Innovations in child welfare interventions for caregivers with substance use disorders and their children

https://doi.org/10.1016/j.childyouth.2019.03.040Get rights and content

Highlights

  • Cases in the child welfare system involving caregiver substance use disorder(s) need new approaches.

  • Relationship-focused interventions offer new opportunities to keep families together during recovery and to improve child welfare outcomes.

  • Four innovative models: Project BRIGHT, Family-Based Recovery, C.A.R.E. and Mothering From the Inside Out are described.

  • Common mechanisms for change are identified: 1) increasing caregiver reflective functioning; 2) increasing caregiver and child emotional regulation capacities and; 3) increasing the quality of parent-child relationships through strengthening caregiver responsiveness, sensitivity, and attunement.

  • These targets contribute not just to greater parenting capacities but also to maintaining sobriety.

Abstract

Families who enter the Child Welfare System (CWS) as a result of a caregiver's substance use fare worse at every stage from investigation to removal to reunification (Marsh, Smith, & Bruni, 2011). Intervening with caregivers with Substance Use Disorders (SUDs) and their children poses unique challenges related to the structure and focus of the current CWS. Research demonstrates that caregivers with SUDs are at a greater risk for maladaptive parenting practices, including patterns of insecure attachment and difficulties with attunement and responsiveness (Suchman, Paulo, DeCoste, & Mayes, 2006). Caregivers with SUDs have also often experienced early adversity and trauma. However, traditional addiction services generally offer limited opportunities to focus on parenting or trauma, and traditional parenting programs rarely address the special needs of parents with SUDs. This article details four innovative interventions that integrate trauma-informed addiction treatments with parenting for families involved in the child welfare system. Common mechanisms for change across programs are identified as critical components for intervention. This work suggests the need for a paradigm shift in how cases involving caregivers with substance use disorders are approached in the child welfare system.

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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