Statement of Children and Family Futures

Hearing to Review the Use of Child Welfare Waiver Demonstration Projects to

Promote Child Well-Being

House Committee on Ways and Means

Subcommittee on Income Security and Family Support

July 29, 2010

 Children and Family Futures (CFF) thanks you for the opportunity to submit this
written statement for the record of the July 29, 2010 Hearing to Review the Use of Child
Welfare Waiver Demonstration Projects to Promote Child Well-Being held by the House
Committee on Ways and Means Subcommittee on Income Security and Family Support.
Our comments reflect the views of our own organization and do not represent those of
any of our funders or sponsors.

Children and Family Futures (CFF) is a non-for-profit organization based in

Irvine, California. Our mission is to improve the lives of children and families,
particularly those affected by substance use disorders. CFF consults with government
agencies and service providers to ensure that effective services are provided to families.
CFF advises Federal, State, and local government and community-based agencies,
conducts research on the best ways to prevent and address the problem, and provides
comprehensive and innovative solutions to policy makers and practitioners.

We thank the Subcommittee for its leadership in the area of child welfare, and
particularly for your work and support of the new funding provided for the Maternal,
Infant, and Early Childhood Home Visiting Program under the Patient Protection and
Affordable Care Act (P.L. 111-148). The availability of $1.5 billion over the next 5 years
to states and tribes to support evidence-based home visiting programs is a significant
investment in prevention funding. It is our hope that this funding will be used by states
and tribes to assist at-risk families, and in particular, families with substance use
disorders.

While this new prevention funding is an important first step in providing much
needed resources to prevent child abuse and neglect, there is broad consensus among
policymakers, advocates, and legislators that the child welfare financing system at the
federal level needs improvement. The vast majority of funding supports children only
after removal from their home, with very little support or funding provided to prevent
their removal in the first place. The lack of flexibility and current program restrictions
has frustrated states in their efforts to ensure the safety, permanency, and well-being of
at-risk children and their families. In particular, states are hampered in their ability to
drawn down federal child welfare funding to support families and children impacted with
substance use disorders

To encourage innovation and build a knowledge base of effective strategies to

inform the child welfare financing reform debate, Congress in 1994 established Section
1130 of the Social Security Act giving the Secretary of the U.S. Department of Health
and Human Services (HHS) the authority to approve State demonstration projects by
waiving certain provisions of Title IV-B and IV-E of the Social Security Act. Commonly
referred to as child welfare waivers, the Adoption and Safe Families Act (ASFA) of 1997
extended and expanded HHS’ authority to grant child welfare waivers by approving up to 10
new waiver projects each year. A component of the waiver project required that the state
conduct rigorous program evaluations with outcome and process components. However
while waiver projects already in place could continue, the authority to approve new Title IV-
E waivers for states without a waiver expired on March 31, 2006. 1

Child Welfare Waivers and Substance Abuse

The impact of substance abuse on families with younger children is well-

documented to have major effects on a significant number of these children and families,
and to co-occur with other closely linked problems, including mental illness,
developmental delays, and family violence. An estimated 11 percent of kids under the
age of 18 live with a parent who is an alcoholic or a parent in need of treatment for illicit
drug abuse. Another group of children living with the effects of parental substance abuse
are the estimated 500-600,000 infants who are born each year having been prenatally
exposed to alcohol or illicit drugs. Only about 5 percent of them are identified at birth,
and even fewer are referred to social service agencies or child protective services.
Cumulatively, this means that nine million children and youth under 18 were prenatally
exposed and are at risk due to that exposure and the co-occurring problems that
accompany exposure. The data on this issue is included in the recent publication CFF
prepared for the Substance Abuse and Mental Health Services Administration
(SAMHSA), Substance-exposed Infants: State Responses to the Problem. 2

Since 1994, four states – Delaware, Illinois, Maryland, and New Hampshire –
received approval for and implemented waiver demonstrations to assist families with
substance use disorders. The waivers in Delaware, Maryland, and New Hampshire
focused on the early identification of parents with substance use disorders and service
referrals by linking families to existing treatment resources and supportive services to
encourage caregivers to enter treatment and prevent out-of-home placement. The Illinois
waiver emphasizes the recovery of caregivers who are not yet in treatment but whose
children have already been removed from the home, using intensive case management
through recovery coaches and supportive services to improve treatment participation and
retention rates, to facilitate reunification of parents with their children, and to increase the
timeliness of decisions regarding other permanency options. While the waiver projects in
Delaware, Maryland and New Hampshire have ended, the Illinois waiver has been
extended through 2011. 3

To date, the interim results from the continued demonstration project operating in
Illinois point to positive outcomes for the families receiving the services provided under
the waiver. These include:

• Parents assigned to the recovery coach group were significantly more likely to
achieve family reunification as compared to parents assigned to the control group.

1
“Summary of the Title IV-E Child Welfare Waiver Demontrations,” June 2010. Available at:
http://www.acf.hhs.gov/programs/cb/programs_fund/cwwaiver/2010/summary_demo2010.pdf
2
Available at : http://www.ncsacw.samhsa.gov/files/Substance-Exposed-Infants.pdf
3
“Synthesis of Findings: Substance Abuse Child Welfare Waiver Demonstrations,” September 2005.
Available at: http://www.acf.hhs.gov/programs/cb/programs_fund/cwwaiver/substanceabuse/index.htm
 • Children in the recovery coach group, on average, experienced a faster reunification
than children in the control group (689 days vs. 815 days for the control group).
• There is no evidence that families are being reunified too quickly, as there were no
differences with regard to subsequent reports of maltreatment between the recovery
coach group and the control group. 4

With a reduction in the length of out-of-home placement as well as increased

likelihood of reunification, the results in Illinois point to strategies that other states should
be encouraged to explore. Unfortunately, the current financing structure for child welfare
severely limits the ability of a state to operate such a program and receive federal funding
in support of the activities under Title IV-E or Title IV-B of the Social Security Act.

We continue to believe that broad child welfare financing reform is necessary to

support State efforts to assist vulnerable families, including families affected with
substance use disorders. We stand ready to offer recommendations and look forward to
working with the Subcommittee in pursuit of a more comprehensive array of services
which have been found necessary for families to recover and funding that helps families
and children impacted with substance use disorders. 5

However, should you explore the continuation of child welfare waiver authority,
we offer the following recommendations for your consideration.

1. Any legislative language to extend child welfare waiver should retain the
flexibility for States to apply for, and design services, that specifically
target children and families impacted by substance use disorders.

2. Serving vulnerable families requires a comprehensive, integrated approach

involving numerous partners at the federal, state and local level. States
should be encouraged and supported in their efforts to coordinate their
child welfare agencies with state agencies that administer substance abuse
treatment programs, including through models that include the co-location
of substance abuse and child welfare workers. HHS, through a
collaborative relationship between the Administration for Children and
Families (ACF) and the Substance Abuse and Mental Health Services
Administration (SAMHSA) should be required to provide technical
assistance to states who are interested in designing, implementing, and
evaluating child welfare waiver demonstration projects that specifically
target families with substance use disorders.

4
Testa, Mark F., Ryan, Joseph, P., Hernandez, Pedro M., & Huang, Hui. “Illinois AODA IV-E Waiver
Demonstration Interim Evaluation Report.” Children and Family Research Center, the University of
Illinois at Urbana-Champaign, September 2009.
5
See: Werner, D., Young, N.K., Dennis, K., and Amatetti, S. Family-Centered Treatment for Women with
Substance Use Disorders - History, Key Elements and Challenges. Department of Health and Human
Services, Substance Abuse and Mental Health Services Administration, 2007. See also: Dennis, K.,
Young, N.K., and Gardner, S.G. Funding Family-Centered Treatment for Women with Substance Use
Disorders. Irvine, CA: Children and Family Futures, Inc., 2008.
 3. In reviewing and approving state waivers designed to assist families with
substance use disorders, the Secretary of HHS should ensure that
SAMHSA plays a role in the approval, implementation, and evaluation of
the waiver demonstration.

4. As part of the evaluation of waivers for families with substance use

disorders, states should be required to submit annual reports on their efforts
to shift funding from narrow programs in the child welfare array of
services to the kind of comprehensive family treatment programs that have
proven results. This should include a funding inventory that would describe
efforts to secure funding from other potential sources including Substance
Abuse Prevention and Treatment Block Grant funding, Medicaid,
Temporary Assistance for Needy Families (TANF) funding for board and
care in residential programs, and the previously mentioned home visiting
funding, as well as support for child development and child care services
needed for children of parents in recovery. And as discussed above,
SAMHSA should be part of any efforts to assist states in the design and
evaluation of the waiver demonstrations that intend to assist families with
substance use disorders.

Thank you again for the opportunity to submit testimony for the record on this
important topic, and for your work on behalf of vulnerable families. We look forward to
working with the Subcommittee on legislation to improve the child welfare system, and
in particular to improve the array of services and resources available for states to assist
families and children impacted with substance use disorders.