Sobriety Treatment and Recovery Teams (START)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
High
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Sobriety Treatment and Recovery Teams (START) has been rated by the CEBC in the area of: Family Stabilization Programs.

Target Population: Families with at least one child under 6 years of age who are in the child welfare system and have a parent whose substance use is determined to be a primary child safety risk factor

Brief Description

START is an intensive child welfare program for families with co-occurring substance use and child maltreatment delivered in an integrated manner with local addiction treatment services. START pairs child protective services (CPS) workers trained in family engagement with family mentors (peer support employees in long-term recovery) using a system-of-care and team decision-making approach with families, treatment providers, and the courts. Essential elements of the model include quick entry into START services to safely maintain child placement in the home when possible and rapid access to intensive addiction/mental health assessment and treatment. Each START CPS worker-mentor dyad has a capped caseload, allowing the team to work intensively with families, engage them in individualized wrap-around services, and identify natural supports with goals of child safety, permanency, and parental sobriety and capacity.

Program Goals:

The goals of Sobriety Treatment and Recovery Teams (START) are:

  • Ensure child safety
  • Reduce entry into out-of-home care, keeping children in the home with the parent when safe and possible
  • Achieve child permanency within the Adoptions and Safe Families Act (ASFA) timeframes, preferably with one or both parents or, if that is not possible, with a relative
  • Achieve parental sobriety in time to meet ASFA permanency timeframes
  • Improve parental capacity to care for children and to engage in essential life tasks
  • Reduce repeat maltreatment and re-entry into out-of-home care
  • Expand behavioral health system quality of care and service capacity as needed to effectively serve families with parental substance use and child maltreatment issues
  • Improve collaboration and the system of service delivery between child welfare and mental health treatment providers

Essential Components

The essential components of Sobriety Treatment and Recovery Teams (START) include:

  • Administered and housed by a child welfare agency
  • Serves families with co-occurring child maltreatment and parental substance abuse as a primary risk factor for child safety
  • Focuses on keeping children safely with their parent(s) whenever possible, avoiding child removal by front-loading services
  • Takes only new cases within 30 days of referral to the agency in order to utilize the crisis period as a springboard to engage parents in services
  • Adheres to a timeline that ensures quick movement from child protective services (CPS) report to treatment
    • Key fidelity timeframes include:
      • Referral to START within 30 days of report to CPS
      • First shared-decision-making meeting with the family within 2 days of referral to START
      • Behavioral health assessment within 2 days of first meeting
      • Addiction treatment begins within 3 days of assessment, with minimum of 4 treatment sessions in the first 10 days of treatment
  • Employs full-time family mentors who are housed and supervised by CPS:
    • People in long-term recovery from addiction to drugs and/or alcohol with experiences that sensitize them to child maltreatment and family addiction selected as family mentors
    • Pairs one family mentor with one CPS worker as a dyad with a shared caseload
    • A maximum of 4 worker-mentor dyads form a team with a dedicated supervisor
    • No more than 12-15 families per caseload for the mentor-worker dyad
    • Intensive CPS involvement, including at least weekly home visits by both the worker and family mentor for the first 60 days of the case
  • Ensures that parents have six months minimum of documented sobriety prior to reunification or case closure
  • Uses casework protocols related to visitation, reunification, and safety planning
  • Uses shared decision-making with frequent family team meetings (FTM) that include the family, CPS staff, and service providers
  • FTMs occur at key points such as:
    • At referral to START to plan with the family for child safety and placement
    • 30 days and 6 months into the case
    • At relapse
    • When crises occur
    • When treatment recommendations change
  • Serves both mothers and fathers (biological, assumed, adoptive, or paramour) in child welfare and addiction/mental health treatment
  • Refers parents to addiction and mental health services including holistic, trauma-informed assessments, level-of-care placement, and intensive services at the level, dosage, and repetition required by the client
  • Collaborates with behavioral health providers supported by cross-training, team-building, contracts/ agreements, and agreed upon START tenets
  • Communicates intensively between CPS and treatment providers via immediate reports to CPS of drug test results, missed appointments, and safety concerns; written weekly reports of treatment attendance/progress; monthly direct line and steering meetings; and monthly case reviews
  • Requires that community providers deliver high quality, trauma-informed, gender-specific, and co-occurring disorder capable treatment using evidence-based approaches and therapies when possible
  • Uses continuous quality improvement guided by program evaluation data analyzed for model fidelity and child welfare outcomes
  • Ensures that children are safe and have their basic needs met, are screened for developmental and social-emotional delays, and are linked with needed services
  • Refers parents/families to parenting supports to address parenting in recovery, bonding between parents and children, and parenting skills

Child/Adolescent Services

Sobriety Treatment and Recovery Teams (START) directly provides services to children/adolescents and addresses the following:

  • Lack of safety and basic needs, poor well-being and mental health, delayed development

Parent/Caregiver Services

Sobriety Treatment and Recovery Teams (START) directly provides services to parents/caregivers and addresses the following:

  • Parental substance use and mental health disorders, lack of family stability, below average parenting capacity
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Both mothers and fathers are served. Families, including extended family, friends, and community supports, are included in Family Team Meetings (where shared decision-making takes place). Parents are linked with community recovery supports and supports for concrete needs. Addiction treatment providers include extended family in family addiction education sessions.

Delivery Settings

This program is typically conducted in a(n):

  • Birth Family Home
  • Foster/Kinship Care
  • Outpatient Clinic
  • Residential Care Facility

Homework

Sobriety Treatment and Recovery Teams (START) includes a homework component:

Homework may be required by some behavioral health treatment providers.

Languages

Sobriety Treatment and Recovery Teams (START) does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

Personnel: one CPS supervisor for every 4 worker/mentor dyads, CPS workers, Family Mentors, contracts/agreements with addiction treatment providers for assessment and treatment (may include employment of a START Service Coordinator), drug testing, flexible funds for wraparound needs. Ideally, a facilitator for family team meetings.

Minimum Provider Qualifications

START CPS Supervisor: Minimum of five years of CPS casework experience, meets agency requirements for promotion

START CPS Worker: May be new to CPS or an experienced worker, must complete agency CPS training prior to doing field work

START Family Mentor: High school diploma or GED, two years of work experience of some sort, at least three years of recovery from addiction, active participation in recovery supports, no current criminal justice or CPS involvement

START Service Coordinator (if this position is included): Meets state, agency, and insurance requirements to provide assessments and case management for addiction and co-occurring mental health disorders

Education and Training Resources

There is not a manual that describes how to implement this program; but there is training available for this program.

Training Contacts:
Training is obtained:

A manual is under development, but some chapters and protocols are available through the developer. Recommended training includes:

  • Consultation to leaders and administrators regarding systemic changes necessary to implement the program
  • On-site training available for front-line staff
  • Ongoing consultation recommended regarding implementation and how to overcome barriers
Number of days/hours:

2-4 hours/month of consultation, usually by phone 1-2 days of on-site training

Implementation Information

Since Sobriety Treatment and Recovery Teams (START) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

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Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Sobriety Treatment and Recovery Teams (START) as listed below:

Readiness checklist and site selection checklist, available through the developer. Checklists help leadership determine whether key elements are currently in place to support the model, what prework might be needed, and what data is important to site selection.

Formal Support for Implementation

There is formal support available for implementation of Sobriety Treatment and Recovery Teams (START) as listed below:

The developer and associates can provide ongoing technical assistance, coaching, and consultation to leadership and front-line staff to help navigate and work through implementation issues and barriers.

Fidelity Measures

There are fidelity measures for Sobriety Treatment and Recovery Teams (START) as listed below:

Fidelity measures are embedded into a data collection system and ideally similar data collection systems should be developed by those adopting the model. The evaluation of fidelity includes explicit directions through process evaluation and data collection/analysis. These instructions are available from the developer.

Implementation Guides or Manuals

There are implementation guides or manuals for Sobriety Treatment and Recovery Teams (START) as listed below:

Manual chapters and practice guides are available through the developer. The chapters address topics such as stages of implementation, essential elements, evaluation, family mentors, and essential meetings. Practice guides address topics such as drug testing and minimum work standards.

Research on How to Implement the Program

Research has been conducted on how to implement Sobriety Treatment and Recovery Teams (START) as listed below:

Hall, M. T., Huebner, R. A., Sears, J. S., Posze, L., Willauer, T. & Oliver, J. (2015). Sobriety Treatment and Recovery Teams in rural Appalachia: Implementation and outcomes. Child Welfare, 94(4), 119-138.

Huebner, R. A., Posze, L., Willauer, T. M., & Hall, M. T. (2015). Sobriety Treatment and Recovery Teams: Implementation fidelity and related outcomes. Substance Use & Misuse, 50(10), 1341-1350. doi:10.3109/10826084.2015.1013131

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Permanency

Show relevant research...

Huebner, R. A., Willauer, T., & Posze, L. (2012). The impact of Sobriety Treatment and Recovery Teams (START) on family outcomes. Families in Society Journal of Contemporary Social Services, 93(3),196-203.

Type of Study: Matched comparison group design
Number of Participants: 322 Families (531 Adults and 451 Children)

Population:

  • Age — Parents: 25-28 years, Children: Mean=2.7 years
  • Race/Ethnicity — Parents: 78% White and 22% African Americans, Children: Not specified
  • Gender — Parents and Children: Not specified
  • Status — Participants are families with co-occurring child abuse and neglect and parental substance use disorders.

Location/Institution: Four START sites in two urban, one rural and one Appalachian county

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this outcome study was to test the impact of the Sobriety Treatment and Recovery Team (START) program on rates of parental sobriety and rates of child placement in state custody (foster or residential care). Measures utilized include risk of child abuse rating on the continuous quality assessment (CQA), in addition three data sets were used as measures, START Information Network (START-IN), investigation, and OOHC (out-of-home care). This study consisted of three groups: START-served, START-referred but not accepted, and matched comparison. Results indicate that many families, despite numerous challenges, achieved sobriety and retained custody of their children with START. Children receiving START services entered state custody at half the rate expected. Mothers in START achieved nearly twice the rates of favorable outcome, compared to similar women in the state. Fathers achieved sobriety rates much lower than mothers, suggesting that a more potent intervention is needed for fathers. Limitations include lack of randomization, lack of follow-up, and the study does not provide causal conclusions to support that the results can be attributed to the START program.

Length of postintervention follow-up: None.

Huebner, R. A., Willauer, T., Posze, L., Hall, M. T., & Oliver, J. (2015). Application of the evaluation framework for program improvement of START. Journal of Public Child Welfare, 9(1), 42-64.

Type of Study: One group pretest-posttest study
Number of Participants: 420 Families (673 Parents)

Population:

  • Age — Parents: 25-28 years, Children: Mean=1.5 years
  • Race/Ethnicity — Parents: 78.6% Caucasian, 20.1% African American, and 1.3% Hispanic; Children: 69.3% Caucasian, 27.9% African American, 2.0% Hispanic, and 0.8% Other
  • Gender — Parents: 409 Female and 264 Male, Children: 53.5% Male and 46.5% Female
  • Status — Participants were families with co-occurring child abuse and neglect and parental substance use disorders.

Location/Institution: Four START sites in two urban, one rural and one Appalachian county

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study applies the Children’s Bureau program evaluation framework to the Sobriety Treatment and Recovery Team (START) program, an integrated program between child welfare and substance abuse treatment. A cluster analysis of START participants in 420 families identified three subgroups. Measures utilized include the North Carolina Family Assessment Scale for General Services (NCFAS-G) and a family mentor checklist. The study was conducted in phases. In phase one, data on child placement, parental sobriety, and parental capacity in addition to data on START process and treatment variables were used to identify three homogeneous outcome subgroups. In phase two, characteristics of the cluster subgroups were compared to identify differences that might inform program improvement. Results indicate that intact families (i.e., father, mother, and child[ren]) retained child custody throughout treatment and achieved the highest rates of sobriety. Despite similar substance use disorders and loss of parental custody, group two was mostly reunified and group three was rarely reunified. Limitations include lack of randomization of participants, lack of comparison group, lack of follow-up, and the cluster analysis does not provide causal conclusions to support that the results can be attributed to the START program.

Length of postintervention follow-up: None.

References

Huebner, R.A., Willauer, T., Brock, A., & Coleman, Y. (2010). START family mentors: Changing the workplace and community culture and achieving results. The Source, 20(1), 7-10.

Posze, L. R., Huebner, R. A., & Willauer, T. M. (2013). Rebuilding a family bond. Addiction Professional. Retrieved from http://www.addictionpro.com/article/rebuilding-family-bond?page=show

Contact Information

Name: Tina M. Willauer, MPA
Agency/Affiliation: Kentucky Department for Community Based Services
Email:
Phone: (502) 526-1323

Date Research Evidence Last Reviewed by CEBC: October 2015

Date Program Content Last Reviewed by Program Staff: February 2016

Date Program Originally Loaded onto CEBC: February 2016