Incorporating a Healthy Living Curriculum within Family Behavior Therapy: A Clinical Case Example in a Woman with a History of Domestic Violence, Child Neglect, Drug Abuse, and Obesity

Abstract

Women reported to child protective service agencies frequently report problems that significantly interfere with the health and well-being of their children and themselves. Behavioral treatment programs appear to be effective in managing these co-existing problems, such as domestic violence and substance abuse. However, evidence-supported interventions are rarely exemplified in complicated clinical cases, especially within child welfare settings. Therefore, in this case example, we describe the process of adapting an evidence-supported treatment to assist in managing significant co-existing health-related problems in a mother who was referred due to child neglect and drug abuse. At the conclusion of therapy, the participant reported improvements in perceived family relationships, illicit drug use, child maltreatment potential, whereas other health-related outcomes were mixed. Most improvements were maintained at 4-month follow-up. Issues relevant to implementing evidence-based treatments within community contexts are discussed, including methods of increasing the likelihood of valid outcome assessment, managing treatment integrity, and adjusting standardized treatments to accommodate co-occurring problems.

A controlled evaluation of family behavior therapy in concurrent child neglect and drug abuse.

“…These intervention components included (a) teaching family members to identify home hazards and generate their own strategies to making their homes safer and more stimulating for children during tours of the home; (b) improving financial management skills of mothers by reviewing sources of income and expenses, and brainstorming methods of increasing income and decreasing expenses utilizing financial management worksheets to reduce stress that often triggers substance use and neglectful behavior through distraction, irritability and avoidance of educational and caretaking responsibilities; (c) teaching mothers to differentially reinforce their children for desired behaviors while ignoring undesired behaviors (Forehand & McMahon, 1981) and to discipline undesired behaviors of children by first explaining how environmental circumstances may have led to the undesired behavior and then instructing them to practice desired behaviors several times (Azrin & Besalel, 1981); (d) teaching mothers to react to emergent conditions that affect their families (e.g., lack of food) with the aforementioned self-control method (emergency management; Urgelles, Donohue, Wilks, Van Hasselt, & Azrin, 2012); and (e) HIV and STD prevention utilizing the aforementioned stimulus control procedures to teach mothers to recognize and effectively manage antecedents to sexually transmitted diseases (e.g., unprotected sex, intravenous drug use, promiscuity, prostitution), self-control and communication skills training to encourage assertion in requesting safe sexual activity or refusal of substance use that involve needles. This modified FBT has demonstrated preliminary efficacy in controlled and uncontrolled case trials specific to coexisting child neglect and drug abuse in home-based settings (Donohue & Azrin, 2001; Donohue et al, 2010; LaPota et al, 2011; Romero, Donohue, & Allen, 2010; Romero, Donohue, Hill, et al, 2010).…”

“…Several case trials have examined the effects of family behavior therapy (FBT; Donohue & Allen, 2012; Donohue & Azrin, 2011) in mothers who have been reported to child protective services for child neglect and drug abuse. These case trials have demonstrated noticeable improvements in various undesired behaviors, including child abuse potential, illicit drug and alcohol use, family relationships, stress, domestic violence, and HIV risk behaviors (Donohue et al, 2010; LaPota, Donohue, Warren, & Allen, 2011; Romero, Donohue, & Allen, 2010; Romero, Donohue, Hill, et al, 2010). The integration of HIV prevention components in FBT is noteworthy, given the high risk of HIV and AIDS in this population (see Nijhawan, Kim, & Rich, 2008).…”

A Standardized Method of Preventing and Managing Emergencies Within the Context of Evidence-Based Therapy Implementation

“…Multiple intervention components may be administered, including (a) treatment planning to assist in determining which interventions to emphasize in therapy, (b) behavioral goals and contingency management to assist in motivation, (c) stimulus control to assist in spending less time with individuals and situations that have involved substance use and other problem behaviors and more time with individuals and situations that have not involved substance use, (d) self-control to assist in decreasing urges to use drugs and other impulsive behavior problems, (e) communication skills training to assist in assertiveness training and establishing social relationships with others, and (f) financial training to assist in gaining employment and managing finances. FBT has demonstrated success in controlled trials (Azrin, Acierno, et al, 1996; Azrin, Donohue, Besalel, et al, 1994; Azrin, Donohue, Teichner, et al, 2001; Azrin, McMahon, et al, 1994; Donohue, Azrin, et al, 1998) and preliminary efficacy in case trials (e.g., Donohue & Azrin, 2002; Donohue, Romero, et al, 2010; LaPota, Donohue, Warren, & Allen, 2011).…”

Examination of the Influence of Cognitive Behavior Therapy Components, Consumer Satisfaction and Engagement in Mothers Referred for Drug Abuse and Child Neglect on Treatment Outcomes

“…This intervention was originated from the Community Reinforcement Approach (Azrin et al, 1982) and has demonstrated efficacy in both controlled (Azrin et al, 1996;Azrin, McMahon, et al, 1994;Chow et al, 2015, Donohue et al, 2014 and uncontrolled clinical trials (e.g. Donohue et al, 2010;Galante et al, in press;Gavrilova et al, 2017;LaPota et al, 2011;Plant & Holland, 2018;Romero et al, 2010). Although FBT has been adapted to fit the needs of several distinct populations, it has maintained similar core cognitive behavioral intervention components (Donohue et al, 2009).…”