Ryan, J.P., Choi, S., Hong, J.S., Hernandez, P., & Larrison, C.R. (2008). Recovery coaches and substance exposed births: An experiment in child welfare. Child Abuse & Neglect, 32, 1072-1079.
This study was an evaluation of the use of recovery coaches in child welfare to reduce the number of new substance-exposed births. The context was a demonstration project in Illinois, designed to develop innovative strategies to serve children and families, which involved an existing service partnership between the Department of Alcoholism and Substance Abuse (DASA) and the Department of Children and Family Services (DCFS). Subjects were substance-involved parents of children in foster care, where temporary custody of the children had been granted to DCFS by the Juvenile Court Assessment Program (JCAP). The intervention involved intensive case management by substance abuse recovery coaches, who provided clinical assessments, advocacy, service planning and outreach. These coaches, who were employed by a non-affiliated agency independent of the child welfare agencies, were given specialized training, and carried caseloads of approximately eight clients.
An experimental design was used. After JCAP assessments, subjects were randomized to intervention and control groups. The total sample was 931, with 670 and 261 in intervention and control groups respectively. Both groups received traditional substance abuse services, while the intervention group also received the services of recovery coaches. The evaluation was based on data from agency records: assessment-related information (JCAP) plus caregiver demographics, placement history, and maltreatment occurrences (DCFS). The number of substance-exposed births-substantiated by child protection-was recorded for each female caregiver; both at intake and during the study period (April/00 to Dec/05).
In a simple bivariate analysis, the percentage of reported new substance-exposed births was significantly lower in the recovery coach group (15%) than in the control group (21%). In a multivariate analysis, three categories were significantly associated with fewer new substance-exposed births: 1) mothers with recovery coaches, 2) younger mothers, and 3) mothers with fewer previous substance-exposed births. Overall, the evidence supports the use of recovery coaches.
This evaluation was well-designed, and appears to have been generally well-conducted. The treatment groups were well-matched; no significant differences in family characteristics-including prior substance-exposed infants-were found. Survival analysis (Cox Regression) was used in the multivariate analysis to examine predictors of time to a new substance-exposed birth; this was necessary because individual mothers could enter the study at different points, and thus be at risk of delivering substance-exposed infants for different periods (M = 3.12 years, min. = 18 months).
No information was included about the experience or professional qualifications of the recovery coaches, or about the amount and type of services provided on a case-by-case basis.Where a program like this appears to have clear clinical benefits, the question of the cost-benefit ratio arises. If the resulting reduction in social costs could be shown to exceed program costs, this would be a powerful argument in favor of the program.