Addressing Substance Use Disorders Among Families Involved with the Child Welfare System: A Cross-Agency Collaboration

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Expiration Date: October 12, 2020

attachment A: wave 1 key informant interview discussion guide mathematica policy research

ADDRESSING SUBSTANCE USE DISORDERS AMONG FAMILIES INVOLVED WITH THE CHILD WELFARE SYSTEM: CHALLENGES AND PROMISING STRATEGIES IN RURAL COMMUNITIES

Instrument 1.

Discussion Guide for Key Informant Interviews for Wave 1

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Instructions for interviewers:

Tailor the following discussion guide by (1) skipping sections or questions not relevant for the informant; or (2) modifying questions to reflect his/her role, his/her professional perspective/ knowledge, or information obtained prior to the interview. Use the follow-up questions or probes as needed to obtain additional needed information or clarification. If interview time runs short, you can skip some questions.

Send the informed consent to each respondent before the interview. Before beginning, ask the respondent(s) if they read and understood the informed consent; offer to read the informed consent; then ask the consent questions for participation in the study and for audio-recording. If the interview includes more than one respondent, ask respondents to keep comments from the discussion confidential.

I. Roles, responsibilities, and experience

1. Can you please tell us about your role and responsibilities with [institution/organization]?

• How long have you worked in this position?

• How many years have you worked in this field, including current and earlier experience?

• What is your relevant expertise or experience working with rural families that are involved in the child welfare system and have parental substance use?

2. What role does your organization/agency play in regard to child welfare, substance use issues, and especially the intersection between the two?

II. Key issues in rural communities

A. Community context

1. What are the main issues concerning substance use and child welfare?

2. What do you consider to be strengths of rural communities?

• Strengths could include a history of cross-agency collaboration, a small-community feel, strong sense of family, etc.

3. What are the greatest needs in rural communities?

4. What do you see as the major gaps in social services in rural communities?

• Services that are under-resourced, understaffed, or nonexistent (these could be related or unrelated to the child welfare and SUD treatment service systems)

• What factors drive these gaps (for example, limited qualified providers, facilities, recent events or policies, stringent licensing requirements)?

B. Child welfare

1. What are the key issues that rural child welfare systems face in regard to families struggling with substance use?

• Issues related to child welfare practices (such as intake, investigation, or differential response procedures), workforce, foster care capacity, treatment capacity, identifying substance use, or assessing treatment needs

• Would you say that these issues are new?

• Are these issues motivated or driven by legislative, regulatory, or other types of events?

2. How are these issues different for rural communities compared to urban or suburban ones?

3. How have rural communities responded to these issues?

4. What changes (in practice or policy) has your organization/institution made or suggested in response to [the issues raised]? What policies or practices affect the child welfare system’s response to the issues raised?

• These could be policies or practices of the child welfare agency, the court system, and other entities with mandated reporters (schools, hospitals, etc.)

• For example, practices that determine whether out-of-home placements are made or affect the number of children in foster care

C. Substance use and mental health

1. What can you tell us about the current substance use issues in rural communities?

• What are the most common types of substance use and use disorders in rural communities?

• How has substance use, especially opioid use, affected rural communities?

2. How do rural communities deal with co-occurring substance use issues and mental or physical health issues? Has co-occurrence affected the services offered in rural communities or the way they are delivered?

3. How does [opioid/prevalent substance] use compare to the use of other substances, in terms of its impact on family needs?

4. How have [opioids/prevalent substances] affected the types and severity of maltreatment reported to the child welfare system?

D. Barriers/challenges and strategies/solutions

1. What are the main barriers and challenges in delivering services to families living in rural areas with parental SUD and involved in the child welfare system?

[Probe for barriers and challenges around each issue]

• Workforce issues (for example, staff shortages and turnover, insufficient training); probe for specifics (for example, what types of staff)

• Infrastructure or technology issues (for example, lack of transportation or limited teladoc services)

• Service system issues (for example, lack of collaboration or information-sharing across systems; onerous regulatory requirements)

• Treatment capacity (probe for information on specific types of treatment services, waitlists, criteria or requirements for treatment)

2. How do these barriers and challenges differ from those faced by urban and suburban communities?

3. To what extent are these barriers unique to child welfare and substance use, relative to other types of human services (such as housing, food, or employment assistance)?

4. How do these barriers differ for opioid-use issues compared to other types of substance use issues?

III. Promising models/interventions/strategies

1. How can rural areas overcome these challenges? What models/interventions/strategies are used?

[Probe for strategies for each challenge mentioned]

• Child welfare issues

• Substance use disorder issues

• Workforce issues

• Infrastructure or technology (distance/remoteness issues)

• Service system issues

• Capacity issues

2. Which of these models/interventions/strategies have you studied, used, or seen in action, and how have they worked?

• Which aspects of these models/interventions/strategies are most important to helping families succeed?

• What else is needed to make these models/interventions/strategies more successful?

3. What advice would you give other rural communities interested in these models/interventions/strategies?

IV. Opportunities for improvement

A. Federal resources

1. What federal resources or opportunities (initiatives, policies, grants, or other funding, etc.) support efforts to help child-welfare-involved families with parental substance use in rural communities?

• How are communities and organizations leveraging federal funding opportunities (for example, through a Medicaid Section 1115 waiver, the Comprehensive Addiction and Recovery Act or the 21st Century Cures Act, or programs funded by the Substance Abuse and Mental Health Services Administration, such as the State Opioid Response (SOR) initiative)?

• How are communities and organizations planning to use funds through the Family First Prevention Services Act?

2. What other federal resources could support the implementation of these models/interventions/strategies?

3. What are the obstacles to taking advantage of these opportunities?

4. What can facilitate better use of these opportunities?

5. How could these resources be used to disseminate promising strategies to other rural areas?

6. How could these resources be used to address the challenges and key child welfare issues we have been discussing?

B. State and local resources

1. What state and local opportunities could be leveraged to support improved services for helping those with parental substance use among child-welfare-involved families in rural areas?

2. What other local resources could support these programs?

3. What are the obstacles to taking advantage of these opportunities?

4. What can facilitate better use of these opportunities?

5. How could these resources be used to disseminate to other rural communities the strategies we have discussed?

6. How could these resources be used to address the challenges and key child welfare issues we have been discussing?

V. Recommendations for other respondents

1. Are there any experts you would recommend we speak with about the challenges facing rural communities in dealing with families that are involved with the child welfare system and have substance use issues?

• These informants might include administrators or practitioners in child welfare, substance use treatment, public health, law enforcement, or judicial/legal matters.

• Can you tell me a little about them? What is their title? What is their main role?

• Can you provide email and telephone numbers of those you would recommend?

2. Are there any articles, reports, websites, or other sources that you recommend we review to help ourselves understand the issues facing child-welfare-involved families with substance use issues?

3. If they mentioned a promising model: Is there any literature you recommend we review to help us understand the [model/program/intervention]?

4. If they mentioned a promising model: We are interested in getting more information about [model/program/initiative]. Whom do you recommend we contact to learn more about their strategies, resources, and outcomes?

• These professionals might include administrators or practitioners in child welfare, substance use treatment, public health, law enforcement, or judicial/legal matters.

• Can you tell me a little about them?

• Can you provide email and telephone numbers of those you would recommend?

Closing remarks: Thank participant for their input and provide contact information for future questions or concerns.

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