ARIZONA FAMILIES F.I.R.S.T. PROGRAM
Annual Evaluation Report
State Fiscal Year 2012
Prepared for
Arizona Department of Economic Security
Division of Children, Youth and Families
Phoenix, Arizona

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

Center for Applied Behavioral Health Policy
500 N. Third Street, Suite 200
Phoenix, AZ 85004
Email: cabhp@asu.edu
Website: http://cabhp.asu.edu

ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012
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.
Kavitha Elamparithi, Chris Fike, Pradeep Jayapal, Eshwari Mente, 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: Cathy Hasenberg, Tamara Boling, Mark Klym, Janice
Mickens, and Jeanine Diaz of ADES; and Kelly Charboneau and Steve Lazere of ADHS.
Finally, the authors wish to express appreciation to the staff and directors of the 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:
Shafer, M.S., Fike, C., Elias, G., Rivera, R., & Ashley, A. (2012). Arizona Families
F.I.R.S.T. Program: Annual Evaluation Report for the Period July 1, 2011 – March 31,
2012. Tempe, AZ. Arizona State University.

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012

TABLE OF CONTENTS
Acknowledgements ......................................................................................................................... 2
Table of Contents ............................................................................................................................ 3
Executive Summary ........................................................................................................................ 4
Section 1: Introduction ................................................................................................................... 6
Figure 1: Overview of the AFF Program Model ................................................................. 7
Exhibit 1: List of DES Regions, DES Counties, and RBHA Providers .............................. 8
Figure 2: AFF Providers and RBHA Agencies by County ................................................. 9
Section 2: Evaluation Framework and Data Sources ................................................................... 10
Section 3: Arizona Families F.I.R.S.T. Individuals and Services Received ................................ 12
Exhibit 2: AFF Total Referrals & Unique Individuals ...................................................... 12
Figure 3: AFF Total Referrals by Quarter, SFY 2009-SFY 2012 ..................................... 12
Exhibit 3: Disposition of Total Referrals to the Program ................................................. 13
Exhibit 4: AFF Referrals to Selected Events – Duration in Business Days ...................... 14
Exhibit 5: Total Individuals Assessed for SFY 2012 ........................................................ 15
Exhibit 6: Substances Used by AFF Individuals 30 Days Prior to Enrollment ................ 16
Exhibit 7: Total Individuals Served and Funding Source ................................................. 17
Exhibit 8: Individuals Receiving DES Funded Services ................................................... 18
Exhibit 9: Individuals Receiving RBHA Funded Services ............................................... 19
Exhibit 10: Levels of Care ................................................................................................ 19
Exhibit 11: Patterns of AFF Closure and Length of Service ............................................. 20
Section 4: AFF Program Outcomes ............................................................................................. 21
Exhibit 12: Pre-AFF and Post-AFF Referral Report Findings .......................................... 21
Exhibit 13: Permanency Achieved by Children of Parents in AFF .................................. 22
Exhibit 14: AFF Drug Test Data Reported by DES/AFF Providers ................................. 23
Section 5: Summary ..................................................................................................................... 24

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012

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 that include transportation and
housing, counseling, and aftercare services. 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 and movement forward. 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 20121 are as follows:
Increases in Timeliness, Availability, and Accessibility of Services
 Overall, unique individuals referred to the AFF program for all four quarters of SFY 2012
increased by 22% compared to SFY 2011. During all four quarters of SFY 2012, 6,154
unique individuals were referred to the AFF program, constituting 6,868 total referrals,
averaging 1,717 total referrals per quarter.
 Nearly all referrals to the AFF program (97%) received at least one recorded outreach
attempt, and approximately two-thirds (66%) accepted services, representing a slight
decrease from last year.
 During the first three quarters of SFY 2012, outreach occurred in a timely manner,
averaging .66 business days, and AFF services were initiated, on average, within 11 days of
referral.
 A total of 2,377 individuals were assessed during the first three quarters of SFY 2012,
representing 75% of the 3,179 new individuals served by the AFF program during the first
three quarters. Assessments were completed nearly equally by DES providers and RBHA
providers, representing a shift from last year, when the majority of individuals (56%) were
assessed by DES providers only.
1

Throughout this report, reference will be made to SFY 2012; these references will be to the first three quarters of the
SFY (i.e. for the period of July 1, 2011 – March 31, 2012), unless noted otherwise.

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012


The total individuals served increased by 52% during first three quarters of SFY 2012
(5,011) compared to the first three quarters of SFY 2011 (3,298).
Recovery from Alcohol and Drug Problems
 92% of AFF individuals reported use of some substance in the 30 days immediately prior to
their assessment, with marijuana (67%), alcohol (65%), and methamphetamine (51%)
continuing to be the more commonly reported substances of use.
 Nearly 65% of all AFF individuals were referred for drug testing.
 On average, AFF individuals were tested 1.99 times per month during the reporting period
of AFF program participation.
 Among known drug test results (18,517), 86% of tests were negative, indicating no drug use.
Child Safety and Reduction of Child Abuse and Neglect
 83% of individuals referred to AFF services had at least one allegation of child maltreatment
prior to enrolling in the program.
 Almost 90% of all AFF individuals had no subsequent maltreatment report filed during this
report period.
Permanency for Children through Reunification
 Children in out of home placement were up by 48% compared to SFY 2011.
 Children in out of home placement at year’s end were up 65% over SFY 2011.
 Utilization of adoption and guardianship was up modestly from SFY 2011, but remain
infrequently applied as permanency options.
Achievement of Self-Sufficiency through Employment
 Thirteen individuals were referred to AFF from the JOBS program during the first three
quarters of SFY 2012.
 23% of individuals referred to the AFF program from were employed at the time of their
AFF program closure.

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012

SECTION 1
INTRODUCTION
Arizona Families F.I.R.S.T. 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.
Individuals 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 with services provided 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 services;
concrete supportive services, such as transportation and housing; and an aftercare phase to support
ongoing sobriety and recovery. Essential elements based on family needs in conjunction with
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 individuals through various stages of the AFF
program.

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012

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

Close
Case

Figure 1
Overview of the AFF Program Model
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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012
Exhibit 1 summarizes the county, DES provider agency, and associated RBHA within each of the
five DES regions. DES-contracted agencies in bold italics also participate in the RBHA network as
either a RBHA or a RBHA network provider.
Exhibit 1
List of DES Regions, Counties, DES Providers, and RBHAs
SFY 2012
DES
Regions
Central &
Southwest
Pima

County
Maricopa
Pima
Coconino

Northern

Southwest

Yavapai

DES Provider Agency
TERROS

Magellan

Community Partnership of
Southern Arizona (CPSA)
Arizona Partnership for
Children (AzPaCCoconino)
Arizona Partnership for
Children (AzPaC-Yavapai)

Community Partnership of
Southern Arizona (CPSA)

Mohave

WestCare Arizona

Apache and
Navajo

Old Concho Community
Assistance Center
Arizona Partnership for
Children (AzPaC-Yuma)
WestCare Arizona

Yuma
La Paz

Southeast &
Gila and Pinal
Central
Cochise, Graham,
Southeast Greenlee, and
Santa Cruz

Regional Behavioral
Health Authority

Horizon Human Services2

Northern Arizona Regional
Behavioral Health Authority
(NARBHA)

Cenpatico Behavioral Health of
Arizona, Inc.
Cenpatico Behavioral Health of
Arizona, Inc.

Southern Arizona
Cenpatico Behavioral Health of
Behavioral Health Services
Arizona, Inc.
(SEABHS)

2

Horizon Human Services terminated their contract with DES and ceased serving AFF clients on February 29, 2012.
DES reports that CPS clients with substance abuse issues were referred to the local RBHA and other unspecified
community based services.

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012

Figure 2
AFF Providers and RBHA Agencies by County

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012

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 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 the Arizona State University,
Center for Applied Behavioral Health Policy (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 as required by contract. 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)3.
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.

3

DBHS encounters data are entered into the CIS within 210 days of service provision. Consequently, DBHS data
shown may not fully contain all services provided in these time frames.

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012
2.1

Changes in Analytic Approach

In consultation with DES representatives, a number of changes and enhancements have been made
to the analytic approaches employed in this report. SFY 2011 data have been updated since the
issuance of the SFY 2011 annual report as provider reporting and data reconciliation occurs for a
number of months following initial data submission. For this reason, comparisons to SFY 2011
Annual report may not correspond.
2.1.1 Referrals Used for Analysis. Previous annual reports counted only the first valid referral
(received within the fiscal year) and excluded subsequent referrals (i.e. re-referrals) that occurred
within six months of the original referral (182 days). In this year’s report, total referrals (including
re-referrals) are being counted for analyses, regardless of their proximity to one another. This
change impacts referral counts and the items in Exhibit 2. This change will also affect other counts
throughout the report, including outreach attempts, assessments, services, and closures.
2.1.2 Calendar Days vs. Business Days. In the SFY 2011 report, Exhibit 5 used business days
for First Outreach Contact data. All other data in this exhibit were reported in calendar days. This
year, all cycle time measures reported in Exhibit 4 (formerly Exhibit 5) are calculated using
business days.
2.1.3 Assessments. DBHS encounters data are entered into the CIS within 210 days of service
provision. Consequently, DBHS data shown may not fully contain all services provided in these
time frames. In previous annual reports, an assessment had to be reported before any reported
corresponding services would be counted. In this year’s report, all reported services were counted,
regardless whether an assessment was also reported. This change will impact (increase) the number
of individuals served and the count of services received. This change will not impact Exhibit 5
(assessments), where actual assessments are reported.
2.1.4 Services for Continuing Individuals. In previous annual reports, only those services
provided to individuals referred during the report year were counted. In this year’s report, services
for continuing individuals (those individuals who began services in SFY 2011 and have continued
AFF services in SFY 2012) are counted, in addition to those services for individuals referred in SFY
2012. This change will impact (increase) the number of individuals served and the count of services
received.
2.1.5 Level of Care Determination. Previously, Level of Care (LOC) was reported for
individuals receiving AFF services funded by DES only. In this year’s report, LOC determinations
are reported for all individuals, regardless of service funding source (DES v. ADHS).
2.1.6 Drug Testing Information. Drug testing information has been enhanced to identify all
testing that was requested and reported and the associated results of this testing.
2.1.7 Terminology Changes. A terminology change has been made this year. In this year’s
report, “total referrals” is used to refer to all referrals and “unique individuals” is used to refer to all
individuals referred to and/or served in the AFF program. A unique individual can have multiple
referrals, services, drug-test referrals, etc.
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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012

SECTION 3
AFF INDIVIDUALS AND SERVICES RECEIVED
Sections 3.1 and 3.2 present data for all 12 months of SFY 2012; all subsequent sections will be
restricted to data for the first three quarters of SFY 2012.
3.1

AFF Program Referrals

As depicted in Exhibit 2, 6,868 total referrals (representing 6,154 unique individuals) were referred
to the AFF program during all four quarters of SFY 2012, averaging approximately 1,717 total
referrals per quarter. The number of total referrals to the AFF program increased by nearly 25% for
SFY 2012 as compared to SFY 2011, while the number of unique individuals increased by 22%.
Figure 3 displays the number of total referrals by quarter from SFY 2009 through SFY 2012.
Exhibit 2
AFF Total Referrals & Unique Individuals
SFY 2012
SFY 2011
(Reported4)
1,264

SFY 2011
(Updated5)
1,373

Oct-Dec (Q2)
Jan-March (Q3)

1,282
1,217

Apr-June (Q4)
Total Referrals
Unique Individuals

July –Sep (Q1)

SFY 2012

% Change6

# Change

1,742

369

26.88

1,395
1,356

1,557
1,884

162
528

11.61
38.94

1,296

1,394

1,685

291

20.88

5,059
4,954

5,518
5,031

6,868
6,154

1,350
1,123

24.47
22.32

2000
1800
1600
1400
1200
1000
800
2012-Q4

2012-Q3

2012-Q2

2012-Q1

2011-Q4

2011-Q3

2011-Q2

2011-Q1

2010-Q4

2010-Q3

2010-Q2

2010-Q1

2009-Q4

2009-Q3

2009-Q2

2009-Q1

600

Figure 3
AFF Total Referrals, by Quarter, SFY 2009 – SFY 2012
4

These numbers were reported in the SFY 2011 AFF Annual Evaluation.
These numbers represented data that have been updated since the completion of the AFF Annual Evaluation SFY 2011
which accounts for any lag in data entry from AFF providers and incorporates the new approach (See Section 2.1.1)
6
SFY 2012 serves as the source, based on change from SFY 2011 Updated.
5

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012
3.2

Client Outreach and Engagement

Exhibit 3 provides a comparison of client outreach and engagement patterns across all four quarters
of SFY 2012 and all four quarters of SFY 2011. Despite the significant increase in the number of
unique individuals referred to the AFF program (up 22% from SFY 2011), AFF providers were able
to maintain their patterns of performance in engaging individuals into treatment. Nearly every
referral was contacted by an AFF provider (97% of total referrals), and the rate of referred
individuals agreeing to accept AFF services continues to be the norm (65% of total referrals).

Total Referrals

Exhibit 3
Disposition of Total Referrals to the Program
SFY 2012
SFY 20117
SFY 2012
(All four quarter data)
(All four quarter data)
5,518
6,868
n

Total referrals with record
of outreach attempt
Total referrals accepting
services
Total referrals closed
(pre-service)

%

n

%

5,392

97.72

6,633

96.58

3,698

67.02

4,485

65.30

1,164

21.09

1,364

19.83

All subsequent analyses to be reported are in reference to the first three quarters of SFY 2012.

7

These numbers represent updated SFY 2011 data.

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012
3.3

Annual Case Processing

As evidenced in Exhibit 4, the average duration from referral to first outreach attempt, during the
first three quarters of SFY 20128, was less than one business day. The average number of days from
referral to acceptance of AFF services was 11 days.9 On average, referrals were sent to the RBHAs
within 8 days, and the average duration from referral to first AFF service was 11 days. The average
number of days from referral to AFF pre-service closure this year was 35 days.
Exhibit 4
AFF Referral to Selected Events - Duration in Business Days
(Number of Total Referrals10; n = 5,183)
SFY 2012; Q1-Q3
First
Accepting
Outreach
AFF
Sent to
First AFF
Attempt
Services
RBHA
Service

Pre-Service
Closure

n11

5,036

3,435

2,156

3,335

826

12

97.13

66.27

41.59

64.34

15.93

Median # Days

1.00

9.00

6.00

8.00

34.00

Mean # Days

0.66

11.28

8.24

10.57

35.03

Standard Deviation

0.75

8.95

7.82

9.17

16.53

Minimum # Days

0

0

0

0

0

Maximum # Days

6

42

34

41

82

%

8

Throughout this report, reference will be made to SFY 2012; these references will be to the first three quarters of the
SFY, unless noted otherwise.
9
Client acceptance of AFF services has traditionally been reported using the contractor’s interpretation of when a client
accepted services. To ensure consistency, starting in SFY 2011, and continuing in SFY 2012, acceptance of AFF
services was to be reported using the date a client signed the Release of Information.
10
Referrals are the unit of analysis.
11
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.
12
Percent calculated out of 5,183 total referrals.

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012
3.4

DES Provider Assessments and DBHS Enrollments

Nearly 50% (n = 2,37713) of all individuals referred to AFF were assessed during the first three
quarters of SFY 2012. 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 5, approximately 46% of the individuals were assessed by RBHA providers
only (472 in SFY 2011; 1,090 in SFY 2012) representing more than a 131% increase from last year.
Correspondingly, fewer individuals (1,272 in SFY 2011; 1,117 in SFY 2012) were assessed by DES
providers only (47%), a 12% decrease from last year.
Exhibit 5
Total Individuals Assessed
SFY 2012; Q1-Q3
n
DES only
1,117
DES & RBHA
170
RBHA only
1,090
Totals
2,377

%
46.99
7.15
45.86
100.00

13

This figure includes individuals who had been referred to the AFF program in SFY 2011, but not assessed until SFY
2012, along with clients who were referred and assessed during SFY 2012.

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012
3.5

Substance Use Among Individuals at Time of AFF Assessment

Exhibit 6 provides a summary of primary substance use and all substances individuals reported
using just prior to their initial assessment. As part of the assessment, individuals are asked to selfreport all substances used, and to identify substances that were used most frequently in the
preceding 30 day period. Similar to last year, 92% of individuals reported substances of use (not
just primary use) to be: marijuana (67%), alcohol (65%), and methamphetamine (51%). Among
those individuals reporting primary substance use, marijuana (34%), methamphetamine (31%), and
alcohol (23%) continue to be the more commonly reported primary substances used. Also of note,
reports of heroin/opioid use (8%) and primary use (4%) increased overall compared to SFY 2011.

Exhibit 6
Substances Used by AFF Individuals 30 Days Prior to Enrollment
(Total Assessed Individuals: 2,377)
SFY 2012; Q1-Q3
All Substance Primary Substance
Use Reports14
Use Reports15
n
%
n
%
16
2,176
91.50
1,931
88.70
Individuals Reporting Use
Marijuana
1,287
66.65
651
33.71
Alcohol
1,262
65.35
441
22.84
Methamphetamine
980
50.75
592
30.66
Cocaine/Crack
301
15.59
67
3.47
Other Narcotics
162
8.39
57
2.95
Heroin/Opioids
154
7.98
82
4.25
Hallucinogens
68
3.52
6
0.31
Benzodiazepines
62
3.21
6
0.31
Other Drugs
47
2.43
15
0.78
Other Sedatives
32
1.66
6
0.31
Other Stimulants
23
1.19
8
0.41
Inhalants
5
0.26
0
0.00

14

All substances are not mutually exclusive; therefore they do not sum to 100%.
Primary substances are mutually exclusive; therefore they sum to 100%.
16
The order of substances has been changed in this year’s report to reflect the highest count to lowest count of all
substance use reports.
15

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012
3.6

Individuals Served by Funding Source

A total of 5,011 individuals received AFF services during the first three quarters of SFY 2012. As
depicted in Exhibit 7, approximately 37% (n = 1,832) of the individuals served were continuing
individuals from SFY 2011. The percentage of individuals receiving services funded by DES only
decreased slightly this year (32%) compared to last (34%). The percentage of individuals receiving
AFF services through a combination of DES and RBHA funding decreased as well approximately
13% this year (41%) as compared to last (54%). This shift in service funding was coupled by a
significantly higher percentage of individuals receiving AFF services funded solely by a RBHA in
SFY 2012 (27%) compared SFY 2011 (12%). This growth in leverage of RBHA funding for
services may reflect a greater utilization of the Substance Abuse Prevention and Treatment (SAPT)
Block Grant17 by the RBHAs. SAPT Block Grants are provided by the Substance Abuse and Mental
Health Services Administration (SAMHSA) to ADHS/DBHS which in turn allocates these funds to
the RBHAs. These grants provide funding for the prevention and treatment of individuals dealing
with substance abuse. SAPT Block Grants require service to specific populations, including
pregnant women who use drugs by injection, pregnant women who use substances, other persons
who use drugs by injection, and substance using women with dependent children and their families.
Information about SAPT fund source utilization for AFF individuals was not available for this
evaluation.
Exhibit 7
Total Individuals Served and Funding Source
SFY 2012; Q1-Q3
n
New and Continuing AFF Individuals
5,011
New Individuals (SFY 2012)
3,179
Continuing Individuals (SFY 2011)
1,832

%
100.00
63.44
36.56

# of Individual by Service Funding Source
DES only Funded Individuals
Shared Funding Individuals
RBHA only Funded Individuals18
Total

1,582
2,075
1,354
5,011

31.57
41.41
27.02
100.00

DES Funded Individuals
DBHS Funded Individuals

3,657
3,429

17

Arizona Department of Health Services, Division of Behavioral Health Services, 2011;
http://www.azdhs.gov/bhs/pdf/SAPTFAQs.pdf
18
This includes SAPT funding utilized by the RBHAs.

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012
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). Levels of care
are determined at the time a client is assessed, with a specific set of services 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. RBHA-funded services data continue to be
classified by service domains. Consequently, for this year’s report, summaries for DES- and
RBHA-funded services are displayed separately to better reflect services provided. Exhibit 8
summarizes the number of individuals who received AFF services funded by DES during the first
three quarters of SFY 2012. As evidenced in Exhibit 8, supportive services and counseling were the
more commonly provided types of services, as they were last year.
Exhibit 8
Individuals Receiving DES-Funded Services 19
SFY 2012; Q1-Q3
DES-Funded Service
Medication
Medication Monitoring
Psychiatric Evaluation
Counseling
Family
Group
Individual
Supportive Service
Case Management
Child Care
Clothing Assistance
Food Assistance
Housing/Rent
Parenting Skills
Re-engagement
Transportation
Utilities Assistance
Other
Drug Test

Unique Individuals
n = 3,657
n
%
4
0.11
8
0.22
22
0.60
16

0.44

1,060

28.99

997

27.26

2,082
3
40
32
31
3
114
919
32
665

56.93
0.08
1.09
0.88
0.85
0.08
3.12
25.13
0.88
18.18

2,529

69.16

19

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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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012
Exhibit 9 provides a summary of the number of RBHA-funded individuals who were provided at
least one unit of service in one or more service domains during the first three quarters of SFY 2012.
Similar to last year, support service (55%) and treatment service (53%) remain the most commonly
provided services for RBHA funded individuals.
Exhibit 9
Individuals Receiving RBHA-Funded Services20
SFY 2012; Q1-Q3
Unique Individuals
RBHA-Funded Services
n = 3,429
Service Domain
Treatment Service
Rehabilitation Service
Medical Service
Support Service
Crisis Intervention Service
Inpatient Service
Residential Service
Behavioral Health Day Program

n
1,828
451
487
1,895
126
19
65
13

%
53.31
13.15
14.20
55.26
4.72
0.55
1.90
0.38

Exhibit 10 summarizes the levels of care that AFF individuals were assigned throughout their AFF
service period. These data are reflective of only those AFF individuals who were assigned one or
more level of care. An additional 1,193 AFF individuals (24% of all individuals with services) were
never assigned a level of care. Many of these individuals may have been RBHA only funded with
services provided by a community agency other than the designated AFF provider. Similar to last
year, outpatient (42%) services was the predominant level of care assignment with residential
treatment continuing to be assigned in only rare instances (less than 1%).
Exhibit 10
Levels of Care21
SFY 2012; Q1-Q3

Levels of Care23
Education
Outpatient
Outpatient – Intensive
Residential – Adult
Residential – Child
Aftercare

Unique Individuals
n = 5,01122
n
%
908
18.12
2,094
41.79
1,006
20.08
28
0.56
0
0.00
344
6.86

20

These data reflects RBHA and SAPT-funded treatment.
Unique client(s) is the unit of analysis; level of care is not mutually exclusive.
22
From all funding sources, not just DES
23
RBHA clients are included in this count.
21

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012

3.8

Service Closure and Services Duration

During the first three quarters of SFY 2012, 3,258 cases were closed by AFF providers (see Exhibit
11), representing a significant increase compared to SFY 2011 (1,700). The rate of individuals
completing their service plans this year (27%) decreased by nearly 12% compared to SFY 2011
(39%).
Exhibit 11
Patterns of AFF Closure and Length of Service 24
SFY 2012; Q1-Q3

Closure Reason
Individuals Completing
Discontinued
Service Plan Participation
Refused Services
Unable to Locate
No Substance Abuse
Incarcerated
Problem
Moved Out of Area
Death
Total

24

n

%

882
1,145
421
409
245
82
69
5
3,258

27.06
35.15
12.91
12.55
7.51
2.51
2.12
0.15
100.00

Median
161
101
37
19
2
97
42
152
-

Mean
177.30
125.99
74.06
53.89
16.55
110.62
84.38
224.80
-

Standard
Deviation
118.73
100.30
93.92
85.29
28.66
99.33
106.81
218.06
-

Length of service is calculated using calendar days, and is based on closures in the current year.

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012

SECTION 4
AFF PROGRAM OUTCOMES
This section highlights the outcomes achieved by individuals who have participated in the AFF
program. Outcomes are assessed in the following legislatively-specified domains: 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 12, among the 5,011 individuals that received AFF services, 4,175 (83%)
had at least one allegation of child maltreatment prior to their referral to the AFF program. Of these
pre-referral maltreatment allegations, 58% were substantiated and 21% were unsubstantiated.
Exhibit 12
Pre-AFF and Post-AFF Referral Report Findings
SFY 2012; Q1-Q3
Pre-Referral
Allegation Finding

Post-Referral
Allegation Findings

Total
n
Substantiated
Proposed
Unsubstantiated
None25
No Report26
Total

Substantiated
%

Proposed

n

%

n

%

Unsubstantiated
n

%

None25
n

No Report25

%

n

%

2,887

57.61

117

4.05

19

0.66

120

4.16

28

0.97

2,603

90.16

174

3.47

2

1.15

3

1.72

4

2.30

13

7.47

152

87.36

1,052

20.99

58

5.51

7

0.67

113

10.74

5

0.48

869

82.61

62

1.24

0

0.00

0

0.00

0

0.00

0

0.00

62

100.00

836

16.68

26

3.11

1

0.12

16

1.91

4

0.48

789

94.38

5,011

100.00

203

4.05

30

0.60

253

5.05

50

1.00

4,475

89.30

Of the individuals with a maltreatment report at the time of their referral to the AFF program, those
with substantiated findings showed a recurrence rate of under 10%, while those with
unsubstantiated findings at AFF referral demonstrated a slightly higher rate of recurrence (17%).
Overall, regardless of maltreatment allegation status at the time of AFF referral, 89% of all AFF
individuals had no subsequent filing of an allegation of child maltreatment.

25
26

No allegation findings in DES CHILDS, allegations may be pending.
No allegation report data found in DES CHILDS.

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012
4.2

Permanency Achieved by Children of Parents in AFF

As depicted in Exhibit 13, a total of 3,982 children associated with AFF individuals in the first three
quarters of SFY 2012, were in CPS out of home placement at some point during the reporting
period. Compared to SFY 2011, 48% more children were reported in out of home placement in
SFY 2012. More than 77% of these children were still in out of home placements at the end of the
reporting period, compared to 69% at SFY 2011 year end. The rate of permanency (22%) was
down slightly this year compared to last, but among these children, both guardianship and adoption
were up. About 22% of the AFF individuals’ children who were placed in out of home care
achieved permanency, down 4% from last year. Both guardianships (3% SFY 2012 compared to 2%
SFY 2011) and adoptions (6 in SFY 2012 compared to 1 in SFY 2011) showed modest
improvements this year. The number of days in out of home placement ranged from a median of
180 days for reunifications to 400 days for adoption.
Exhibit 13
Permanency Achieved by Children of Parents in AFF
SFY 2012; Q1-Q3
n
%
Total Children
3,982
100.00
27
Still in Care
3,073
77.17
28
Other
45
1.13
29
Achieved Permanency
864
21.70
Days in Out of Home Care Among Children Achieving Permanency
n
Achieved Permanency
Reunification
Guardianship
Adoption

864
829
29
6

%
100.00
95.95
3.36
0.69

Median Days
180.93
276.97
400.17

Mean Days
166
240
397

27

Removals 07/01/2010 - 03/31/2012, No placement as of 03/31/2012
Removals 07/01/2010 - 03/31/2012, Discharge by 03/31/2012
29
Removals 07/01/2010 - 03/31/2012, Permanency by 03/31/2012
28

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012
4.3

Recovery from Substance Abuse

According to AFF program guidelines, DES-contracted providers are required to verify that AFF
individuals are tested for drug use at least twice per month during each month of AFF program
participation. In SFY 2012 there were 5,011 unique individuals who received AFF services; of
those, nearly 65% had been referred for drug testing at least once, and 34% were referred at least
twice a month throughout their entire AFF program participation. On average, those AFF
individuals who were referred for drug testing were tested 1.99 times per month, approximating the
AFF program guideline. For these individuals with known drug test results (18,517), 86% were
negative, indicating no drug use, while 65% yielded negative drug test results 100% of the time.
Exhibit 14
AFF Drug Test Data Reported by DES/AFF Providers
SFY2012; Q1-Q3
n
Unique AFF Individuals with Services
With Referrals for Drug Tests
3,233
Without Referrals for Drug Tests
1,778
Total Unique Individuals
5,011
With at least two (2) drug tests
1,097
referrals per month of service
Mean
Drug test referrals per month

30

Drug Test Referral Outcomes
Negative
Positive
Pending
Cancelled
Refused/Altered
Total
4.4

%
64.52
35.48
100.00
33.93

Standard Deviation
1.99
1.61

n

%
15,947
2,570
2,327
20
352
21,216

75.16
12.11
10.97
0.09
1.66
100.00

Employment Outcomes for Jobs-Referred AFF Individuals

During the first three quarters of SFY 2012, 13 individuals were referred to AFF directly from the
JOBS program. In addition to these 13 individuals, approximately 408 individuals were
concurrently enrolled in the JOBS program at the time of their referral to the AFF program. Three
of the 13 individuals referred to the AFF program from JOBS were employed, eight unemployed,
and the employment status of one individual was unknown at the time of their AFF program
closure. One individual referred from the JOBS program was continuing to receive AFF services at
the time of this report.
30

Referrals that had no positive or refused drug referrals.

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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012

SECTION 5
SUMMARY
This report summarizes the key processes and outcomes of the Arizona Families F.I.R.S.T.
program, now in its 12th year of operation. The continued commitment of the legislature to
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 SFY 2012, 6,868 total referrals, representing 6,154 unique individuals, were made to the AFF
program statewide. This represents a 25% increase in total referrals compared to SFY 2011. For the
individuals referred and their families, the AFF program continues to provide services in a manner
consistent with the program design. During SFY 2012, AFF participants received outreach,
assessment, engagement, and treatment services in a timely manner. AFF providers made efforts to
contact referred individuals within one business day. AFF services were accepted by participants,
on average, within 11 days of referral to AFF, a decrease from SFY 2011 where providers were
reporting approximately two weeks from referral to service acceptance.
Those individuals who are engaged in AFF 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 2012, nearly 46%
of AFF individuals received AFF services with funding solely provided by a RBHA, up
significantly from 12% reported in 2011. This growth in RBHA funding, including potential
utilization of SAPT funds that prioritize funding to women, reflects a promising trend in leveraging
additional local resources to meet the needs of AFF individuals.
Recovery from Alcohol and Drug Problems
Consistent with previous years, the overwhelming majority of AFF individuals assessed in SFY
2012 self-reported use of marijuana, alcohol, and methamphetamine. The results of drug screens
conducted with AFF individuals to detect continued drug use indicate that almost 65% of AFF
individuals were drug free throughout their AFF participation. Individuals receiving AFF services
were drug tested, on average, 1.99 times per month of AFF program participation.
Child Safety and Reduction of Child Abuse and Neglect
Most individuals (83%) served by the AFF program had at least one allegation of child
maltreatment prior to enrolling in the program. Nearly 90% of all AFF individuals had no
subsequent maltreatment report filed during this report period.
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ARIZONA FAMILIES F.I.R.S.T. Annual Evaluation Report SFY 2012
Permanency for Children through Reunification
The number of children and the proportion of AFF individuals with children in out of home care
grew significantly in SFY 2012. Among children that achieved permanency, guardianships and
adoptions were observed to be more frequently applied in SFY 2012 compared to previous years.
Achievement of Self-Sufficiency through Employment
Employment activity is reported only for those individuals referred to the AFF program who were
referred for AFF services by the JOBS program. Among these individuals, 23% were employed at
the time of their AFF program closure.

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