The MMAC target population for services is low-income, substance-abusing, pregnant or postpartum women with young children, who are residents of Cobb or Douglas counties. The population primarily consists of low-income, single females, with a long history of substance abuse. Women served are generally in their early 20s. The ethnic makeup of clients varies but seems to be about 50 percent Caucasian and 50 percent ethnic minority. The majority of children served by the program are under the age of 5. The director of women's services for the program commented on some recent changes in population characteristics. She reported serving a population of adult women who are much younger than in past years and also reported serving a higher percentage of Hispanics currently than in the past.
MMAC referral criteria include the following: any woman who is pregnant or within 12 months postpartum and has young children if she meets the following criteria: 1) self- reports of any drug or alcohol use, 2) positive toxicological screening of the mother, or 3) positive toxicological screening of the infant shortly after birth. Most clients must be TANF eligible if not already on TANF (due to funding requirements - see the funding section for details) and also must have and maintain rights to their children or be eligible to petition for rights to their children, even if they do not currently have custody. MMAC will work with women going through the TPR process with one child, as long as the mother still has rights to a second child. At the time of referral, all clients must sign a release statement and consent form for services. If women referred do not meet these criteria, they are referred to basic outpatient services provided by the county.
MMAC averages about 70-80 clients per month, including an average of 6 pregnant clients. Referrals primarily come from CPS, which on average refers approximately 50-60 clients per month, or 75 percent of monthly referrals, for screening assessments and treatment. Referrals can also come from hospitals, the courts, the criminal justice system, and other social service agencies such as DPH. Referrals can be voluntary or mandatory, and there is some preference for mandatory cases because this gives MMAC a little more leverage with the client. Currently, cases are 50 percent reunification clients and 50 percent family preservation clients. Most of the other cases referred from DFCS come from the TANF employment program.
Most cases from CPS are from investigations (intake), but cases may also come from ongoing and foster care cases. For a CPS referral, a DFCS caseworker reviews the intake or ongoing case with his/her supervisor, and upon determination that MMAC would be appropriate for the client, the worker faxes a referral to MMAC for consideration. The MMAC director of women's services reports that the referral process with CPS is relatively simple. Prior to a decision to refer, DFCS can also call and request a client screening. With an MMAC administrator on site at DFCS, client screenings or drug testing can be done on the day a client is in the office during investigation. This way, clients do not have a chance to hide their problems prior to testing. MMAC then provides a recommendation to DFCS on placement and treatment based on the mother's level of commitment to change.
Referrals from the hospital can come to the program prior to CPS involvement with a call from the hospital regarding a patient at risk and meeting the criteria for the program. There is no existing CPS law to intervene during pregnancy. Women who are suspected of drug use or test positive for drugs prior to delivery are immediately eligible for the MMAC program, and in fact, state law requires that priority for the program be given to pregnant women. The implicit threat to the mother is that the child will be removed if the baby is born drug-positive. If successful in the program, the family may never become a DFCS case. However, if babies in the county are delivered at the hospital with a positive toxicology, CPS policy is to remove the child from the parent, the case is mandated to go to court, and MMAC may become involved at that point.
The juvenile court refers cases to MMAC by a court-order for MMAC reunification services. However, despite a court order recommending services (especially residential placement), MMAC might decide after assessment that the client is not appropriate and recommend an alternate treatment plan. This decision is based on client assessment, need, risk of the family, and when the client does not feel she can abide by the structure of the residential facility. Referrals from criminal justice generally come from the parole office staff. If a female parolee has a severe problem with relapse or parole violation related to substance abuse, the parole chief will refer to MMAC. This is done at an administrative parole hearing and will include a directive remanding the parolee to MMAC or jail if she does not comply.
Criminal justice also occasionally uses MMAC as part of a parole plan for inmates planning to leave the correction system who are at high risk and have no home. The parole office chief in Douglas County appreciates MMAC for its therapeutic approach in cases. Clients can also be returned to jail or enrolled in a program run by parole, but the Chief felt that the corrections staff tended to be too authoritative and not as therapeutic in its services. Referrals from other sources are few and can generally be made informally.
With all the multiple roles of MMAC staff (as placement/treatment consultant, drug screeners, liaisons, etc.) and their work with many agencies, staff members often become aware of probable clients prior to any referral for services, and in some cases they actually participate in the pre-referral screening process. The result is a uniquely collaborative and less formal referral process between MMAC and other public agencies.