Barrier Removal : North Carolina Work First/Child Protective Services Substance Abuse Initiative

Program/Practice Name: North Carolina Work First/Child Protective Services (CPS) Substance Abuse Initiative

Contact Information:

Starleen Scott Robbins
North Carolina Department of Health and Human Services 
Division of Mental Health, Developmental Disabilities and Substance Abuse Services
3005 Mail Service Center
Raleigh, NC 27699-3005 
Phone: (919) 715-2774
starleen.scott-robbins@dhhs.nc.gov

Kea Alexander
North Carolina Department of Health and Human Services
Division of Social Services
325 N. Salisbury Street 
MSC 2408
Raleigh, NC 27699-2408
Phone: (919) 334-1073
kea.alexander@dhhs.nc.gov

Type of Program/Practice: A joint initiative of North Carolina's Division of Social Services (DSS) and the Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH/DD/SAS), the Work First/CPS Substance Abuse Initiative provides appropriate assessment, treatment referral, and care coordination for Work First (TANF) recipients and eligible Food and Nutrition Services (FNS) recipients.

Program/Practice Description: The goal of the Work First/CPS Substance Abuse Initiative is to provide early identification and connection to treatment of Work First recipients and eligible Food and Nutrition Services recipients who have substance abuse problems severe enough to affect their ability to become self-sufficient. The program also assists parents who have substance abuse problems and who are involved with CPS engage in appropriate treatment. Each county’s department of social services has access to a Qualified Professional in Substance Abuse (QPSA), contracted by the Local Management Entity (LME). Generally, QPSAs are located in local county departments of social services and are easily accessible to families and social services staff. All Work First applicants are screened using a standardized verbal screening tool for risk of substance abuse. If the verbal screening tool results are negative, an additional tool, the ‘Substance Abuse Behavioral Indicator Checklist II’, based on observation, may be utilized. With any of the screening tools, if there are indicators of substance abuse, a referral is made to the QPSA, who completes an assessment. FNS applicants with a Class H or I Controlled Substance Felony meeting eligibility criteria are automatically referred by FNS to the QPSA for an assessment. Based on the assessment, if treatment is indicated a referral is made and the QPSA coordinates the individual's progress through treatment. Working together, the QPSA and DSS develop a plan for the individual to ensure success and self-sufficiency.

Background/Program History: In 1997, the North Carolina General Assembly passed N.C. G.S. 108A-29.1, which prescribed, "Any applicant or current recipient who is determined to be addicted to alcohol or drugs, and in need of substance abuse treatment, to participate in treatment in order to receive Work First benefits " and N.C. G.S 108A-25.2, which stated, "The law requires individuals convicted of Class H or I controlled substance felony offenses are eligible to participate in the Work First and food stamp program." As a result of State legislation, a memo of agreement (MOA) was executed between DSS and DMH/DD/SAS. Responding to concerns from the local departments of social services, the initiative was expanded to Mental Health Services in 2001 with voluntary mental health screenings now part of the initiative. As a result of Child Welfare Cases in 2001, the initiative also was expanded to include child protective services and child welfare.

Innovations and Results: Recognizing that substance abuse and mental health issues are key barriers to employment and self-sufficiency for many Work First and Food and Nutrition Services applicants and participants, North Carolina created the Work First/CPS Substance Abuse Initiative, an interagency effort between DSS and DMH/DD/SAS at the state and local level. The QPSA role is unique as both an accessible substance abuse assessor often offering same day assessments to consumers, and as a knowledgeable consultant for DSS staff. In SFY 2010 a total of 14,080 individuals were assessed statewide through this Initiative, with 2,577 entering treatment.

Operations: Under an MOA between DSS and DMH/DD/SAS:

  • Joint responsibilities of DMH/DD/SAS and DSS

    • Develop and provide training for county DSS and LME/provider regarding Work First, FNS, and Substance Abuse.
    • Provide technical assistance to county DSS and LMEs/providers regarding Work First, FNS and Substance Abuse program development.
  • DMH/DD/SAS

    • Provide funding to LMEs to assist with hiring QPSAs, and fund non–Medicaid reimbursable expenditures, i.e., costs of tools.
    • Develop consent for release of information in accordance with 42 CFR Part 2: Confidentiality of Alcohol and Drug Patient Records and HIPPA.
  • DSS

    • Develop policies and procedures for county DSS to follow in implementing and administering the Work First and Food and Nutrition Services substance abuse requirements.
    • Distribute standardized consent for release.

Each LME establishes a local MOA between county DSS and LME and/or QPSA provider, which is reviewed annually. All Work First adult applicants/recipients are screened for possible substance abuse problems. Currently there is voluntary screening for mental health issues in place. All eligible FNS applicants with a Class H or I Controlled Substance Felony are referred to the QPSA for a substance abuse assessment. The number of QPSAs varies for each LME; there can be one to four QPSAs per LME based on the size of their Work First population and catchment area.

The local MOA will identify who will conduct the screening (QPSA or DSS staff). In general, the DSS conducts the screening and the QPSA provides diagnostic interviews, ensures random toxicology screens are administered as a part of treatment, provides case consultation with DSS staff, provides orientation to the Work First/Substance Abuse Initiative for Work First clients, collects data, provides training for DSS staff, provides care coordination including client advocacy and referral for treatment, assists with transportation and child care, tracks provision of services, follows up with treatment providers, reports to county DSS, and acts as liaison between the LME, treatment providers, and county DSS.

Funding: The initiative was originally funded by discretionary Temporary Assistance for Needy Families funds. However, as of 2002, it is funded by Substance Abuse and Mental Health Services Administration Substance Abuse Prevention and Treatment Block Grant funds, which are allocated to LMEs. The Initiative funds about $40,000 to $160,000 for QPSA salaries.

Staffing: QPs need to be:

  • Licensed clinical addictions specialist;
  • Certified clinical supervisor;
  • Certified substance abuse counselor;
  • M.A. in human services plus 1 year substance abuse supervised experience;
  • B.A. in human services plus 2 years of substance abuse supervised experience; or
  • B.A. in non-human services plus 4 years substance abuse supervised experience.

Tips to Implementation: Through the years of implementing the Work First/CPS Substance Abuse Initiative, the North Carolina Department of Health and Human Services has learned that the initiative is always evolving and requires ongoing revisions of policy across the child welfare, substance abuse/mental health, and Work First systems. A consistent message must be conveyed from all parties (DSS, DMH/DD/SAS, LMEs, and QPSAs).

Keys to Success:

  • More successful when the QPSA is out-stationed in DSS; easier to provide follow through, be accessible to applicants, create collaborative relationships with DSS, and solve transportation issues.
  • Need for confidential space within sites for QPSAs and other treatment providers to serve clients.
  • Practical and efficient screening tools, particularly the Substance Abuse Behavioral Indicator Checklist.
  • Need to provide accessible and appropriate treatment services.
  • Ongoing monitoring needed through reviews of MOAs, performance agreement, and audit.
  • Need to provide ongoing support and staff training for QPSAs and DSS staff.

The following tools are associated with North Carolina Work First/Child Protective Services Substance Abuse Initiative.  Please send us an email at upitoolkit@icfi.com for more information about these tools.

Memorandum of Agreement