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 parents 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 child 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 to transform the system of service delivery between child welfare and SUD/mental health treatment providers

Logic Model

View the Logic Model for Sobriety Treatment and Recovery Teams (START).

Essential Components

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

• Structural Fidelity to the START Model:
• Administered and housed within a child welfare agency
• Built upon a collaborative governance structure including:
• Behavioral health treatment providers supported by:
• Cross-training
• Team-building
• Shared decision-making (SDM)
• Contracts/agreements
• Expectations for intensive communication between child welfare and treatment providers via immediate reports to child welfare of:
• Drug test results
• Missed appointments
• Safety concerns
• Written weekly reports of treatment attendance/progress
• Monthly direct line and steering meetings
• Monthly case reviews
• Treatment providers who are expected to deliver approaches and therapies that have the following characteristics:
• High-quality
• Trauma-informed
• Gender-specific
• Given at the same time as a treatment for a co-occurring disorder
• Evidence-based, when possible
• Employs family mentors who:
• Work within the child welfare agency
• Receive supervision from child welfare
• Experiencing long-term recovery from SUDs with experiences that sensitize them to child maltreatment and family SUDs
• Pairs one family mentor with one child welfare worker as a dyad with a shared caseload
• A maximum of 4 worker-mentor dyads form a team with a dedicated supervisor
• Caseload with no more than 12-15 families for the mentor-worker dyad.
• Serves the target population of families with child maltreatment and parental SUD as a primary risk factor for child safety that are new to the child welfare agency or have a closed case at the time of report/referral.
• Implementation Fidelity to START Strategies:
• Adheres to the START Timeline that specifies the number of business days between the initial child welfare report/referral and the parent being engaged in at least 4 SUD treatment sessions as follows:
• Referral to START within 10 days of the initial child welfare report/referral
• First SDM meeting with the family within 2 days of referral to START
• Behavioral health assessment within 2 days of first SDM meeting
• SUD treatment begins within 3 days of assessment, with minimum of 4 treatment sessions in the first 10 days of treatment
• Adheres to the START Minimum Work Guidelines that specify the intensity of child welfare services and include:
• At least weekly home visits by both the worker and family mentor for the first 60 and 90 days of the case, respectively
• SDM meetings that occur at key points such as:
• At referral to START to plan with the family for child safety and placement
• At relapse
• When in a crisis
• When treatment recommendations change
• At regular intervals
• Frequent visits between parent and child
• Parents have six months minimum of documented sobriety prior to reunification or case closure
• Engages parents in SUD and Mental Health services including:
• Holistic care
• Trauma-informed assessments
• Level of care placement
• Intensive services at the level, dosage, and repetition required by the parent
• Uses a family-centered approach and practices:
• Family includes:
• Children
• Mothers
• Fathers
• Significant others
• Caregivers such as foster parents and other relatives
• Provides comprehensive services to both mothers and fathers
• Refers parents/families to parenting supports to address parenting in recovery, bonding between parents and children, and parenting skills.
• Ensures that children are:
• Safe
• Having their basic needs met
• Screened for developmental and social-emotional delays
• Linked with needed services
• START must be based on principles implemented by decision making that is shared by families, child welfare staff and service providers.
• START must be constantly evolving toward the use of best practices in child welfare and SUD treatment.
• START respects that children optimally belong with their family, seeks to promote parent/child bonding through frequent visitation and parent coaching, and keeps children safely with family whenever possible.
• START sites must be engaged in continuous quality improvement guided by program evaluation data.

Program Delivery

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, and trauma needs

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 SDM meetings. Parents are linked with community recovery supports and supports for concrete needs such as housing, legal services, or child care. SUD treatment providers include extended family in family SUD education sessions. Family mentors coach all members on understanding and responding to persons with SUDs.

Recommended Intensity:

Minimum of weekly home visits by the child welfare worker and family mentor. SUD and co-occurring mental health treatment intensity as determined by qualified behavioral health professional, minimum of two SUD treatment sessions per week. Depending on behavioral health assessment, recommended level of care may include detoxification, residential, medication-assisted treatment (MAT), intensive outpatient, outpatient (individual, group, and family therapy), co-occurring mental health and trauma treatment, transitional housing, and psychiatric care. Various treatments may be concurrent or sequential and may be repeated as needed.

Recommended Duration:

Cases are open and worked on by child welfare for an average of 14 months. Behavioral health treatment duration is determined by assessment and client progress but is generally complete when the child welfare case closes. Six months of continuous, documented sobriety is required before returning children to their parent(s) or closing an in-home case.

Delivery Settings

This program is typically conducted in a(n):

• Birth Family Home
• Foster / Kinship Care
• Outpatient Clinic
• Group or Residential Care

Homework

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

Parents need to complete child welfare case plan activities and homework may be required by some behavioral health treatment providers.

Resources Needed to Run Program

The typical resources for implementing the program are:

• One child welfare supervisor for every 4 worker/mentor dyads
• Child welfare workers
• Family mentors
• A facilitator for SDM meetings
• Contracts/agreements with SUD treatment providers for assessment and treatment (may include employment of a START Service Coordinator)
• Drug testing
• Flexible funds for wraparound needs

Manuals and Training

Prerequisite/Minimum Provider Qualifications

START Child Welfare Supervisor: Minimum of five years of child welfare casework experience, meets agency requirements for promotion

START Child Welfare Worker: May be new to child welfare or an experienced worker, must complete agency child welfare 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 sustained recovery from SUDs, active participation in recovery supports, no current criminal justice or child welfare involvement

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

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Program Manual Information:

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

The first chapter of the manual, that explores the model and its theoretical base, is available for download at https://www.cffutures.org/start-home/start_manual_ch1/. The full manual is available to jurisdictions with training and technical assistance contracts through Children and Family Futures.

Training Information

There is training available for this program.

Training Contact:

• Tina Willauer, MPA
  START@cffutures.org
  phone: (714) 505-3525

Training Type/Location:

Recommended training includes:

• Consultation and technical assistance (TA) to leaders and administrators regarding systemic changes necessary to implement the program including program evaluation strategies.
• On-site training for front-line staff and supervisors in both child welfare and SUD treatment agencies on START strategies including hiring and working with family mentors, case management, and collaboration.
• Ongoing consultation and TA 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

Pre-Implementation Materials

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

Prospective START Affiliates engage in readiness and feasibility planning with members from the National START Training and Technical Assistance Program. All exploration stage activities are designed to evaluate organizational capacity for implementation of the National START Model.

Formal Support for Implementation

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

START is a complex, collaborative model that requires a commitment to a multiyear, cross-system dedicated effort. Affiliates negotiate and enter training and technical assistance (TA) contracting agreements (with detailed scope of work deliverables) to support state and/or local implementation of the National START Model. Programmatic and evaluation implementation supports for leadership, evaluation, and frontline staff may vary but generally fall into four categories: 1) virtual, phone, and email-based technical assistance; 2) on-site training, technical assistance, and leadership meetings; 3) virtual training; and 4) reporting, project management, and other activities. Formal fidelity reviews are provided approximately halfway through TA. On average, START Affiliates receive 2-4 years of training and TA prior to achieving full implementation and certification readiness. Affiliates may contract with the National START TTA Program for program evaluation services or may conduct their own evaluation with TA support.

A cost worksheet is available from the purveyor for those wishing to calculate the cost of model components.

Fidelity Measures

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

The National START TTA Program conducts fidelity reviews approximately halfway through TA using self-report and aggregate data supplied by the affiliate. States contracting to become certified state infrastructure affiliates are trained on the fidelity review process and provided with the tool which is not available to the public.

Fidelity Measure Requirements:

Fidelity measures are required to be used as part of program implementation.

Implementation Guides or Manuals

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

Access to the full START Model Implementation Manual (totaling 10 chapters) is only available through formalized training and technical assistance. However, chapter one is available in the public domain and can be accessed/downloaded here: https://www.cffutures.org/files/START/START_Chapter_1.pdf

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

Implementation Cost

There have been studies of the costs of implementing Sobriety Treatment and Recovery Teams (START) which are listed below:

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

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, 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

Huebner, R. A., Hall, M. T., Smead, E., Willauer, T., & Posze, L. (2018). Peer mentoring services, opportunities, and outcomes for child welfare families with substance use disorders. Children and Youth Services Review, 84, 239–246. https://doi.org/10.1016/j.childyouth.2017.12.005

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

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

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Permanency

Additional References