Background

Co-occurring parental substance use and child maltreatment has increased in recent years and is associated with poor child welfare outcomes. The Sobriety Treatment and Recovery Teams (START) program was developed to meet the needs of these families.

Objective

A randomized controlled trial was implemented to compare START to usual child welfare services on three outcomes: out-of-home care (OOHC) placements; reunification; and subsequent child maltreatment.

Participants and setting

Families reported to child welfare services in Jefferson County, Kentucky, were eligible if they had a current finding of child maltreatment or services needed, substance use as a primary risk factor, a child under six years of age, and no other open child welfare cases.

Methods

Biased coin randomization was used for a control: treatment randomization ratio of 1:2. Analyses were conducted using intent-to-treat (ITT), though a subsample of families receiving services was also analyzed. Differences were assessed using t-tests, chi-square, and risk ratios.

Results

A total of 348 families including 526 children were randomized to START (n = 346) and usual services (n = 180). There were no significant differences between groups on the three outcomes in the ITT sample or the subsample that received services, though the START OOHC rate was 7 percentage points lower (relative difference: 21.6 %) and the reunification rate was 13 percentage points higher (relative difference: 27.6 %) in the subsample.

Conclusions

Although differences between groups were not significantly different, the relative differences were meaningful and this is the third study showing lower rates of OOHC among START relative to usual services. Additionally, the START reunification rate is higher than the overall U.S. average in spite of notable risk factors.

中文翻译：

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针对同时发生物质使用和儿童虐待的家庭的清醒治疗和恢复团队：一项随机对照试验

背景

近年来，同时发生的父母滥用药物和虐待儿童的情况有所增加，并且与儿童福利状况不佳有关。制定清醒治疗和恢复团队 (START) 计划是为了满足这些家庭的需求。

客观的

实施了一项随机对照试验，将 START 与普通儿童福利服务在三个结果方面进行比较：户外护理 (OOHC) 安置；统一；以及随后的虐待儿童。

参与者和设置

向肯塔基州杰斐逊县儿童福利服务机构报告的家庭，如果目前发现儿童受到虐待或需要服务，药物滥用是主要风险因素，儿童未满 6 岁，并且没有其他公开的儿童福利案例，则有资格.

方法

偏向硬币随机化用于控制：治疗随机化比例为 1:2。使用意向治疗 (ITT) 进行分析，但也分析了接受服务的家庭的子样本。使用 t 检验、卡方和风险比评估差异。

结果

共有 348 个家庭（包括 526 名儿童）被随机分配到 START（n = 346）和常规服务（n = 180）。尽管 START OOHC 率低 7 个百分点（相对差异：21.6 %），而团聚率高 13 个百分点（相对差异：27.6 %) 在子样本中。

结论

尽管各组之间的差异没有显着差异，但相对差异是有意义的，这是第三项显示 START 与常规服务相比 OOHC 发生率较低的研究。此外，尽管存在显着的风险因素，但 START 的统一率仍高于美国的整体平均水平。