Best Practices in the Treatment of Substance-Abusing Women in the Child Welfare System

ABSTRACT

This paper reviews the literature on women's chemical dependency and its effects on their children. Many risk factors (e.g., a history of traumatic exposure) and consequences (interference with parenting) of substance abuse are unique for women, giving rise to special treatment needs of substance-abusing women with children. Substance-abusing mothers also experience unique barriers to receiving the services they need to recover, such as absence of child care and lack of gender-specific treatment in their communities. Model programs are described and recommendations are offered for best treatment practices for women with chemical dependency who present in the child welfare system.     

Characteristics of Sexually Abused Children and Their Nonoffending Mothers Followed by Child Welfare Services: The Role of a Maternal History of Child Sexual Abuse

Considering the importance of mother’s support in the adaptation of a sexually abused child, it is relevant to determine if the mothers and children involved in an intergenerational cycle of child sexual victimization differ from dyads in which only the child has been abused. The purpose of this study was to compare mother–child dyads with sexually abused children according to whether the mother had herself been victim of child sexual abuse. The sample included 87 dyads with sexually abused children aged 3–18 years old and their mothers (44 reporting maternal and child abuse), followed by social welfare services of the province of Quebec (Canada). The two groups of mothers were compared on their past family abuse experiences and past family relations, their mental health history, their current psychological distress, their parenting behaviors, and their current levels of family functioning. Children were compared on their adaptation. Multivariate analyses indicated that mothers reporting child sexual abuse were more likely to report more other maltreatments in their childhood and greater prevalence of lifetime history of alcohol abuse disorders, dysthymia, and panic disorder compared with mothers who had not experienced CSA. Compared to children whose mothers had not experienced CSA, those whose mothers had experienced CSA showed higher rates of problems behaviors and were more likely to report having been sexually abused by a trusted person. These results highlight the specific clinical needs for the assessment and treatment for sexually abused children whose mothers experienced child sexual abuse.     

Psychiatric,Family, and Ethnicity-Related Factors That Can Impact Treatment Utilization Among Hispanic Substance Abusing Adolescents

SUMMARY

There is great significance to improving our understanding of predictors of treatment utilization among Hispanic substance abusing youth. One hundred and ten Hispanic substance abusing adolescents and their parents participated in a study of treatment utilization. Analyses showed that adolescents with lower numbers of externalizing disorders (χ² = 4.18, df = 1, p < .05) and parents with better parenting strategies (χ² = 8.73, df = 2, p < .05), predicted overall treatment utilization (residential + outpatient). Better parenting practices and higher parental years in the U.S. predicted more utilization of outpatient services and lower parenting stress predicted more utilization of residential services. Without specialized engagement strategies, adolescents and families most in need may be the least likely to engage in recommended treatment.     

Mothers’ Parenting Stress and Engagement: Mediating Role of Parental Competence

ABSTRACT

Guided by role-strain theory and the spillover hypothesis, this study used data (n = 2,637) from the Fragile Families and Child Wellbeing Study to examine the link between mothers’ parenting stress, perceived parental competence, and parental engagement when the child was age 1, 3, and 5, respectively. Analyses were based on a multiple-sample path analysis that tested direct and indirect effects for mothers of biologically intact and nonintact families. Mothers who reported higher levels of parenting stress at child age 1 experienced lower levels of perceived parental competence at child age 3. Higher levels of perceived parental competence at child age 3 predicted increased mother–child engagement levels at child age 5. Test of indirect effects confirmed that perceived parental competence mediated the relationship between parenting stress and parental engagement for mothers of intact and nonintact families. Implications are discussed.     

Pregnant and Postpartum Adolescents' Perceptions of the Consequences of Child Abuse

A study of 263 pregnant and postpartum indigent and minority teens was conducted in order to examine their perceptions of the consequences of child abuse and their own child abuse history. Teens identified drug and alcohol abuse and teen suicide as the most serious consequences of abuse. Interestingly, they did not identify pregnancy as a consequence. Twenty-seven percent reported a history of abuse. Identifying behavioral and emotional consequences of abuse is important because it affects both the well-being of the adolescent mother and her child. An experience of abuse and its behavioral consequences may interfere with a teen's ability to benefit from parenting intervention programs. Therefore, parenting programs may wish to consider the necessity of screening for a history of abuse as well as adding components on behavioral problems adolescent mothers are concerned about. Additionally, there is a need to reach out to pregnant, parenting and future parents in other settings such as prisons, psychiatric, and residential centers, since issues of abuse may coexist with other behaviors.     

Engagement in Child Protective Services: The Role of Substance Abuse,Intimate Partner Violence and Race

Effectively engaging parents has been a continuing challenge for child protection workers. A lack of engagement can lead to significant negative consequences for families. This preliminary study explored the ability of family factors (e.g.; legal involvement, history with child protective services, substance abuse, child placement, intimate partner violence, identifying as Black, Latino or biracial) to predict parent engagement with child welfare services. A four dimensional measure of engagement with child protective services (Yatchmenoff, Res Soc Work Pract 15(2):84–96, 2005) was used which included receptivity, buy-in, working relationship and mistrust. The variables of parental substance abuse, intimate partner violence and identifying as Black, Latino or biracial were significant predictors of all four dimensions of engagement although each dimension was predicted by a unique combination of these factors. Substance abuse positively predicted engagement while intimate partner violence and identifying as Black, Latino or biracial negatively predicted engagement. The implications of these findings for child protection practice are described. Recommendations are made for future research.     

Toward Father‐friendly Parenting Interventions: A Qualitative Study

Levels of father participation in parenting interventions are often very low, yet little is known about the factors which influence father engagement. We aimed to qualitatively explore perceived barriers to, and preferences for, parenting interventions in a community sample of fathers. Forty‐one fathers across nine focus groups were interviewed using a semi‐structured interview. Data were analysed using inductive thematic analysis. Key barriers to father participation identified included: the perception that interventions are mother‐focused; beliefs about gender roles regarding parenting and help‐seeking; mothers’ role as ‘gatekeeper’; lack of knowledge and awareness of parenting interventions; and lack of relevance of interventions. Fathers reported preferences for specific content and intervention features, facilitator characteristics, practical factors, and highlighted the need for father‐targeted recruitment and advertising. Many of the barriers and preferences identified are consistent with previous research; however, fathers’ beliefs and attitudes around gender roles and help‐seeking, as well as the perception that interventions are predominantly mother‐focused, may be key barriers for community fathers. Strategies to overcome these barriers and better meet the needs of fathers in promoting and delivering parenting interventions are discussed.     

The Association of Maternal Depressive Symptoms with Child Externalizing Problems: The Role of Maternal Support Following Child Sexual Abuse

This study examines the role of abuse-specific maternal support in the association between parent depressive symptoms and child externalizing problems in a sample of children with a history of sexual abuse. In total, 106 mother–child dyads were studied. The association between maternal depressive symptoms and child delinquency behaviors was found to partially operate through abuse-specific maternal support, which was assessed via parent report. Implications of the findings for parenting programs are discussed, and future research directions are considered.     

Early Adolescents' Perceptions of Mothers' and Fathers' Parenting Styles and Problem Behavior

We investigated early adolescents' perceptions of parenting styles in mother–father–adolescent triads along with child self-reported problem behaviors (substance abuse and delinquency). We also examined the various combinations of mothers' and fathers' parenting styles by child gender in relation to problem behavior. Participants included 3,353 children (aged 12 to 14) from the National Longitudinal Survey of Youth—97. Results from our structural equation model indicated that mothers and fathers may use different parenting strategies and that permissive parenting may not be as detrimental as previously assumed. In addition, youth perceptions of each parent were equally important in explaining problem behavior among both daughters and sons, but the perception of an authoritarian mother showed stronger adverse effects on sons, even after controlling for poverty and peer influence.     

Child Sexual Abuse Intervention: An Exploratory Study of Policy Concerns and Implications for Program Development

ABSTRACT

This exploratory study was designed to determine public opinion regarding intervention options for intrafamilial child sexual abuse offenders, victims, and families. The study investigated the public's willingness to support strategies of victim protection, offender control, and treatment services in various types of child sexual abuse intervention strategies. The respondents to the statewide survey generally supported established, adversarial intervention strategies, and had mixed reactions lo several of the diversion program strategies. The findings suggest that policy makers may have to compromise lo obtain public support when designing and implementing intervention programs for intrafamilial child sexual abuse. The article addresses policy issues and concludes with implications for program development.     

Establishing a Parenting Program for Fathers in Substance Abuse Treatment

This paper describes a systemic, trauma and attachment model for a parenting program for fathers in residential substance abuse treatment. It emphasises the complex nature of delivering parenting programs in this context and the importance of going beyond simple linear principles of reward and punishment, upon which many other parenting programs are predicated.     

The Role of Technology in Mediating Use of Outpatient Substance Abuse Treatment Services

ABSTRACT

This study examined the relationship between Connect, a telephone-based information and support system, and the use of outpatient substance abuse treatment services. Regression models were formulated to examine the relationship between use of substance abuse treatment services and Connect. The results indicate that Connect use was not significantly related to the likelihood of using treatment (N = 240). However, an inverse relationship was found between Connect and use of treatment services (n = 123). The findings raise the conceptual issue of whether one introduces technology as an “add-on” to or as a “substitute for” traditional substance abuse treatment services.     

Program variation in treatment outcomes among women in residential drug treatment

Multilevel modeling was used to assess the program characteristics associated with treatment retention among 637 women in 16 residential drug treatment programs in the Drug Abuse Treatment Outcome Study. Women who were pregnant or had dependent children had higher rates of retention in programs in which there were higher percentages of other such women. Longer retention was associated with higher rates of posttreatment abstinence. Bivariate analyses showed that programs with higher proportions of pregnant and parenting women provided more services related to women's needs. The findings support the provision of specialized services and programs for women in order to improve outcomes of drug abuse treatment.     

Culturally Competent Substance Abuse Treatment for Asian/Pacific Islander Women

Summary

In response to the urgent need for substance abuse treatment among pregnant and postpartum Asian/Pacific Islander (A/PI) women, heath care and social service providers in a rural community of Hawaii established a culturally based, women-centered residential treatment program. The program was designed to address barriers that often prevent A/PI women from engaging and completing treatment. Treatment included Hawaiian healing practices or deep cultural therapy, provision for newborns to live with their mothers, infant health-care services, parent education, and infant-mother bonding guided by kupu-na (elders) of the community.

Analysis of twenty-one in-depth interviews revealed factors that A/ PI women participants found vital to their treatment process: having their children with them in a non-punitive, mutually respectful treatment milieu; working with consistent, competent residential staff and culturally-sensitive interdisciplinary professionals; and involvement in a range of substance abuse interventions, including cultural healing practices.

Findings underscore the importance of learning about and affirming women's lived-experiences and cultural contexts in the development of culturally competent practice models, interventions, research procedures, and policies that focus on the complex needs of chemically dependent pregnant and parenting women (Brindis & Theidon, 1997).     

Depression and Parenting by Nonoffending Mothers of Children Who Experienced Sexual Abuse

Parenting may be one mechanism by which depression in nonoffending mothers impacts child emotional and behavioral adjustment after sexual abuse. This study examined the relationship between self-reported maternal depression and parenting behaviors by nonoffending mothers of children who experienced sexual abuse. The participants were 204 nonoffending biological mother–child pairs recruited from a clinic providing services for children who experienced sexual abuse. The mothers completed pretreatment self-report measures of demographic information, depression, and parenting behaviors. Children (7 to 17 years) completed a measure of mothers’ parenting behaviors. Mothers with clinically high levels of self-reported depression employed more inconsistent parenting behavior and provided poorer monitoring/supervision of their children than mothers without clinically high levels of self-reported depression. Implications for clinical practice and future research are discussed.     

The Voice of the Child in Parenting Coordination: Views of Children,Parents, and Parenting Coordinators

This article examines the views of children, parents, and parenting coordinators (PCs) on child inclusion in the parenting coordination process. Participants in a parenting coordination pilot project in Montréal, Quebec—10 children (ranging in age from 8–17 years old), 14 parents, and 2 PCs—were interviewed at the end of the project. The goal was to understand their perceptions of child participation in parenting coordination interventions. Overall, a vast majority of children and parents agreed that children should be given a forum in parenting coordination and their voices heard. Feedback from PCs on their child inclusion experience also provided rare insight into this practice. Results confirm the importance for children of being heard in postseparation interventions, even when parental conflict is high. These findings add to the growing literature on the participation of children in postseparation interventions.     

Better practices in parent engagement: lessons from the USA and England

This paper undertakes an international comparison of parent engagement in the USA and England. Research from both countries is reviewed to establish the extent to which parent engagement is achieving the benefit of an improved fit between need and services and what, if any, differences exist between the experiences of parents in the USA and England. Despite some unique differences, research from both countries identifies similar experiences among parents. Those studies indicate that parent engagement is not yet contributing to the provision of services that are more timely, appropriate, or adequate in meeting parent need. The barriers to achieving a better fit between needs and services are explored and system-wide issues that limit the effectiveness of engagement with parents are discussed. The paper presents the Munro Review of Child Protection in England as a catalyst for change in improving the child welfare system's approach to parent engagement and establishing a better fit between needs and services. Consideration of the applicability of the Munro Review findings to the USA child welfare system or replication of such a review is proposed.     

Maternal substance abuse and disrupted parenting: Distinguishing mothers who keep their children from those who do not

Women with substance abuse disorders typically have psychosocial characteristics that put them at risk for disrupted parenting. Prior research indicates that comprehensive, accessible services tailored to the mothers' needs can contribute to family stability. This study further explores the complicated interplay of how maternal risk and protective characteristics and service elements are associated with reunification. The study contributes to existing literature by following mothers for three years; examining service needs as identified by the mother herself; using a summary proportion score to reflect the totality of services received to matched service needs identified; and using logistic regression to examine interactions of services received with critical maternal characteristics. The sample is comprised of 458 substance-abusing mothers enrolled during pregnancy or postpartum in the Washington State Parent-Child Assistance Program (PCAP), an evidence-based case management intervention. Participants' custody status was well distributed among four categories based on continuity of parenting. Findings indicate that at program exit 60% of the mothers were caring for their index child. These mothers had more treatment and mental health service needs met, had more time abstinent from alcohol and drugs, secure housing, higher income, and support for staying clean and sober. Among women with multiple psychiatric diagnoses, the odds of regaining custody were increased when they completed substance abuse treatment and also had a supportive partner. Mothers who lost and did not regain custody had more serious psychiatric problems and had fewer service needs met. We discuss implications of our findings for child welfare policy and practices.     

Computer-mediated parenting education: Digital family service provision

Computer-mediated family service provision holds the promise of equal efficacy, lower cost, and higher accessibility than traditional parent education groups that require parents to travel to a service venue, thereby alleviating often-cited pragmatic barriers to participation in parenting programs. Hence, examinations of which populations are attracted to particular service modalities are a necessary step in building a reliable evidence base. The scant computer-mediated parent education literature indicates that online parenting programs are beneficial to indicated or secondary prevention programs seeking to bolster specific parent, child, or dyadic outcomes; it is reasonable to ask, then, if this service provision mechanism would be equally effective for all parents, outside of targeted intervention designs. The current paper describes the provision of computer-mediated parenting services to a large sample of parents (N = 192, 89.6% female, average age 40 years; 27% racial/ethnic minority) with no shared prevention indicator through an employer-based program. Our research questions on service provision and utilization include: Who is served by primary prevention programs like this? Do participants report satisfaction with computer-mediated services commensurate with traditional face-to face services? In addition to significant differences in perceived social support by gender, marital status, and number of children younger than 18 living in the home, results from three measures of parenting attitudes and behaviors (e.g., discipline style, sense of competence, and locus of control), indicate that this sample has some confidence in their general abilities as parents, but struggle to feel an internal sense of control over their children's behavior, with the greatest number of parents tending towards overreactive discipline. Associations between these indicate a consistent pattern such that dysfunctional parenting practices tend to co-occur, and parents who do employ dysfunctional strategies feel less competent as parents. Participants report high satisfaction with these services, at equal or better rates than reported in the parent education literature. This work provides evidence that computer-mediated parenting services can attract and exceed expectations of participants with clinical and subclinical but moderate parenting needs, indicating that this service delivery mode has the potential to reach a wide number of individuals ideally situated for prevention services.     

Barriers to Integrated Treatment of Substance Abuse and Trauma Among Women

Despite increasing empirical support for an integrated approach to treating trauma and substance abuse, many substance abuse treatment programs have been slow to embrace integrated models of practice. Using an embedded case study design, the purpose of this study was to understand barriers that prevented a substance abuse treatment provider and 20 professionals and staff from adopting an integrated approach to treating substance abuse and trauma. Data analysis revealed 2 kinds of barriers that prevented substance abuse treatment professionals from fully integrating substance abuse and trauma: systemic and professional barriers. These barriers have to be taken into account when trying to move providers and professionals toward integrated approaches to treating substance abuse and trauma.