One way The Duke Endowment explores opportunities to build evidence is through investments in early-stage pilots that develop and test the feasibility of innovative ideas. Organizations that use evaluation and concepts from the field of implementation science when developing innovative programs may increase their likelihood of eventual success. This article shares early observations from one such investment, the Starlight program at Tamassee Hope Village.
Substance use disorder is responsible for up to 80 percent of child welfare interactions[1], yet most residential substance use treatment programs for women with children serve only the women themselves, straining the bond between mother and child. In the small rural community of Tamassee, South Carolina, Tamassee Hope Village (formerly the Tamassee DAR School) is exploring a new way to keep mothers and children together through an innovative program called Starlight. Starlight focuses on providing an integrated therapeutic environment for families that research suggests increases the caregivers’ odds of completing treatment and maintaining care for their children and reducing drug and alcohol consumption.[2]
Tamassee is in the fourth year of implementing the program, testing the feasibility of a three-year residential intervention to deliver targeted family preservation outcomes for mothers in recovery and their children. Early implementation has yielded valuable lessons and adaptations, and early-stage outcomes show promise for family stability.
“We were interested in learning more about how the intensity and breadth of Tamassee’s program might eventually improve trauma symptoms, support sustainable recovery, strengthen parent-child attachment and enhance long-term outcomes for participating families,” said Tamika Williams, director of the Endowment’s Child & Family Well-Being program area. “We feel that Tamassee’s commitment to identifying and adapting its services to community needs and the rigor they applied to creating this program offer the promise of success.”
Tamassee is not a large institution, but it has been innovating to serve its remote mountain community for more than a century. Tamassee DAR School began as a boarding and day school in 1910 to meet the educational needs of the community’s children. When the number of public schools serving this area increased in the 1960s, the site became a group home for children from families in crisis and added an early learning center for local families. In the 2020s, as child welfare models moved away from group homes, Tamassee once again reinvented itself as Tamassee Hope Village and launched the Starlight program in 2022.
Four specific factors make the Starlight program unique, the first three of which are supported by research.[3] First, it is one of the few residential substance use recovery programs in the region that serves mothers and their children. Second, it offers a full spectrum of supports in addition to direct recovery services, including those for health, mental health, education, employment and other aspects of a healthy, stable life. Third, it provides complete on-campus wrap-around services and education for children, so that they can heal alongside their mothers. Fourth, and in response to the experience of residents in an earlier pilot, Tamassee is testing a program duration of three years rather than the typical 180 days offered by many residential recovery programs.
The Starlight program is delivered in four phases. In all four stages, services for children focus on therapy and education, while mothers focus on life skills and spiritual growth. For mothers, Stage I (3 months) offers core introductory programming and time to assess the fit between the program and the family. In Stage II (9 months), mothers focus on counseling, recovery and parenting. Graduation from this intensive therapeutic recovery happens at the end of year one. Stage Ill begins in year two, with a focus on education and job skills, and in Stage IV — which can last through year three — families use Starlight support services to prepare for the transition to independent living.
Tamassee selected the Protective Factors Survey, 2nd Edition (PFS‑2) to measure outcomes for Starlight program participants. PFS‑2 is a psychometrically validated instrument that measures five protective factors for families before, throughout and after the intervention.
Starlight also incorporates two evidence-informed intervention programs into its therapeutic approach: Circle of Security and Love and Logic. Both are woven into parenting groups and one-on-one parent coaching. Various members of the Starlight staff had at least some exposure to, or experience working with, the PFS‑2 and the two interventions, making it faster and easier to implement them with confidence and fidelity.
Two aspects of Tamassee’s Starlight program made it a good fit for the Endowment’s Child & Family Well-Being strategy of developing and testing innovative approaches to preserving family stability. First, Tamassee had a track record of adapting to meet community need. Second, it applied many practices from the field of implementation science to create and launch the program on its campus and to continually tweak and improve it.
As a well-established nonprofit organization, Tamassee had the physical and operational infrastructure in place to deploy the Starlight program, as well as a culture of using data measures and reporting for continuous improvement. This allowed Tamassee to launch a robust program faster than an organization starting from scratch might have.
Tamassee used many of the principles of implementation science in its year of planning and launching Starlight. These included:
Tamassee’s leadership and key staff researched several program models during the development of Starlight and built a strong relationship with Blue Monarch in Monteagle, Tennessee — a 20-year-old, two-year program that has served more than 1,000 women and re-established relationships between more than 370 children and their mothers. Tamassee staff and board visited the Blue Monarch campus four times for peer-to-peer staff shadowing and coaching, as well as policy, procedure and document sharing.
Tamassee staff also visited and learned from other residential recovery programs for mothers and children, including two six-month programs — The Phoenix Center’s Serenity Place in Greenville, S.C., and Miracle Hill Renewal Center in Greenville, S.C. — and another two-year program, Thistle Farms in Nashville, TN.
In planning to implement the Starlight program, Tamassee staff realized that while they had the buildings and infrastructure to house families and provide the necessary meeting and common spaces, they would need additional staff to deliver the program. This meant hiring staff with the expertise and ethos to successfully engage mothers in therapeutic relationships and become trusted resources for them. Tamassee also hired a child life specialist, funded by The Duke Endowment, to conduct individual therapeutic interventions, such as play therapy, with the children in Starlight families, as well as family and group counseling.
While not an exact replication, the Starlight program is modeled closely on the Blue Monarch approach. Observations from Blue Monarch shaped Starlight’s program stages, schedule, staffing, curriculum and models, community guidelines and more. This included creating and deploying standards and processes for recruiting and training staff and providing that staff with ongoing training and support — including regular coaching from Blue Monarch — to fortify staff competency and confidence in working with Starlight mothers and children.
In terms of program design, various members of the Starlight staff had at least some exposure to or experience working with the PFS‑2, Circle of Safety and Love and Logic, making it faster and easier to implement them with confidence and fidelity.
Prior to implementation, Tamassee staff worked with multiple partner organizations in the region to collectively determine the best ways to provide the holistic services necessary to help families move toward independent living, such as adult medical and pediatric visits, pregnancy support, children’s reading programs, nutrition assistance, tobacco cessation, adult education and job training, Starlight now partners with many of those organizations to deliver specialized supportive services. One of the organizations that staff met with during the program model assessment phase, Serenity Place, now serves as a key referral partner for Starlight, along with the S.C. Department of Social Services.
In response to early feedback from moms in treatment and staff, Tamassee made several changes to the Starlight program structure during the second and third years of implementation. Based on participant feedback, one change was to flex families’ time in Stages III and IV of the program. This provided families with the unique services and support they need to transition to fully living on their own.
Another adjustment was to move the “graduation” celebration from the end of year two to the end of the year one recovery phase, creating a milestone that felt more achievable to moms. Although that important milestone is now celebrated earlier, all but one of the moms have stayed or are staying for the full three years. A third adjustment was to create a peer support role for moms in their second or third years, allowing them to serve as “big sisters” to help support first-year moms through the rigorous recovery process.
For those interested in exploring resources to better understand and employ implementation science, we suggest the National Implementation Research Network (NIRN) or The Center for Implementation.
Starlight is still in an early stage and its numbers are small, but preliminary outcomes are encouraging for the program’s feasibility.
Starlight began in 2022 with seven participating families. To date, the program has served a total of 26 mothers and 39 children. Target outcomes are a 50% increase across the five protective factors measured through PFS‑2 assessments from intake to graduation. Preliminary results among seven graduating families show overall gains in protective factors; however, performance varied significantly by domain, signaling an opportunity for deeper exploration that has fueled staff conversations about how to improve program delivery.
In addition — and of utmost importance — four mothers have regained custody of their children from the S.C. Department of Social Services and two others are in the process of reunification.
After four years of experience with Starlight, Tamassee is now focused on honing their learning to adapt and modify their approach. Funds are in place to renovate two more cottages, and plans include increasing staff to serve up to 20 moms at a time. This expansion will provide Tamassee with a larger population for data-gathering, allowing them to further refine their approach to improve PFS‑2 outcomes while helping more families. Ideally, this will provide more clarity about the program’s effects and the most relevant measurements for continuous quality improvement over time.
“The factors contributing to family instability are complex and intertwined. So are the solutions that result in long-term family unity and stability,” said Williams. “Tamassee is trying something very new, which always takes a great deal of thought, preparation and practice. As they apply more rigor and gather more evidence, they will continue to hone and strengthen the Starlight program, queuing it up for deeper evaluation to prove the efficacy of this approach. We look forward to following their progress and learning alongside them to inform other efforts the Endowment undertakes throughout the Carolinas.”
Neo, S.H.F., Norton, S., Kavallari, D. et al. Integrated Treatment Programmes for Mothers with Substance Use Problems: A Systematic Review and Meta-analysis of Interventions to Prevent Out-of-home Child Placements. J Child Fam Stud 30, 2877–2889 (2021). https://doi.org/10.1007/s10826... ↑
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