Sobriety treatment and recovery teams for families with co-occurring substance use and child maltreatment: A propensity score-matched evaluation

Abstract

Background and ObjectivesThe U.S. has seen increased prevalence of substance use, child maltreatment, and child entry into out-of-home care (OOHC). This study tested whether Sobriety Treatment and Recovery Teams (START) were superior to usual child welfare services with regard to: (1) OOHC placements within 12 months of the index maltreatment event; (2) reunification for children who were placed in out-of-home care; and (3) subsequent maltreatment within 12 months of the index maltreatment event. MethodsAdministrative data from families involved with Child Protective Services in Kentucky between 2010 and 2016 were analyzed. Propensity score matching was used to match the youngest child in families receiving START to children in families receiving usual services (N = 1042). Between-subjects statistical tests were used to estimate treatment effects in the 12 months following initial maltreatment. ResultsChildren in families receiving START were less likely to be placed in OOHC than children in families receiving usual services (20.7% vs. 34.2%; 95% confidence interval (CI) = −17.6%, −9.2%); p < 0.001). Of children who were placed in OOHC, a higher percentage of those receiving START were reunified with their caregivers, though differences were not statistically significant (50.0% vs. 41.6%; 95% CI = −7.1%, 24.0%; p = 0.32). Rates of subsequent maltreatment were higher among children in families receiving START than those in families receiving usual services (12.3% vs. 6.1%; 95% CI = 3.0%, 9.3%; p < 0.001). ConclusionsWith regard to preventing OOHC placements, START outperformed usual services. Of children placed in OOHC, half of those served by START were successfully reunified in spite of notable risk factors. Finally, recurrent maltreatment was higher among children in families receiving START, perhaps due to increased surveillance relative to usual services.