Following receipt of referrals, SALS and CPS social workers often would talk one-on-one via phone, meet in a group, or informally to begin the process of “aligning with the client.” Because CPS social workers usually are regarded by clients to be “tough” (as a result of their role), SALs made an attempt to set a positive working relationship, based upon drawing out parents’ perspective of the situation as it related to the possible impact of their substance use and educate them about what a drug or alcohol assessment actually entails (“Do you know what this means?”). An effort also was made to distinguish the role of SALs from that of CPS social workers. For example, in Region I, the SAL frequently told parents “My job is to be your advocate.” SALs tried to make appointment with parents as soon as possible, within one or two days. Scheduling was somewhat more complex in Region III because the SAL covered four different offices (i.e., Nampa, Caldwell, Payette, and Emmett).
In spite of these efforts to start with parents in a positive, client-centered approach, an as- sessment of data up to December 31, 2004, revealed 25.84% of parents dropped out from the initial referral. For about one-third of cases (of the 25%), SALs provided reasons these refer- rals chose not to enroll in the program. The majority of reasons clients chose not to enroll in PTP were: 1) no wait list for treatment thus they could enter treatment, 2) refusal to participate due to working, living too far away, or having no time, and 3) failure to follow through for reasons, including no contact and not showing up for scheduled appointments. Starting Janu- ary 2005, the referral system changed in that the SALs counted only referrals who actually showed up for the initial meeting and signed the consent form. Consequently, it was no longer possible to measure the initial drop-out rate.
Meetings of SALs and parents The first face-to-face meeting with parents was a continuation of the positive, neutral tone of the telephone conversation. In Region III, the SAL usually began with “What got you here?” to allow parents to tell their own story in their own way. SALs also made sure early in the process that parents understood the confidentiality policies and that SALs were man- dated reporters. While in Region I, the SAL frequently began with the question “What hap- pened with Child Protection,” The Region III SAL did not refer to CPS initially until parents mentioned the department. SALs exercised their clinical judgment as to whether to proceed with the drug/alcohol assessment questions during this initial meeting, based on participants’ understanding of problems and willingness to take steps to change (Motivational Interviewing Stages of Change). Evaluator observations of SALs in each region confirmed that they were using MI techniques, such as open-ended questions (e.g., “Tell me about your week…” “What do you need to do for the kids to come home…”), scaling questions (e.g., “What puts you at a ‘four’ in your recovery?”), eliciting clients’ perspective (e.g., “What do you think you need in terms of treatment help?”), reflections, affirmations, summarization, and asking about barriers (e.g., as transportation).
Idaho Pre-Treatment Program