Sobriety Treatment and Recovery Teams

Substance Use Prevention or Treatment In-home Parent Skill-Based Promising

Sobriety Treatment and Recovery Teams (START) serves families with at least one child under 6 years of age who are involved in the child welfare system and have a parent with substance use disorders (SUD). The START model was designed to recruit, engage, and retain parents in SUD treatment while keeping children safe. The goals of START are to prevent out-of-home placements, promote child safety and well-being, increase permanency for children, encourage parental SUD recovery, and improve family stability and self-sufficiency.

The START model places families at the center of treatment and includes them in the decision-making team during treatment and case planning. Intervention activities include: (1) intensive SUD recovery services, (2) coaching to help parents with parenting and life skills, (3) intensive Child Protective Services (CPS) case management, and (4) individual, group, and/or family counseling for parents, children, and other family members. Teams are responsible for monitoring families’ progress and coordinating their care across agencies and providers, including CPS, family mentors, SUD treatment providers, the judicial system, and family service agencies. CPS workers and family mentors as a dyad share small caseloads of 12 to 15 families. Family mentors also provide peer support to families. Family mentors are in long-term recovery from SUD.


Sobriety Treatment and Recovery Teams is rated as a promising practice because at least one study achieved a rating of moderate or high on study design and execution and demonstrated a favorable effect on a target outcome.


Date Research Evidence Last Reviewed: Dec 2020


Sources

The program or service description, target population, and program or service delivery and implementation information was informed by the following sources: The California Evidence-based Clearinghouse for Child Welfare, the program or service developer’s website, the program or service manual, and the studies reviewed.


This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, visit the Review Process page or download the Handbook.

Target Population

START serves families with at least one child under 6 years of age who are involved in the child welfare system and have a parent with substance use disorders (SUD).

Dosage

Within 30 to 45 days after a CPS report is made and CPS initiates a referral to START, families are expected to participate in several key Timeline activities. This includes an initial shared decision-making team meeting to discuss case and treatment planning. Parents are also expected to complete an SUD assessment and complete at least 4 intensive SUD treatment sessions within the Timeline. Additional shared decision-making meetings are convened at the end of this Timeline, and later, as needed.

Additionally, families receive weekly home visits from their CPS caseworker for at least the first 60 days. Family peer mentors visit families weekly for at least the first 90 days. Parents must have 6 months of documented sobriety before their case can be closed and/or families can be reunified. The intervention lasts for an average of 14 months. 

Location/Delivery Setting
Recommended Locations/Delivery Settings

Families typically receive services in their community, such as outpatient SUD treatment. Families also receive home visits from their CPS caseworkers and family peer mentors.

Location/Delivery Settings Observed in the Research

  • Home
  • Mental Health Center, Treatment Center, Therapist Office

Education, Certifications and Training

START workers, family mentors, and supervisors must be employed by CPS and meet the required education, training, and experience requirements set by the agency and the START model. Family mentors must be in successful long-term recovery from SUDs, be actively participating in recovery supports, and have no current criminal justice or child welfare involvement.

All START programs must receive training and technical assistance support through the National START TTA Program at Children and Family Futures. Ongoing consultation of about 2 to 4 hours per month is also recommended.

 

Program or Service Documentation
Book/Manual/Available documentation used for review

Willauer, T., Posze, L., & Huebner, R. A. (Eds.). (2018). The Sobriety Treatment and Recovery Teams (START) Model:  Implementation manual. Lake Forest, CA: Children and Family Futures.    

Available languages

START materials are available in English.

Other supporting materials

START Informational Video

START Manual Excerpt (Chapter 1)

Contact Information for Developers

Website: https://www.cffutures.org/start/

Phone: (714) 505-3525

Email: START@cffutures.org

Results of Search and Review Number of Studies Identified and Reviewed for Sobriety Treatment and Recovery Teams
Identified in Search 7
Eligible for Review 2
Rated High 0
Rated Moderate 2
Rated Low 0
Reviewed Only for Risk of Harm 0
Outcome Effect Size
and Implied Percentile Effect
N of Studies (Findings) N of Participants Summary of Findings
Child safety: Child welfare administrative reports -0.08
-3
1 (2) 134 Favorable: 0
No Effect: 2
Unfavorable: 0
Child permanency: Out-of-home placement 0.51
19
2 (2) 992 Favorable: 1
No Effect: 1
Unfavorable: 0

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group.

Outcome Effect Size
and Implied Percentile Effect
N of Studies (Findings) N of Participants Summary of Findings Months after treatment
when outcome measured
Child safety: Child welfare administrative reports -0.08
-3
1 (2) 134 Favorable: 0
No Effect: 2
Unfavorable: 0
-
Kentucky Cabinet for Health and Family Services, Department for Community Based Services, 2018
Subsequent Report of Child Maltreatment -0.20
-7
- 134 - 6
Subsequent Substantiated Report of Child Maltreatment 0.03
1
- 134 - 6
Child permanency: Out-of-home placement 0.51
19
2 (2) 992 Favorable: 1
No Effect: 1
Unfavorable: 0
-
Huebner, 2012
Percent of Children Placed in State Custody (during study period) 0.56 *
21
- 810 - 0
Kentucky Cabinet for Health and Family Services, Department for Community Based Services, 2018
Children Placed in State Custody -0.10
-3
- 182 - 0

*p <.05

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Section 5.10.4 and may not align with effect sizes reported in individual publications.

Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.

Full citations for the studies shown in the table are available in the "Studies Reviewed" section.

Sometimes study results are reported in more than one document, or a single document reports results from multiple studies. Studies are identified below by their Prevention Services Clearinghouse study identification numbers.

Studies Rated Moderate

Study 10935

Huebner, R. A., Willauer, T., & Posze, L. (2012). The impact of Sobriety Treatment and Recovery Teams (START) on family outcomes. Families in Society, 93(3), 196-203. https://doi.org/http://dx.doi.org/10.1606/1044-3894.4223

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.

Study 10933

Kentucky Cabinet for Health and Family Services, Department for Community Based Services. (2018). Title IV-E Child Welfare Waiver Demonstration: Kentucky interim valuation report. https://chfs.ky.gov/agencies/dcbs/dpp/pb/Documents/Kentucky%20Wavier%20Demonstration%20Interim%20Evaluation%20Report%202018.pdf

Kentucky Cabinet for Health and Family Services, Department for Community Based Services. (2018). Kentucky Title IV-E Waiver semi-annual progress report. https://chfs.ky.gov/agencies/dcbs/dpp/pb/Documents/Kentucky%27s%20Title%20IV-E%20Waiver%20Semi-Annual%20Progress%20Report%20KY%20April%202018.pdf




Studies Not Eligible for Review

Study 10934

Hall, M. T., Wilfong, J., Huebner, R. A., Posze, L., & Willauer, T. (2016). Medication-assisted treatment improves child permanency outcomes for opioid-using families in the child welfare system. Journal of Substance Abuse Treatment, 71, 63-67. https://doi.org/10.1016/j.jsat.2016.09.006

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10936

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. https://doi.org/10.1080/15548732.2014.983289

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10937

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. https://doi.org/10.3109/10826084.2015.1013131

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10938

Huebner, R. A., Young, N. K., Hall, M. T., Posze, L., & Willauer, T. (2017). Serving families with child maltreatment and substance use disorders: A decade of learning. Journal of Family Social Work, 20(4), 288-305. https://doi.org/10.1080/10522158.2017.1348110

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10939

Usher, C. L., & Wildfire, J. B. (2003). Evidence-based practice in community-based child welfare systems. Child Welfare, 82(5), 597-614.

This study is ineligible for review because it does not measure and report program or service impacts on at least one eligible target outcome (Study Eligibility Criterion 4.1.5).