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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.imPliCations For PraCtiCe • With adequate supports and timely access to treatment, many children can stay safely with their substance-abusing parents through treatment; keeping families together then promotes parent/child attachment and development of parental capability.• Parents can achieve higher rates of sobriety than is often reported when more potent intervention models are implemented through child welfare.

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 paradigm. Over four years of service delivery, the time from the child protective services report to completion of five drug treatment sessions was reduced by an average of 75 days. This trend was associated with an increase in parent retention, parental sobriety, and parent retention of child custody. Conclusions/Importance: Understanding the implementation processes necessary to establish complex integrated programs may support realistic allocation of resources. Although implementation fidelity is a moderator of program outcome, complex inter-agency interventions may benefit from innovative measures of fidelity that promote improvement without extensive cost and data collection burden. The implementation framework applied in this study was useful in examining implementation processes, fidelity, and related outcomes.

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