The Challenge:

In 2013, over 50 percent of the 36,000 cases investigated by Connecticut’s Department for Children and Families (DCF) had an indication of parental substance use.1 Driven in part by the opioid crisis, the prevalence of substance use among child welfare-involved families underscored the need for solutions that supported individuals during recovery. DCF aimed to tackle this challenge, with the overall goal of preventing child removals and preserving family stability.

The Project:

The GPL worked with the Connecticut Department of Children and Families and other project partners to establish the Family Stability initiative, which:

1. Expanded substance use recovery and parent support services to 500 families in need. The project expands treatment by Family Based Recovery (FBR) clinicians providing substance use recovery and parenting support services to approximately 500 families across the state. FBR is an intensive intervention that provides regular home-visits to promote positive parent-child interactions, increase parental awareness and understanding of child development, and help parents maintain their recovery. The overall aim of the project is to increase family stability and prevent removals of children from their homes by supporting parents in recovery, preventing child neglect, and promoting healthy child development.
2. Reengineered referral, enrollment, and data-sharing systems to systematically match families with the right services, and track their progress along the way. Prior to the project, substance use was very unevenly detected or flagged in DCF cases. In cases where substance use was detected, there was no consistent method of ensuring families were matched to the appropriate services. The PFS project helped to reengineer these processes; project partners were able to:
   1. Establish a systematic process of identifying and flagging when substance use appeared in child welfare cases. Project partners created tools to support DCF staff in consistently screening for substance use, allowing for substance use to be detected with more regularity.
   2. Develop a standardized intake process, so each family flagged went through the same evaluation and referral process. Social workers were then trained in matching families to services.
   3. Track families from enrollment to uptake to successful completion of the program through agency-provider data sharing.
3. Identified and filled a gap in services for families with children aged 3-6. The expanded FBR services are available to families with children aged 0-6, filling a much-needed gap in services for families with children aged 3-6. Prior to the project, parenting support and substance use services were available for families with young children (aged 0-3) and children over 6 years old. 3-6 years old is a crucial period in a child’s development, but the existing service array unintentionally failed to offer substance use services to families with children in this age range. Through the project, the provider adjusted their model and expanded their services in order to cover families with children in this key age group.

The Innovation:

In addition to progressing the state’s family stability and child welfare goals, the Connecticut project featured innovative solutions to common problems. In particular, the project:

1. Catalyzed further systems transformations. One of the benefits of the Pay for Success (PFS) model is its role in unlocking changes in the way government provides services (i.e. in identifying the right target population, referring them to the appropriate services, and tracking progress in real-time). As a result of the project’s success with this type of systems reengineering, DCF is now implementing agency-wide performance improvement initiatives to scale the approaches developed under the Family Stability project to other areas of the agency.
2. Demonstrates potential for outcome measurements to be tied directly to core agency goals. Outcome payments in the Family Stability project are tied to key agency objectives: 1) avoiding the need for child removals from the home, and 2) preventing re-referrals into the child welfare system. These long-term outcomes are combined with shorter-term measures (i.e. reduction in substance use) in a way that reflects DCF’s key objectives.
3. Implements a rigorous evaluation to advance the intervention’s evidence base. The project is evaluated by a randomized control trial to determine if FBR is effective in preventing children from being removed from their homes and families from being re-referred to DCF. This rigorous evaluation will equip leaders in Connecticut and across the country to make informed future policy and funding decisions related to child welfare and substance use treatment.