Sobriety Treatment and Recovery Teams
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.
A re-review of START was conducted in November 2022 due to an error in the review of Study 13388. The re-review did not affect the design and execution rating for the study or the program or service rating.
Date Research Evidence Last Reviewed: Dec 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 download the Handbook of Standards and Procedures, Version 1.0
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 Manual Excerpt (Chapter 1)
For More Information
Website: https://www.cffutures.org/start/
Phone: (714) 505-3525
Email: START@cffutures.org
Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.
| 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
 and Implied Percentile Effect
|
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
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 |
-0.10
-4 |
2 (6) | 2228 |
Favorable:
0 No Effect: 5 Unfavorable: 1 |
- |
| Study 10933 - Sobriety Treatment and Recovery Teams (START) vs. Usual Services Control (Cluster) (Hall, 2021) | |||||
| Subsequent Substantiated Report of Child Maltreatment |
-0.08
-3 |
- | 526 | - | 0 |
| Study 10935 - Sobriety Treatment and Recovery Teams (START) vs. Propensity Score Matched Comparison (Huebner, 2021b - Not conducted in a usual care or practice setting) | |||||
| 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 |
| Study 10933 - Sobriety Treatment and Recovery Teams (START) vs Usual Services Control (Kentucky Cabinet for Health and Family Services, 2018a) | |||||
| 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 |
- |
| Study 10933 - Sobriety Treatment and Recovery Teams (START) vs. Usual Services Control (Cluster) (Hall, 2021) | |||||
| Children Placed in State Custody (%) |
0.05
1 |
- | 526 | - | 0 |
| Study 10935 - Sobriety Treatment and Recovery Teams (START) vs. Matched Control (Huebner, 2012 - Not conducted in a usual care or practice setting) | |||||
| Children Placed in State Custody (%) |
0.56
*
21 |
- | 810 | - | 0 |
| Study 10935 - Sobriety Treatment and Recovery Teams (START) vs. Propensity Score Matched Comparison (Huebner, 2021b - Not conducted in a usual care or practice setting) | |||||
| 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 |
| Study 10933 - Sobriety Treatment and Recovery Teams (START) vs Usual Services Control (Kentucky Cabinet for Health and Family Services, 2018a) | |||||
| 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.
The participant characteristics display is an initial version. We encourage those interested in providing feedback to send suggestions to preventionservices@abtglobal.com.
The table below displays locations, the year, and participant demographics for studies that received moderate or high ratings on design and execution and that reported the information. Participant characteristics for studies with more than one intervention versus comparison group pair that received moderate or high ratings are shown separately in the table. Please note, the information presented here uses terminology directly from the study documents, when available. Studies that received moderate or high ratings on design and execution that did not include relevant participant demographic information would not be represented in this table.
For more information on how Clearinghouse reviewers record the information in the table, please see our Resource Guide on Study Participant Characteristics and Settings.
| Characteristics of the Participants in the Studies with Moderate or High Ratings | ||||||
|---|---|---|---|---|---|---|
|
Study Location
|
Study Year
|
Age or Grade-level
|
Race, Ethnicity, Nationality
|
Gender
|
Populations of Interest*
|
Household Socioeconomic Status
|
| Study 10933 - Sobriety Treatment and Recovery Teams (START) vs Usual Services Control | ||||||
| Characteristics of the Adults, Parents, or Caregivers | ||||||
| Kentucky, USA | 2015 | -- |
71% Caucasian 25% African American 6% Hispanic/Latino 4% Other |
100% Female |
100% Biological parent; 58% Single; 1% Current residence homeless shelter |
5% Income above $25,000 13% Income $19,001-24,999 1% Income $10,000-19,000 79% Income less than $9,999 13% Employed Part-Time |
| Study 10933 - Sobriety Treatment and Recovery Teams (START) vs. Usual Services Control (Cluster) | ||||||
| Characteristics of the Children and Youth | ||||||
| Jefferson County, KY, USA | 2015 | 63% Birth-23 months, 15% 2-5 years, 18% Over 5 years |
61% White 39% Racial Minority |
49% Male 48% Female |
-- | -- |
| Study 10935 - Sobriety Treatment and Recovery Teams (START) vs. Propensity Score Matched Comparison | ||||||
| Characteristics of the Children and Youth | ||||||
| Kentucky, USA | 2007 | Average age: 2.8 years; 37% Neonate, 11% Infant, 9% Toddler, 27% Early Childhood, 14% Middle Childhood, 3% Adolescent |
71% White/White Hispanic 29% Black/Biracial 2% Hispanic |
53% Male 47% Female |
Track of the CPS report - Investigation: 92%; Track of the CPS report - Alternative: 8%; Findings for the CPS report - Substantiated: 89%; Findings for the CPS report - Unsubstantiated: 3%; Findings for the CPS report - In Need of Services: 8%; Findings for the CPS report - Services not Needed: 1%; 0.4% Children in study sample experienced sexual abuse |
94% Poverty/income risk |
| Study 10935 - Sobriety Treatment and Recovery Teams (START) vs. Matched Control | ||||||
| Characteristics of the Children and Youth | ||||||
| Midwest, USA | 2006 | Average age: 2.7 years; 47% being infants under 1 year | -- | -- | -- | -- |
| Characteristics of the Adults, Parents, or Caregivers | ||||||
| Midwest, USA | 2006 | Median age of fathers: 28 years; Median age of mothers: 25 years |
78% White 22% African American |
-- | 85% Poly-substance users; Rates of usage: 53% Marijuana, 45% Opiates, 40% Crack/cocaine, 31% Benzodiazepines, 5% Methamphetamine, 22% A variety of other substances |
57% Fathers employed full- or part-time 26% Mothers employed full- or part-time |
“--” indicates information not reported in the study.
* The information about disabilities is based on initial coding. For more information on how the Clearinghouse recorded disability information for the initial release, please see our Resource Guide on Study Participant Characteristics and Settings. The Clearinghouse is currently seeking consultation from experts, including those with lived experience, and input from the public to enhance and improve the display.
Note: Citations for the documents associated with each 5-digit study number shown in the table can be found in the “Studies Reviewed” section below. Study settings and participant demographics are recorded for all studies that received moderate or high ratings on design and execution and that reported the information. Studies that did not report any information about setting or participant demographics are not displayed. For more information on how participant characteristics are recorded, please see our Resource Guide on Study Participant Characteristics and Settings.
Studies Rated Moderate
Study 10933Kentucky Cabinet for Health and Family Services, Department for Community Based Services. (2018a). 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. (2018b). 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
This study was conducted in a usual care or practice setting (Handbook Section 6.2.2)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/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, 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, 108563. https://doi.org/10.1016/j.jsat.2021.108563
Some contrasts that received a moderate or high design and execution rating in this study were not from research conducted in a usual care or practice setting (Handbook Section 6.2.2) [see Individual Study Findings section above for additional information on contrasts that did or did not meet this criterion]Studies Rated Low
Study 13388Hall, 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).