Addressing the treatment needs of children affected by maternal addiction: challenges and solutions

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Abstract

This paper examines treatment needs of the children of women served in the Center for Substance Abuse Treatment's Residential Women and Children and Pregnant and Postpartum Women (RWC/PPW) program. It integrates statistical information from CSAT's cross-site evaluation of the program and clinical insights obtained from one RWC treatment site, the Arkansas CARES project. The cross-site data provide broad-based information about the extent to which clients' children experience various risk factors, while the project data provide concrete information about major administrative and clinical challenges to the provision of needed child services in a parent-focused residential treatment setting. Data from both perspectives suggest that many children admitted into residential treatment with their mothers need an array of long-term supportive services, requiring a new focus and a commitment of resources from substance abuse treatment providers.

Introduction

When parents are involved in substance abuse, the repercussions extend to the whole family system. As women typically serve as the primary caregiver in their families, maternal addiction to alcohol or other drugs (AOD) can have important consequences for their children. In addition to the direct biological effects of addiction during pregnancy, indirect effects by way of inconsistent, disruptive, or neglectful caregiving can also be harmful.

Potential negative effects of maternal addiction on children are of great concern, as there is reason to believe that a great many children are currently being reared by mothers with addiction problems. There are no reliable estimates of the number of children in the U.S. whose mothers are addicted to AOD, but the information available suggests the number is in the millions. The 2001 National Household Survey on Drug Abuse (NHS) found that 3.7% of pregnant women reported using illicit drugs in the prior month (SAMHSA, 2002). The 1996 NHS survey suggests that 10% of children (more than 7 million) have at least one parent who is dependent on alcohol or illicit drugs, and that 6% have at least one parent who is in need of treatment for illicit drug use (Huang, Cerbone, & Gfroerer, 1998).

As awareness of the extent of substance abuse problems among mothers has increased, so has concern about the health and development of children born to addicted mothers. For the past two decades, much attention has focused on the effects of prenatal exposure to alcohol and drugs (especially cocaine) on the health and early developmental course of children (for recent reviews see Frank et al., 2001, Kaltenbach, 1996, Young, 1997). Recent studies have become increasingly sophisticated, taking into account aspects of children's lives (such as poverty, family instability, parental mental illness, continued parental drug use) that may combine with prenatal exposure to AOD to increase vulnerability to developmental problems (e.g. Asher-Ornoy et al., 1996, Singer et al., 2002). The Maternal Lifestyles Study, e.g. (Lester, 1998), an ongoing study of the impact of prenatal cocaine exposure, take particular care to document important family, home, and neighborhood factors, such as maternal depression, parenting stress, social support, or exposure to violence, that may also affect the child. In addition to the adverse affects of prenatal exposure to AOD, all children whose mothers abuse substances may be at ongoing risk of adverse developmental impacts, regardless of their prenatal exposure status. As yet, however, little has been done to document systematically the various biological and environmental risk conditions faced by children of substance-abusing mothers.

One purpose of this paper is to provide such documentation, drawing upon data assembled in a cross-site evaluation of the Residential Women and Children and Pregnant and Postpartum Women (RWC/PPW) program, funded by the Center for Substance Abuse Treatment (CSAT) in the Substance Abuse and Mental Health Services Administration. (See Porowski, et al., this issue, for additional information on the RWC/PPW program and its evaluation.) The second purpose is to draw lessons from the experiences of the Arkansas CARES project in service children of mothers in residential substance abuse treatment.

A large and growing body of literature on risk and protective factors suggests that experiencing high numbers of environmental risks can have serious negative consequences for any child. A greater understanding of the experiences of children whose mothers abuse AOD can help inform service providers as they seek to address the complex needs of this group of children. The richness of the evaluation data provided an opportunity to document these experiences and risk conditions.

The Arkansas Center for Addiction Research, Education and Services (Arkansas CARES), at the University of Arkansas for Medical Sciences implements the CSAT model for delivering comprehensive residential substance abuse treatment services to women and their children. Established in 1991, Arkansas CARES received CSAT funding (1995–1998) for an RWC demonstration project. The primary goal of the children's component of Arkansas CARES' RWC project is to build positive assets in children. To accomplish this goal, program staffs focus on enhancing protective factors (e.g. parental supervision and monitoring, nurturing parenting, effective interpersonal skills, academic achievement, age-appropriate development) and decreasing risk factors (e.g. harsh or neglectful parenting, exposure to violence, and unstable home environments). Key elements of the program include nurturant caregiving, therapeutic services, child-directed play, developmentally appropriate activities to enhance learning, positive discipline, limit setting, problem-solving, conflict resolution, effective communication skills, and supporting children's education.

Like other pioneers in the field of mother–child treatment, Arkansas CARES was not prepared at first to meet complex needs of children enrolled in treatment with their mothers. However, within 3 years, the program evolved from a volunteer-run nursery for newborns to a year-round, extended-day children's program offering on-site child care, early intervention, mental health, early childhood education, and academic support services for children from birth to 12 years. In the course of this evolution, program staff learned much about the unique opportunity that mother–child substance abuse treatment providers have to intervene in the lives of clients' children, and about the associated challenges and issues. As yet, few providers have experience offering comprehensive residential care to both children and their mothers. The treatment community can benefit from an examination of the experiences of the mother and child substance abuse treatment providers that are the focus of this special issue.

Section snippets

Methods

Information about risk factors experienced by children of substance-abusing mothers is based on data collected from mothers and children enrolled in a cross-site study of demonstration treatment projects funded from 1993 to 2001 under CSAT's RWC/PPW program. Each RWC/PPW project provided residential substance abuse treatment programs for pregnant and parenting women, and their infants and children, and participated in a national cross-site evaluation. The RWC/PPW national cross-site evaluation

Results

The mean number of risk conditions experienced by children in this sample was 6.5 (SD=1.7), and the median number of risk factors was 6. Table 1 shows the prevalence of specific risk conditions in this sample compared to children nationally. Nine of the 11 risk factors were present for at least half of the children in this sample. Two risk factors were present for almost all of the families: family low-income status (91%) and single-parent home (91%). Two were less common: 28% of children's

Implications of exposure to risk conditions

Each of the risk factors described above raises concerns about affected children's future well-being. The high rate of children in this sample living in poverty (91%), for example, is a cause for concern, since poverty has been shown to be negatively associated with a wide array of health, cognitive, and socioemotional outcomes in children (Bolger et al., 1995, Bradley and Whiteside-Mansell, 1997, Duncan and Brooks-Gunn, 1997, McLeod and Shanahan, 1993, Vrijheid et al., 2000).

However, while

Conclusion

Children whose mothers have serious substance abuse problems represent an important at-risk group in their own right. Many of these children experience biological risks (such as prenatal exposure to AOD) and they face an array of environmental risks including low income, low maternal education, maternal mental illness, instability in caregivers, residential instability, child abuse and neglect, little father involvement, and experiences in foster care. These obstacles may, without intervention,

Acknowledgements

Study funded by the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. Contents are solely the responsibility of the authors and do not necessarily represent the official views of the agency.

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