Children exposed to parental substance abuse, mental illness, and violence face profound challenges, including increased risk for emotional and behavioral problems, substance abuse, and victimization. In this article, we describe the characteristics of a sample of children of women entering treatment. These children had been exposed to domestic violence, frequent child welfare involvement, and residential instability. Parental entry into treatment affords treatment providers an opportunity to intervene early with these children, enabling them to offer supportive and preventive services and to help children build skills to avoid problems later. Treatment providers are encouraged to offer assessment and services to children of parents entering treatment, capitalizing on the opportunity to intervene early with a group of children who are at risk for problems with significant individual and social consequences. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 445–459, 2005.
Mothers are the principal informants on children's emotional and behavioral functioning. Maternal assessments of child functioning can be influenced by a mother's own psychological state. The magnitude and valence of distortion in maternal assessments associated with current maternal mental health and substance abuse symptoms were explored in a clinical sample of 253 mothers with co-occurring disorders and histories of trauma. Analyses estimated the correlation between current maternal symptoms and child assessments after controlling for maternal history of disorders, child's history of service utilization for emotional and behavioral problems, and demographic characteristics. Current maternal psychological distress was associated with more pessimistic assessments on the problem-focused Child Behavior Checklist, whereas current maternal substance abuse problems were associated with more optimistic assessments on both problem-focused and strength-based measures. Clinicians and researchers may choose to take distortion into account when treatment plans or measures of change are based on maternal assessments.
Using data from a common cross‐site protocol administered at study enrollment, in this article we examine key characteristics of 2,729 participants in the Women, Co‐Occurring Disorders and Violence Study (WCDVS), including demographics, physical health, mental health, substance abuse, trauma experiences, parenting status, and past history of service use. These data are important because they represent the first federal initiative that addresses the significant lack of appropriate services for women with co‐occurring substance use and mental health disorders who have experienced trauma. Study findings reveal a very vulnerable population with extensive histories of abuse and substantial physical and mental health service needs. Data suggest a pressing need for increased availability of physical and mental health services capable of serving the complex needs of women with co‐occurring disorders and histories of interpersonal violence (physical and/or sexual abuse). Equally important are funding strategies to support needed services. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 429–443, 2005.
Using a quasi‐experimental design, this study examined the effectiveness of a standardized intervention model designed to build resiliency in children of women with co‐occurring mental health and substance use disorders and histories of interpersonal abuse. The children and mothers who participated in this study were a subset of the sample used for the Women, Co‐occurring Disorders and Violence Study (WCDVS). The children's intervention model consisted of three components: clinical assessment, service coordination and advocacy, and a psychoeducational skills‐building group. Children in the comparison group received individual, group, and family services. Six‐month and 12‐month outcomes were examined among 253 children. Children in the intervention group improved significantly more than children in the comparison group. © 2007 Wiley Periodicals, Inc. J Comm Psychol 35: 823–843, 2007.
A conceptual model for community-based strategic planning to address the criminalization of adults with mental and substance use disorders, the Sequential Intercept Model has provided jurisdictions with a framework that overcomes traditional boundaries between the agencies within the criminal justice and behavioral health systems. This article presents a new paradigm, Intercept 0, for expanding the utility of the Sequential Intercept Model at the front end of the criminal justice system. Intercept 0 encompasses the early intervention points for people with mental and substance use disorders before they are placed under arrest by law enforcement. The addition of Intercept 0 creates a conceptual space that enables stakeholders from the mental health, substance use, and criminal justice systems to consider the full spectrum of real-world interactions experienced by people with mental and substance use disorders with regard to their trajectories, or lack thereof, through the criminal justice system.
Historically, children of parents with co-occurring substance abuse and mental health disorders and histories of violence/trauma have been overlooked in behavioral health treatment systems. The Women, Co-occurring Disorders and Violence Study (WCDVS) was a 5-year initiative funded by the United States Substance Abuse and Mental Health Services Administration (SAMHSA) that included a Children's Study that explored the treatment needs of children of women with these multiple disorders. This article describes the development of the Children's Study intervention that included clinical assessment, group intervention, and resource coordination/advocacy for children aged 5-10 to build resilience through increasing coping skills, improving interpersonal relationships, and helping coalesce positive identity and self-esteem. Innovative procedures, including the participation of consumer/survivor/recovering women and mothers, in the planning, implementation, and administrative applications of this intervention and study are also highlighted. It is recommended that programs begin to implement family-focused integrated treatment approaches that can potentially increase protective factors for children affected by parental mental illness, substance abuse, and violence.
Data from the Women with Co-occurring Disorders and Histories of Violence Study are used to examine characteristics distinguishing mothers currently providing care for all their minor children (n = 558) from mothers separated from one or more minor children (n = 1396). Mothers are described and compared on background characteristics and experiences, well-being and current functioning, situational context, and services used. Analyses control for number of children, race, and years of education. Mothers separated from children have more children, less education, have more often been homeless, in juvenile detention or jail, and have lower incomes than mothers living with all their children. Mothers separated from children have more extensive experiences of traumatic and stressful life events, and the groups differ in current functioning and patterns of services used. While cross-sectional data do not allow causal inferences, challenges faced by mothers have significant implications for policy and programs.
ⅢIn this special issue of the Journal of Community Psychology, the second of a two-part series, we have been allowed the opportunity to assemble articles on empirical findings from the Women, Co-Occurring Disorders and Violence Study~WCDVS!. The WCDVS was a 5-year initiative jointly supported by the three centers of the Substance Abuse and Mental Health Services Administration~SAMHSA!-the Center for Substance Abuse Treatment~CSAT!, the Center for Mental Health Services~CMHS!, and the Center for Substance Abuse Prevention~CSAP!-to identify and evaluate comprehensive, integrated, trauma-informed service systems designed to address the needs of women with co-occurring disorders and a history of trauma.Nine sites were selected to participate in the national evaluation. With technical assistance from the study's Coordinating Center, these sites focused on the design and full-scale implementation of integrated service models, as well as multisite evaluation protocols. Each site employed a quasi-experimental design in which an integrated, trauma-informed intervention designed specifically for the needs of these women was compared to usual treatment at a substance abuse or mental health agency. For purposes of the evaluation, all sites administered the same assessments at baseline, 6 months, and 12 months, along with any additional site-specific measures. In addition, CSAT funded a Children's Subset Study, which involved four of the WCDVS study sites, to examine the effectiveness of a standardized intervention program for promoting emotional and behavioral strengths in children who have been exposed to interpersonal violence and whose mothers have histories of co-occurring disorders and trauma.In the first special issue of the Journal of Community Psychology, published in July 2005, we laid out the rationale and theoretical foundations for intervention with this population, described the population, discussed conceptual and pragmatic considerations in implementing the intervention, explored special concerns and compromises in designing the evaluation, and provided a voice for the "C0S0R" women-women who were Consumers of mental health services, Survivors of trauma and abuse, and in Recovery from substance use. We emphasized the importance of empowering these women through the design of the intervention program, the roles of C0S0Rs at the agencies that participated in the study, and the way in which the study governed itself nationally.In the current issue, we provide empirical results. The first article, by Chanson Noether and representatives from the sites in the study, provides findings from the Children's Subset Study. At 6 months, children's improvement was predicted by their mothers' improvement and recovery. At 12 months, regardless of their mothers' outcomes, children at the intervention sites showed greater positive change than children at the comparison sites. The article highlights the importance of preventive intervention with children of mothers with co-occurring disorders and histories of trauma.The other fi...
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