Summarized List of Publications and Reports
Parenting attitudes and behaviors among parents involved with the child welfare system and affected by substance use disorders
Qualitative and quantitative data were used to measure the attitudes and practices of parents involved with Ohio START. Qualitative data indicated statistically significant improvements in parent’s expectations of their children, parent-child family roles, and children’s power and independence. Parents shared their experiences with START and related life changes through a qualitative interview process revealing six themes – being present for their children, engaging in activities with their children, enjoying providing care for their children, the ability to maintain employment for financial stability, better emotional regulation and stress management, and a sense of pride in their accomplishments.
Yoon, S., Ploss, A., Hutzel, M., Webb, R., Hatfield, A., Lee, J. Y., Munshi, A., Radney, A., & McClellan, J. (2024). Parenting attitudes and behaviors among parents involved with the child welfare system and affected by substance use disorders. Child Abuse & Neglect, 149, e106657.
Specifying cross-system collaboration strategies for implementation: A multi-site qualitative study with child welfare and behavioral health organizations
Implementing a cross-system intervention requires multi-level system alignment. In this qualitative study, data were gathered from over 100 child welfare agencies, treatment organizations, and regional substance use and mental health boards in Ohio who are involved in implementing START. Administrative-level staff, frontline staff, or a combination of the two identified seven cross-system collaborative strategies for implementation – to support staffing the program, administrators contract out for expertise, provide joint supervision, and co-locate contracted staff; service access was promoted through referral protocols and expedited access agreements; and shared decision-making and data sharing support alignment of case plans.
Bunger, A. C., Chuang, E., Girth, A. M., Lancaster, K. E., Smith, R., Phillips, R. J., Martin, J., Gadel, F., Willauer, T., Himmeger, M. J., Millisor, J., McClellan, J., Powell, B. J., Saldana, L., & Aarons, G. A. (2024). Specifying cross-system collaboration strategies for implementation: A multi-site qualitative study with child welfare and behavioral health organizations. Implementation Science, 19(1).
Ohio START: An adaptation of the National Sobriety Treatment and Recovery Teams model
Ohio START, replicating the National START Model, is implementing and testing an adaptation to the target population by serving families with children aged 0-18. Findings from data gathered from October 2017 – June 2023 show support for expansion of the target population. Despite the age of the children, teams facilitated timely access to services and the odds of case plan completion increased with each additional child within the family home. There was no statistically significant difference in parents’ ability to complete their child welfare case plans based on the age of the child(ren). Additional studies are needed to compare outcomes for START participants and otherwise eligible non-participants. Note: Testing of this adaptation to the START target population was approved by the co-purveyors of the model.
Dellor, E., Allbright-Campos, M., Lee, J.Y., Bunger, A.C., Gadel, F., & Freisthler, B. (2024). Ohio START: An adaptation of the National Sobriety Treatment and Recovery Teams model. Children and Youth Services Review, 160, e107575.
Benchmarking trauma in child welfare: A brief report
Exposure to trauma is a common occurrence. Data was collected from parents and children involved with two child-welfare based initiatives, Ohio START and Enhancing Permanency in Children and Families (EPIC), also located in Ohio. Teams used the Adverse Childhood Experiences (ACE) Questionnaire with adults and Children’s Trauma and Assessment Center’s (CTAC) Trauma Screening Checklists for children aged 0-5 and 6-18. Results from the trauma screening tools indicate that parents and their children aged 6-18 involved with child welfare primarily because of parental substance use have higher rates of trauma exposure than those in a comparison group.
Dellor, E.D., Yoon, S., Bunger, A.C., Himmeger, M., Freisthler, B. (2022). Benchmarking trauma in child welfare: A brief report. Journal of Interpersonal Violence, 37(19-20).
Feasibility of engaging child welfare-involved parents with substance use disorders in research: Key challenges and lessons learned
Parents in Ohio who participated in START were eligible for this study, which used a pre and post-test design to explore the effectiveness of the intervention in positive parenting, parent-child attachment, protective factors within the family, and adaptive child functioning. Evaluators identified two community partner-level challenges – gaining buy-in from child welfare agencies and identifying eligible participants through caseworker collaboration. Six study participant-level challenges were identified – apprehension to participate in research, participants who required multiple contact attempts, incorrect or out-of-service phone numbers, limited data, lack of cell reception or minutes, persistent ‘no shows,’ and participant entry into rehabilitation or legal incarceration. Evaluators identified strategies for each identified challenge.
Yoon, S., Coxe, K., Bunger, A., Freisthler, B., Dellor, E., Langaigne, A., & Millisor, J. (2021). Feasibility of engaging child welfare-involved parents with substance use disorders in research: Key challenges and lessons learned. Journal of Public Child Welfare, 16(4).
The Sobriety Treatment and Recovery Teams program for families with parental substance use: Comparison of child welfare outcomes through 12-months post-intervention
This article highlights the first sustained effects study of START where outcomes were tested from the initial CPS report through 12-months post-intervention. Using propensity score matching, a total of 784 children receiving START services from across four sites were compared to 784 children receiving child welfare treatment as usual (TAU). Outcomes were tested during three intervals: 1) the intervention period; 2) six months post-intervention; and 3) 12-months post-intervention. Results indicated that the primary impact of START was significantly reduced rates of OOHC placement, with results sustained through 12-months post-intervention (accounting for both family clusters and site differences).
Huebner, R. A., Hall, M. T., Walton, M. T., Smead, E., Willauer, T., & Posze, L. (2021). 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.
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
An urgent need exists for child welfare and substance use disorder (SUD) interventions that safely preserve families, engage parents in treatment services, and improve child and parent outcomes. This study is the first to test the effects of START on Black families by comparing child welfare and parent outcomes for 894 children and their 567 primary parents in three groups: 1) Black children served by START; 2) Black children served in treatment as usual (TAU); and 3) White children served in START. Comparisons included placement in state custody and repeat child abuse or neglect (CA/N) during the intervention period, and at 12-months post-intervention. In summary, START is a potent intervention, co-implemented with SUD treatment providers, that kept Black and White children safely with their families through the intervention and at 12-months post-intervention.
Huebner, R.A., Willauer, T., Hall, M. T., Smead, E., Poole, V., Hibbeler, P.G., & Posze, L. (2021). 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.
Sobriety Treatment and Recovery Teams for families with co-occurring substance use and child maltreatment: A randomized controlled trial
This article provides an overview of a randomized controlled trial comparing START to usual child welfare services based on three outcomes: out-of-home care (OOHC) placements, reunification, and subsequent maltreatment. Based on a large sample from Jefferson County, Kentucky, this study showed lower rates of OOHC among START cases compared to usual services, and a higher overall reunification rate compared to the U.S. average despite increased risk factors.
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.
Establishing cross-systems collaborations for implementation: Protocol for longitudinal mixed methods study
Evaluators developed a study protocol using counties in Ohio currently implementing START. The protocol proposes using qualitative and quantitative data measures to examine the collaborative strategies associated with START implementation and service delivery outcomes within each county’s system and organizational context. These data will inform the development of the Collaborating Across Systems for Program Implementation (CAPSI) tool, a decision-making guide that helps identify and use appropriate collaborative strategies.
Bunger, A., Chuang, E., Girth, A., Lancaster, K., Gadel, F., Himmeger, M., Saldana, L., Powell, B., & Aarons, G. (2020). Establishing cross-systems collaborations for implementation: Protocol for a longitudinal mixed methods study. Implementation Science, 15(1).
Peer mentoring services, opportunities, and outcomes for child welfare families with substance use disorders
As use of peer recovery support services in the child welfare setting grows, this article explores the specific services provided by peers as well as the risks, opportunities, and outcomes associated with hiring people in recovery from a substance use disorder. Results of the study include higher rates of parent-child unification when face-to-face visits occur regularly with the peer recovery specialist, and increased career advancement opportunities for individuals in peer roles.
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.
Serving families with child maltreatment and substance use disorders: A decade of learning
The Regional Partnership Grant (RPG) program demonstrated that family-centered strategies can improve child and parent outcomes. This article highlights the lessons from 10 years of implementing and evaluating programs to meet the needs of families affected by parental substance use and child maltreatment. The study highlights five specific, effective, family-centered strategies from START that can be implemented in any jurisdiction. The strategies outlined in the article, when operational, lead to improved parenting capacity, increased parental sobriety, and fewer out-of-home care placements for children.
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.
“Like a marriage:” Partnering with peer mentors in child welfare
A family-centered, team approach in child welfare presents both opportunities and challenges when working with families who have substance use disorders. This article summarizes four key processes that support successful partnership between peer mentors, caseworkers, and supervisors. Findings from this article will support field staff and practitioners in developing strong collaborative teams that integrate peer mentors into child welfare settings.
Sears, J.S., Hall, M.T., Harris, L.M., Mount, S., Willauer, T., Posze, L. & Smead, E. (2017). “Like a marriage:” Partnering with peer mentors in child welfare. Child and Youth Service Review, 74, 80-86.
Medication-assisted treatment improves child permanency outcomes for opioid-using families in the child welfare system
Parents who are involved in the child welfare system and use opioids are less likely to retain custody of their children. This is the first study of its kind to describe Medication-Assisted Treatment (MAT) utilization and child permanency outcomes for parents who use opioids and are involved with the child welfare system in comparison to those families who did not receive MAT services. Outcomes indicate additional months of MAT increased odds of parents retaining custody of their children. Receipt of MAT services did not differ by age, gender, county of residence, or drug use though individuals who identified themselves as White were more likely to participate in MAT services.
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.
Sobriety Treatment and Recovery Teams in rural Appalachia: Implementation and outcomes
This study describes the implementation and outcomes of START in a rural Appalachian county with high rates of poverty, nonmedical prescription drug use, and child maltreatment. Children served in START in the rural Appalachian county were less likely to experience reoccurrence of child abuse and neglect at six months, or re-enter foster care at 12 months.
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(5), 119- 138.
Sobriety Treatment and Recovery Teams: Implementation fidelity and related outcomes
Integrating service delivery strategies is a challenging process. This study examines the first five years of START implementation in Kentucky and describes the process of strengthening moderators of implementation fidelity, trends in adherence to START delivery standards, and trends in parent and child outcomes. Outcomes indicate achieving implementation fidelity to service delivery standards requires a pre-service year and two full years of operation along with persistent leadership. The framework in this study is useful in examining implementation processes, fidelity, and related outcomes.
Huebner, R.A., Posze, L., Willauer, T. & Hall, M.T. (2015). Sobriety Treatment and Recovery Teams: Implementation fidelity and related outcomes. Substance Use & Misuse, 50(10), 1341-1350.
Application of the Evaluation Framework for Program Improvement of START
This study applied the Children’s Bureau program evaluation framework to START, an integrated program between child welfare and substance use treatment providers. A cluster analysis of three subgroups concluded that intact families retained custody throughout treatment and achieved higher rates of sobriety.
Huebner, R.A., Willauer, T., Posze, L., Hall, M.T., & Oliver, J. (2015a). Application of the Evaluation Framework for Program Improvement of START, Journal of Public Child Welfare, 9(1), 42-64.
The impact of Sobriety Treatment and Recovery Teams (START) on family outcomes
START is an integrated model that pairs child protective workers with family mentors to address the complex needs of families affected by parental substance use and child maltreatment. This study examined the effect of START on parental sobriety and rates of child placement. Mothers in START achieved sobriety at 1.8 times the rate of typical treatment; children were placed in state custody at half the rate of treatment as usual. A cost analysis showed that for every dollar spent on implementing START, $2.22 was offset in the cost of foster care.
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.
