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Program Profile

Baltimore City (Md.) Family Recovery Program

Evidence Rating: Promising - One study Promising - One study

Program Description

Program Goals
The Baltimore City Family Recovery Program (FRP) is a family drug court designed to serve families involved with child welfare due to parental substance use. The program provides comprehensive case management and immediate, intensive substance abuse services for parents involved in Children in Need of Assistance (CINA) proceedings. The program serves parents with substance abuse issues that led to the placement of their children in foster care after removal from the home. The goal of FRP is to encourage sobriety and improve quality of life for parents in order to increase the likelihood of reunification for families and decrease the length of stay in foster care for children.

Target Population
To be eligible to participate in FRP, parents must have a substance use–related child welfare allegation (such as Drug Exposed Newborn, Neglect Due to Drug Use, etc.). Participants must be the parent or legal guardian of a child 5 years old or younger who has been placed in shelter care for at least one night and has never been named on a CINA petition.

Parents may voluntarily request to be referred into the FRP at the following CINA court hearings: shelter care hearings, preliminary hearings, CINA adjudicatory hearings, CINA dispositional hearings, and FRP court hearings. Participants may be referred to the FRP for a new term after a previous discharge if they have a new or different child and meet eligibility requirements.


Program Theory
The U.S. Department of Health and Human Services (HHS) estimated that more than 900,000 children were victims of parental neglect or abuse between 2003 and 2004 (HHS, 2004). In addition, it is estimated that parent substance abuse is a significant contributor to child maltreatment in the majority of all child welfare cases (National Center on Addiction and Substance Abuse, 1999). One of the fastest growing program models designed to address the challenges of serving these families is the family treatment drug court (also known as dependency drug court or family treatment court). Family treatment drug courts require a collaboration between court, treatment, and child welfare practitioners, who work together to create practical case plans for parents that will allow them to achieve sobriety, provide a safe home, and become responsible enough to take care of themselves and their children to keep the family together.

Family treatment drug courts are modeled on adult drug courts and include regular court hearings, intensive judicial monitoring, the provision of substance abuse treatment, and other wraparound services. However, family treatment drug courts differ from adult drug courts in several ways. First, most adult drug court participants are male, whereas most of those served by family treatment drug courts are female. In addition, parents in family drug treatment courts are involved in services due to non-criminal issues related to child maltreatment and criminal sanctions are generally not employed, while participation in adult drug court is typically offered in lieu of jail time. The primary motivation for participating in family drug treatment court is reunification, while adult drug court participants try to avoid incarceration. Finally, family drug treatment court addresses multiple, complex family problems that are not typically addressed in adult drug court. In addition to substance abuse treatment, parents must address other issues, such as employment, housing, and parent practices, to be reunified with their children. Thus, successful treatment completion does not guarantee ultimate success in a family drug treatment court.


Program Components
The FRP is administered through the Maryland Juvenile Court. FRP participants are enrolled in the program for 1 year, beginning on the date of the original court referral. FRP court hearings are generally held every Friday. Parents are required to undergo random and scheduled drug testing throughout the program term. Because parents are required to maintain safe, substance-free environments for their children, the court can also require drug tests of other individuals in the household to assess compliance.

The program provides parents with immediate access to the substance abuse treatment they need within 24 hours of assessment. Treatment can include individual and group counseling, relapse prevention, self-help groups, preventative and primary medical care, general health and nutrition education, parenting skills, and domestic violence education. The FRP also offers parents other support services, such as mental health care, transportation, housing assistance, and case management support. Services are tailored to meet the needs of parents who are in crisis and require intensive, ongoing treatment and services.

Evaluation Outcomes

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Study 1
Permanent Placement

Burrus, Mackin, and Aborn (2008) found that within the 16-month study window, there was no statistical difference between the number of Family Recovery Program (FRP) cases and non-FRP cases that reached permanency. Thirty-five percent of FRP cases, compared to 38 percent of non-FRP cases reached permanency. For cases that did reach permanency, the non-FRP cases reached permanent placement faster (249 days on average) than the FRP cases (325 days on average). This difference was statistically significant.

Frequency of Permanency Decisions FRP cases resulted in significantly more reunifications and significantly fewer placements in longer-term foster care compared to non-FRP cases. Seventy percent of FRP cases resulted in reunification, compared to 45 percent of non-FRP cases. Approximately half as many FRP cases (16 percent) resulted in placements in long-term foster care, compared to non-FRP cases (32 percent).


Kinship Foster Care
There was no statistical significance between FRP and non-FRP cases in the number of days children spent in non-kinship foster care. Children in non-FRP cases spent 414 days in kinship substitute care, compared to the 381 days children in FRP cases spent in kinship substitute care.

Non-Kinship Foster Care
Children whose parents attended FRP spent significantly less time in non-kinship foster care than children whose parents did not participate. On average, FRP children spent 252 days in non-kinship foster care, compared to 346 days for non-FRP children.

Time to Treatment Entry
FRP parents entered treatment more rapidly than non-FRP parents after the date of petition for Children in Need of Assistance (CINA). On average, FRP parents entered their first treatment episode 57 days after the date of petition for CINA, compared to 88 days after the date of petition for non-FRP parents. This difference was statistically significant.

Treatment Length of Stay
FRP parents also stayed in treatment longer than non-FRP parents. On average, the length of stay in outpatient treatment for FRP parents during the first 12 months of the CINA case was 138 days, compared to an average of 82 days for non-FRP parents during the same time frame. This difference was statistically significant.

Treatment Completion
Finally, FRP parents completed treatment more often than non-FRP parents. Sixty-four percent of FRP parents completed treatment, compared to 36 percent of non-FRP parents (a statistically significant difference).
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Evaluation Methodology

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Study 1
Burrus, Mackin, and Aborn (2008) utilized a quasi-experimental design to examine whether child welfare and treatment outcomes are different for Family Recovery Program (FRP) parents and non-FRP parents. The outcome study included 200 FRP cases and 200 non-FRP cases. Data collection began in February 2008 and continued through June 2008. The data collection window for each case was the date of petition for shelter plus 16 months. This was selected to allow researchers to include permanency outcomes in the majority of cases, based on the Adoption and Safe Families Act (ASFA) timeline permanency compliance, which requires that a permanency decision be made within the first 12 months of the 18 months of out-of-home placement. However, a greater number of FRP cases started later in the study window than non-FRP cases. Therefore, the analysis examining permanent placement may be affected because the FRP cases did not have the opportunity to reach permanency during the study window.

Only cases with a substance use allegation and at least one child age 0 to 5 who had not been previously named on a Children in Need of Assistance (CINA) petition were included. For FRP cases, data was collected on one parent per case, usually the maternal parent. The evaluation included most cases that entered the program during the first 16 months of operation. The comparison group included cases that entered the child welfare system with similar characteristics to the FRP group during 2004–2005, prior to the implementation of the FRP. FRP parents were 71 percent African American and 27 percent white. Ninety-eight percent were mothers. Non-FRP parents were 70 percent African American and 28 percent white; all were mothers. Half of the children whose parents participated in FRP were girls, with an average age of 2 years. Half of the children whose parents did not participate in FRP were also girls; their average age was 3.5 years. There were no significant differences between the FRP and non-FRP cases except in two factors: non-FRP children were older, and more non-FRP parents were married or partnered (58 percent, compared to 42 percent of FRP parents).

The study authors developed an administrative data extraction form based on a tool developed for a national evaluation of Family Treatment Drug Courts (Worcel et al., 2007). The extraction form was designed to collect all data elements required for the outcome study. Data was collected from the following sources: eQuest Web-based Electronic Juvenile Case Court File; FRP Drug Court MIS; OBSCIS I&II run by the Maryland Department of Public Safety and Correctional Services; and Substance Abuse Management Information Systems (SAMIS) run by the Maryland Department of Health and Mental Hygiene and Alcohol and Drug Abuse Administration.

Approximately 25 percent of FRP cases and 32 percent of non-FRP cases included more than one child. Therefore, a statistical technique called linear mixed models was used in the analysis, which allowed for nesting of multiple children (or episodes) in one case and results in single independent observations. The findings are presented at the case level and include all children in the cases. For a dichotomous event, such as individual reunification, Pearson’s chi-squared tests were used to determine statistically significant differences between the two groups. For parent-level treatment outcomes, t-tests were used to measure average differences between the groups.
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Cost

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Burrus, Mackin, and Aborn (2008) used a modified version of the Transactional and Institutional Cost Analysis (TICA) methodology to determine the relevant transactions associated with the Family Recovery Program (FRP) and the costs of those transactions. Using TICA, cost estimates were applied to data collected for the outcome study to determine costs and cost savings associated with the FRP, compared to traditional child welfare case processing. The sample of FRP and non-FRP cases from the outcome study was used for the cost study. Operation of the FRP costs $1.2 million per year. During 2006–2007, approximately 165 families were served. Thus, the average cost per family is about $7,272. Child welfare costs include foster care, long-term foster care, guardianship, and adoption subsidies. The cost study results showed estimated child welfare costs for the FRP cases were a little more than $4.6 million over a 16-month period, compared to $6.7 million for non-FRP cases. This represented a child welfare system savings of $10,471 per FRP case. Program costs include alcohol and drug treatment, drug court staff and operating costs, supportive housing and transportation assistance, and other wraparound services. The total program cost of treatment for FRP cases was a little more than $1.4 million, which is more than the total cost of treatment for non-FRP cases (a little over $1 million). This represented a service cost of $1,773 more per FRP case. Total cost savings after accounting for FRP program costs attributable to the 200 families served equal $1,004,456 or $5,022 per case.
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Implementation Information

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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Burrus, Scott W.M., Juliette R. Mackin, and Jennifer A. Aborn. 2008. Baltimore City Family Recovery Program (FRP) Independent Evaluation: Outcome and Cost Report. Portland, Ore.: NPC Research.
http://www.npcresearch.com/Files/Baltimore_City_FRC_Outcome_and_Cost_0808.pdf
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Additional References

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These sources were used in the development of the program profile:

Burrus, Scott W.M., Juliette R. Mackin, and Michael W. Finigan. 2011. “Show me the Money: Child Welfare Cost Savings of a Family Drug Court.” Juvenile and Family Court Journal 62(3):1–14.

Center for Substance Abuse Treatment. 2004. Family Dependency Treatment Courts: Addressing Child Abuse and Neglect Cases Using the Drug Court Model. Washington, DC: Bureau of Justice Assistance.
https://www.ncjrs.gov/pdffiles1/bja/206809.pdf

Department of Health and Human Services. 2004. Child Maltreatment 2004. Washington, DC: Administration on Children, Youth and Families, Children’s Bureau.

National Center on Addiction and Substance Abuse. 1999. No Safe Haven: Children of Substance Abusing Parents. New York, NY: National Center on Addiction and Substance Abuse.

Worcel, Sonia D., Beth L. Green, Carrie J. Furrer, Scott W.M. Burrus, and Michael W. Finigan. 2007. Family Treatment Drug Court Evaluation: Final Report. Portland, OR: NPC Research.
http://www.npcresearch.com/Files/FTDC_Evaluation_Final_Report.pdf
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Program Snapshot

Age: 0 - 5

Gender: Both

Race/Ethnicity: Black, White

Geography: Urban

Setting (Delivery): Courts

Program Type: Alcohol and Drug Therapy/Treatment, Drug Court, Family Court, Wraparound/Case Management, Children Exposed to Violence

Targeted Population: Females, Children Exposed to Violence, Alcohol and Other Drug (AOD) Offenders, Families

Current Program Status: Active

Listed by Other Directories: Child Exposure to Violence Evidence Based Guide

Program Director:
Family Recovery Program
239 North Gay Street
Baltimore MD 21202-4822
Phone: 443.692.0090
Fax: 443.692.0094

Researcher:
Juliette Mackin
Executive Vice President and Senior Research Associate
NPC Research
5100 SW Macadam Avenue, Suite 575
Portland OR 97239
Phone: 503.243.2436 ext: 114
Fax: 503.243.2454
Website
Email

Researcher:
Scott W.M. Burrus
Project Director, Baltimore City FRP Evaluation Site
NPC Research
4380 SW Macadam Ave, Suite 530
Portland OR 97239
Phone: 480.204.4923
Website
Email