Project Description

TennesseeHelen Ross McNabb Center’s New Beginnings for Children, Women, and Families (NB) provides treatment to at least 800 children and their substance-addicted families in the Knox, East, and Smoky Mountain Department of Children's Services (DCS) regions of Tennessee. East Tennessee children are at high risk of maltreatment due to abnormally high number of mothers using and abusing substances. These children need stability, healthy living environments and families free from substance addiction. NB addresses the needs of these substance-exposed children and their families through early intervention and family assessment, housing services, family-centered treatment and integrated healthcare.

Comprehensive family assessment identifies strengths and needs within holistic domains and serves as an evaluative tool to measure progress at specified intervals. NB helps families find or retain stable housing, a key factor in long-term recovery from substance addiction. NB helps families where children are at risk for placement into the State's custody and with families where DCS has removed children and child welfare seeks quick, safe reunification. Children live with their mothers and families in transitional and permanent housing in community and agency-owned settings. Length of participation by the family will be dependent on need. NB has 15 committed partners including healthcare providers where NB triages and screen children of referred mothers and State of Tennessee and regional DCS where NB embeds and co-locates staff. NB uses evidence-based and trauma-informed approaches including Trauma Focused Cognitive Behavior Therapy, Motivational Enhancement Techniques, Matrix Model, Nurturing Parenting Program, Trauma Recovery and Empowerment Model (TREM), Keys to Interactive Parenting (KIP) and a proven in-home substance abuse treatment model (Family Behavior Therapy or Strengthening Families). NB families access appropriate services including in-home family service, children's services, domestic violence services, parent skill-building classes, case management and care coordination, social networking and family events and inclusion services for fathers and partners. NB integrates physical and behavioral healthcare services. Therefore, the program provides care coordination with case management and has nurse practitioner for adults and volunteer pediatrician for children available onsite. NB provides knowledge to the field through a quasi-experimental design using two treatment groups (community-based intensive outpatient and in-home treatment services) and a control group (structured transitional housing with intensive outpatient treatment - residential treatment). Helen Ross McNabb Center's (HRMC) evaluation team uses both qualitative and quantitative analysis to assess effectiveness of program strategies. NB's ultimate goal is to bring healing to families affected by substance addiction,thereby improving child well-being and permanency outcomes in East Tennessee.

Target Population

New Beginnings for Children, Women and Families targeted:

General: The target population is children affected by parental substance abuse (who are in or at-risk of being placed in TN’s custody) and their families.

In-home/Out-of-home Focus: NB serves both in and out-of-home cases. NB supports TN DCS’s goal to avoid placements into care or decrease time in care.

Major Project Goals

Goal 1: After receiving New Beginnings’ family-centered substance abuse services, children will experience improved well-being, permanency, and enhanced safety with their families.

Goal 2: New Beginnings’ Regional Partnership and local child welfare regions increases system capacity, integration and coordination of services and data to decrease the number of out-of-home placements for children affected by substance abuse to decrease length of stay for children already in the State's custody.

Goal 3: New Beginnings will contribute to the field of knowledge for the prevention of child abuse and neglect by evaluating effectiveness of interventions provided to participants and disseminating results.

Major Program Services

Family-Centered Treatment

  • Residential treatment with child(ren) on-site and in-home treatment
  • Comprehensive Family Assessment and Family Treatment Planning
  • Trauma Assessment and Interventions
  • Parenting Skill Building
  • Domestic Violence

Community-Based Intensive Services Housing

  • Case Management
  • Transitional and Permanent Housing
  • Housing financial assistance

In-Home Services

  • Family Behavioral Therapy
  • Nurturing Parenting
  • Case Management

Intensive Coordinated Case Management

  • Co-Location
  • Collaboration with the Department of Children's Services and other key partners

Integrated Healthcare

  • Mental Health Services
  • On-site Nurse Practitioner and Pediatrician
  • Physical Assessment and Treatment

Evidence-Based Practices:

  • Motivational Enhancement Therapy
  • Matrix Model
  • Hazelden's Co-Occurring Disorders Program
  • Nurturing Parenting
  • Seeking Safety
  • Celebrating Families!
  • Family Behavior Therapy

Partner Agencies and Organizations

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

Treatment

  • Helen Ross McNabb Center - Lead Agency

Child Welfare

  • Tennessee Department of Child and Family Services
  • DCS Regional Catchment Areas (Knox, East TN, Smoky Mountain)

Health Services

  • Knox County Health Department
  • East TN Children’s Hospital
  • Life Spring's Women's Healthcare
  • University of Tennessee Medical Center
  • Fort Sanders Perinatal Center

Housing

  • Knox County Community Action Committee

Faith-Based Organization

  • Compassion Coalition

Evaluation

  • Helen Ross McNabb Center
  • Laura Denton, Ph.D., Independent Consultant

Dissemination Activities

The partners work collectively to ensure that community partners and stakeholders are kept informed about the progress and outcomes of the proposed services. They:

  • Prepare articles for publication regarding the project’s research
  • Present lessons learned through local, state and regional venues

Sustainability Strategies and Activities

Involvement of Partners: Eastern Tennessee Regional Partner meetings convene to facilitate working together.

Integrating Activities: Participation in DCS's In-Home Tennessee collaborative.

Evaluation

As part of the RPG program, each grantee is conducting a local evaluation of its program. These evaluations not only help grantees track their outcomes, but also contribute to the knowledge base on approaches that improve the well-being and functioning of families affected by substance abuse and in which children are at risk of maltreatment. HRMC is conducting two evaluations of New Beginnings for Children, Women and Families (NB). The first evaluation uses a matched comparison group design to compare the outcomes of participants receiving intensive outpatient and in-home services with those enrolled in intensive outpatient with supported living treatment. The second uses a randomized controlled trial (RCT) to evaluate the effects of receiving assistance from a designated housing facilitator on families enrolled in intensive outpatient or in-home services. The sample sizes are 800 families (700 in the program group and 100 in the control group) in the matched comparison group evaluation and 700 families split evenly between the program and control groups, in the RCT. The evaluation also includes an implementation study and may include a cost-benefit analysis.

Outcome Study Designs: Clients participating in the matched comparison group study enroll in 1 of 3 treatment modalities: intensive outpatient, in-home or intensive outpatient with supported living. An HRMC staff member recommends a mode of services based on each adult’s score on the Addiction Severity Index assessment and his or her needs and resources, such as housing, childcare and transportation. Ultimately, though, each client chooses the service option in which he or she wants to enroll. For the RCT, clients receiving in-home and intensive outpatient treatment modalities, with children, self-select their interest in benefitting from additional housing facilitation; the evaluation team then randomly assigns those participants to receive a housing facilitator or services as usual. Random assignment is stratified by whether clients are receiving intensive outpatient or in-home services, and by the three catchment areas HRMC serves.

The grantee is assessing NB outcomes in five areas: (1) child well-being, (2) child permanency, (3) child safety, (4) adult recovery and (5) family functioning and stability. HRMC collects follow-up data at program exit and 3, 6, 12 and 18 months after program exit. HRMC collects primary data for the evaluation on child well-being, family functioning and adult recovery. In addition, HRMC works closely with the Tennessee Department of Children’s Services to gain access to child welfare administrative records in order to study children’s safety and permanency outcomes.

Additional Evaluation Components: The local evaluation of NB also includes an analysis of implementation across service options. HRMC may also conduct a cost-benefit analysis, examining costs and benefits across the residential, intensive outpatient and in-home service options.

RPG National Cross-Site Evaluation Participation: In addition to this evaluation, HRMC is participating in the RPG cross-site evaluation, which studies family outcomes, program implementation and RPG partnerships across the 17 grantees.

Administrative Structure

Helen Ross McNabb Center, a community-based non-profit treatment organization serves as the lead agency for the New Beginnings Project. HRMC works with local DCS partners, courts, substance abuse treatment, health care providers, child and family service, mental health agencies and faith-based organizations to ensure families have access to a comprehensive continuum of care. Regional Partnership Meetings, inclusive of the 15 partner organizations, convene monthly.

Will Giebert is the lead Program Evaluator with the Helen Ross McNabb Center Research and Evaluation (R&E) Department and serves as the principal investigator on the NB project. Kiley Compton is the Research and Evaluation Coordinator overseeing evaluation and grant management activities. Mr. Giebert and Ms. Compton ensures that evaluation and grant responsibilities, timeline milestones and reports are accomplished timely. The R&E Department performs much of the on-site evaluation work in consultation with Dr. Laura Denton, the external, third-party evaluation consultant.

The R&E Department reports to the Senior Director of Administrative Services. Mary Katsikas is the Senior Director of Children and Youth Mental Health Programming and has administrative oversight for New Beginnings. Mary reports to the Regional Vice President of Clinical Services.

 

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Project Details

  • Lead Agency:
    Helen Ross McNabb Center (formerly Child and Family Tennessee)
  • Location:
    Knoxville, Tennessee
  • Geographic Area and Congressional District Served:
    Serving three Department of Children's Services (DCS) regional catchment areas; Knox, East Tennessee and Smoky Mountain; Congressional District 2
  • Program Funding:
    $1,176,470/Year;
    $1,000,000 Federal;
    $176,470 Match
  • Proposed Number Served:
    Children: 160/year
    Adults: 160/year
    Families: 800 over 5 years
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