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Project Description


The Penquis Regional Linking Project (PRLP) is a project of The Penquis District Linking Partnership, an existing regional partnership of organizations and providers including child welfare, social service agencies, courts, healthcare and public health entities; kinship care, substance abuse treatment and an institution of higher education. The PRLP uses a trauma-informed system of care approach to increase well-being, improve permanency and enhance the safety of children ages 0-5 and their families in the Penobscot and Piscataquis counties of Maine who are affected by substance use. This project serves rural families from an intergenerational perspective, understanding that substance use disorders impacts the entire family system. By tapping the existing resources, strengths and collaborative experience of a well-established regional partnership, this grant project further strengthens the Partnership by introducing the Sanctuary Model®, building trauma-informed, enhanced integration and quality service capacity among child serving and substance abuse treatment agencies in an impoverished, rural/frontier region of the state.

The PRLP works in a partnership with families to provide support as families move through a continuum of care. Specifically, Navigators work with families to assess their strengths and needs, assist and advise them in building formal and informal supports, help them gain access to substance abuse screening and treatment and provide financial assistance to remove barriers such as transportation and childcare that prevent families from accessing resources. By encouraging the parent or caregiver to drive the service, Navigators can help the family tap into underutilized services and fill service gaps by providing a prenatal series and a parenting education series, the Nurturing Parenting Program.

Target Population

PRLP targeted:

General: PRLP has selected to primarily focus this proposal on children ages 0-5 who are affected by a parent or caregiver's substance abuse and at risk of entering foster care.

The secondary population of focus is the Penquis District Linking Partnership itself and its member agencies as the PRLP moves to implement a coordinated, trauma-informed system of care for the primary target population.

In-home/Out-of-home Focus: The project will serve children in or at–risk of an out-of-home placement.

Major Project Goals

The purpose of the Project is to build a trauma-informed, family-focused integrated service system that mitigates the negative effects that substance abuse may have on children and families, with specific emphasis on substance affected infants in rural and frontier settings.

Goal 1:  To increase the well-being, improve the permanency outcomes for and promote the safety of children who are in foster care or are at-risk for being placed in foster care as a result of a parent’s or caregiver’s substance abuse;

Goal 2:  To increase culturally inclusive, trauma-informed, enhanced integration and service capacity among child serving agencies across the child welfare, substance abuse, health care and mental health behavioral health systems in a rural/frontier region of the state;

Goal 3:  To reduce the stigma of substance abuse and addiction through the development of culturally inclusive, trauma-informed systems of care; and

Goal 4: To mitigate the negative effects that substance abuse may have on children and families, with specific emphasis on substance affected infants in rural and frontier settings.

Key Major Program Services

Case Management and Case Conferencing

  • Service Navigation

Parenting/Family Strengthening

  • Standard Parenting Skills Training/Education or Parenting Classes
  • Evidence-Based Parenting or Family Strengthening Program

Trauma-Informed Services

  • Sanctuary Model®

Specialized Outreach, Engagement and Retention

  • Co-location

Children’s Screening/Assessment

Adult Screening/Assessment

Emergency Financial Assistance

Cross-Systems/Interagency Collaboration – Clinical-Related Activities

  • Cross training

Cross-Systems/Interagency Collaboration – Program and Policy-Related Activities

  • Cross training
  • Co-location
  • Technical assistance
  • Workshops/Training
  • Monthly Partnership Newsletter
  • Participation in interagency collaborative committees

Evidence-Based Practices:

  • The Nurturing Parent Program for Families in Substance Abuse Treatment and Recovery

Partner Agencies and Organizations

The Regional Partnership Grants encouraged service providers to develop and/or strengthen cross-system linkages between substance abuse treatment, child welfare, dependency court, and other service systems. The following partners are included:

Child Welfare

  • Department of Health and Human Services, Office of Child and Family Services
  • Families And Children Together (F.A.C.T.)
  • Wings for Children and Families, Inc.

Substance Abuse

  • Department of Health and Human Services, Office of Substance Abuse
  • Wellspring Substance Abuse and Mental Health Services
  • Bangor Area Recovery Network (B.A.R.N.)


  • Bangor Family Treatment Drug Court


  • Eastern Maine Medical Center (EMMC)
  • Maine State CDC Public Health Nursing
  • Helping Hands with Heart
  • Bangor Public Health & Community Services


  • Penobscot Nation
  • Wabanaki Health and Wellness

Other Partner Agencies

  • University of Maine Center on Aging and School of Social Work
  • University of Louisville Kent School of Social Work
  • Community Caring Collaborative
  • National Trauma Advisory Council

Dissemination Activities

PRLP recognizes that for people nationwide to access the findings of what is successful, it needs to disseminate widely and at all levels. Locally, evaluation findings and performance updates are presented regularly to the Penquis District Linking Partnership. Unique aspects of the system and capacity-building efforts are shared with a variety of far-reaching audiences, including national venues such as Children's Bureau conferences (NCAAN) and social work conferences (SSWR, CSWE), as well as regional and statewide conferences. In addition, written products and evaluation findings are disseminated on the PRLP website and through the Penquis Regional Linking Partnership eUpdate.

Sustainability Strategies and Activities

Involvement of Partners: It is the intent of the PRLP to develop a system of care that is integrated into the culture of service providers in the Penquis region and maintain a series of designated program elements subsequent to the grant-funded period.

Sustainability Approach: The partnership has undertaken two strategic planning processes: one for sustaining partnership supports and the other for sustaining services. Other sustainability efforts include: supporting ongoing coordination of a referral system for families; continued updates of the website; continued use of a tracking database for outcomes related to well-being and permanency outcomes for children; presentations at state and national conferences on the model to encourage replication in other parts of rural America; efforts to build community supports over time to sustain the system of care; ongoing meetings of the Penquis District Linking Partnership, and broad fund raising efforts with community partners.

Institutionalizing Strategies: Sanctuary Model® will become self-sustaining as local trainers provide training to new staff and booster trainings and technical assistance to sites as needed.


To further the RPG program’s goal of expanding the knowledge base on approaches that improve the well-being and functioning of families affected by substance abuse, each RPG grantee is conducting a local evaluation. Penquis Regional Linking Partnership’s (PRLP) local evaluation uses a matched comparison group design to examine the effects of its Navigator Program on substance abuse treatment- and child welfare-involved families. Comparison group families do not receive services through the PRLP grant; they come from two comparison counties and may receive services available in the community there. The expected sample size for the evaluation is 500 pregnant women or families with young children, split evenly between the program and comparison groups. The evaluation also includes a study of the Sanctuary Model’s implementation and outcomes, a cost-effectiveness and cost-benefit analysis and an annual client survey.

Outcome Study Design: PRLP Navigators serve families of children from birth to age 6 who are affected by a caregiver’s substance abuse. These families have a child in or at risk of an out-of-home placement and live in Penobscot or Piscataquis County. The evaluation team is forming a comparison group using a two-stage matching process. First, the team selected two comparison counties, Kennebec and Somerset, with similar socio-demographic characteristics to Penobscot and Piscataquis Counties. Within the population of those counties, the local evaluator identifies comparison group members using propensity score matching, a statistical method of identifying comparison group members based on how closely their characteristics resemble those of program group members. The matching process uses state-level administrative data and considers characteristics such as age, gender, race or ethnicity, income and risk factors for child welfare involvement and substance abuse.

PRLP is assessing child permanency, child safety and adult recovery outcomes for both the program and comparison groups using administrative records from the Office of Substance Abuse and the Office of Child and Family Services. The project is using primary data collected by the Navigators to assess child well-being and family functioning and stability outcomes.

Additional Evaluation Components: The project also includes a study of the Sanctuary Model®, which examines the implementation of the model as well as two key outcomes. The first outcome is whether the project was able to increase trauma-informed, enhanced integration and service capacity at the organizational level in four child-serving agencies in the rural Penquis region. These organizations operate in the case management, substance abuse, health care and mental/behavioral health fields. The second outcome is whether the project improved member perceptions, partnership functioning and trauma-informed practices among the 32 members of the broader PRLP. In addition, a fiscal evaluation measures the cost-effectiveness and costs and benefits of project interventions, including the average cost per child of delivering selected units of service and aggregate client program costs compared to realized benefits. Finally, Families And Children Together conducts an annual client survey and interviews to measure satisfaction with services, access to services and trauma-informed care from families’ perspectives.

RPG National Cross-Site Evaluation Participation: PRLP is also contributing outcomes, program implementation and partner collaboration data to the RPG national cross-site evaluation.

Administrative Structure

Established in 2010, the Penquis District Linking Partnership grew out of a need to serve families of Neonatal Abstinence Syndrome (NAS) babies more efficiently and ultimately to provide a more systematic approach and commitment of a larger network to collaborate on service delivery. The Penquis District Linking Project has selected Families And Children Together (F.A.C.T.) as its primary agency for the Project. As lead agency, F.A.C.T. ultimately makes fiscal decisions and ensure quality services, while at the same time, provides monthly reports to the partnership to ensure that the project is developing according to the plan as agreed.

The partnership meets monthly to consider challenges, success and how to build on the communities' strengths to overcome them. This partnership is comprised of over 25 member agencies, as well as parent and caregiver partnership advocates, serving or representing families in Penobscot and Piscataquis counties. The partnership provides the overall partnership infrastructure including Steering Committee and conduit for communications to the full membership. The Penquis District Linking Partnership utilizes a consensus model of decision-making.


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