An intensive child welfare program for families with substance use and child abuse or neglect, built on cross-system collaboration and integrated service delivery with substance use disorder treatment services.
The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness from this review. It does not necessarily reflect all the evidence about the program. The research was selected and assessed for inclusion on the Menu and towards the evidence rating because it met selection criteria related to the specific topic area, study design, quality assessment and the outcomes of interest.
Overview
Evidence Rating
Pathway
- Early help
- Targeted and specialist
- Continuing care
Australian Study
Risk of Bias
Cost
Target Age Group
About
Sobriety Treatment and Recovery Team (START) is an intensive child welfare program for families with at least one child under 6 years of age who is in the child welfare system and a parent whose substance use is determined to be a primary child safety risk factor. START pairs child protective services workers trained in family engagement with family mentors (peer support employees in long-term recovery) and uses a system-of-care and team decision-making approach with families, treatment providers and the courts.
Aims
- Achieve parental sobriety and parental capacity to care for children
- Increase parental capacity to engage in essential life tasks
- Reduce and prevent out-of-home care.
Impact
Evidence suggests a positive effect for out-of-home care. Children in the START group were less likely to be placed in out-of-home care when the child protection services case is open, compared to children in the comparison group.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| System | Out-of-home care | Yes | Not found | Not found |
How to read the table:
When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Using the Menu page.
START has an evidence rating of Supported.
This means that START has evidence from one randomised controlled trial (RCT) or quasi-experiment (QE) demonstrating positive, short-term impact on at least one child and family outcome.
This assessment is based on one research output of QE design. START has not received a Well-supported rating as it has not yet replicated its results in another rigorous RCT or QE with a different population or setting.
| Study design | Number of research outputs included |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | Not identified or included |
| Quasi-experiment | 1 |
The evidence has some concerns with risk of bias.
The quality of evidence of the included QE is low and results should be interpreted with caution.
The study was conducted in the United States and does not include Aboriginal children and families.
Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.
Location
- The study used a dataset obtained from the START Information Network in the United States.
Sample
- A total of 322 families (531 adults and 451 children) participated in this study. 2 comparison groups were employed; with 367 families in the START-referred but not accepted comparison group and 150 families in the matched comparison group.
- Participating parents identified as White (78%), African-American (22%) and Hispanic.
Implementation
Delivery model, mode and setting
- START is delivered in-person, to the parent and child, separately or together.
Target cohort
- Families with children with a substantiated case of child abuse or neglect
- Children up to age 3.
Program delivery
- Cases accepted to START begin services within one to 2 days of the referral.
- START is initiated with a family team meeting that includes a specifically trained Child Protection Services social service worker paired with a family mentor, the START team, and the parental substance use disorders (SUDs) treatment coordinator.
- A strong collaborative partnership with SUDs treatment providers is required to coordinate treatment services to the client. The collaboration is supported by contracts and agreed upon START tenets.
- Each START worker-mentor dyad has a capped caseload, allowing the team to work intensively with families, engage them in individualised wrap-around services and identify natural supports with goals of child safety, permanency, and parental sobriety and capacity.
- Ongoing coordinated case management occurs weekly with the START supervisor and SUD treatment coordinator.
- START involves frequent in-home services and visits to parents and caretakers. Where possible, children are retained in the home.
- Family mentors escort parents to meet with treatment providers, guide them into recovery supports and use their special knowledge to coach the parent on relapse prevention, sober parenting and daily living.
Duration and intensity
- A START case is typically open for 14 months and family mentors spend an average of 52 hours in direct contact with family members. 6 months of continuous, documented sobriety is required before returning children to their parents or closing an in-home case.
- The child welfare worker and family mentor conduct home visits at least weekly, and parents receive a minimum of 2 SUD treatment sessions per week.
- The various treatments may be concurrent or sequential and may be repeated as needed.
Guides and manuals
- There is a START Model Implementation Manual available through formalised technical assistance and training.
Additional information
- The Children and Family Futures website has more information about the START model.
Staffing
- START Child Welfare Supervisor should have a minimum of 5 years of child welfare casework experience and meet agency requirements for promotion.
- Family mentors should have a minimum of a high school diploma and at least 3 years of sustained sobriety.
Training
- We were unable to locate any information on training requirements to implement START.
To our knowledge, START is not available and has not been implemented in Australia.
Cost
We were unable to locate any information on the cost of delivering START.
References
Studies identified and included in the review
- Huebner RA, Willauer T, Posze L. (2012). The impact of Sobriety Treatment and Recovery Teams (START) on family outcomes. Families in Society 93(3): 196-203.
Studies identified but not counted towards the evidence rating due to study quality
No studies that were identified were excluded due to study quality.