The Role of Medications for Opioid Use Disorder (MOUD) in Child Welfare Outcomes: Evidence from Ohio START Implementation

Background and Purpose: Parental opioid misuse remains a significant driver of child welfare involvement, contributing to increased rates of child maltreatment, family separation, and system burden. Despite growing evidence that medications for opioid use disorder (MOUD) improve treatment retention and reduce opioid-related harm, their uptake in child welfare contexts remains limited. This study examines MOUD utilization within Ohio’s implementation of the Sobriety Treatment and Reducing Trauma (START) model—a specialized intervention pairing caseworkers and family peer mentors to support family recovery. We assess whether MOUD use is associated with improved parent and child outcomes.

Methods: We used administrative data from Ohio START data collection system and the Statewide Automated Child Welfare Information System (SACWIS) for families enrolled in START. Our analytic sample ranged from 127 to 476 parents depending on outcome availability. Multilevel regressions were conducted to account for parents nested within families and adjusted for parent age at case opening, sex, race, and ethnicity. Key outcomes included: (1) case length in days (n=373), (2) percent of time sober during the case (n=280), (3) successful program completion (n=463), (4) whether the focal child experienced out-of-home placement (n=476), and (5) reunification following placement (n=127). MOUD use was the primary independent variable. To adjust for multiple comparisons, Bonferroni correction was applied, setting the threshold for statistical significance at p<0.01.

Results: The average case length was 378.5 days (SD=239.2). Of the 476 parents, 27.5% had a focal child who experienced out-of-home placement. Among the 127 discharged from placements, 52.0% were reunified. MOUD utilization was significantly associated with improved parental outcomes. Parents receiving MOUD spent a greater proportion of the case period sober (b=19.81, SE=4.60, p<0.001) and had more than twice the odds of successful completion (OR=2.35;95% CI [1.11-4.94]). After Bonferroni correction, only the association with increased sobriety remained statistically significant. MOUD use showed no statistically significant association with case length (p=0.26), child out-of-home placement (p=0.83), or reunification among those placed (p=0.65). These findings suggest MOUD supports parental recovery and treatment engagement but may not translate directly to changes in short-term child welfare outcomes.

Conclusions and Implications: Our findings show the value of MOUD as part of a comprehensive response to opioid misuse in families involved in child welfare. While the intervention enhanced parent-level recovery outcomes, additional supports may be needed to influence downstream child outcomes. Future work should examine mechanisms through which MOUD impacts child safety and permanency, and how implementation fidelity or service context shape outcomes. Policy implications include promoting MOUD integration into child welfare planning and increasing provider capacity to deliver medication-assisted treatment within family-serving systems. In practice, these results highlight the importance of interdisciplinary coordination—ensuring families not only access MOUD but also receive sustained behavioral and parenting support to meet child welfare goals.