Research & Demonstration Projects

The Strong Start Study (Denver, CO)

At a Glance

Project Name:

The Strong Start Study: Strengthening Young Families Affected by Substance Use through High Fidelity Wraparound 

City & State:

Denver, Colorado (Denver Metro Area) 

Target Population:

Pregnant Women in Substance Use Treatment and Their Infants 

Partnering Organizations:

JFK Partners - University of Colorado Denver School of Medicine

Colorado Department of Human Services (CDHS)

Division of Developmental Disabilities/Early Intervention Colorado (Part C)

Division of Behavioral Health/Women’s Substance Use Disorders Treatment 

Local Evaluator:

JFK Partners - University of Colorado Denver

Project Overview
Download an overview presentation

The QIC-EC Research and Development funding opportunity brought together three, well established organizations within the state of Colorado that share a common interest in the well-being of young children and their families: JFK Partners, Early Intervention Colorado, and the Women’s Substance Use Disorders Program. The purpose of The Strong Start Study: Strengthening Young Families Affected by Substance Use Through High Fidelity Wraparound is to build on this common interest through the development of collaborative interventions with pregnant women in substance use treatment in the Denver Metro Area and their infants. Attention to both physical and emotional birth outcomes and subsequent developmental needs of the child who has been prenatally exposed to alcohol and/or other drugs, will be the focus of maltreatment prevention efforts. The Strong Start Study is grounded in the knowledge that early intervention does make a difference and can be a mediating factor for positive family outcomes.

The Strong Start Study will utilize High Fidelity Wraparound, a promising intervention practice, to deliver a collaborative intervention that will include gender-specific substance use treatment through Special Connections and early intervention services through Part C. The philosophical values of Wraparound, that guide the intervention, reflect respect for family choice, and strengths and resourcefulness in meeting needs. Wraparound’s fundamental aim is to strengthen families by drawing upon family, friends, and community to establish effective systems of natural supports.

Strong Start’s evaluation will assess the impact of the intervention on child and parent outcomes by utilizing an experimental design with random assignment to intervention and comparison groups that. The evaluation will also make use of qualitative techniques to examine relationships between collaborating partners and state policy that impact the families served.

Project Goals
The Strong Start Study will examine the extent to which the collaborative interventions of substance use treatment and Part C services, and the leveraging of family supports facilitated through High Fidelity Wraparound delivered by this project: increases protective factors, decreases risks factors, improves child development, increases families strengths, and decreases the rates of child maltreatment. The study will also seek to answer a number of related research questions, including:

  1. 1. How can Early Intervention services strengthen protective factors in these families?
  2. How can women’s substance use treatment join with Part C for collaborative interventions?
  3. How can High Fidelity Wraparound reduce the risks associated with maternal substance use?
  4. To what extent can High Fidelity Wraparound increase protective factors for these families?

Participating Organizations
Lead Agency:
JFK Partners: University Center of Excellence in Developmental Disabilities (UCEDD). JFK Partners is an interdepartmental, educational, clinical service, research, and dissemination program of the University of Colorado Denver School of Medicine, with primary affiliations with The Children’s Hospital, and the State of Colorado Health Care Program for Children with Special Needs (Title V). JFK Partners was one of the original 12 University Affiliated Facilities funded in 1968 under MCH funding, and in 1970 with funding under the Administration of Developmental Disabilities. In addition to core federal and State of Colorado funding as a UCEDD, JFK Partners receives core funding as a Leadership, Education in Neurodevelopmental Disabilities (LEND) project under the Combating Autism Act.

The goal at JFK Partners is to develop, implement, and disseminate a coordinated group of applied research, demonstration, and training projects directed at meeting the needs of persons with, or at risk of, disabilities and their families. The target population of families in The Strong Start Study fits within the focus of this primary goal of JFK Partners based on the multiple risk factors to development of prenatal substance exposure, including: (a) the neurological risk due to prematurity and low birth weight that has been associated with maternal alcohol and other drug use, and (b) the social and emotional development of infants and young children affected by parental substance use.

Partnering Organizations
Early Intervention Colorado: Part C.
  A key component of the Part C program, which is authorized under the Individuals with Disabilities Education Act (IDEA), is to identify and provide early intervention to infants and toddlers who have developmental delays. Early intervention helps families support and promote their child’s development within their family activities and community life. Colorado’s Early Intervention system offers supports for children birth through two years of age who have special developmental needs by connecting families with early intervention services, such as occupational, speech or physical therapy, to help infants and toddlers grow and develop, and to help families in this process.

Women’s Substance Use Disorders Program: Special Connections. The Alcohol and Drug Abuse Division (ADAD) and the Division of Mental Health, both within the Colorado Department of Human Services, became the Division of Behavioral Health (DBH) in August 2008. The mission of DBH is to ensure culturally competent, comprehensive care that promotes individual, family, and community resiliency and recovery. Within the DBH, the Women’s Substance Use Disorders Program oversees gender-specific treatment, known as Special Connections, through comprehensive services aimed at reducing substance use and associated problems. Treatment staff for Special Connections must have specialized training and experience in women-specific issues and services. Special Connections services are designed to increase women’s access, engagement, and retention in substance use treatment. Comprehensive case management, transportation, and child care may be provided or arranged. Program policies and procedures are premised on the understanding that women’s substance use disorders differ from that of men both in etiology and the treatment and services required for its remediation.

Partner organizations and roles are listed below:

Partner Organization


JFK Partners - University of Colorado Denver

Lead Agency - Local Evaluation 

CDHS/DDD - Early Intervention Colorado

Oversight of Part C Services 

CDHS/DBH - Women’s Treatment Programs

Oversight of Special Connections


Local Evaluation Plan
The evaluation for the proposed study will utilize an experimental design with random assignment to intervention and comparison groups that will assess the impact of High Fidelity Wraparound intervention on child and parent outcomes. Participants for the study will be pregnant women who are in substance abuse treatment. Services to reduce the risk of child maltreatment among this population will make use of quantitative and qualitative techniques.

The evaluation will use outcomes measures based on known protective factors. Variables for data collection include: (a) child developmental status, (b) family strengths, (c) likelihood of child maltreatment, (d) service utilization, (e) intervention fidelity, (f) characteristics of children and mothers, (g) community risk factors, and (h) costs associated with the intervention. Qualitative data from Wraparound documents will be used to identify strengths within the group, trends in needs within certain life domain areas, and particular aspects of parenting related to culturally-based values and expectations. Measuring the fidelity of the intervention to the Wraparound model and the strength of the differences between outcomes in the two conditions will give evidence of the efficacy of this intervention with this population.

Contact Information
M. Kay Teel, Ph.D., LCSW

Principal Investigator
University of Colorado Denver

Steven Rosenberg, Ph.D.
Local Evaluator
University of Colorado Denver

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