Serving families with child maltreatment and substance use disorders: A decade of learning

ABSTRACT

An increase in parental substance use disorders (SUD) and the number of infants and toddlers entering foster care has prompted federal and state efforts to change the treatment paradigm toward more integrated and family-centered strategies. The Regional Partnership Grant (RPG) program demonstrated that family-centered strategies can improve child and parent outcomes. The current challenge is to bring effective strategies to scale. This conceptual article highlights the lessons learned from 10 years of implementing and evaluating programs to meet the needs of families affected by parental SUD and child maltreatment. Effective family-centered strategies identified by the RPG program are illustrated with specifics from the Sobriety Treatment and Recovery Team program. These effective strategies could be implemented in any jurisdiction and include (1) collaboration toward integrated services between child welfare and SUD treatment, (2) timely access to SUDS treatment, (3) recovery management and support, (4) tailored family services, and (5) adaptation to local jurisdiction needs. When these strategies are operational, children are more likely to be safe and remain in parent custody, and parents are more likely to achieve sobriety and improve their parental capacity. Future research might examine the unique impact of each of the five strategies independently.     

Comparing the effectiveness of behavioral interventions in adults with co-occurring tobacco and substance use disorders: a systematic review of literature

ABSTRACT

This systematic literature review compares the e?ectiveness of various behavioral interventions delivered to persons with co-occurring tobacco and substance use disorders. It examines ?ndings of six randomized trials and three secondary analyses from randomized trials. Based on the ?ndings of this literature review, support is given to the following: (1) The consequences of tobacco use and smoking are deadly, costly, and can have an inhibitory e?ect on the progress of people in substance abuse treatment, (2) tobacco cessation options are a preventive intervention that can be easily incorporated into a treatment facility’s standard of practice and should be made available within the context of all substance abuse treatment facilities, and (3) concurrently treating tobacco use disorder and substance use disorder(s) is an e?ort that will help meet the social work profession’s Grand Challenge to ‘Close the Health Gap.’     

Nine-year psychiatric trajectories and substance use outcomes: an application of the group-based modeling approach

This study identifies longitudinal psychiatric trajectories of 934 adult individuals entering chemical dependency treatment in a private, managed care health plan and examines the relationship of these trajectories with substance use (SU) outcomes. The authors apply a group-based modeling approach to identify trajectory groups based on repeated measures of psychiatric severity for 9 years and identify four distinct groups. Results of multivariate logistic generalized estimating equation models find an association between psychiatric trajectories and long-term SU. Older cohorts and life course measures of marital status and employment status as individuals changed over time are related to drug and some alcohol outcomes.     

Bullying victimization,negative emotions,and substance use: utilizing general strain theory to examine the undesirable outcomes of childhood bullying victimization in adolescence and young adulthood

Bullying victimization has been directly associated with a variety of negative outcomes, but there are still many unknowns as to how deleterious emotional states resulting from victimization influence other undesirable events. The current study draws on Agnew’s general strain theory to examine multiple outcomes of youth victimized by repeated bullying prior to adolescence. Data from the National Longitudinal Survey of Youth 1997 were used to examine indicators of diminished moods and negative emotions on substance use for bullying victims in adolescence and again during young adulthood. Findings from various LISERL models indicate that bullying victimization directly increases diminished moods for males and females in adolescence. Additionally, childhood bullying victimization directly increases substance use in adolescence and young adulthood for males but not females. Finally, diminished moods in adolescence and negative emotions in young adulthood increase substance use for females but not for males. Policy implications and limitations for this analysis are discussed.     

Psychopathology,physical complaints and health risk behaviors among youths who were victims of childhood maltreatment: A comparison between home and institutional interventions

Based on investigations of child maltreatment by Child Protective Services (CPS), several children who are identified receive some kind of individual or familial intervention. However, the literature has shown conflicting results in regard to the later functioning of the children who are target of different protective measures in different settings, compared to other youths who receive no intervention. We assessed childhood adversity, psychopathology, physical complaints and health risk behaviors among youths who received one of two different protective interventions during childhood (home vs. institutionalization group), and we compared them with youths who receive no intervention (comparison group). In total, 216 youths participated, with ages ranging from 14 to 23 years (M = 17.05 years, SD = 1.8 years; 105 males, 111 females), including 136 youths that were contacted based on their CPS records completed during their childhood, and 80 youths from the community without CPS identification.     

Parental style,parental practices,and socialization outcomes: An investigation of their linkages in the consumer socialization context

This study aims to generate insights into the mechanisms through which parental style influences adolescent consumer socialization. Toward this end, it examines two alternative conceptual frameworks: (1) The mediation model which posits two key dimensions of parental style (responsiveness and demandingness) as antecedent variables affecting adolescent consumer socialization directly and indirectly through parental socialization practices and (2) the moderation model which posits each parental style dimension as a moderator of the link between parental socialization practices and adolescent socialization outcomes. The influences of maternal and paternal parental styles on adolescent socialization outcomes are investigated separately and compared. Results provide stronger support for the mediation model. They also show that mothers’ parental style and practices are more influential than fathers’ in shaping adolescents’ consumer socialization outcomes.     

Propensity to perpetrate abusive behaviors: Internet survey of the role of gender,childhood maltreatment,and perception of maltreatment in Nigeria

This article reports on propensity to perpetrate abusive behaviors and examines the role of gender, childhood maltreatment, and perception of abusive behaviors on the propensity. Findings suggest that propensity to perpetrate abusive behaviors cuts across all types of maltreatment (i.e., physical, sexual, and emotional abuse, child neglect, and child labor). Although abusive behavior with high propensity for perpetration includes corporal punishment, propensity to perpetrate abusive behaviors differed by gender. Men were more likely than women to indicate propensity to perpetrate abusive behaviors. Those who perceived behaviors as not abusive, as well as those who reported childhood experience of abusive behaviors, were more likely to intend to perpetrate abusive behaviors. Although childhood experience of sexual abuse was related to perpetration of sexual abuse, history of perpetrating sexual abuse comprised the largest effect size of the propensities to perpetrate abusive behaviors. Implications of findings for policy, practice, and services are discussed.     

Self-reported and case file maltreatment: Relations to psychosocial outcomes for youth in foster care

The aim of the current study was to explore the relation between maltreatment and psychosocial outcomes for youth in foster care, and how this relation differs according to reporter type (self-report or case file). Participants included 285 children and adolescents and their caregivers who completed self-report questionnaires about lifetime maltreatment and psychosocial adjustment. Youths' case files containing lifetime maltreatment reports were obtained from Division of Social Services (DSS), and were coded for physical and sexual abuse, emotional maltreatment, and neglect using the Modified Maltreatment Classification System (MMCS; English & LONGSCAN Investigators, 1997). Crosstabs analysis was used to summarize proportions of youth whose caregivers reported clinically significant internalizing and externalizing and average to high adaptive functioning within groups of youth who had a) neither self-reported nor case file maltreatment, b) only case file maltreatment, c) only self-reported maltreatment, and d) both case file and self-reported maltreatment for each maltreatment type (physical and sexual abuse, emotional maltreatment, and neglect). Results showed that externalizing symptoms differ according to reporter type for physical and sexual abuse, and that internalizing symptoms differ according to reporter type for sexual abuse. Implications for methodology in maltreatment research are discussed.     

Risk,protection, and substance use in adolescents: a multi-site model

This article reports findings from a national longitudinal cross-site evaluation of high-risk youth to clarify the relationships between risk and protective factors and substance use. Using structural equation modeling, baseline data on 10,473 youth between the ages of 9 and 18 in 48 high-risk communities around the nation are analyzed. Youth were assessed on substance use (cigarette, alcohol, and marijuana use), external risk factors including family, school, peer and neighborhood influences, and individual risk and protective factors including self-control, family connectedness, and school connectedness. Findings indicate strong direct relationships between peer and parental substance use norms and substance use. Individual protective factors, particularly family and school connectedness were strong mediators of individual substance use. These findings suggest that multi-dimensional prevention programming stressing the fostering of conventional anti-substance use attitudes among parents and peers, the importance of parental supervision, and development of strong connections between youth and their family, peers, and school may be most effective in preventing and reducing substance use patterns among high-risk youth.     

Predictors of suspension and negative school outcomes: a longitudinal investigation

Research suggests that suspension is not an effective deterrent and that more should be done to meet the needs of those who are continually suspended.     

Shame and guilt in men exposed to childhood sexual abuse: a qualitative investigation

This study examined the experiences of shame and guilt in adult males sexually abused as children. Seven participants attending a service for male sexual abuse completed measures of shame, guilt, dissociation, and childhood trauma history and subsequently participated in a focus group. All participants experienced childhood sexual abuse in the "severe" range and showed elevated scores for shame, guilt, and dissociation. Four superordinate themes with associated subordinate themes emerged: (a) self-as-shame (foundations of self-as-shame, fear of exposure, temporary antidote: connection), (b) pervasiveness and power of doubt and denial (from others, from self, consequences of incredulity), (c) uncontrollability (of problems after disclosure, of rage, of intrusions and emotional pain), and (d) dissociation. Results are discussed with reference to the existing literature and the emerging "self-as-shame" construct, which appeared to encapsulate participants' view of themselves.     

HIV rapid testing in substance abuse treatment: implementation following a clinical trial

The Substance Abuse Mental Health Services Administration has promoted HIV testing and counseling as an evidence-based practice. Nevertheless, adoption of HIV testing in substance abuse treatment programs has been slow. This article describes the experience of a substance abuse treatment agency where, following participation in a clinical trial, the agency implemented an HIV testing and counseling program. During the trial, a post-trial pilot, and early implementation the agency identified challenges and developed strategies to overcome barriers to adoption of the intervention. Their experience may be instructive for other treatment providers seeking to implement an HIV testing program. Lessons learned encompassed the observed acceptability of testing and counseling to clients, the importance of a "champion" and staff buy-in, the necessity of multiple levels of community and agency support and collaboration, the ability to streamline staff training, the need for a clear chain of command, the need to develop program specific strategies, and the requirement for sufficient funding. An examination of costs indicated that some staff time may not be adequately reimbursed by funding sources for activities such as adapting the intervention, start-up training, ongoing supervision and quality assurance, and overhead costs.     

Adolescent substance use and family-based risk and protective factors: a literature review

Adolescent substance use has become a serious concern nationwide. Although there are many ways of viewing adolescent substance use, family influence has been established as one of the strongest sources of risk and protection. A review of the literature indicated relevant theories for understanding adolescent substance use and specific family-based variables influencing adolescent substance use. In general, there seems to be a relationship between adolescent substance use and family-based risk and protective factors. Relevant theories identified in the literature review include family systems theory, social cognitive theory, social control theory, and strain theory. Specific family-based risk and protective factors include family relationships such as with siblings and parents and family characteristics such as ethnicity and religious backgrounds. Future implications for research and prevention/intervention in relation to family-based risk and protective factors are discussed.     

The influence of childhood maltreatment and self-control on dating violence: a comparison of college students in the United States and South Korea

Various aspects of social learning and self-control theories have been applied to partner violence among multiple samples in the United States, but these theoretical approaches have been less commonly studied cross-culturally. Consequently, childhood maltreatment and low self-control have been identified as risk factors for various outcomes in primarily American samples. This study examined the relationships between childhood maltreatment, low self-control, and dating violence among college students in South Korea and the United States. Findings indicated that experiencing childhood maltreatment and having low self-control were key predictors of perpetration and victimization for both psychological and physical relationship violence. Witnessing interparental violence during childhood was less consistently predictive of one's involvement in a violent dating relationship. Implications for theory and policy are discussed.     

Parental substance misuse and statutory child protection in England: Risk factors and outcomes

Parental substance misuse is a significant child welfare issue and associated with increased risk of child maltreatment. The aim of the present study was to understand what social care outcomes children who live with parental substance misuse have, and to assess factors associated with those social care outcomes over a two-year period. The paper reports on a retrospective longitudinal study of 299 children all living with parental substance misuse and referred to one local authority in England. Data were collected from children's social work case files about procedural social care outcomes and factors which may be associated with those outcomes. Using cluster analysis, a new typology of children's longitudinal trajectories through the children's social care system was developed, consisting of five distinct types. Analysis indicated that some children received too little intervention from children's social care despite ongoing concerns, while other children were potentially unnecessarily caught up in the social care system. Factors associated with children having the poorest outcomes were: caregiver instability resulting from substance misuse, parenting capacity and household instability. The study's findings indicate that some children who live with parental substance misuse are at significant risk of harm, but others are not and may be better supported through non-statutory services such as early help.     

Getting reluctant substance abusers to engage in treatment/self-help: a review of outcomes and clinical options

This review examines the results from 19 outcome studies, involving 1,501 cases, within 10 different clinical approaches to getting alcohol or drug abusers to engage in treatment or self-help. Each approach is summarized and its "success rate(s)" presented. Comparisons are made across various subcategories, such as alcohol vs. drug abusers, adolescents vs. adults, and experimental conditions vs. controls. A distinction is drawn between "Dual-Purpose" approaches, which combine engagement with counseling of the concerned person who originally sought help for the substance abuser, and "Engagement-Primary" approaches, which generally confine their efforts (through working with family members and others) to getting the substance abuser into treatment/self-help. "Best bet" clinical options are presented in terms of which particular approach appears to have the edge with which kind of substance abuser.     

Teachers' delivery skills and substance use prevention program outcomes: the moderating role of students' need for cognition and impulse decision making

The purpose of this study was to extend the literature in both substance use implementation and persuasive health communication by examining the extent to which students' need for cognition and impulsive decision-making moderated the relationship between teachers' classroom communication behavior and program outcomes in an evidence-based middle school substance use prevention curriculum. Participants included 48 teachers and their respective 7th grade students who participated in a randomized trial testing the effectiveness of personal coaching as a means to improve the quality with which teachers implemented the All Stars curriculum. Need for cognition and impulse decision-making were both associated with positive changes in lifestyle incongruence and commitments to not use substances for students whose teachers displayed greater interactive teaching. Further, need for cognition was associated with lower alcohol use rates while impulse decision making related to lower rates of marijuana use in classes with interactive teaching.     

History of sexual abuse and parental alcohol misuse: Risk,outcomes and protective factors in adolescents

This study examined the school performance, suicidal involvement, disordered eating behaviors, pregnancy risk and chemical use of teenagers with a history of sexual abuse or parental alcohol misuse and found that they had higher rates of these adverse outcomes than among a comparison group of teenagers without such background risk factors. Adolescents with dual-risk background reported higher levels of suicide risk, disordered eating, sexual behaviors and chemical abuse than teenagers with only one background risk factor. Among index group members, protective factors against these adverse outcomes included a high degree of religiosity and the ability to discuss problems with family or friends. Risk factors that increased the likelihood of adverse outcomes included depression, perceived substance use in school and worries about family financial security.The first author was supported in the preparation of this article by a grant from the Lois and Samuel Silberman Fund of New York.