Reducing parental substance use, improving child health outcomes, and enhancing family resilience among rural families through Ohio START (Sobriety, Treatment, and Reducing Trauma)

/ ABSTRACT Co-occurring parental substance use disorder and child maltreatment are key risk factors associated with health inequities and disparities among children and families in rural areas. Importantly, rural communities face geographic, economic, and social barriers that limit their access to high-quality healthcare resources and services, exacerbating health disparities. Ohio Sobriety, Treatment, and Reducing Trauma (Ohio START) is a family-centered child welfare service delivery intervention that builds on cross-system collaboration with behavioral health service organizations to provide timely access to behavioral health services for families involved with the child welfare system. Ohio START also supports parents’ journey to recovery through peer mentors with lived experience in substance use recovery and previous child welfare involvement. Ohio START, while promising, has not been rigorously studied to determine how it modifies parents’ spatial and social environments to reduce parental substance use and improve child health outcomes in rural communities. It is also unclear how parents experiencing economic disadvantage change their spatial and social environments in rural communities where there are fewer service resources. These are important questions that, if answered, could enhance interventions to better serve socioeconomically disadvantaged families in rural communities. Capitalizing on unique opportunity to leverage the ongoing Ohio START initiative and access child welfare– involved families in rural areas, we seek to collect novel, longitudinal activity space and social networks data from 400 families engaging in Ohio START. The study has three specific aims: (1) To determine whether the proximity and availability of behavioral health providers in child welfare workers’ referral networks from parental activity spaces predicts intermediate and long-term family health outcomes. (2) To examine how Ohio START family peer mentoring services affect attributes of parental activity spaces and social networks and family resilience over time, and how these changes are associated with long-term family health outcomes. (3) To test whether rurality moderates the effects of activity spaces, behavioral health services referral networks, and social networks on intermediate and long-term family health outcomes. The study aims directly address one of the NICHD’s research priorities “Understanding Social Determinants of Health and Developmentally Informed Strategies to Mitigate Health Disparities.” The proposed project will produce valuable knowledge that can be used to modify START and other family-level intervention efforts to mitigate risks and maximize protection in parents’ spatial and social networks to enhance family resilience, prevent child maltreatment, and promote child well-being in socioeconomically disadvantaged rural communities. Project Number: 1R01HD119145-01 | Fiscal Year: 2025 | NIH Institute/Center: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) | Principal Investigator: Susan Yoon | Institution: OHIO STATE UNIVERSITY, Columbus, OH | Award Amount: $671,486 | Activity Code: R01 | Study Section: Psychosocial Development, Risk and Prevention Study Section[PDRP] View on NIH RePORTER: https://reporter.nih.gov/project-details/1R01HD11914501