental health 

treatment. LADCs are self-employed, and the State considers them to be 

independent treatment providers. This arrangement helps DCYF to identify LADCs 

who are well-educated in the substance abuse and mental health treatment fields 

and who can consistently provide this perspective to CPSWs. 

New Hampshire’s HHS certifies LADCs as treatment providers and hires them. Local 

district office CPS supervisors select and interview candidates with oversight by 

the DCYF clinical social worker and the Project First Step program manager. LADCs 

provide their services for a flat hourly rate that covers assessment, direct service, 

and case management (no billable hours). To be consistent with the integrated 

service model, LADCs must also be certified counselors. Health insurance and 

typical fringe benefits can be built into the hourly rate. So far, LADC services in 

each district office approximate full-time hours. 

DCYF has developed a coordinated system for supervising LADCs that involves 

workers, mentors, supervisors, and administrators. Regarding their clinical practice, 

LADCs are required to arrange for their own clinical supervision. LADCs also are 

included in supervision sessions by district office CPS supervisors, ideally with 

CPSWs who are jointly assigned to specified cases. This approach provides an 

opportunity for essential discussions about child safety, stability, permanency, and 

well-being in the context of the parent’s substance abuse and recovery. LADCs 

provide regular reports to the Project First Step program manager, specifying the 

quantity and types of interventions and treatment recommendations resulting from 

the CPS cases referred to them. CPS supervisors and LADCs from each district 

office come together on a regular basis to present progress resulting from Project 

First Step. 

LADCs participate in the child welfare core New Worker Training, which includes 

shadowing child welfare staff. They also participate in trainings on case planning 

and permanency planning. With this training, Project First Step LADCs can better 

facilitate clients’ compliance with both their treatment plan and child welfare case 

plan, as well as facilitate collaboration between treatment providers and CPSWs.

Project First Step LADCs provide ongoing education at district office staff meetings 

for CPSWs to learn when and how to use the LADCs effectively. They also provide 

education on community issues. In Nashua and Manchester, they have conducted 

sessions on the growing heroin use, and in Nashua, the LADC has educated CPSWs 

on how to recognize and approach clients who may be using methamphetamine. 

LADCs and CPSWs also can evaluate how they handled past cases and discuss how 

they can improve service delivery for future cases.
35

Joint Accountability, Outcomes, and Evaluation

To evaluate the Title IV-E Waiver Demonstration Project, HHS secured a 5-year 

contract with UNH. The contract allowed the university to have access to CPSWs 

and their files, including notes from confidential interviews. The contract covered all 

DCYF policies and procedures. Additionally, UNH and DCYF professionals consulted 

with each other to develop a mutual understanding of evidence-based evaluation 

and child welfare practice. 

Given DCYF involvement with families often entails several short-term interventions, 

the evaluation of the Title IV-E Waiver Demonstration Project included a longitudinal 

component. UNH was able to track families longitudinally, over a 5-year period, 

even during the times when DCYF was not involved. The university secured 

families’ participation by providing stipends. The research indicated that children 

in the enhanced group slept better, experienced less mobility, and had greater 

declines than children in the standard group in the following categories: anxiety 

and depression, withdrawn/depressed, somatic problems, attention problems, 

aggressive behavior, thought problems, and rule breaking.4

Since the random assignments and control and experiment groups were concluded 

in 2004, DCYF has not contracted UNH to do continued analysis. Since 2004, LADCs 

have been reporting data to their DCYF supervisors. LADCs are to answer the same 

set of questions for each client in a Microsoft Excel spreadsheet. Questions include 

the following:

• 

• 

• 

• 

• 

 How quickly the LADC was involved with the client;

When the client received an assessment;

What services were recommended to the client; 

Had the client been served by the LADC in the past; and

Percentage of males versus females served.

DCYF uses the data from these reports to shape the future applications of Project 

First Step to other regions in the State and to justify the use of PSSF and CAPTA 

grants to support the program. Also, the information is aiding in the design of other 

community-based treatment models being developed by the New Hampshire HHS.

CONTACT: Erica Gesen, Administrator

Division for Children, Youth and Families

New Hampshire Department of Health and Human Services

Phone: 603-271-7298

E-mail: eungarelli@dhhs.state.nh.us

4 Bluhm, B. (2007). Ibid.
36

Sacramento County: Early Intervention Specialists and

Specialized Treatment and Recovery Services

Background and Purpose

In 1995, Sacramento County implemented the Alcohol and Other Drug Treatment 

Initiative (AODTI) in response to evidence that substance abuse was a problem for 

a large number of families served by county agencies. The AODTI was enacted to 

ensure that substance abuse services would be an integral part of the health and 

human services system. The goal of the AODTI was to develop the ability of child 

welfare social workers, public health nurses, eligibility workers, and neighborhoodbased services staff to provide systematic screening and intervention services to 

clients with substance use disorders. The AODTI planned to accomplish this goal by 

enhancing the workers’ understanding of substance use, abuse, and dependence.

Because of the AODTI, five system-wide reforms were subsequently instituted 

throughout Sacramento County: (1) a comprehensive cross-system joint training 

program, (2) a substance abuse treatment system of care, (3) a dependency drug 

court, (4) Early Intervention Specialists (EISs), and (5) specialized treatment 

and recovery services. The comprehensive cross-system joint training program 

involves training all child welfare workers on substance use disorders and ways to 

access treatment resources. This program also involves training substance abuse 

treatment providers on the child welfare and dependency court systems. The 

substance abuse treatment system of care includes a managed wait list, expansion 

of group services, implementation of pre-treatment groups, and prioritization 

of child welfare clients for immediate access to substance abuse services (after 

Federally mandated priority access to clients). 

The EIS workers and the Specialized Treatment and Recovery Services (STARS) 

workers are the two ways that Sacramento County provides substance abuse 

specialists in connection with the Sacramento County Dependency Drug Court 

(DDC). EIS workers ensure timely assessment and treatment authorization for 

families at the initial detention hearing. STARS workers are recovery management 

specialists who assist parents in entering and completing substance abuse 

treatment and other court requirements.

Roles and Responsibilities

A preliminary step in the court procedure involves the identification of parents who 

meet the DDC admission criteria at the time of the initial child detention hearing. 

The EIS worker reviews intake petitions from Child Protective Services (CPS) and 

identifies petitions alleging neglect or abuse related to parental substance use, 

including cases in which a child tested positive for drugs at birth. The EIS worker 

administers a preliminary substance abuse assessment to parents. From the results 

of the preliminary assessment, the EIS worker provides the county’s authorization 

for treatment payment and makes a referral to the appropriate level of care. 
37

The EIS workers and STARS workers employ Motivational Interviewing (MI) 

techniques to initially engage parents and motivate them to enter treatment. 

The EIS worker refers parents to the STARS program, which provides specialized 

recovery case management. The EIS worker develops a preliminary substance 

abuse recovery plan, reflecting the appropriate level of care, in consultation with 

the STARS worker. Each parent who is referred to STARS is matched with a recovery 

specialist who assists the parent in accessing substance abuse treatment services, 

develops a liaison role with CPS and other professionals, and provides monitoring 

and accountability for the parent in complying with treatment requirements. The 

STARS program provides immediate access to substance abuse assessment and 

engagement strategies, intensive management of the recovery aspect of the child 

welfare case plan, and routine monitoring and feedback to CPS and the court. 

The primary responsibility of the STARS worker is to maintain a supportive 

relationship with the parent, emphasizing engagement and retention in substance 

abuse treatment while providing recovery monitoring for CPS and the DDC. Optimal 

caseloads are 18–20 clients per STARS worker. The STARS worker monitors urine 

testing, substance abuse treatment, and self-help group compliance and provides 

regular compliance reports to the court, social worker, and minor’s counsel. Drug 

testing is administered on a random basis, and collection is observed by the 

STARS worker. The STARS worker provides regular compliance reports regarding 

drug testing, treatment participation, and self-help group attendance. Compliance 

reports are sent to CPS, legal counsel, and the DDC twice each month. 

Through a supportive relationship based on MI strategies, the STARS worker 

supports the parent’s adherence to the case and treatment plans and court orders. 

The STARS worker helps the parent integrate learned rehabilitation skills into his 

or her daily life. The STARS worker also acts as a liaison between the court, client, 

and recovery center and provides referrals to self-help meetings that are close to 

the parent’s home and appropriate to the parent’s needs. In addition, the STARS 

program provides aftercare services and follow-up to families to decrease the 

probability of relapse. Aftercare services ensue when the parent has completed 

formal treatment and continue for as long as CPS has an open case with the family. 

Locations and Settings

CPS and Alcohol and Drug Services (ADS) jointly employ EIS workers. These 

workers are out-stationed at the dependency court, where they administer the 

preliminary substance abuse assessment at the time of the detention hearing, make 

a referral to an appropriate level of substance abuse treatment, and refer parents 

to the STARS program. 

The STARS program is operated by a local, non-profit, community-based 

organization that provides treatment services through a contract with Sacramento 

County. The recovery specialist attends DDC hearings and acts as a liaison 

with community-based treatment to ensure linkages to treatment recovery and 

supports. STARS program service contacts are conducted in a variety of locations, 

including in the home, at substance abuse treatment agencies (residential, 
38

outpatient, and intensive outpatient), in hospitals, and at community agencies. The 

parent is initially required to meet with his or her STARS worker at least twice each 

week. Based on the parent’s progress, the intensity is then lowered to one contact 

per week and then decreased to once every 2 weeks. 

The STARS program also is located close to the court, which reduces the number of 

clients who may get “lost” on their way from court to the program. The program in 

Sacramento is located right across the street from the court house.

Underlying Values and Principles

The Juvenile Dependency Drug Court Steering Committee meets twice each 

year to discuss evaluation results and any changes recommended to the DDC. A 

Memorandum of Agreement (MOA) was signed by key court, CPS, STARS, and 

evaluation staff. This MOA emphasizes the collaborative nature of the DDC and 

allows the evaluation team access to client records to conduct evaluations and 

research and to ensure client protection.

Funding

Original resources used to develop and begin implementation of the system 

improvements involved one-time grant funds. When presented with evidence of 

cost-effectiveness and efficiencies by the administration, the Sacramento County 

Board of Supervisors has consistently acted in support of these efforts. The EIS 

worker position is funded through CPS. The STARS program is funded through local 

tobacco litigation settlement funds (30 percent), which are used to match State and 

Federal Title IV-B and case management funds (70 percent).

Staff Development, Training, and Supervision

EIS workers are master’s level social workers with training and experience in 

substance abuse services and motivational enhancement therapy. CPS supervises 

these workers. 

STARS workers must possess an alcohol and drug counselor certification and are 

trained in motivational enhancement therapy as well. Three supervisors within 

the STARS program closely monitor the STARS workers. In addition, every STARS 

worker meets weekly with the clinical director, who is a licensed clinical social 

worker. 

Since 1995, all child welfare workers have been required to participate in joint 

training with substance abuse treatment provider staff on substance abuse, child 

welfare, and the courts. The training is provided by a professional trainer. This 

comprehensive cross-system joint training began with three levels of training: (1) 

4 days of required basic information on substance abuse for all child welfare staff; 

(2) 4 days of required information on substance abuse screening, brief intervention, 

motivational enhancement, and substance abuse treatment for all child welfare 

workers with cases; and (3) 4 days of required group treatment skills for all 
39

substance abuse treatment provider staff. The group intervention training was 

voluntary for any CPS staff. 

This comprehensive cross-system joint training is provided at all levels 

(administrators, managers, and supervisors) to clarify training goals and practice 

expectations. Training supervisors reinforce change in practice and quality 

assurance. 

Recently, the training program was revised to meet the changing needs of CPS 

and substance abuse treatment provider staff. The 8 days of training for child 

welfare staff has been consolidated into 4 days of core training, and mandatory 

2-day training on MI was added. The group intervention training was renamed 

“co-facilitation,” and Sacramento County now offers voluntary 4-day training on 

adolescent mental health and substance abuse.

Joint Accountability, Outcomes, and Evaluation

Sacramento DDC program outcomes are assessed in two primary areas: parental 

treatment status and child placement outcomes. Analyses are conducted to 

examine differences between comparison and treatment cohorts for parental 

treatment participation: length of stay in treatment, treatment modality (residential 

versus outpatient), and satisfactory completion of treatment. Analyses related 

to child placement outcomes are conducted including child placement type 

(reunification versus other permanency outcomes) at various time points after the 

child’s initial placement in out-of-home care, time to reunification among those who 

reunified, and total time in out-of-home care. A separate follow-up analysis among 

those children who were reunified is conducted to examine rates of reentry into 

out-of-home care. In addition, analyses are conducted on the relationship of the 

parent’s primary drug to both treatment completion and the child’s placement. 

Evaluation results are reviewed twice each year to assess the program’s continued 

success. The most recent evaluation report includes information on six groups of 

parents and children, a comparison group, and five cohorts of DDC participants. 

Comparison participants are those who entered the dependency system before EIS 

and STARS implementation (January through May 2001) and met the criteria for 

DDC. This group received standard CPS and ADS Division services. Court-ordered 

participants are those who entered the dependency system from October 1, 2001, 

through September 30, 2007, and who received EIS and STARS services and were 

court-ordered to receive DDC supervision. 

The DDC program produced substantial cost savings from increased 24-month 

reunification rates of court-ordered children relative to the comparison group. The 

cost-savings estimate takes into account the reunification rates, time of out-ofhome care, time to reunification, and cost per month of out-of-home care. The 24 

month reunification rate for the comparison group was 27.2 percent. The 24 month 

reunification rate for the court-ordered group was 46.1 percent, which accounted 

for 962 children. 
40

If we assumed a reunification rate of only 27.2 percent for the court-ordered group, 

then 394 fewer children would have reunified. By deducting the time to reunification 

for the court-ordered group (9.22 months) from the average length of out-of-home 

care for the comparison group (33.1 months), we find a 23.88 month difference. 

The savings due to the estimated additional 394 children who reunified through 

the DDC program totals $17,572,290 (394 children multiplied by 23.88 months 

multiplied by $1,867.66 out-of-home care costs).

CONTACT: Sharon DiPirro-Beard, Program Coordinator

Sacramento County Alcohol and Drug Services Division

Phone: 916-875-2038

E-mail: dipirro-beards@saccounty.net
41

Washington: Substance Abuse Services Initiative

Background and Purpose

In 2005, the Washington State Children’s Administration (Children’s) became 

increasingly aware that a relatively high percentage of its clients needed substance 

abuse and mental health treatment services. Children’s was also aware that a 

relatively low percentage of its clients received those needed services. In fiscal 

years 2004–2005, 31 percent of dependency cases filed involved substance 

abuse as a contributing factor, whereas only 6 percent of the parents completed 

treatment. 

However, 31 percent was understood to be an underestimate because it was based 

on information obtained during the initial investigation phase. Children’s ongoing 

caseworkers anecdotally estimate the number of cases in which substance abuse is 

a factor to be 75–80 percent. 

The identified issues were parents not following through on substance abuse 

assessment recommendations and being unable to engage sufficiently in the 

treatment process. 

The situation provided Children’s with the motivation to seek increased collaboration 

with the Division of Alcohol and Substance Abuse (DASA). Both Children’s and 

DASA are part of Washington’s Department of Social and Health Services (DSHS). 

The collaboration effort is called the Substance Abuse Services Initiative (SASI). 

The Chemical Dependency Professional (CDP) program, as part of the overall 

collaborative effort, provides substance abuse specialists. 

In 2005, DSHS appealed to the Washington legislature to allocate funding to the 

CDP initiative. DSHS received funding through Senate Bill 5763, the Omnibus 

Treatment of Mental and Substance Abuse Disorders Act of 2005, for 22 full-time 

employees statewide. These substance abuse specialists, or CDPs, help social 

workers by providing case management services to parents who are in need of 

substance abuse services. CDPs focus on case management to enhance clients’ 

motivation to engage in the treatment process through treatment completion.

Roles and Responsibilities

The Washington legislature and the SASI oversight committee established the roles, 

responsibilities, and qualifications of the CDPs. The legislation’s full list of potential 

CDP roles is as follows, with the italicized roles being those that the SASI oversight 

committee recommends:

Conducting on-site chemical dependency screening and assessment, facilitating 

progress reports to department social workers and staff on substance abuse 

issues, in-service training of department social workers and staff on substance 

abuse issues, referring clients from the department to treatment providers, and 

providing consultation on cases to department social workers.
42

Washington’s DSHS system has six regions and thirty nine counties that vary 

considerably. For example, one region has thirteen small counties, but another has 

just one large county. Each region also has varying characteristics in population 

and access to services. Some are urban and have high population density, whereas 

others are rural with small populations. 

Because of these regional differences, the SASI oversight committee provided some 

local flexibility for counties to determine the exact roles and responsibilities of CDPs. 

Although conducting assessments can be a component of a CDP’s role, SASI did not 

recommend assessment as a primary role for CDPs because of the identified need 

for case management services. Case management includes referring clients for 

assessment, helping clients to access services, and bridging gaps in service systems. 

CDPs can conduct assessments, however, in situations when the assessments cannot 

be conducted in a timely manner by a local treatment agency. In rural areas, where 

there are fewer treatment agencies, for example, a CDP might focus on conducting 

assessments. In urban areas, where there are comparatively more treatment 

agencies, CDPs are more likely to provide case management services.

Locations and Settings

Currently, Washington funds 22 full-time Children’s CDP positions. In essence, 

the CDPs are stationed in local Children’s offices, but are hired and clinically 

supervised by local treatment agencies. The SASI oversight committee approves 

job descriptions and contracts. 

DASA contracts with counties to provide State-licensed treatment services. Counties 

subcontract with local treatment agencies to hire and clinically supervise CDPs. The 

county and Children’s management jointly identify and hire the CDPs. The county 

hiring authority announces the position and conducts interviews of candidates. 

Children’s management participates in the interviews. 

CDPs are stationed in local Children’s offices. The positions were distributed based 

on client population. Each county Children’s office is responsible for establishing 

a workspace for its CDP. Typically, the Children’s office determines the most 

appropriate location for the CDP.

Underlying Values and Principles

The SASI oversight committee, made up of professionals from both Children’s and 

DASA, meets every 2 months to administer and oversee the CDP initiative. SASI 

was made formal in 2005 after more than a year of planning and development. The 

collaboration is guided by a Memorandum of Understanding (MOU), which outlines 

joint values and principles. The MOU is useful in motivating all agencies involved 

to work together despite traditionally varying principles between child welfare and 

substance abuse systems. On the practice level, however, philosophical differences 

may remain in such areas as whether the client is the parent, child, or family; 

whether the goal is child safety, family preservation, or parental recovery; and the 

appropriate timelines for meeting those goals.
43

Beyond these incentives to work together that are outlined in the MOU, the 

agencies also collectively recognize that investing in the collaboration supports 

clients through treatment completion. Parents who complete treatment are more 

likely to reunify with their families. The prospect of reunifying with children can be 

a strong motivator for parents to complete treatment. In addition, the legislature’s 

funding for mutual clients is influenced by the development and success of these 

collaborative efforts.

Funding

Washington Senate Bill 5763, mentioned previously, provided expanded funding for 

substance abuse treatment of approximately $32 million for adults and $6.7 million 

for youth. The State legislature allocates funding authorized in Senate Bill 5763 to 

Children’s for 22 full-time employees statewide.

Washington spends $1.144 million per year on CDPs’ salaries and benefits. This 

total does not cover the full costs to support the program. DASA and Children’s 

contribute additional dollars from other sources to supplement training, travel, and 

administrative costs. In addition, the agencies alternate funding the substance 

abuse program manager, who acts as a liaison between the agencies and is 

responsible for implementing the initiative. 

Children’s had 10,873 total clients (including children and youth) involved with 

DASA treatment services at some level in fiscal years 2004–2005. As SASI 

increases its ability to identify and refer clients in need of treatment, treatment 

capacity issues arise. Accessibility to treatment services varies from county to 

county. Treatment capacity is augmented by the treatment expansion funds 

allocated under Senate Bill 5763, as well as discretionary grants from the Federal 

Government, such as Access to Recovery (ATR) funds. The State of Washington 

ATR initiative provides vouchers for substance abuse treatment and/or recovery 

support services to low-income individuals who are involved with child protective 

services, shelters and supported housing, free and low-income medical clinics, and 

community detoxification programs. The target areas are Snohomish, Clark, Pierce, 

Yakima, King, and Spokane counties. The SASI oversight committee also identifies 

and seeks ways to meet funding challenges. 

Staff Development, Training, and Supervision

Each CDP must have completed an associate’s degree, a chemical dependency 

certification, and 2,000 hours of clinical supervision. Currently, Washington State 

faces a shortage of qualified CDP professionals. DASA and the Department of 

Health, which handles the licensing and certification, are working to address this 

challenge. 

Children’s headquarters provides training for all new CDPs, but is still determining 

the best way to provide ongoing training and development. Ongoing cross-training 

is desired, but goals have to be negotiated between county-level needs and DASA 

as well as Children’s statewide objectives. 
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The CDP reports to a designated manager in his or her county Children’s office. 

The county office is responsible for developing workflow procedures and often does 

this in consultation with its CDP. Children’s and county management jointly resolve 

employee disputes and conduct CDP evaluations.

Joint Accountability, Outcomes, and Evaluation

Oversight is provided by the SASI oversight committee, made up of professionals 

from both Children’s and DASA. Children’s and DASA are continuing to refine 

their roles in tracking and analyzing outcomes of the CDP initiative. As part of the 

treatment expansion funds allocated under Senate Bill 5763, for example, DASA 

documents how much money this program has saved the State by comparing the 

cost of substance abuse treatment with the costs clients typically incur without 

treatment. Children’s, DASA, and the counties are also working on ways to improve 

information sharing and track clients across systems. The SASI oversight committee 

is helping to design and implement simple strategies for overcoming these 

challenges.

The attention of State legislators also provides for a certain level of accountability. 

State legislators have inquired about the program’s effectiveness. DASA and 

Children’s are preparing data to demonstrate that more clients have entered and 

completed treatment since the program’s inception. If DASA and Children’s are able 

to demonstrate the program’s success, the program may receive more funding in 

the future. 

CONTACT: Sue Green, Family Services Manager

Department of Social and Health Services

Division of Behavioral Health and Recovery

Phone: 360-725-3732

E-mail: sue.green@dshs.wa.gov
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Table 1. Commonalities Matrix of Substance Abuse Specialis

Connecticut Delaware Illinois Massachusetts New 

Hampshire

BackgroundYear program began Early 1990s 1996 2000 2004 1998 

Number of specialists in program

8-9 4 20-24 6 2 

Title IV-E Waiver Demonstration site X X X

Previous history of collaboration between systems

X X 

PurposeResponds to Federal decree XReduces costs of out-of-home placements and/or reduces time of children in foster care

X X X 

Removes barriers and improves linkages between CWS and AOD to better serve parents

X X X X 

Improves the capacity of CWS to serve parents with AOD problems

X X 

Improves collaboration between systems X X X X X 

CWS = child welfare services; AOD = alcohol and other drugs
46

Connecticut Delaware Illinois Massachusetts New 

Hampshire

Employment and LicensingEmployed by State or county CWS agency X X Employed by communitybased AOD treatment agency XEmployed by contracted service provider X Self-employed and contracted by child welfare XUnionized employees X XLicensed/certified AOD counselors X X X X (preferred) X 

Licensed Clinical Social Workers XSpecialists’ Location (place of work)Area, regional,county, or district CWS offices

X X X X 

Contracted service provider’s office, near juvenile court X 
47

Connecticut Delaware Illinois Massachusetts New 

Hampshire

Roles and ResponsibilitiesCase management X X X Screening and/orassessment

X X X 

Referral to treatment X X X 

Facilitation of access to treatment X X Urine testing X X X Consultation to CWS X X X X X Training to CWS X X X X X Training to court XSupport to parents while in treatment X X Home visits X X X Information sharing with CWS and/or courts X X Development and implementation of substance abuse capacity-building plans for CWS

X
48

Connecticut Delaware Illinois Massachusetts New 

Hampshire

Underlying Values and PrinciplesMOU or other agreement formally outlines joint values and principles for the programMOU or other agreement outlining joint values and principles influences the implementation of the program (but was not specifically developed for the program)

X X 

MOU or other agreement outlines systems’ and/or other programs’ roles in program implementation

X X X 

Other factors influence ongoing development of joint values and principles

X X X X 

FundingState funded X X XFederal funds (i.e., CAPTA, Title IV-E, Title IV-B)

X X

Multiple sources (i.e., partial State funding, tobacco settlement, and agency budget reallocation)

MOU = Memorandum of Understanding; CAPTA = Child Abuse Prevention and Treatment Act 
49

Connecticut Delaware Illinois Massachusetts New 

Hampshire

Staff Development, Training, SupervisionSupervised by CWS X X 

Supervised by contracted service provider X Receives dual supervision X X

Attends regular meetings to maintain program purpose and/or foster collaborative relationships

X X X X 

Receives CWS New Worker Training X X X

Participates in cross- training X X X X X 

Joint Accountability, Outcomes, and EvaluationRegularly collects data X X X X 

Collects standardized data X X 

Regularly analyzes and reports data X 


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HHS Publication No. (SMA) 10-4557

Substance Abuse and Mental Health Services Administration

Printed 2010