Content area
Full Text
The Sobriety Treatment and Recovery Teams (START) model is designed for families with co-occurring substance use and child maltreatment. This study describes the implementation and outcomes of START in a rural Appalachian county with high rates of poverty, non-medical prescription drug use, and child maltreatment. Despite a severely limited addiction treatment infrastructure at baseline, children served by START were less likely to experience recurrence of child abuse or neglect within 6 months or re-enter foster care at 12 months compared with a matched control group.
Parental substance use and child maltreatment are complex and interconnected problems. It is estimated that more than one million parents enter treatment for substance use each year (Young, Boles, & Otero, 2007). While many of these parents will not face contact with child protective services (CPS; Scannapieco & Connell-Carrick, 2007; Smith & Testa, 2002; Street, Whitlingum, Gibson, Cairns, & Ellis, 2008), between 40% and 80% of all families referred to CPS include a parent using alcohol or drugs (Young, Gardner, & Dennis, 1998). CPS cases with parental substance use comprise up to 79% of out-of-home-care (OOHC) placements (Besinger, Garland, Litrownik, & Landsverk, 1999), and parental substance use often predicts maltreatment recurrence (Barth, Gibbons, & Guo, 2006; Fuller, Wells, & Cotton, 2001; Wolock, Sherman, Feldman, & Metzger, 2001).
Given these intersecting challenges, partnerships between child welfare and addiction treatment providers are imperative. Some recent progress has been made. Drabble (2007) outlined barriers to cross-system collaborations, and Oliveros and Kaufman (2011) described promising practices for improved addiction treatment with parents involved with CPS. However, more research and development are needed, particularly for areas like rural Appalachia, where program development is often neglected despite continued barriers to treatment utilization and access (Clark et al., 2002). Indeed, the challenges facing rural Appalachia demand innovative responses that may well provide new knowledge and strategies for cross-system collaborations serving families.
Appalachia encompasses 420 counties across 13 states and is home to over 25 million people, 42% of whom live in rural areas, compared to 20% nationally (Appalachian Regional Commission [ARC], 2014). Despite the War on Poverty and other efforts to improve key economic and health indicators, disparities persist in the Central Appalachian subregion, which includes counties within Kentucky, Tennessee, Virginia, and West Virginia. Many Central...