Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Cooperating University

University of Kentucky


Social Work

Degree Program

Social Work, PhD

Committee Chair

Hall, Martin

Committee Co-Chair (if applicable)

Barbee, Anita

Committee Member

Barbee, Anita

Committee Member

Fernandez, Jose

Committee Member

Golder, Seana

Committee Member

Mays, Glen

Author's Keywords

Child Welfare; addiction; healthcare; health economics; sobriety treatment and recovery teams; Kentucky


Child protective services agencies have long observed the complicating role that parental substance use and addiction plays in cases of child maltreatment. Families who struggle with these problems present unique challenges for child welfare professionals. These families are typically more difficult to engage, more likely to have children removed from the home, and have poorer outcomes when compared to other families. These poorer outcomes often include health problems. Addiction has well-known effects on health, and the specific manifestations of these problems for parents have been documented for years in child protection casework. However, what has been less investigated are the ways that these issues correspond to the health of the children involved in these cases. In many instances, children in these homes are severely injured and require acute medical care. These harms commonly result in significant increases in public spending; especially for state Medicaid programs. In Kentucky, the Cabinet for Health and Family Services created special child welfare units called Sobriety Treatment and Recovery Teams (START) to serve families where children have been harmed as a result of their parent’s substance use. Previous research efforts suggest that families who participate in START have more favorable outcomes than comparable families who received standard services. These past efforts have even documented cost savings attributable to the work of START in the form of fewer days spent in out of home care for children. This study aimed to expand on that past research by investigating whether similar costs savings are also being generated in the form of reduced Medicaid spending on the children whose parents received START services.