WITHDRAWN: Addressing the Complex Needs of Child Welfare-Involved Families with Parental Substance Abuse: Effectiveness of the FAIR Program.

Introduction: The Families Actively Improving Relationships (FAIR) program integrates evidence-based treatments for substance use, parenting, and mental health problems, and assistance with ancillary needs. Across the US, in 2015, 4 million referrals, regarding 7.2 million children were made to the child welfare system (CWS), the majority of which were for neglect. Locally there is a steady increase in CWS reports (14.2% in 2014 to 15.9% in 2016), with parental substance abuse identified as the primary driver. Families involved in the CWS are at risk for myriad effects including substance use, HIV, incarceration, homelessness, unemployment, low education, and transgenerational maltreatment. Risks are amplified for children who enter foster care, with length of time in care related to increased risk.

FAIR is an intensive, outpatient treatment conducted in the environment in which families live to promote generalizability and sustainment. Randomized pilot outcomes suggest reductions in substance abuse, maladaptive parenting, and mental health problems (Saldana, 2015), paving the way for the current evaluation. This presentation will describe a nearly completed effectiveness trial, the goal of which is to determine viability of providing FAIR within a Medicaid billable environment.

Methods: A dynamic waitlist design was utilized to maintain rigor while affording the opportunity of receiving FAIR regardless of condition (per request of the CWS). Parents (n = 99; 74 mothers and 25 fathers) who were reported to the CWS for child neglect and illicit substance abuse, and who were enrolled in Medicaid were eligible. Assessments were at 0, 4, 8, 16, and 24 months (repeated based on condition). Program expenses and Medicaid reimbursements were collected. CWS administrative data will be collected.

Results: Parents reported a history of methamphetamine (99%; 1-30 years), heroin (30%; 1-9 years), and/or other opiate (64%; 1-21 years) use; 23% reported IV-drug use. By 8 months post-FAIR initiation, parental child abuse potential, substance use, mental health symptoms, stress and ancillary needs showed significant reductions. Preliminary outcomes suggest all but parental stress maintained significance through 24 months. Non-official system outcomes suggest 62% of families either remain intact or have been reunified. Financial challenges were found when delivering FAIR beyond 20 miles of the clinic—a significant barrier given the high proportion of rural families involved in the CWS.

Conclusions: FAIR is a potentially promising treatment for a significant portion of CWS-involved families. However, reimbursement structures available for low-income and at-risk populations are limited posing implementation challenges. Discussion will emphasize policy considerations.