Connecticut Substance Abuse/Child Welfare Project: State Will Pay for Success, But Hasn’t Defined It

Connecticut has announced it is underway with a pay-for-success venture that will reward private funders if they are successful in using a substance abuse treatment model to curb re-referrals to, and out-of-home placements made by, child protective services.

One wrinkle: It’s not clear yet what the definition of “successful” will be.

It’s not looking good for the Family First Preservation Services Act, which would have opened up federal IV-E entitlement funds for several services aimed at preventing the need for foster care in certain maltreatment cases. But the Connecticut Department of Children and Families (DCF) will test the impact of one piece of Family First: The gambit that evidence-based drug treatment for parents can address family crises without reliance on foster care.

The agency announced a pay-for-success (PFS) project through which 500 families will receive family-based recovery (FBR), a model of substance abuse treatment developed at Yale University that provides in-home, attachment-based parent-child therapy and substance abuse treatment. Each family is assigned two clinicians and a family support specialist.

Treatment includes three in-home visits per week, two focused on parental sobriety and psychological well-being and one with the parent and child to strengthen bonding and promote the child’s healthy development.

For the uninitiated: PFS projects, which are often referred to as social impact bonds as well, use private capital to address some of the most persistent and complex social issues. In this model, a promising (but often untested) intervention is funded up front with private sector and/or philanthropic capital.

If certain outcomes are met, the government pays back the investors with a bonus. If the project fails, the government does not bear any cost burden.

It is still a relatively new and untested approach to developing services for youth and other at-risk populations. But with tightening budgets at the state and local level, there is much hope that PFS models will prove the worthiness of new approaches.

Connecticut began consideration of a child welfare PFS in 2013, and released Request for Information (RFI) regarding improving outcomes for families involved in Child Protective Services and impacted by substance use.

By May of 2014, it had settled on a project to address substance abuse.

“By focusing our social impact project in this area, we hope to increase reunification rates and reduce costs of long-term stays in foster care,” DCF Director of Development Elizabeth Duryea told Youth Services Insider back in 2014.

Indeed, those goals are among the benchmarks by which this project will be measured. The four outcomes being tracked for the project:

• Enrollment in the FBR process
• Toxicology screens of participants
• Re-referrals to DCF of families who have entered the FBR process
• Out-of-home placements made subsequent to the initiation of the FBR process

The screens and enrollment will be validated by an independent third party. Re-referrals to DCF and out-of-home placements will be evaluated through a Randomized Controlled Trial (RCT), conducted by UConn Health.

And here is where it gets somewhat murky. Pressed by Youth Services Insider for details on what level of achievement would actually trigger repayment by the state – either in full or in part – representatives from DCF and its intermediary partner, Social Finance, did not provide specifics to Youth Services Insider.

So we know that re-referrals and out-of-home placements will be the significant standards by which success will be measured, and the method for gauging success on those counts will be a randomized control study.

But stakeholders on the project have not disclosed is how much better than the control group this project needs to be in order to get paid back by Connecticut. It suggests that either the exact benchmarks for success haven’t been worked out, or for some reason the partners do not want to release those benchmarks yet.

“We look forward to talking more when the state releases the contract,” said Social Finance Communications Director Alex Zaroulis.

We will update again when they define what success means in this pay-for-success project.