Innovations in child welfare interventions for caregivers with substance use disorders and their children
Introduction
In the child welfare system (CWS), cases involving caregiver substance use disorders (SUDs) are among the most complex with poorer outcomes documented at every point in the process (Marsh et al., 2011). Intersecting structural, case, and treatment level factors contribute to why SUDs cases represent such a challenge for the system to manage and address (Bosk, Van Alst, & Van Scoyoc, 2017). New approaches that offer innovative models which attend to the complexity of SUDs, particularly with regard to its impact on parenting and children's socio-emotional development are needed for effective intervention and to improve case outcomes (Suchman et al., 2006; Suchman, Mayes, Conti, Slade, & Rounsaville, 2004). In this conceptual paper, we introduce readers to the importance of relationship-focused interventions in SUDs treatment, highlighting the evidence that supports a paradigm shift in how SUDs cases within child welfare are managed. We then identify four innovative treatment models, specifying the common mechanisms for change across them. Following this discussion, we present the development of each model, investigating the ways in which specific local conditions and constraints contributed to their emergence, design, and delivery. Taken together, these case studies provide templates for how relationship-focused interventions could be implemented within the child welfare system, offering new opportunities to keep families together during recovery and to improve CWS outcomes.
Section snippets
The complexity of SUDs cases in the child welfare system
Not only are CWS cases involving caregiver SUDs among the most challenging, they are also among the most prevalent with 50–80% of families within the CWS impacted by SUDs in some way (Marsh et al., 2011). A helpful framework from which to understand the complexity of SUDs cases in the CWS is through an ecological-transactional model which highlights the bidirectional effects between individuals, their relationships, and their environments (Sameroff & MacKenzie, 2003). Moving beyond risk and
Program description and development
The BRIGHT intervention (Building Resilience through Intervention: Growing Healthier Together) was developed as a response to the developmental and behavioral needs of young children (birth through 5 years old) and their parents who were receiving treatment for SUDs and Co-Occurring Disorders (CODs). The Institute for Health and Recovery (IHR) had long noted the consequences of traumatic stress experienced by these children in their work with families struggling with substance misuse since its
Discussion
Although each model presented here originated in different ways in different contexts, all interventions responded organically to a need to provide more appropriate services to caregivers with SUDs often in the child welfare system and to address these needs in the context of recovery. Taken together, these case studies represent a new paradigm for SUDs treatment within the child welfare system and offer a complete set of interventions—from integrated residential treatment, to in-home addiction
Conclusion
Project BRIGHT, C.A.R.E, FBR, and MIO represent innovative models for intervention for caregivers with SUDs that reflect current research on the needs of this population. Taken together, each model presents options for creating the full continuum of care for integrated intervention for treating SUDs in the context of parenting from residential to in-home to dyadic outpatient and individual outpatient treatment. While different levels of evidence of efficacy accompany each model, it is
Acknowledgements
The authors gratefully acknowledge: Dale H. Saul, Jeanette Radawich, Amy Myers, Michelle St. Pierre, Heather Simon, Jean Adnopoz, Cindy DeCoste, Jessica Borelli, Susan Bers, Lauren Dennehy, Naomi Libby Amanda Lowell, Linda Mayes, Amy Sommer, Eda Spielman, Karen Gould, Thomas McMahon, Steve Martino, Katie Arnone, Gweniver Bell, Christina Carlone, Rachel Dalton, Lourdes de las Heras, Hailey Dias, Ashley Winch, Carolynn Flynn, Peg Wright, Norma Finkelstein, Susan O’Donnell and participants and
Funding Acknowledgements
Funding for Project BRIGHT has been provided by the following grants: SAMHSA 1U79SM063114 (PI: Finkelstein), HRSA R40MC31764 (PI: Paris), and SAMSHA 1U79SM059460 (PI: Finkelstein). Funding for the C.A.R.E. Model has been provided by SAMHSA SM636062 (PI: Ruisard). Funding for Family-Based Recovery has been provided by the following grants: State of Connecticut and Social Finance LLC. Funding for Mothering from the Inside Out has been provided by the following grants: NIH/NIDA R01DA17294 (PI:
Conflicts of interest
The authors have no conflicts of interest to report.
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2022, Children and Youth Services ReviewCitation Excerpt :System and Programmatic Design that Aligns with the Needs and Experiences of Mothers in Recovery. Collectively, quotes in this study illustrated ways in which mothers felt that “sometimes the system works against [them], against families” and reinforce the importance paradigm shifts in the CWS toward promising practices for working with mothers with SUD (e.g., Project BRIGHT, C.A.R.E. Model, Family-Based Recovery, Mothering from the Inside Out, Bosk et al., 2019; Sobriety Treatment and Recovery Teams, Hall et al., 2021). Aligning system procedures with a focus on empowerment is a core recommendation and primary implications emphasized by mothers include: (a) strengths-based and collaborative case planning with shared decision making; (b) simplified, coordinated care; (c) concurrent instrumental supports with substance use treatment; and (d) destigmatized and accessible early intervention.
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2022, Aggression and Violent BehaviorCitation Excerpt :This risk can be escalated by child welfare mandated safety plans that require the victimized parent to cease residing or even associating with the perpetrator in order to avoid child removal (Armstrong & Bosk, 2020). Despite the clear overlap, many policies and clinical responses to substance misuse, IPV, and child maltreatment address these issues separately, missing critical opportunities to address intersecting, synergistic issues with linked etiology (Smith et al., 2011; Suchman et al., 2018; Bosk et al., 2017; Bosk et al., 2019; Armstrong & Bosk, 2020). Singular approaches to addressing substance misuse, IPV, and child maltreatment often utilize practice frameworks that have competing logics or values which are inherently contradictory (Bosk et al., 2017; Suchman et al., 2006).
All in the family: parental substance misuse, harsh parenting, and youth substance misuse among juvenile justice-involved youth
2021, Addictive BehaviorsCitation Excerpt :The current findings suggest one way to interrupt the intergenerational consequences of parental SUD would be to integrate family treatment and parenting components into SUD treatment. Currently, treatment for SUD is individually-based and the relationship between use and parenting is either adjunctive or does not occur at all (Bosk et al., 2019). A few interventions such as Mothering from the Inside Out (Suchman et al., 2017), Family-Based Recovery (Hanson, Saul, Vanderploeg, Painter, & Adnopoz, 2015), and Project BRIGHT (Paris, Sommer, & Marron, 2018), focus on addressing the unique treatment needs of parents with SUD, but these all focus on the early childhood years.