Sobriety Treatment and Recovery Teams
Parental substance use is reshaping child welfare. With START, more families can stay safely together.
As the sole national implementation partner, Children and Family Futures helps jurisdictions bring child welfare staff, treatment providers, and family mentors together around one coordinated model.
8
States with START
100+
Implementation sites
5,000+
Families served
Title IV-E
“Supported”
Federal evidence rating
The Challenge
What child welfare is up against
Child welfare, treatment, courts, and recovery systems have different goals. Once aligned, turning a shared goal of family safety into coordinated action is difficult.
Parental substance use is a major factor in removals
The number of children in out-of-home care decreased by 41.2% between 2000 (N=812,163) and 2025 (N=477,607). At the same time, the number of children in out-of-home care with parental alcohol or drug abuse as a circumstance reported at removal increased by 32.8% between 2000 (N=136,769) and 2025 (N=181,620).
Coordination breaks down at the case level
Child welfare staff and treatment providers operate on different timelines, with different mandates, and unclear handoffs. Families experience the system as fragmented at the moment they need it to be aligned.
Families feel the gaps between systems
Parents with substance use disorders often face urgent child welfare decisions while trying to access treatment. When those systems do not align, families can lose opportunities to stay safely together.
What Changes
When removals felt inevitable, Buncombe County changed course.
1/3 fewer
children in foster care in Buncombe County, a reduction of 100 children
Buncombe County, North Carolina, watched its foster care population approach 400 children at the height of the opioid crisis. Their child welfare team was defaulting to a removal approach with parents experiencing substance use disorder. Removals felt inevitable.
Then they implemented START. Family mentors, peers in long-term recovery, joined the child welfare team. The county shifted from investigative assessments to family assessments. Decisions began including the family at the table. Treatment access happened in days, not weeks.
The change extended beyond the county. Buncombe County’s experience later helped inform North Carolina’s decision to adopt START statewide.
“We moved away from a punitive approach and began treating the cases as family assessments versus investigative assessments. In part because of START, we reduced our total foster care population by a third or 100 children.”
Rebecca Smith · Social Work Director, Buncombe County HHS, North Carolina
Certified affiliates
Where START is certified
Certification recognizes the jurisdictions and state agencies that operate START with fidelity to the national model. Fifteen certified affiliates span Kentucky, Ohio, and North Carolina. Certification dates are shown for each.
Kentucky, 4 certified
Ohio, 10 certified
North Carolina, 1 certified
Iowa
Nevada
Kansas
Maryland
New York
The Evidence
START outcomes, side by side
Peer-reviewed research and federal evaluation document results across family safety, recovery, and foster care costs.
Mothers achieving sobriety
Children entering state custody Lower is better, children in START families are half as likely to enter custody
Children safely at home one year after case closure
Black children safely at home one year after case closure
Return on investment Avoided foster care costs per dollar invested
Sources: peer-reviewed START outcome studies and the Title IV-E Prevention Services Clearinghouse. Full citations available in the START Program Brief.
Proof
What child welfare leaders say about START
“Now in its 18th year, START’s longevity is a testament to two things: the strong outcomes we’ve seen for our families and the investment in Kentucky by the Department for Community Based Services and our community partners to sustain and improve this work over time.”
Lesa DennisCommissioner, Kentucky Department for Community Based Services
How It Works
What happens after you reach out
START implementation follows five phases, beginning with readiness and continuing through long-term sustainment. We shape each phase around your jurisdiction.
Readiness assessment
Together, we determine whether START fits your jurisdiction, what implementation will require, and how you will define success.
Implementation planning
We work with you to define staffing, workflows, partner agreements, the implementation timeline, and family mentor employment.
Training
We train leaders, supervisors, frontline staff, family mentors, and community partners for their roles in the model.
Launch support
During early operations, we coach the team as it troubleshoots, adjusts, and stabilizes. Most engagements include twice-monthly meetings.
Sustainment
We continue with fidelity assessment, coaching, and quality improvement to prevent drift. The model is built to survive turnover.
Common Questions
What child welfare leaders ask before reaching out
Next Step
Explore what it would take to keep more families safely together.
Whether you are evaluating START, planning implementation, or expanding across counties, talk with us about your goals, readiness, and the right next step.
