Parenting services for families affected by substance abuse

This article describes the development, implementation, and replication of a group-based parenting program for families affected by substance abuse. The Nurturing Program for Families in Substance Abuse Treatment and Recovery improves parenting, as measured on objective scales; enhances parents' satisfaction and competence, as measured by participant reports; and is based on principles demonstrated to be effective in reducing risk of both child abuse and neglect and substance abuse for both parents and children.     

Using administrative data to evaluate the effectiveness of the Healthy Families Oregon home visiting program: 2-year impacts on child maltreatment & service utilization

The present study used state administrative databases to examine the 2-year outcomes of a large-scale randomized study of the impact of the Healthy Families Oregon (HFO) home visiting program. 2727 eligible first-time mothers were randomly assigned to either the HFO program or to a community services-as-usual control group. Outcomes for the current study were tracked for 2 years post-random assignment for all study participants through administrative data linkages to Oregon's statewide child welfare system, self-sufficiency services, and substance abuse treatment programs. Results indicated that families assigned to HFO program were no more or less likely to have a substantiated child abuse report than were controls (6.3% vs. 6.0%), but were significantly more likely to have an unsubstantiated report (9.7% vs. 7.9%). Among HFO families who were reported to the child welfare system, 86.2% (94 children) were reported after they had exited the program, while 13.8% (15 children) had a report while enrolled. However, 50.5% of children with unsubstantiated reports were reported while families were receiving HFO services, suggesting a surveillance effect for unsubstantiated reports. HFO families, compared to controls, were also significantly more likely to have been enrolled in Temporary Assistance for Needy Families (TANF) services for the first time, to have received more days of Supplemental Nutrition Assistance Program (SNAP), and to be enrolled in publically-funded substance abuse treatment services. Results suggest that early effects of home visitation on outcomes that can be measured through administrative data are small to modest, and that findings related to documented child welfare systems involvement may require more nuanced data than are typically used and/or available from state agency systems.     

Impact of Intensive Case Management on Child Welfare System Involvement for Substance-Dependent Parenting Women on Public Assistance

This study examined the impact of intensive case management (ICM) on decreasing child welfare system involvement in a sample of substance-dependent parenting women who participated in a welfare demonstration study comparing ICM to usual screen-and-refer models employed in welfare settings. Previous research established the effectiveness of ICM in both increasing engagement in substance abuse treatment and in promoting abstinence, and the current study tested whether ICM had downstream impacts on child welfare outcomes not directly targeted by the intervention. The sample included 302 mothers recruited from welfare offices and their 888 minor children. Child welfare outcomes were available from administrative records for four years following study entry and included incident reports and out-of-home child placements. An initial positive effect of ICM was found on child placements, but its impact lessened over time and was likely due to the increased contact with case managers that occurred early in the study. Overall, minimal benefits of ICM were found, suggesting that while ICM was effective in the areas of treatment engagement and abstinence, there were no downstream benefits for child welfare outcomes. Implications of findings in terms of increased need for cross-system collaboration are discussed.     

Opioid Use Disorder,Attachment, and Parenting: Key Concerns for Practitioners

In the United States, the current epidemic of opioid use disorders impacts many parents and their children. Historically, interventions for parents with substance use disorders have focused on two separate areas, achieving and maintaining abstinence and learning parenting skills. These interventions do not address the parent/child relationship, and the impact of parental opioid use disorder on attachment. Insecure attachment, particularly disorganized attachment, negatively affects the child’s development and safety. Attachment should always be considered when doing a safety assessment or planning an intervention for parents with opioid use disorders. This conceptual paper describes the impact of parental opioid use on attachment across the developmental span of childhood, highlighting research about opioid use disorder, parenting, and attachment which is relevant for practitioners working with parents with opioid use disorders, as child protection workers, substance abuse counselors, or therapists. Identification, attachment assessment tools, and empirical research on attachment-based interventions are discussed.     

Addressing substance abuse treatment needs of parents involved with the child welfare system

The goal of this paper is to synthesize available data to help guide policy and programmatic initiatives for families with substance abuse problems who are involved with the child welfare system, and identify gaps in the research base preventing further refinement of practices in this area. To date, Family Treatment Drug Court and newly developed home-based substance abuse treatment interventions appear the most effective at improving substance abuse treatment initiation and completion in child welfare populations. Research is needed to compare the efficacy of these two approaches, and examine cost and child well-being indicators in addition to substance abuse treatment and child welfare outcomes.     

Substance-abusing child welfare parents: treatment and child placement outcomes

The authors present findings from their study of 167 child welfare parents referred for substance abuse assessments. Relationships between gender, prior treatment, court-ordered intervention, significant others' support, and treatment and placement outcomes are examined. Findings indicate significant others' support positively influences all outcomes while court-ordered intervention is not predictive. Prior treatment is associated with continued substance abuse. Gender differences exist for assessment completion and several client characteristics. Implications for practice are drawn.     

Replication of the KEEP foster and kinship parent training program for youth with externalizing behaviors

This article presents findings from Maryland KEEP, a replication of KEEP (Keeping Foster and Kinship Parents Trained and Supported), a foster and kinship parent training intervention. We examined child behavior change, changes in caregiver parenting style, and permanency and placement stability at baseline and then after the KEEP intervention. The KEEP intervention was provided to 65 foster and kinship parents providing care for children ages 4–12. Children who participated in the study were referred due to behavior problems, as reported by foster parents: they all scored in the clinical range for externalizing behavior on the Child Behavior Checklist (CBCL). Baseline and posttest analyses assessed for child behavior and parenting style changes. Permanency data, including placement moves and exits from child welfare were examined. Overall, foster and kinship parents reported significantly fewer child behavior problems at posttest; severity levels on the CBCL and scores on the Parent Daily Report decreased. However, there were not any changes in parenting styles from baseline to posttest. Placement stability significantly increased between baseline and post-KEEP intervention. The results provide support for the effectiveness of KEEP for a child welfare population with a high level of behavior problems and for the effectiveness of KEEP as a training program for foster and kinship parents.     

Recovery coaches and the stability of reunification for substance abusing families in child welfare

Substance abuse is a long-standing challenge for child welfare systems. Parental substance abuse disrupts family stability, family cohesion, and jeopardizes the well-being of children. In the current study we test an intervention to improve child welfare outcomes for substance abusing families, specifically the probability of families achieving a stable (at least 12 months) reunification. The intervention was an integrated case management model where recovery coaches were appointed to substance abusing parents associated with an open foster care placement. A diverse group of families (n = 1623) were randomly assigned to either a control group (services as usual) or an experimental group (services as usual plus a recovery coach). Multinomial logistic regression indicated that substance abusing parents associated with a recovery coach were significantly more likely to achieve a stable reunification as compared with similar families in the control group.     

The influence of concrete support on child welfare program engagement,progress, and recurrence

Families living in poverty are significantly more likely to become involved with child welfare services, and consequently, referred to interventions that target abusive and neglectful parenting practices. Program engagement and retention are difficult to achieve, possibly because of the concrete resource insufficiencies that may have contributed to a family's involvement with services in the first place. Various strategies have been used to enhance program completion, such as motivational interventions, monetary incentives, and financial assistance with concrete needs. This study examines the influence of adjunctive concrete support provided by home visitors on families' (N = 1754) engagement, retention, and satisfaction with services as well as parenting outcomes. Using propensity stratification, mixed modeling procedures revealed that increasing concrete support predicted greater engagement, satisfaction, goal attainment, and lower short-term recidivism. Results suggest that adjunctive concrete support is a potentially beneficial strategy for promoting service engagement and satisfaction and increasing short-term child safety.     

An assessment of outcomes following parents' participation in a child abuse prevention program

The purpose of this study was to evaluate the outcomes following participation in the ESPACE parents' workshop. A group of 55 parents who participated in the program, implemented in elementary schools in the Quebec city region, was compared to a group of 217 parents who did not attend the prevention workshop. The results revealed that attending parents suggested more adequate interventions to the vignette depicting a hypothetical situation of sexual abuse compared to nonattending parents. Attending parents are found to be more likely to suggest interventions sustaining the child in her own problem-solving process, seek help from specialized agencies, and attempt to offer emotional support to the victim. Data also reveal that the parents workshop has a positive outcome on knowledge. While the workshop is associated with beneficial outcomes, attendance rates are low. The findings are discussed in the context of identifying means to foster parent involvement in the prevention of child abuse.     

Do Parent Preferences for Child Conduct Problem Interventions Impact Parenting Outcomes? A Pilot Study in Community Children's Mental Health Settings

A pilot, doubly randomized preference trial was conducted to investigate the impact of providing parents preferences on parenting outcomes. Families with children having conduct problems were randomly assigned to a choice group in which they received their preferred treatment among the four intervention options or a no‐choice group in which they were randomized assigned to one of the four options. Results of mixed‐effects models showed that parents in the choice group who selected Parent Management Training‐Oregon Model (PMTO) had better parenting outcomes over time compared to parents in the choice group who selected child therapy. It highlights the importance of incorporating parent preferences in the delivery of evidence‐based treatments.     

“It's just broken branches”: Child welfare-affected mothers' dual experiences of insecurity and striving for resilience in the aftermath of complex trauma and familial substance abuse

The voices of mothers of color who have been affected by the child welfare system are typically marginalized and are largely left unheard. Yet, attending to their experiences may yield a wealth of strategies for system change and for other women to change their path or avoid child welfare system involvement altogether. Using augmented qualitative analytic methods from two phenomenological studies that utilized the life histories approach, the current study lifts up the voices of 15 women of color with past child welfare involvement as foster youth (and, for many, as mothers). The study findings highlight experiences within two broad themes: a) immense insecurity; and b) resilience, across domains in the lives of child welfare affected women. The mothers in this study share their insights into the aftermath of complex trauma and substance abuse within their families, particularly the relational, housing, and financial insecurity it wreaked as well as how they garnered resilience through perseverance, faith and empathy, and establishing stable homes. Implications for practice, policy, and future research are discussed.     

Effects of a video feedback parent training program during child welfare visitation

Behavioral parent training programs have documented efficacy for improving behaviors among parents and their children and are frequently used by child welfare agencies to prevent removal of a child from the parental home or to facilitate reunification. Although an ideal time for parent training might be during supervised visits where parents may practice skills with their children under the guidance and support of a therapist or caseworker, this is not typically the case. Most often, parents within the child welfare system receive parent training in small groups without their children present, and to date, few studies have examined effects of behavioral parent training interventions during supervised visitation. In this study, concurrent multiple baseline across behaviors design was used to examine effects of a behavioral parent training program, Filming Interactions to Nurture Development (FIND), on parental skill acquisition with four mothers who had lost custody of their children but were being considered for reunification. Children emitted little or no problem behaviors during baseline or intervention, so parenting behavior was the primary dependent variable. Results obtained across participants documented a clear functional relation between implementation of the FIND intervention and increases in developmentally supportive parenting behaviors. Results of social validity and contextual fit measures suggest the intervention was perceived by mothers to be positive, feasible, and appropriate within the child welfare context. Practical and conceptual implications, limitations of this study, and directions for future research are discussed.     

Experiences of Mothers Who Are Child Sexual Abuse Survivors: A Qualitative Exploration

Child sexual abuse has been associated with a number of problems affecting women over their lifespan, including difficulties with parenting. However, there is a modest number of qualitative studies examining the impact of child sexual abuse on survivors who are mothers. There is a particular need for qualitative investigations that ask survivors who are mothers general questions about the impact of child sexual abuse on their lives rather than those that specifically ask about the impact of child sexual abuse on parenting. The former approach would allow survivors to describe effects that may impact parenting but that survivors do not consciously link to affecting their parenting. Such information may inform interventions to assist this population of survivors. This secondary data analysis examined themes revealed in interviews with 44 survivors of child sexual abuse who were mothers. Participants were seeking treatment for their child sexual abuse and completed an in-person interview in which they were asked open-ended questions about the sexual abuse they experienced as a child and how their abuse affects them now as adults. The interviews were recorded, transcribed, and coded using thematic analysis. The following six themes emerged from the narratives: (a) being a parent, (b) family of origin dysfunction, (c) the impact of abuse, (d) the abuse history and response to abuse, (e) coping, and (f) hopes and desires for the future. This study highlights several ways in which child sexual abuse impacts survivors who are mothers, areas for further study, and the need for interventions to assist this population in meeting the challenges they face as mothers.     

Substance abuse and child welfare: clear linkages and promising responses

Parental substance abuse is a significant factor in many of the families served in the child welfare system. This article examines: (1) the prevalence of substance abuse among families involved with the child welfare system; (2) the impact of substance abuse on child welfare practice; (3) how both the Adoption and Safe Families Act of 1997 and welfare reform legislation intensify the need to address parental substance abuse effectively; and (4) promising strategies for addressing these families' needs.     

Does Family Intervention for Adolescent Substance Use Impact Parental Wellbeing? A Longitudinal Evaluation

Adolescent substance abuse is a common problem and family interventions are emerging as a strategy to prevent it and assist family coping. The effectiveness of a prevention‐focussed family intervention was evaluated for its secondary impacts on improving parental mental health and family functioning. Twenty‐four secondary schools in Melbourne Victoria were randomly assigned to either a control condition or an intervention titled Resilient Families. The two intervention levels analysed were: (1) a parenting booklet only and; (2) combining the booklet with face‐to‐face parent education sessions. Parent surveys at baseline were followed up one year and four years later. Repeated‐measures analysis (n = 560) found parents attending parent education demonstrated reductions in mental health symptoms, however this had negative effects on family cohesion and no impact on family conflict. These findings were interpreted in terms of parent education assisting parent mental health by promoting assertive parenting styles that may increase adolescent‐parent tension by encouraging firmer parental boundaries and strategies to reduce adolescent substance use.     

Linking Changes in Parenting to Parent–Child Relationship Quality and Youth Self‐Control: The Strong African American Families Program

A randomized prevention trial was conducted contrasting families who took part in the Strong African American Families Program (SAAF), a preventive intervention for rural African American mothers and their 11‐year‐olds, with control families. SAAF is based on a conceptual model positing that changes in intervention‐targeted parenting behaviors would enhance responsive‐supportive parent–child relationships and youths' self‐control, which protect rural African American youths from substance use and early sexual activity. Parenting variables included involvement‐vigilance, racial socialization, communication about sex, and clear expectations for alcohol use. Structural equation modeling analyses indicated that intervention‐induced changes in parenting were linked with changes in responsive–supportive parent–child relationships and youth self‐control.     

Fathers matter: involving and engaging fathers in the child welfare system process

Research suggests that children with involved and engaged fathers tend to have more positive outcomes relative to physical, cognitive, and social emotional health. Of children who become involved in the child welfare system, involving multiple parents in the case (e.g. mother and father) often results in a greater chance of a child returning home, fewer placement episodes, and reduced trauma that may be caused by separation anxiety. With the rise of single parenting homes (which are mostly maternal) in the United States, child welfare agencies are examining the efficacy of engaging multiple caregivers (esp. fathers) in the child welfare process. Research suggests that in order to involve fathers in child welfare processes, practices and policies must be intentional in implementing systems and protocols that encourage involvement of all parents regardless of relationship status of the parents. However, few child welfare agencies are required to inquire about fathers or involve fathers in the child’s case. The purpose of this paper is to highlight efforts of the Connecticut Comprehensive Outcome Review (CCOR) process and discuss challenges and lessons learned from interviews and listening forums/focus groups that included social workers and fathers who are involved in the child welfare system in the state of Connecticut. Recommendations and considerations on engaging and involving fathers are discussed.