The skill and substance abuse experience of SALs were invaluable in meeting this challenge. The primary adjustment made to the PTP for the complexity of participants’ needs was to make the application of the program flexible, client friendly, and at the clinical discretion of SALs. For example, the PTP was introduced when the SAL judged parents were ready to con- sider this option -- not always at the first session. Parents could participate in the program for a variable time -- from one session to as many as it took to enter treatment. Participation could be interrupted, depending on the circumstances (e.g., interrupted by jail time, parents unreach- able) and then resumed again. Another modification to address the challenges of working with this population was to redesign the SOCRATES instrument. It was simplified to eliminate the category of “feeling ambiguity” because it was difficult for parents to address these questions. Although an ideal research design may demand more consistency in application, the reality of these families’ circumstances made these adjustments necessary.
Amount of paperwork for SALs. A second challenge to program implementation was the paperwork required from SALs for BPA approval for state treatment funding. BPA standards were so exact that SALs typically received “correction/more information needed” or “notice of clarification” responses from BPA several times for each case, causing treatment delay. Additional delays resulted from fax machines not working, and unclear guidelines for sub- mission. These problems surfaced during the monthly telephone conferences of the principal grant partners and were referred to the Program Manager for Substance Abuse for resolution. Although problems still occured, at the time of this report, SALs indicated they may have se- cured a special “status” with BPA that facilitated the approval process for their clients. Toward the end of the project, with the advent of ATR funding, the paperwork increased again because of federal requirements for monitoring and tracking clients funded through that program.
External State Treatment Funding Factors. On October 27, 2004, SALs in Regions III and IV received notification of a budget crisis in treatment funding. The state monies in the substance abuse treatment budget (administered by BPA) would not cover treatment through the last two months of the fiscal year (May and June 2005). Only the top federal priority of pregnant women who are intravenous drug users could be guaranteed treatment, and the rest would go on waiting lists. Consequently all treatment in these regions would be limited for the rest of the year. Region I was not affected by the budget shortfall.
In October 2004, the ATR federal grant was awarded to Idaho, providing wraparound services and an influx of treatment dollars. ATR was designed to help develop services and supports for drug-affected clients (e.g., housing, ongoing aftercare) and help pay for substance abuse treat- ment. Although the grant was awarded in October 2004, it wasn’t until April 2005, that money became available for treatment. By this time, several community-based substance abuse treatment programs had closed or reduced staff, and BPA did not approve people for treatment immediately. Consequently, the advent of ATR funds was slow to alleviate the waiting lists in all three regions and continued to impact PTP since treatment was not available. In addition, the delay of treatment funding for parents challenged the ability of DHS to make “reasonable efforts” in reuniting families.
Idaho Pre-Treatment Program