Sobriety Treatment and Recovery Teams: Implementation Fidelity and Related Outcomes

Abstract

Background: Although integrated programs between child welfare and substance abuse treatment are recommended for families with co-occurring child maltreatment and substance use disorders, implementing integrated service delivery strategies with fidelity is a challenging process. Objective: This study of the first five years of the Sobriety Treatment and Recovery Team (START) program examines implementation fidelity using a model proposed by Carroll et al. (2007). The study describes the process of strengthening moderators of implementation fidelity, trends in adherence to START service delivery standards, and trends in parent and child outcomes. Methods: Qualitative and quantitative measures were used to prospectively study three START sites serving 341 families with 550 parents and 717 children. Results: To achieve implementation fidelity to service delivery standards required a pre-service year and two full years of operation, persistent leadership, and facilitative actions that challenged the existing paradigm. Over four years of service delivery, the time from the child protective services report to completion of five drug treatment sessions was reduced by an average of 75 days. This trend was associated with an increase in parent retention, parental sobriety, and parent retention of child custody. Conclusions/Importance: Understanding the implementation processes necessary to establish complex integrated programs may support realistic allocation of resources. Although implementation fidelity is a moderator of program outcome, complex inter-agency interventions may benefit from innovative measures of fidelity that promote improvement without extensive cost and data collection burden. The implementation framework applied in this study was useful in examining implementation processes, fidelity, and related outcomes.

Keywords:

• father substance abuse
• mother substance abuse
• child abuse and neglect
• treatment implementation
• access to treatment
• inter-agency collaboration

THE AUTHORS

Ruth A. Huebner holds a PhD in Psychology from the University of Wisconsin. Her entire career was devoted to work with children and families in several roles from clinical practice to research. As a former child welfare researcher in Kentucky's child welfare agency, she led the CQI system and was instrumental in developing the state's capacity as a learning organization. She recently retired as a full professor from Eastern Kentucky University and a doctoral faculty from the University of Kentucky. She has conducted numerous program evaluation efforts for Kentucky and on federal grants and has more than 40 peer-reviewed publications, book chapters, and one edited book on autism. Currently she is an independent consultant in child welfare

Lynn Posze, MA, LPCC, is the START assistant director for Behavioral Health at the Kentucky Department for Community Based Services. She manages projects serving families with co-occurring child maltreatment and substance use disorders and provides technical assistance to improve quality and outcomes. Her clinical experience was in publicly funded behavioral health, where she provided integrated mental health and substance use disorder services to both adults and adolescents. She is a frequent presenter on topics such as women and addiction, trauma-informed care, and process improvement

Tina M. Willauer is the director of the Kentucky Sobriety Treatment and Recovery Teams (START) program at the Department for Community Based Services (DCBS). In this role, she oversees the development, implementation, and administration of START and serves as a resource and consultant, providing technical assistance for matters of child protective services, substance abuse, and program administration. Ms. Willauer obtained her Master's Degree in Public Administration from Cleveland State University and Bachelor's Degree in Criminal Justice from Bowling Green State University. She was instrumental in developing, implementing, managing, and leading the nationally recognized START program in Cleveland, Ohio. She has devoted her career to serving children and families and brings a unique perspective based on 24 years of experience in the child welfare field. She has served as a front line social worker, supervisor, senior manager, and consultant within the public child welfare system, with a focus on child maltreatment and substance use disorders. Ms. Willauer presents and trains both locally and nationally on the START model, program development and implementation, substance use disorders, recovery, and other child welfare topics

Dr. Martin T. Hall is an assistant professor in the Kent School of Social Work at the University of Louisville. He serves as the current evaluator for the Sobriety Treatment and Recovery Team (START) program in Kentucky. In addition, he has had a longstanding interest in the epidemiology of non-medical prescription drug use, particularly in understudied populations (e.g., rural Appalachians; institutionalized youth). His work has demonstrated that psychological distress and health status may underlie some forms of prescription drug misuse

GLOSSARY

• Child abuse and neglect (CAN): Substantiated allegation that a child has been abused, including physical, sexual, or emotional abuse, or neglected, including neglect of basic needs, medical neglect, educational neglect, or lack of supervision. Allegations of CAN are investigated by social service workers and, in this state, identified as substantiated when the preponderance of the evidence supports the allegation and/or additional findings of abuse and/or neglect.

• Child protective service (CPS) report: Documentation of an allegation of CAN received by the agency from an internal reporting source, such as a social worker, or an external reporting source, such as medical or school personnel.

• Implementation fidelity: The degree to which interventions are delivered as originally designed or stated in the program description. Measured as the amount of adherence to the stated or essential program strategies, including serving the target audience with the frequency and duration of services intended.

• Implementation moderators: Processes that support fidelity and include aligning agency policies to fit the intervention, facilitation strategies, including monitoring and staff capacity building, delivering the expected quality of service, and promoting participant responsiveness. Intervention complexity is also considered as a moderator of implementation fidelity.

• Outcomes: The measured result(s) that follow the intervention.