This Kentucky program actually has its roots in neighboring Ohio, where the Sobriety Treatment and Recovery Team (START) began in Cleveland during the depths of the 1990s cocaine epidemic.
“We eventually began seeing the opioid epidemic’s effects here,” says Erin Smead, program director. “So in 2006, people banded together and formed Kentucky START.”
Currently operating in seven counties around the Commonwealth, START is a child welfare-based model for families with young children, co-occurring substance misuse, and child maltreatment. It partners with child welfare and behavioral health workers to pair a social worker with a family member.“START gets involved quickly when we are notified of a problem,” Smead says. “From the time a case is assigned, it moves on a rapid timeline.”
The team meets the family and shares in decision making. The first priority is making sure the child is safe. Services are coordinated with a local behavioral health agency. A full holistic assessment of the parents (substance misuse, mental health, and trauma) is conducted within 48 hours, to get them treatment services quickly.
Family mentors play a significant role in early engagement. “We also utilize peer support, where an individual in long-term recovery, who’s had their own experiences, can walk them through the process,” Smead adds. “We pick up the parents and drive them to the facility for their treatment session. So much positive engagement happens during that car ride.”
START assists in making safety plans to keep the child in the home while the parents are moving through the recovery process. “We want to build on protective factors for the family, such as having a sober caregiver as part of the plan. We want to provide services to the entire family.”
Cases are open for 14 months on average. Sometimes courts are involved.
The program has proven to be very effective at improving outcomes for mothers. “Sobriety” in the START context is defined as abstinence from alcohol and other drugs as indicated by staff observation and drug test results, as well as advancement in substance use treatment; engaging in community-based recovery supports; and improving parental capacity to care for children. Mothers who participated in START achieved sobriety at nearly twice the rate of mothers treated without START (66 percent and 37 percent, respectively). The program has also proven to be effective at keeping children at home. Children in families served by START were half as likely to be placed in state custody as compared with children in a matched control group (21 percent and 42 percent, respectively). This outcome also results in cost effectiveness—for every $1.00 spent on START, Kentucky avoided spending $2.22 on foster care.
Time is of the essence in handling each case. “When you look at the number of families coming into child welfare with a risk factor of substance misuse, speed matters,” Smead says in conclusion. “The younger the child, the higher the risk factor. There are clocks that are ticking. It’s essential to capture the family during the crisis period in order to get the best possible outcome.”
Which is exactly the quick and effective re-START a family struggling with addiction needs.
Kentucky START was featured in Addiction Policy Forum's 2019 Innovation Now Initiative.