Staffing and supports for implementing cross-system interventions with peer mentors

The overdose and substance use disorder epidemic has had devasting
consequences for families since parental substance use disorders put
children at elevated risk of abuse and neglect To address this dual
crisis, 53 Ohio county child welfare agencies are implementing Sobriety
Treatment and Recovery Teams (START), an effective intervention for
improving parents’ access to substance use disorder treatments (including
Medication Assisted Treatment), sobriety, and reunification with their
children. However, 1/3 of Ohio START teams (mostly rural or Appalachian)
stopped serving families because of high turnover among case workers and
family peer mentors. Family peer mentors are peer supporters with lived
substance use disorder recovery and child welfare histories who help
parents navigate across systems, but often leave their position after
feeling unsupported and stigmatized within child welfare agencies.
Supervision coaching has the potential to improve supportive supervision
practices in child welfare agencies, and create healthy work environments
that support staff retention, and continued implementation which is needed
to address the overdose crisis among families. This project will test the
effectiveness of a supervision coaching strategy to promote workforce
stability and START implementation while also creating conditions for
strategy sustainment in Ohio’s child welfare system. This Hybrid Type III
implementation-effectiveness study will test the impact of CrOss System
Technical Assistance for Retaining Staff (COSTARS), a supervision coaching
strategy for child welfare supervisors focused on supportive supervision
practices, destigmatizing substance use disorder, and improving
collaboration between child welfare and substance use disorder treatment
systems. Building on our earlier research and partnerships, the goal of
the R61 phase is to refine and build the COSTARS model.
R61 Aim 1: We will tailor COSTARS to local supervisor,
family peer mentor and caseworker needs by convening a community
workgroup, conducting a supervision needs assessment, and developing a
manual and fidelity measure for COSTARS. R61 Aim 2: Through a
series of in-person and virtual didactic training, coaching, and fidelity
feedback sessions, we will train COSTARS coaches (a peer
coach paired with an expert supervision coach) to competency. The goal of
the R33 phase is to investigate the real-world effects
of COSTARS. Using a stepped wedge cluster-randomized
implementation trial design, COSTARS will be delivered
to 40 Ohio START teams in 4 waves. R33 Aim 1: Drawing on annual survey
data from all staff members, we will examine the effects
of COSTARS on perceptions of their work environment, and
retention. R33 Aim 2: We will analyze program records from 1300 parents
expected to participate in START to examine the effects
of COSTARS on service timeliness, implementation fidelity, and
parental outcomes. The proposed study is significant because we will build
child welfare system capacity to address the opioid epidemic and address
treatment inequities in rural and Appalachian communities, where overdoses
and child maltreatment are especially high. This study is part of the
NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed
scientific solutions to the national opioid public health crisis. The NIH
HEAL Initiative bolsters research across NIH to improve treatment for
opioid misuse and addiction.