• July/August 2021
  • Vol. 22, No. 7

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Study Finds That START Program Reduces Out-of-Home Care and Increases Reunification Rates

In recent years, incidents of child maltreatment by caregivers with substance use problems have increased. An article in Child Abuse & Neglect discusses a study in Kentucky that investigated whether the Sobriety Treatment and Recovery Teams (START) program had an impact on child welfare outcomes in families affected by substance use.

The START program is an intervention for families with co-occurring child maltreatment and substance use. It involves collaboration between child welfare services, substance use treatment providers, and the courts, with each stakeholder establishing shared plans and goals. There are three specific goals of the START program:

  • Improve child well-being, family functioning, and caregiver recovery
  • Prevent out-of-home care placements 
  • Reduce recurrence of child maltreatment
The study comprised 348 families reported to child welfare services in Kentucky, a state with significantly higher rates of both opioid use disorders and child maltreatment than the national average. All participating families had a substantiated finding of maltreatment or services needed, substance use as a risk factor, a child under 6 years old, and no other open child welfare cases. Participants were randomly assigned to either begin treatment through the START program or Kentucky's usual child welfare services. Three outcomes were tracked: out-of-home care placements, reunification, and subsequent child maltreatment.
The results were favorable for the START program. Participants receiving services through START had an out-of-home care rate that was 7 percentage points lower than the rate for families that received usual services and a reunification rate that was 13 percentage points higher.
For more information, read the article, "Sobriety Treatment and Recovery Teams for Families With Co-Occurring Substance Use and Child Maltreatment: A Randomized Controlled Trial."


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