A strong body of research suggests that using MI counseling strategies improves the rate of entry and retention in substance abuse treatment (Miller & Rollnick, 2002). The positive effect of MI techniques can occur within a few sessions. For example, a recent meta-analysis of 72 outcome studies of addiction treatment that used an average of 2.2 MI counseling sessions found that MI increases treatment retention, treatment adherence, and staff-per- ceived client motivation (Hettema, Steel, & Miller, 2005). However, one of the few studies of women referred to drug abuse treatment by child welfare due to prenatal drug use, found no differences in treatment retention and negative urine analysis results over eight weeks of treatment between the experimental group receiving three MI sessions or the control group receiving two educational videos and a home visit (Mullins, Suarez, Ondersma & Page, 2004).
Summary of Literature Review
Substance abuse has contributed to the maltreatment of children in between one-third and two-thirds of families involved with child welfare agencies. Substance abuse is often accompanied by other difficult problems, such as mental illness, domestic violence, poor housing and neighborhoods, and economic insecurity. ASFA, the federal mandate to shorten timelines for termination, has put additional pressure on the child welfare system to respond to the tremendous challenges of parents who abuse substances. Many barriers stand in the way of meeting this challenge, such as the historically independent functioning of the child welfare and substance abuse treatment systems, the severity of the problems most women face in entering and completing treatment, the low rate of treatment completion, and the lack of sufficient training and resources of the child welfare system. Innovative practices showing hope of improving client outcomes include placing substance abuse professionals within the child welfare system and the use of MI.
4. EVALUATION PLAN AND LOGIC MODEL
Target population. Eligible families for the PTP included parents who were referred by CPS on or after October 20, 2003, in Regions I, III, and IV in Idaho. To qualify for the program, parents in families with substance abuse issues were referred to the SAL located within their region. Children of parents were at home or were recently placed in out-of-home placement.
Evaluation design. Although the classic experiment design with random assignment and a control group is the best way to determine causal connections between interventions and out- comes, the original designers of the proposal did not deem it feasible because of concerns that social workers would not refer families. Instead, a baseline of parent outcomes in the three regions, prior to implementation of SALs, was collected before hiring an evaluator. Unfor- tunately, the data collected were essentially unusable due to major inconsistencies regarding time periods, types of cases included, and types of data collected among the regions. Conse- quently, the evaluation design was cross-sectional, with comparisons to state and national data on outcomes.
The evaluation focused on the effects of SAL services relative to the substance abuse service options that would have been available in the absence of the PTP. Specifically, the evaluation addressed the following questions (see Logic Model, Appendix A):
Idaho Pre-Treatment Program