The Sobriety Treatment and Recovery Team (START) Project

Martin Hal START

START program and evaluators presented study findings at the 2019 National Child Welfare Evaluation Summit in Washington DC. (Pictured, left to right: Martin T. Hall, Erin Smead, Matthew Walton, & Ruth Huebner)


The Sobriety Treatment and Recovery Team (START) model provides services for families with co-occurring substance use and child maltreatment. START is a child welfare-based program that integrates and collaborates with community-based substance use treatment providers and the courts. START child welfare workers receive specialized training in substance use and motivational interviewing and are paired with a recovery mentor, an individual in long-term recovery from substance use. Program goals include preventing out-of-home care placements and recurrence of maltreatment, as well as improving parental wellness, recovery, and capacity.

Child maltreatment is associated with increased risk of negative outcomes across numerous life domains, including brain development, epigenetic changes, obesity, diabetes, malnutrition, substance use disorder, depression, and suicide attempts. Consequently, the economic costs of child maltreatment for survivors are estimated to be $210,012 higher than non-victims over their lifetime. Substance use and child maltreatment are frequently co-occurring, with approximately one-third of child maltreatment victims in the U.S. having parental substance use as a risk factor. Though child welfare services are mandated to keep families intact whenever possible, substance use is associated with increased odds of out-of-home placements. Once removed, children from families with parental substance use are less likely to be reunified with their parents.

A recent study (N = 1042) of START in five Kentucky countiesfound that 21% of children in families served by START entered out-of-home care within 12 months compared to 34% of children in a propensity score-matched comparison group. Of children placed in out-of-home care and whose cases were closed at the time of data analysis, a higher percentage of children served by START were reunified than children served by usual services (51% vs. 42%).

In addition to the direct benefits for families, we believe that some START values and practices may proliferate throughout the child welfare agency. As one example, the START recovery mentors, who are in long-term recovery themselves, seem to increase the empathy that child welfare workers have for adults with substance use problems. In a qualitative study we did with START teams, one child welfare worker noted, “[The recovery mentor] taught me there is nothing, very little, that separates myself from the people I'm working with... I ask myself then if I'd been raised and walked the same life that these people have lived, would I do any different than what they're doing? If I say I would do different, I think I would be lying. I could go on and on about what I learned from her.”

The START evaluation team at UofL – currently comprised of Amy Brooks, Aimee Kelmel, and me – is guided by an empowerment evaluation approach. This approach is defined by an ongoing partnership between START teams and researchers at all stages of the research process, including hypothesis development, study design and implementation, regular monitoring of program fidelity, and implications of study outcomes. Thus, while we write scientific manuscripts for publication in journals like other research groups, we also meet regularly with START administrators, workers, and substance use treatment providers to assess implementation and outcomes, interpret results, and generate new research questions.  This type of partnership is labor intensive, but the deliberate involvement of front-line workers in all facets of the research process is beneficial for both programmatic and evaluation purposes.

What motivates Hall to continue his work in this program? He says, “As a parent myself, the thought of being forcibly separated from my children is terrifying. So it’s a great honor and privilege to play a small role in keeping families intact and seeing parents reclaim their lives.”


For further information contact:

Associate Professor
303 Patterson Hall
University of Louisville
Louisville, KY 40292
P 502.852.3490