Sobriety Treatment and Recovery Teams

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

Sobriety Treatment and Recovery Teams (START) is designed to serve families involved in the child welfare system with at least one child age 5 or younger and one parent diagnosed with a substance use disorder (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. Family mentors also provide peer support to families.


START is rated as a supported practice because at least one study carried out in a usual care or practice setting achieved a rating of moderate or high on design and execution and demonstrated a sustained favorable effect of at least 6 months beyond the end of treatment on at least one target outcome.


Date Research Evidence Last Reviewed: May 2022


Sources

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

 

Date Program/Service Description Last Updated: May 2022


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 is designed to serve families involved in the child welfare system with at least one child age 5 or younger and one parent diagnosed with a substance use disorder (SUD).

Dosage

Within 30–45 days after a CPS report is made and CPS initiates a referral to START, families are expected to participate in several key activities. The first activity is a shared decision-making team meeting to discuss case and treatment planning. Then, parents are expected to complete an SUD assessment and at least four intensive SUD treatment sessions. Additional shared decision-making meetings are held at the end of the 30–45 days, and later, as needed.

Families also receive weekly home visits from their CPS caseworker for at least the first 60 days and weekly home visits from their family peer mentors 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 in outpatient SUD treatment centers. 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 Training and Technical Assistance (TTA) Program at Children and Family Futures. National START TTA recommends that START programs participate in ongoing consultation with its staff for about 2–4 hours per month.

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. 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 9
Eligible for Review 3
Rated High 0
Rated Moderate 2
Rated Low 1
Reviewed Only for Risk of Harm 0
Outcome Effect Size Effect Size more info
and Implied Percentile Effect Implied Percentile Effect more info
N of Studies (Findings) N of Participants Summary of Findings
Child safety: Child welfare administrative reports -0.10
-4
2 (6) 2228 Favorable: 0
No Effect: 5
Unfavorable: 1
Child permanency: Out-of-home placement 0.33
13
2 (8) 3086 Favorable: 4
No Effect: 4
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 Effect Size more info
and Implied Percentile Effect Implied Percentile Effect more info
N of Studies (Findings) N of Participants Summary of Findings Months after treatment
when outcome measured
Months after treatment when outcome measured more info
Child safety: Child welfare administrative reports -0.10
-4
2 (6) 2228 Favorable: 0
No Effect: 5
Unfavorable: 1
-
Hall, 2021
Subsequent Substantiated Report of Child Maltreatment -0.08
-3
- 526 - 0
Huebner, 2021b
Substantiated Recurrence of Child Abuse and Neglect -0.14
-5
- 1568 - 0
Substantiated Recurrence of Child Abuse and Neglect 0.00
0
- 1568 - 6
Substantiated Recurrence of Child Abuse and Neglect -0.34 *
-13
- 1568 - 12
Kentucky Cabinet for Health and Family Services, Department for Community Based Services, 2018b
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 0.33
13
2 (8) 3086 Favorable: 4
No Effect: 4
Unfavorable: 0
-
Hall, 2021
Children Placed in State Custody (%) 0.05
1
- 526 - 0
Huebner, 2012
Children Placed in State Custody (%) 0.56 *
21
- 810 - 0
Huebner, 2021b
Out-of-Home Placement (%) 0.39 *
15
- 1568 - 0
Out-of-Home Placement (%) -0.19
-7
- 1568 - 6
Out-of-Home Placement (%) -0.07
-2
- 1568 - 12
Cumulative Freedom from Out-of-Home Placements (%) 0.50 *
19
- 1568 - 6
Cumulative Freedom from Out-of-Home Placements (%) 0.51 *
19
- 1568 - 12
Kentucky Cabinet for Health and Family Services, Department for Community Based Services, 2018b
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 10933

Kentucky Cabinet for Health and Family Services, Department for Community Based Services. (2018b). Title IV-E Child Welfare Waiver Demonstration: Kentucky interim evaluation 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. (2018a). 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

Hall, M. T., Kelmel, A. B., Huebner, R. A., Walton, M. T., & Barbee, A. A. (2021). Sobriety Treatment and Recovery Teams for families with co-occurring substance use and child maltreatment: A randomized controlled trial. Child Abuse and Neglect, 114, Article 104963. https://doi.org/10.1016/j.chiabu.2021.104963

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.

Huebner, R. A., Hall, M. T., Walton, M. T., Smead, E., Willauer, T., & Posze, L. (2021b). The Sobriety Treatment and Recovery Teams program for families with parental substance use: Comparison of child welfare outcomes through 12 months post-intervention. Child Abuse and Neglect, 120, Article 105260. https://doi.org/10.1016/j.chiabu.2021.105260

Huebner, R. A., Willauer, T., Hall, M. T., Smead, E., Poole, V., Hibbeler, P. G., & Posze, L. (2021a). Comparative outcomes for Black children served by the Sobriety Treatment and Recovery Teams program for child welfare families with parental substance abuse and child maltreatment. Journal of Substance Abuse Treatment, 131, Article 108563. https://doi.org/10.1016/j.jsat.2021.108563


Studies Rated Low

Study 13388

Hall, M. T., Walton, M. T. Huebner, R. A., Higgins, G. E., & Kelmel, A. B. (2021). Sobriety Treatment and Recovery Teams for families with co-occurring substance use and child maltreatment: A propensity score-matched evaluation. Children and Youth Services Review, 131, Article 106256. https://doi.org/10.1016/j.childyouth.2021.106256

This study received a low rating because baseline equivalence of the intervention and comparison groups was necessary and not demonstrated.


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. http://www.jstor.org/stable/45390143

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).

Study 13387

Bunger, A. C., Chuang, E., Girth, A., Lancaster, K. E., Gadel, F., Himmeger, M., Saldana, L., Powell, B. J., & Aarons, G. A. (2020). Establishing cross-systems collaborations for implementation: Protocol for a longitudinal mixed methods study. Implementation Science: IS, 15(1), 55. https://doi.org/10.1186/s13012-020-01016-9

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).