The opioid crisis in the United States has come about because of excessive use of these drugs for both legal and illicit purposes and unprecedented levels of consequent opioid use disorder (OUD). More than 2 million people in the United States are estimated to have OUD, which is caused by prolonged use of prescription opioids, heroin, or other illicit opioids. OUD is a life-threatening condition associated with a 20-fold greater risk of early death due to overdose, infectious diseases, trauma, and suicide. Mortality related to OUD continues to escalate as this public health crisis gathers momentum across the country, with opioid overdoses killing more than 47,000 people in 2017 in the United States. Efforts to date have made no real headway in stemming this crisis, in large part because tools that already exist—like evidence-based medications—are not being deployed to maximum impact. To support the dissemination of accurate patient-focused information about treatments for addiction, and to help provide scientific solutions to the current opioid crisis, this report studies the evidence base on medication assisted treatment (MAT) for OUD. It examines available evidence on the range of parameters and circumstances in which MAT can be effectively delivered and identifies additional research needed.

Medications for Opioid Use Disorder Save Lives

Maternal substance use and child protection: a rapid evidence assessment of factors associated with loss of child care

https://files.eric.ed.gov/fulltext/ED590169.pdf

Why Rural Matters 2015-2016: Understanding the Changing Landscape. A Report of the Rural School and Community Trust.

The role of substance use in child welfare caseloads

On the Rating Scale

Medication-Assisted Treatment Improves Child Permanency Outcomes for Opioid-Using Families in the Child Welfare System.

Families with child maltreatment and parental substance use disorders are a growing population with complex needs. The Sobriety Treatment and Recovery Teams (START) is an integrated model that pairs child protective service workers with family mentors and partners with treatment providers. This is a prospective naturalistic evaluation comparing rates of adult sobriety and child placement in state custody using provider-collected data merged with state administrative data sets. All families in the served and comparison groups had equal risks to child safety. Mothers achieved sobriety at 1.8 times the rate of typical treatment; children were placed in state custody at half the rate expected. These results support START as an effective integrated program.

The Impact of Sobriety Treatment and Recovery Teams (START) on Family Outcomes

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.

Sobriety Treatment and Recovery Teams in Rural Appalachia: Implementation and Outcomes

An increase in parental substance use disorders (SUD) and the number of infants and toddlers entering foster care has prompted federal and state efforts to change the treatment paradigm toward more integrated and family-centered strategies. The Regional Partnership Grant (RPG) program demonstrated that family-centered strategies can improve child and parent outcomes. The current challenge is to bring effective strategies to scale. This conceptual article highlights the lessons learned from 10 years of implementing and evaluating programs to meet the needs of families affected by parental SUD and child maltreatment. Effective family-centered strategies identified by the RPG program are illustrated with specifics from the Sobriety Treatment and Recovery Team program. These effective strategies could be implemented in any jurisdiction and include (1) collaboration toward integrated services between child welfare and SUD treatment, (2) timely access to SUDS treatment, (3) recovery management and suppo...

Serving families with child maltreatment and substance use disorders: A decade of learning

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 ...

Lynn Posze

Papers

Medication-Assisted Treatment Improves Child Permanency Outcomes for Opioid-Using Families in the Child Welfare System.

The Impact of Sobriety Treatment and Recovery Teams (START) on Family Outcomes

Sobriety Treatment and Recovery Teams in Rural Appalachia: Implementation and Outcomes

Serving families with child maltreatment and substance use disorders: A decade of learning

Sobriety Treatment and Recovery Teams: Implementation Fidelity and Related Outcomes.