ARIZONA FAMILIES F.I.R.S.T. PROGRAM
Annual Evaluation Report
State Fiscal Year 2011

Prepared for
Arizona Department of Economic Security
Division of Children, Youth and Families
Phoenix, Arizona
Contract No.: DES060718-001

Prepared by
Center for Applied Behavioral Health Policy
College of Public Programs
Arizona State University

© 2011 by the Arizona Board of Regents for and on behalf of
Arizona State University and its Center for Applied Behavioral Health Policy
Center for Applied Behavioral Health Policy
500 N. Third Street, Suite 200
Phoenix, AZ 85004
email: cabhp@asu.edu
website: http://cabhp.asu.edu

This document may be copied and transmitted freely. No deletions, additions or alterations of contents are permitted
without the expressed, written consent of the Center for Applied Behavioral Health Policy.

Acknowledgements
This report was prepared by the Center for Applied Behavioral Health Policy (CABHP), College
of Public Programs, Arizona State University, under contract number DES060718-001 with the
Arizona Department of Economic Security, Division of Children, Youth and Families
(ADES/DCYF), in partnership with the Arizona Department of Health Services, Division of
Behavioral Health Services (ADHS/DBHS) through the Joint Substance Abuse Treatment Fund.
Michael S. Shafer, Ph.D., Stephen James, Charles Davis, Richard Rivera, Pradeep Jayapal, Sunil
Mukkavilli, Ankur Shukla, and Anuj Vatsa all contributed to this year’s report.
The authors wish to thank the following staff of the ADES/DCYF and the ADHS/DBHS for their
ongoing cooperation and assistance: Susan Blackburn, Tamara Boling, Karen Bulkeley, Cathy
Hasenberg, and Mark Klym of ADES, and Jennie Lagunas and Steve Lazere of ADHS.
Finally, the authors wish to express appreciation to the staff and directors of the nine contracted
AFF provider agencies throughout the state. Their insights and recommendations of strategies
for improving the utility and quality of the information contained in this report are appreciated.
Most notably, their dedication to the families and children served through the AFF program is
recognized and honored.
Points of view represented in this report are those of the authors, and do not necessarily represent
the official position or policies of either the ADES or the ADHS.
Suggested citation:
Center for Applied Behavioral Health Policy. (2011). Arizona Families F.I.R.S.T.
Program: Annual Evaluation Report for the Period July 1, 2010 – March 31, 2011.
Tempe, AZ. Arizona State University.

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TABLE OF CONTENTS
Acknowledgements.......................................................................................................................... i
Table of Contents.............................................................................................................................1
Executive Summary .........................................................................................................................2
Section 1: Introduction....................................................................................................................4
Section 2: Evaluation Framework and Data Sources......................................................................7
Section 3: Arizona Families F.I.R.S.T. Clients and Services Received .........................................8
Section 4: AFF Program Outcomes ..............................................................................................17
Section 5: Summary......................................................................................................................20

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Executive Summary
Arizona Families F.I.R.S.T. (Families in Recovery Succeeding Together; AFF) was established
in 2000 to address adverse conditions related to substance abuse among child welfare-involved
families in which allegations of child maltreatment were determined to be associated with
parental substance abuse. The AFF program provides to these families a variety of treatment and
supportive services, which are designed to reduce or eliminate abuse of and dependence on
alcohol and other substances. Interventions are provided through the Department of Economic
Security, Division of Children, Youth and Families (DES/DCYF) contracted community
providers in outpatient and residential settings, and/or through the Regional Behavioral Health
Authority (RBHA) provider network under the supervision of the Department of Health
Services, Division of Behavioral Health Services (DBHS).
Key elements of the AFF program include an emphasis on: face-to-face outreach and
engagement at the time of program referral; assessments; supportive services, such as
transportation and housing; counseling; and aftercare services to manage relapse occurrences.
The service delivery model incorporates essential elements based on family needs, such as
culturally responsive services, gender-specific treatment, family-involved treatment services, and
motivational enhancement strategies to assist the entire family in its recovery.
Similar to last year, this year’s annual evaluation report is restricted primarily to the first nine
months of the state fiscal year, in order to provide more accurate and more detailed analysis; key
findings for SFY 20111 are as follows:
Increases in Timeliness, Availability, and Accessibility of Services
· Overall, unique individuals2 referred to the AFF program for all four quarters of SFY
2011 increased by 15% compared to SFY 2010. During all four quarters of SFY 2011,
4,954 unique individuals were referred to the AFF program, averaging 1,239 referrals per
quarter.
· Nearly all referrals to the AFF program (97%) received at least one recorded outreach
attempt, and approximately two-thirds (64%) accepted services, representing a 9%
increase from last year.
· During the first three quarters of SFY 2011, unique individual referrals were outreached
in a timely manner, averaging 1 business day, and treatment services were initiated, on
average, within 16.5 days of referral.
· A total of 2,268 individuals were assessed during the first three quarters of SFY 2011,
representing 61% of individuals referred to the AFF program. The majority of
individuals (56%) were assessed by DES providers only, up 12.8% from last year.
· A 20% increase in total clients served was observed between SFY 2010 (2,760) and SFY
2011 (3298).
1

Throughout this report, reference will be made to SFY 2011; these references will be to the first three quarters of
the SFY (i.e. for the period of July 1, 2010 – March 31, 2011), unless noted otherwise.
2
Unique individual referrals represents the number of individuals with one or more referrals to the AFF program
during the study period (i.e. individuals is the unit of analysis, not number of referrals).

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Recovery from Alcohol and Drug Problems
· Based on the initial assessment information collected on 2,268 AFF clients assessed in
SFY 2011, 92.1% of AFF clients reported use of any substance in the 30 days
immediately prior to their assessment, with alcohol (59.8%), marijuana (56.9%), and
methamphetamine (45.4%) continuing to be the more commonly reported substances.
· 68% of all clients served (n = 2251) were drug tested; on average these occurred 1.5
times per month during the reporting period of AFF program participation.
· 82% of all clients with reported drug screens were found to be drug free throughout their
AFF program participation.
Child Safety and Reduction of Child Abuse and Neglect
· Nearly all clients (95.9%) served by the AFF program had at least one allegation of child
maltreatment prior to entering AFF.3
· 13.9% of the clients who had a substantiated or unsubstantiated maltreatment report at
intake had at least one additional allegation of maltreatment filed during the 9-month
evaluation period, which is comparable to the rate observed last year.
Permanency and Reunification
· A total of 2,692 children, who were associated with AFF clients (1,868) in the first three
quarters of SFY 2011, were in CPS out of home placement at some point during the
reporting period. Similar to last year, approximately one-quarter (26%) of children in out
of home placement achieved permanency during SFY 2011. Among children who
achieved permanency, the vast majority (98%) were reunified, representing an 8%
increase from last year.
Achievement of Self-Sufficiency through Employment
· Employment activity is reported only for those clients referred to the AFF program who
were already enrolled in the Jobs program. During SFY 2011, no individuals were
referred to AFF from the Jobs program.

3

Among clients served by the AFF program, the data matching process was unable to identify a pre-referral CPS
report for 2.6% of AFF-referred clients. In addition, 1.5% of clients had a CPS report matched that was greater than
two years in advance of the AFF referral (which was considered an outlier and therefore excluded from analyses).

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SECTION 1
INTRODUCTION
Arizona Families F.I.R.S.T. (Families in Recovery Succeeding Together) was established as a
community substance use disorder prevention and treatment program by Senate Bill 1280, which
passed in the 2000 legislative session. Under the requirements of the Joint Substance Abuse
Treatment Fund that was established under the legislation, an annual evaluation of the Arizona
Families F.I.R.S.T. (AFF) program is required. This evaluation of AFF examines the
implementation and outcomes of community substance use disorder treatment services delivered
by DES contracted providers and the Regional Behavioral Health Authorities (RBHA) network.
AFF is a program that provides contracted family-centered, strengths-based, substance abuse
treatment and recovery support services to parents or caregivers whose substance abuse is a
significant barrier to maintaining or reunifying the family or is a barrier to maintaining
employment. Clients for the program are referred by Child Protective Services and by the Jobs
program. The goal of the program is to reduce or eliminate abuse of and dependence on alcohol
and other drugs, and to address other adverse conditions related to substance abuse.
Interventions are provided through the Arizona Department of Economic Security, Division of
Children, Youth and Families (ADES/DCYF) contracted community providers in outpatient and
residential settings and/or through the RBHA provider network. In addition to traditional
services, AFF includes an emphasis on: face-to-face outreach and engagement at the beginning
of treatment; concrete supportive services, such as transportation and housing; and an aftercare
phase to manage relapse occurrences. Essential elements based on family needs, such as
culturally responsive services, gender-specific treatment, motivational enhancement strategies,
and collaboration with child service providers to assist the entire family in its recovery, are
incorporated into service delivery.
The diagram on the following page shows the flow of clients through various stages of the AFF
program.

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Exhibit 1
Overview of the AFF Program Model
CPS
Case Managers

JOBS
Case Managers

Referred to AFF Provider
· Conduct Outreach
· Engage Client in Services
· Determine AHCCCS Eligibility

AHCCCS
Eligible?

No

·
·
·
·

DES/DCYF
DES Funded Services
Continue with AFF Provider
Conduct Core Assessment
Develop Service Plan
Begin Services

Yes

Continuous
Review of
Title XIX Status

ADHS/DBHS
RBHA Funded Services
·
Connect to RBHA Provider
·
Conduct Core Assessment
·
Develop Service Plan
·
Begin Services

AFF
Supportive Services
Child Care, Transportation, Housing, Job Training, etc.

Access AFF Aftercare Services

Close Case

Center for Applied Behavioral Health Policy Ÿ Arizona State University

Close Case

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Exhibit 2 summarizes the county, DES provider agency, and associated RBHA within each of
the six DES districts. DES-contracted agencies in bold italics also participate in the RBHA
network as either a RBHA or a RBHA network provider.

Exhibit 2
List of DES Districts, Counties, DES Providers, and RBHAs
DES
County
District4
I
Maricopa
II

Pima
Coconino

III

Yavapai
Apache and
Navajo
Yuma

IV

La Paz

DES Provider Agency
TERROS
Community Partnership of
Southern Arizona (CPSA)
Arizona Partnership for
Children (AzPaC-Coconino)
Arizona Partnership for
Children (AzPaC-Yavapai)
Old Concho Community
Assistance Center
Arizona Partnership for
Children (AzPaC-Yuma)
WestCare Arizona

Mohave

WestCare Arizona

V

Gila and Pinal

Horizon Human Services

VI

Cochise, Graham,
Greenlee, and
Santa Cruz

Southern Arizona
Behavioral Health Services
(SEABHS)

Regional Behavioral
Health Authority
Magellan
Community Partnership of
Southern Arizona (CPSA)
Northern Arizona Regional
Behavioral Health Authority
(NARBHA)

Cenpatico Behavioral Health of
Arizona, Inc.
Northern Arizona Regional
Behavioral Health Authority
(NARBHA)
Cenpatico Behavioral Health of
Arizona, Inc.
Cenpatico Behavioral Health of
Arizona, Inc.5

4

These six DES districts were converted into five regions on July 1, 2010. Due to contract design, DES AFF
contractors have remained aligned with the districts.
5
Cenpatico Behavioral Health of Arizona, Inc. became the RBHA for DES District VI on December 1, 2010,
replacing Community Partnership of Southern Arizona (CPSA).

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SECTION 2
EVALUATION FRAMEWORK AND DATA SOURCES
This evaluation report responds to the legislatively-mandated performance indicators of the AFF
program. The data provided within this report are drawn from administrative data submitted to
the evaluation team directly, or obtained from administrative information files maintained by
DES and DBHS. These data, like those reported in previous reports, include:
·
·

·
·

Service utilization data obtained directly from the nine DES-contracted providers;
Enrollment and encounter data provided by the Arizona Department of Health
Services, Division of Behavioral Health Services (ADHS/DBHS) for services
provided through the local RBHA network;
DES CHILDS data, which provides child welfare information; and
DES JAS/AZTEC data, which provides employment services information.

DES providers use a common data reporting format, deployed by CABHP in November 2008.
These data are either entered directly into the AFF data entry web-portal or uploaded by the
provider to the web-portal. The data entered through the AFF web-portal include information
regarding outreach efforts, assessment information, drug testing results, and service provision,
using a service matrix that emulates the categories of service utilized by DES for payment to
their providers.
For those client services that are funded through DBHS/RBHA, enrollment and service
encounter data are provided by DBHS. These data are derived from the DBHS Client
Information System (CIS).6 Using the service domain and levels structure and service
definitions, as specified in the Arizona Department of Health Services’ Covered Behavioral
Health Services Guide and Client Information System File Layouts and Specifications Manual, a
common services taxonomy is used to organize the services funded both by DBHS and DES.
Two additional data sets used for this evaluation include: the DES CHILDS (Children’s
Information Library and Data Source) information system, which provides child welfare data on
allegations of child maltreatment, and the DES JAS/AZTEC (Jobs Automated System/Arizona
Technical Eligibility Computer System) information system, which provides employment
services data.

6

DBHS enters data into the CIS within a 210 day period. Given this, data from the DBHS CIS may not be entirely
accurate or complete.

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SECTION 3
ARIZONA FAMILIES F.I.R.S.T. CLIENTS
AND SERVICES RECEIVED
Similar to last year, this year’s Annual Report has been restricted primarily to the indicators of
program performance that were reported for the first nine months of the State Fiscal Year (SFY)
(i.e. for the period of July 1, 2010 – March 31, 2011). Restricting these analyses to 9 months,
rather than 12, was a mutual agreement made by DES and CABHP last year in recognition of the
short time frame during which the data are available for receipt and analysis by the evaluation
team, and the deadline for submission of the report. Sections 3.1 and 3.2 present data for all 12
months of SFY 2011; all subsequent sections will be restricted to data for the first 9 months of
SFY 2011.
3.1

AFF Program Referrals

As depicted in Exhibit 3, a total of 4,954 unique individuals were referred to the AFF program
during all four quarters of SFY 2011, averaging 1,239 referrals per quarter. The total number of
unduplicated individuals referred to the AFF program for SFY 2011 increased by 15 percent as
compared to SFY 2010.

July -Sep
Oct-Dec
Jan-March
Apr-June
Total Referrals
Unique Referrals

Exhibit 3
Statewide AFF Referrals
SFY 2010
SFY 2011
878
1264
957
1282
1238
1217
1308
1296
4381
5059
4308
4954

% change
44.0 %
34.0 %
-1.7 %
-0.9 %
15.5 %
15.0 %

Figure 1 (on the next page) displays the number of referrals to the AFF program from SFY 2008
through SFY 2011. As these data reflect, referrals to the AFF program have historically
averaged between 1,200 and 1,300 each quarter. During the period of SFY 2009, Quarter 3 and
continuing through SFY 2010 Quarter 2, significant reductions in the number of referrals to the
AFF program were observed, likely due to State budget reductions, which have affected other
DES-funded programs. By SFY 2010, Quarter 3, referrals to the AFF program had returned to
their historical rates, which are now observed to be slightly above those previously observed.

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Figure 1: Quarterly Referrals to AFF – SFY 2008 to SFY 2011
3.2

Client Outreach and Engagement

Exhibit 4 provides a comparison of client outreach and referral patterns across all four quarters
of SFY 2011 and all four quarters of SFY 2010. Approximately 97% of all individuals referred
to the AFF program this year received a recorded outreach attempt, and slightly more than 64%
of referred individuals agreed to participate in AFF services, up 9% from last year. Finally, the
proportion of referrals that were closed without receipt of service was observed to be 17%, up
significantly from last year, but due primarily to more accurate data reported from the providers.
Exhibit 4
Disposition of Cases Referred to the AFF Program
SFY 2010
SFY 2011
(12-month data)
(12-month data)
n
%
n
%
# unique referrals
4308
100
4954
100
# referred individuals with record
3645
84.6
4822
97.3
of outreach attempt
# of referred individuals accepting
2373
55.1
3189
64.4
services
# of referred individuals closed
156
3.6
850
17.2
(pre-service)

All subsequent analyses to be reported are in reference to the first 3 quarters of SFY 2011.

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3.3

Annual Case Processing

As evidenced in Exhibit 5, the average duration from referral to first contact, during the first
three quarters of SFY 20117, was 1 business day, comparable to the rate observed last year.8
The average number of days from referral to client acceptance of AFF services was 14.7 days,
which is significantly longer than that observed in SFY 2010 (mean = 5 days).9 On average,
clients were referred to the RBHAs within 12.4 days, slightly more rapidly than last year (mean
= 15.4 days). Two new cycle time indicators that were added to this year’s report include
duration from referral to first treatment service (mean = 16.5 days), and referral to pre-service
closure (mean = 47.3 days).
Exhibit 5
Duration from AFF Referral to Selected Events
(Number of Unique Client Referrals10; N = 3715)

n13
(%)14
Median # Days
Mean # Days
SD
Minimum # Days
Maximum # Days

First
Outreach
Contact

Individual
Accepting
AFF Services

Referral
Sent to
RBHA

First
Treatment
Service11

Pre-Service
Closure12

3631
(97.7%)
1
1
1.5
0
13

2378
(64%)
14
14.7
10.2
0
41

1559
(42%)
11
12.4
10
0
38

2801
(75.4%)
14
16.5
12.8
0
50

670
(18%)
49
47.3
18.5
1
80

7

Throughout this report, reference will be made to SFY 2011; these references will be to the first three quarters of
the SFY, unless noted otherwise.
8
Only business days were included in this year’s analysis; last year’s analysis also included weekends.
9
Client acceptance of AFF services has traditionally been reported using the contractor’s interpretation of when a
client accepted services. Starting this year, and to ensure consistency, acceptance of AFF services was to be
reported using the date a client signed the Release of Information.
10
Unique client referrals is the unit of analysis.
11
First Treatment Services reflects clients receiving at least one service. Services may include treatment services,
medical services, support service, etc. (assessments and drug tests were not considered services).
12
Pre-Service Closures reflects individuals whose cases were closed before any services were provided. Services
may include treatment services, medical services, support service, etc. (assessments and drug tests were not
considered services).
13
Number of records having event date on or after the date of referral to the AFF program; data falling outside of 2
SDs from the mean were considered outliers, and therefore not included in the analyses.
14
Percent calculated out of 3,715 unique client referrals.

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3.4

DES Provider Assessments and DBHS Enrollments

Approximately 61% (n = 226815) of all individuals referred to AFF were assessed during the first
three quarters of SFY 2011. Assessments were conducted by a contracted DES provider and/or a
RBHA contracted provider, depending on the referred individual’s eligibility status for RBHA
services. As summarized in Exhibit 6, approximately one-half (56.1%) of individuals were
assessed by DES providers only, representing a 12.8% increase from last year. Correspondingly,
fewer individuals were assessed by both DES and RBHA providers (23.1%), or by RBHA
providers only (20.8%), compared to SFY 2010.
Exhibit 6
Assessments Statewide
SFY 2011
n
%
Total Assessments
2268
100
DES only
1272
56.1
DES & RBHA16
524
23.1
RBHA only
472
20.8
3.5

Substance Use Among Individuals at Time of AFF Assessment

Exhibit 7 (on the next page) provides a summary of primary substance use and all substance use
reported by clients at the time of their initial assessment.17 Similar to last year, slightly more
than 92% of clients reported any substance use (not just primary use); alcohol (59.77%),
marijuana (56.94%) and methamphetamine (45.4%) were the more frequently reported
substances used. Among those clients reporting primary substance use, methamphetamine
(31.7%), marijuana (31.15%), and alcohol (22.91%) continue to be the more commonly reported
primary substances used.

15

This figure includes individuals who had been referred to the AFF program in SFY 2010, but not assessed until
SFY 2011 (n = 267), along with clients who were referred and assessed during SFY 2011 (n = 2001).
16
This figure may not accurately represent two separate assessments; there are many different reasons for duplicate
assessments, including the same assessment being erroneously entered twice.
17
Individuals who are assessed complete a self-report of their substance use patterns during the immediately
preceding 30-day period. As part of the assessment, clients are asked to report all substances used, and to identify
substances that are used most frequently.

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Exhibit 7
Substances Used by AFF Clients 30 Days Prior to Enrollment
Total Assessed Clients: 2268

Clients Reporting Use
Alcohol
Methamphetamine
Marijuana
Cocaine/Crack
Other Narcotics
Heroin/Opioids
Other Drugs
Hallucinogens
Benzodiazepines
Other Sedatives
Other Stimulants
Inhalants
3.6

Primary Substance
Use Reports18
n
%
1637
72.18
375
22.91
519
31.7
510
31.15
104
6.35
36
2.2
57
3.48
7
0.43
6
0.38
13
0.79
8
0.49
1
0.06
1
0.06

All Substance
Use Reports19
n
%
2088
92.06
1248
59.77
948
45.4
1189
56.94
299
14.32
152
7.28
105
5.03
34
1.63
54
2.59
68
3.26
48
2.3
29
1.39
12
0.57

Clients Treated by Funding Source

A total of 3,298 individuals received AFF services during the first three quarters of SFY 2011.
As depicted in Exhibit 8, approximately 32% (n = 1045) of the clients served were continuing
clients from SFY 2010. More than one-half (53.76%) of clients served in SFY 2011 received
AFF treatment services from a combination of DES and RBHA funding, representing a 26.56%
increase in combined funded clients from SFY 2010. Concomitantly, significantly fewer clients
in SFY 2011(12.43%) received services funded solely by a RBHA than in SFY 2010 (34.2%).
Exhibit 8
SFY 2011 Clients Served and Funding Source
Total Clients Served in SFY 2011: 3298
SFY 2011
n
%
New and Continuing Clients
SFY 2011 New AFF Clients
2253
68.31
SFY 2010 Continuing AFF Clients
1045
31.69
Service Funding Source
DES only Funded Clients
1115
33.81
Shared Funding Clients
1773
53.76
RBHA only Funded Clients
410
12.43

18
19

Primary substances are mutually exclusive; therefore they sum to 100%.
All substances are not mutually exclusive; therefore they do not sum to 100%.

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3.7

Service Access by Service Type and Domain

In SFY 2011, changes were implemented in the way DES-funded services data were collected,
shifting from a focus on service domains to levels of care (i.e. intensity of service). 20 RBHAfunded services data continue to be classified by service domains. Consequently, for the 2011
annual evaluation report, summaries for DES- and RBHA-funded services will be displayed in
separate exhibits to better reflect services provided.
Exhibit 9 summarizes the number of DES-funded clients associated with specific types of
services that were provided during the first three quarters of SFY 2011.
Exhibit 921
Statewide Patterns of DES-Funded Services
DES-Funded Services
n = 2888
#
%
2
0.1
54
1.9
62
2.1

Type of Service
Medication
Medication Monitoring
Psychiatric Evaluation
Counseling:
Family
Group
Individual

39
967
559

1.4
33.5
19.4

Supportive Services:
Case Management
Child Care
Clothing Assistance
Food Assistance
Housing/Rent
Living Skills Training
Parenting Skills
Re-engagement
Transportation
Utilities Assistance
Other
Drug Tests

2051
16
0
4
30
7
17
40
439
17
369
2251

71.0
0.6
0.0
0.1
1.0
0.2
0.6
1.4
15.2
0.6
12.8
77.9

20

Levels of care are determined at the time a client is assessed, and a specific set of services are provided to a client
based on the designated level of care. Level of care and/or types of services associated with a client may change
over time based on the client’s needs.
21
Unique client(s) is the unit of analysis; type of service is not mutually exclusive. Differences may exist between
services provided and reported for evaluation due to reporting procedures, timing, and data accuracy.

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As evidenced in Exhibit 9 (on the previous page), supportive services (76.3%) and counseling
(46.3%) were the more commonly provided types of services.
Exhibit 10 summarizes the number of DES-funded clients associated with each level of care
during the first three quarters of SFY 2011. Outpatient (41.8%) was the most frequently
assigned level of care during the reporting period.
Exhibit 1022
Levels of Care Associated with DES-Funded Clients
Number of Unique Clients Receiving DESFunded Services
n = 2888
#
%
Level of Care
Education
548
19.0
Outpatient
1207
41.8
Outpatient – Intensive
579
20.0
Residential – Adult
12
0.4
Residential – Child
0
0.0
Aftercare
194
6.7
23
No Specified Level of Care
673
23.3
Exhibit 11 provides a summary of the number of RBHA-funded clients who were provided at
least one unit of service in one or more service domains during the first three quarters of SFY
2011 (see Exhibit 12 on the next page for definitions of the service domains). The majority of
RBHA-funded clients (92%) received support services, and slightly more than one-half (53%)
received treatment services.
Exhibit 1124
Statewide Patterns of RBHA Service Access

Service Domain
Treatment Services
Rehabilitation Services
Medical Services
Support Services
Crisis Intervention Services
Inpatient Services
Residential Services
Behavioral Health Day Programs

RBHA-Funded Services
n = 2183
#
%
1162
53.2
246
11.3
243
11.1
2007
134
31
68
26

91.9
6.1
1.4
3.1
1.2

22

Unique client(s) is the unit of analysis; level of care is not mutually exclusive.
Clients who began services prior to the collection of level of care data were not associated with any level of care.
24
Unique clients is the unit of analysis.
23

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Exhibit 12
Definitions of Service Domains Recognized by the Division of Behavioral Health Services
Treatment Services are provided by or under the supervision of behavioral health
Treatment
professionals to reduce symptoms and improve or maintain functioning. These services
Services
have been further grouped into three subcategories: Behavioral Health Counseling and
Therapy; Assessment, Evaluation and Screening Services; and Other Professional.
Rehabilitation Services include the provision of education, coaching, training,
Rehabilitation
demonstration, and other services, including securing and maintaining employment to
Services
remediate residual or prevent anticipated functional deficits.
Medical Services are provided by or ordered by a licensed physician, nurse practitioner,
Medical
physician assistant, or nurse to reduce a person’s symptoms and improve or maintain
Services
functioning. These services are further grouped into the following subcategories:
Medication; Laboratory; Medical Management; and Electro-Convulsive Therapy.
Supportive Services are provided to facilitate the delivery of or enhance the benefit
received from other behavioral health services. These services are further grouped into
Supportive
the following categories: Case Management; Personal Care Services; Family Support;
Services
Self-Help/Peer Services; Therapeutic Foster Care Services; Unskilled Respite Care;
Supported Housing; Sign Language or Oral Interpretive Services; Supportive Services;
and Transportation.
Crisis Intervention Services are provided to a person for the purpose of stabilizing or
Crisis
preventing a sudden, unanticipated, or potentially deleterious behavioral health condition,
Intervention
episode, or behavior. Crisis Intervention Services are provided in a variety of settings.
Services
Inpatient
Services

Residential
Services

Behavioral
Health Day
Programs

3.8

Inpatient Services (including room and board) are provided by an OBHL licensed Level I
behavioral health agency, and include hospitals, sub-acute facilities, and residential
treatment centers. These facilities provide a structured treatment setting with daily 24hour supervision and an intensive treatment program, including Medical Support
Services.
Residential Services are provided on a 24-hour basis and are divided into the following
categories based on the type of facility providing the services: Level II behavioral health
residential facilities and Level III behavioral health residential facilities.
Day Program Services are scheduled on a regular basis either on an hourly, half day, or
full day basis, and may included services such as therapeutic nursery, in-home
stabilization, after school programs, and specialized outpatient substance abuse programs.
These programs can be provided to a person, group of persons, and/or families in a
variety of settings. Day programs are further grouped into the following three
subcategories: Supervised; Therapeutic; and Psychiatric/Medical.

Service Closure and Treatment Duration

During the first three quarters of SFY 2011, 1,700 client cases were closed by DES/AFF
providers (see Exhibit 13). Clients completing their service program (38.8%) and clients
discontinuing participation prior to service completion (31.6%) were the more commonly
identified case closure reasons cited by providers. Among those clients closed as completing
their service plan, the average length of treatment (LOT) was 92.8 days, compared to 127 days as
reported in SFY 2010.

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Exhibit 13
Statewide Patterns of DES/AFF Closure and Length of Treatment
Clients who received services and were subsequently closed
n = 1700
Closure Reason
#
%
Clients Completing Service Plan
660
38.8
Client Discontinued Participation
537
31.6
All Other Reasons for Closure
503
29.6
25
n
Length of Treatment (LOT)
Median
Mean
Clients Completing Service Plan
454
75
92.8
Clients Discontinuing Participation
405
82
91.1
All Other Reasons for Closure
251
73
85.3

SD
64.3
60.6
61.2

25

Length of treatment (LOT) is defined as the number of days between the first treatment service date following
assessment and the last treatment service date prior to closure by the DES/AFF Provider. LOT is not calculated
when the first and last service dates are the same.

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16

SECTION 4
AFF PROGRAM OUTCOMES
This section highlights the outcomes achieved by clients who have participated in the AFF
program. Outcomes are assessed in the following domains, which were articulated in the
enabling legislation of the AFF program: child safety, family stability and permanency, recovery
from alcohol and drug abuse, and self-sufficiency as reflected in employment.
4.1

Child Safety: Recurrence of Child Maltreatment

As evidenced in Exhibit 14, among the 3,298 clients in the AFF program, 3,163 (95.9%) had at
least one allegation of child maltreatment prior to their referral to the AFF program. Of these
pre-referral maltreatment allegations, 59.6% were substantiated26 and 31% were unsubstantiated.
Consistent with 2010, the majority of maltreatment allegations at intake were for neglect
(79.8%), with physical (16.4%) and sexual abuse (3.8%) less frequently identified.
Exhibit 14
Summary of Pre- and Post-Referral Report Findings27
Pre-Referral Finding
Post-Referral Finding
Totals

Substantiated

Substantiated

Unsubstantiated

Pending/Other

No Report

#

%

#

%

#

%

#

%

#

%

1968

59.6

72

3.7

144

7.3

61

3.1

1691

85.9

28

502

25.5

21

4.2

31

6.2

19

3.8

431

85.9

29

97

4.9

7

7.2

10

10.3

3

3.1

77

79.4

30

1369

69.6

44

3.2

103

7.5

39

2.8

1183

86.4

Unsubstantiated

1021

31.0

67

6.6

131

12.8

33

3.2

790

77.4

Pending/Other

174

5.3

6

3.4

11

6.3

10

5.7

147

84.5

31

135

4.1

3

2.2

4

3.0

0

0.0

128

94.8

3298

100

148

4.5

290

8.8

104

3.2

2756

83.6

SUB

SUB & SUBA
SUBA

No Report Matched

Total

26

In the fall of 2010, CPS broadened the substantiation category to include a ‘proposed substantiated pending
dependency adjudication’ (SUBA) finding; therefore, a child maltreatment allegation was considered ‘substantiated’
if a CPS investigation resulted in a ‘proposed substantiated’ (SUB) finding or a SUBA finding.
27
Pre-referral findings were extracted from the last CPS report initiated prior to the client’s referral to the AFF
program. Post-referral findings were extracted from the first CPS report following the client’s referral to the AFF
program.
28
Represents a ‘proposed substantiated’ finding.
29
Represents cases where both a ‘proposed substantiated’ finding and a ‘proposed substantiated pending
dependency adjudication’ finding were documented.
30
Represents a ‘proposed substantiated pending dependency adjudication’ finding.
31
Among clients served by the AFF program, the data matching process was unable to identify a pre-referral CPS
report for 2.6% of AFF-referred clients. In addition, 1.5% of clients had a CPS report matched that was greater than
two years in advance of the AFF referral (which was considered an outlier and therefore excluded from analyses).

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Of the clients with a maltreatment report (substantiated or unsubstantiated) at the time of their
referral to the AFF program, 13.9% had a recurrence32 (as indicated by a new substantiated or
unsubstantiated allegation of maltreatment filed subsequent to the client beginning AFF
services), which is comparable to the rate observed last year. A recurrence rate of 3.7% was
observed when using a more conservative approach that only incorporates subsequent
substantiated reports following initial substantiated reports. Caution should be taken when
reviewing these findings, since the short duration between pre- and post-referral only allows for
a minimally adequate follow up window in which to monitor maltreatment recurrence.
4.2

Permanency Achieved by Children of Parents in AFF

As depicted in Exhibit 15, a total of 2,692 children, who were associated with AFF clients
(1,868) in the first three quarters of SFY 2011, were in CPS out of home placement at some
point during the reporting period. More than two-thirds (69.3%) of these children were still in
out of home placements at the end of the reporting period. By comparison, in SFY 2010, 72% of
children of parents in AFF were still in care at fiscal year end. About 26% of the AFF clients’
children who were placed in out of home care achieved permanency, down 1% from last year.
Reunification continued to be the predominant form of permanency (98%), occurring, on
average, after the child had been in out of home care for 187 days.

Total Children
Still in Care
Other
Achieved Permanency
Reunification
Guardianship
Adoption
4.3

Exhibit 15
Permanency Achieved by
Children of Parents in AFF
n
%
2692
100
1866
69.3
Days in Out of Home Care Among
134
5
Children Achieving Permanency
692
25.7
Median Days
Average Days
98.1
171
187
679
1.8
213
234
12
0.1
527
527
1

Recovery from Substance Abuse

According to AFF program guidelines, DES-contracted providers are required to drug test AFF
clients at least twice per month during AFF treatment participation. As summarized in Exhibit
16 (on the next page), drug test results were reported for 68% of all AFF clients (n = 2251),
representing a slight improvement from the 65% of clients reported in last year’s report. On
average, AFF clients were tested 1.5 times per month, with the majority of these tests (82%)
reflecting no drug use.

32

This figure was calculated by summing all substantiated and unsubstantiated post-referral findings that had an
initial substantiated or unsubstantiated pre-referral finding (n = 414) and dividing this by the sum of the total
substantiated and unsubstantiated pre-referral findings (n = 2989).

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Exhibit 16
Statewide Summary of AFF Client Drug Test Data
Reported by DES/AFF Providers

4.4

n

%

Total Clients
Clients with a record of at least
one drug test in SFY 2011

3298

100

2251

68.3

Drug Free Ratio

N/A33

81.9

Average # of
tests per month (SD)
1.5 (3.3)

Employment Outcomes For Jobs-Referred AFF Clients

During the first three quarters of SFY 2011, no individuals were referred to AFF from the Jobs
program. One individual, who was referred to AFF in SFY 2010, continued to receive AFF
services during SFY 2011. This individual’s case was subsequently closed with no employment
status documented.

SECTION 5
SUMMARY
This report summarizes the key processes and outcomes of the Arizona Families F.I.R.S.T.
program, now in its tenth year of operation. The continued commitment of the legislature to
critically examine the processes and outcomes of this innovative program has afforded the
opportunity to study the development and operations of a program unique in its scope and focus.
The performance of the AFF program, in relation to each of the five goals articulated by the
legislature, was addressed by utilizing information from a variety of sources, including
administrative data and service utilization records.
Increases in Timeliness, Availability, and Accessibility of Services
In the first three quarters of SFY 2011, 3,298 individuals were served by the AFF program
statewide, representing a 20% increase from 2010. For these individuals and their families, the
AFF program continues to provide services in a manner consistent with the program design.
During SFY 2011, AFF participants received outreach, assessment, engagement, and treatment
services in a timely manner; on average, AFF providers made initial contact with referred
individuals within one business day upon receipt of a referral from CPS. AFF services were
accepted by participants approximately two weeks (14.7 days) after the individual was referred
to AFF, an increase from SFY 2010 where providers were reporting five days from referral to
service acceptance.
Those clients who are engaged in treatment services typically find themselves receiving services
from their local DES provider and/or a RBHA contracted treatment provider in their community,
depending upon their program eligibility. During the first three quarters of SFY 2011, 54% of
33

Since the drug free ratio represents the number of negative drug tests divided by the number of all drug tests, it is
only applicable to present information as a percent, and not as a number.

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AFF clients received AFF services with funding provided by both DES and a RBHA, up from
27% reported in 2010, and significantly fewer clients received services funded solely by a
RBHA.
Recovery from Alcohol and Drug Problems
Consistent with previous years, the overwhelming majority of AFF clients assessed in SFY 2011
self-reported use of methamphetamine, marijuana, and alcohol. The results of drug screens
conducted with AFF clients to detect continued drug use indicate that 82% of the AFF clients
were drug free throughout their AFF participation. Drug tests were conducted, on average, 1.5
times per month.
Child Safety and Reduction of Child Abuse and Neglect
Among those clients served in the AFF program, the rates of recurrence of child maltreatment
following AFF program enrollment continues, as in past years, to be exceedingly low. Nearly all
clients (95.9%) served by the AFF program had at least one allegation of child maltreatment
before enrolling in the program, with the majority (79.8%) of investigations involving allegations
of neglect. Most AFF clients (84%) had no subsequent report filed during this reporting period;
among those clients with a substantiated report at the time of their referral to the AFF program,
only 3.7% had a subsequent filing of a substantiated report during the first three quarters of the
state fiscal year.
Permanency for Children through Reunification
At the end of this year’s reporting period, 69% of children associated with AFF clients remained
in CPS out of home placements, improving from the 72% rate that was observed in 2010.
Among children who achieved permanency in SFY 2011, the vast majority (98%) were reunified
with their parents, up 8% from 2010.
Achievement of Self-Sufficiency through Employment
Employment activity is reported only for those clients referred to the AFF program who were
already enrolled in the Jobs program. During the first three quarters of SFY 2011, no individuals
were referred to AFF from the Jobs program. One individual, who was referred to AFF in SFY
2010, continued to receive AFF services in SFY 2011; this client’s case was subsequently closed,
but no employment status was recorded. Due to the lack of AFF clients referred by the Jobs
program, no determination can be made regarding the AFF program’s performance on this goal.

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