Ohio’s Sobriety, Treatment, and Reducing Trauma (Ohio START) intervention is the state’s response, currently in pilot testing, to the opioid epidemic that is sweeping the nation and has hit Ohio especially hard. The impact of this opioid epidemic on children has been significant: since 2010, there has been a 21% increase in the number of children in out-of-home care. The length of time that children stay in care has also increased by 19%, due in large part to opiate recovery timelines and relapses. The program is designed to keep children of parents with substance use disorders safely in their own homes or to reunify in a timely manner.

And while the trauma that children experience as a direct result of their parents’ opioid abuse is less quantifiable, it is no less real: children in Ohio witness their parents incapacitated, incarcerated, and sometimes even dying. Children who are removed from their parents may be physically safe, but emotionally they have been traumatized by the separation.

What is Ohio START?

Ohio START is an intensive service that emphasizes the child, yet focuses on the whole family. It was launched in April 2017 by Attorney General Mike DeWine, who has been a statewide leader in advocating for increased attention and resources to support children and families affected by the opioid crisis. Funded by a multimillion-dollar grant from the Victims of Crime Act (VOCA), the Ohio START pilot implementation targets the southern region of Ohio, the area of the state most affected by the opioid crisis. Casey Family Programs, which partnered with the Ohio Attorney General’s Office to adapt this program, is providing additional funds for the pilot program.  Both grants are being administered by the Public Children Services Association of Ohio.

Since Ohio has a state-supervised, county-administered child welfare system, Ohio START requires a strong partnership between child welfare and behavioral health at both the state and county levels. All of the counties participating in Ohio START have entered into Memoranda of Understanding (MOU) with their behavioral health partners to ensure that participating families can enter treatment immediately rather than being put on waiting lists. The program also encourages county child welfare agencies to partner with their local courts and community providers. The Attorney General’s Office is supporting these partnerships by providing draft MOUs and release forms that county agencies can use with their partners, so that they can better support families by sharing information.

How does Ohio START work?

The Ohio START pilot was built on the foundation established by the START (Sobriety, Treatment, and Recovery Teams) model in Ohio’s Cuyahoga County and in Kentucky, but with an additional focus on reducing the impact of trauma on children.

When a referral alleging parental substance use is made to a county child welfare agency participating in the pilot:

• The START team, which consists of a caseworker and a peer mentor, goes to the family home. The peer mentor is an employee, usually with the behavioral health agency, who has lived experience with substance abuse and/or the child welfare system. The caseworker is a child welfare staff member who has received specialized training on the START model, the UNCOPE substance abuse screening tool, and a child trauma screening tool.
• In addition to performing the traditional safety/risk assessment, the START caseworker screens for parental substance abuse.
  • If a parent’s UNCOPE score is indicative of substance abuse, the parent is offered the option of participating in Ohio START and entering treatment immediately.
• The START caseworker also administers a child trauma screening during the initial investigation.
  • Children whose screening score is indicative of trauma are referred to appropriate mental health services.
• If a family chooses to participate in Ohio START, a Family Team Meeting (FTM) is held, which includes the family, peer mentor, START caseworker, and other family supports. FTMs are subsequently held every six months or any time there is a crisis, relapse, or change in the case plan.
• The START team visits the family at least once a week; peer mentors often visit more frequently and also support families with transportation to services. Peer mentors are a key component of the model, as they offer hope to parents that recovery is possible. They also help families navigate the complexities of the child welfare and behavioral health/treatment systems.

How will we know if Ohio START is effective?

The assessment-related goal of the Ohio START pilot is to demonstrate that, with the right services and supports in place: (1) children can safely stay at home with their parents; and (2) children that are placed in out-of-home care can return home more quickly. The effects of Ohio START and its outcomes related to these goals will be the subject of an independent evaluation.