Integrated programs for mothers with substance abuse issues: A systematic review of studies reporting on parenting outcomes

Abstract

BackgroundIntegrated treatment programs (those that include on-site pregnancy-, parenting-, or child-related services with addiction services) were developed to break the intergenerational cycle of addiction, dysfunctional parenting, and poor outcomes for mothers and children, yet there has been no systematic review of studies of parenting outcomes.ObjectivesAs part of larger systematic review to examine the effectiveness of integrated programs for mothers with substance abuse issues, we performed a systematic review of studies published from 1990 to 2011 with data on parenting outcomes.MethodsLiterature search strategies included online bibliographic database searches, checking printed sources, and requests to researchers. Studies were included if all participants were mothers with substance abuse problems at baseline, the treatment program included at least one specific substance use treatment and at least one parenting or child service, and there were quantitative data on parenting outcomes. We summarized data on parenting skills and capacity outcomes.ResultsThere were 24 cohort studies, 3 quasi-experimental studies, and 4 randomized trials. In the three randomized trials comparing integrated programs to addiction treatment-as-usual (N = 419), most improvements in parenting skills favored integrated programs and most effect sizes indicated that this advantage was small, ds = -0.02 to 0.94. Results for child protection services involvement did not differ by group. In the three studies that examined factors associated with treatment effects, parenting improvements were associated with attachment-based parenting interventions, children residing in the treatment facility, and improvements in maternal mental health.ConclusionsThis is the first systematic review of studies evaluating the effectiveness of integrated programs on parenting. The limited available evidence supports integrated programs, as findings suggest that they are associated with improvements in parenting skills. However, more research is required comparing integrated programs to addiction treatment-as-usual. This review highlights the need for improved methodology, study quality, and reporting to improve our understanding of how best to meet the parenting needs of women with substance abuse issues.

The state of evidence-based parenting interventions for parents who are substance-involved

“…Clearly, understanding the factors that could foster optimal outcomes for integrated interventions for parents' substance misuse and their parenting is complex (21), particularly when statistics suggested that 60-75% of mothers who entered drug treatment left before their treatment was completed (32). With relevance to the current review, however, Niccols et al (33) noted that parenting interventions focusing on parentchild attachment may be more effective than those focusing on skill development when it comes to fostering parenting improvements for parents who are substance-involved.…”

“…In an effort to combat these barriers, there is an emerging consensus that parenting interventions should involve significant community advocacy (34) and should be integrated into programs that already serve substance-involved individuals of childbearing age (33). For example, more research on interventions that can be embedded into residential treatment programs, jails, and prisons is needed.…”

Fertility-related research needs among women at the margins

“…63,[137][138][139] Further investigation is needed, particularly into how sexual and reproductive health services and parenting skills-building can be integrated into substance use treatment programmes and other health interventions serving people who use drugs. [140][141][142] High rates of abortion have been reported among women who use drugs, some of whom are also sex workers, however, reduction in abortion-related risks and integration of family planning and post-abortion care in this population has not adequately been documented. [143][144][145] Fertility-related assessments prior to pregnancy in this population are limited, although studies focused on women living with HIV in Canada, including women who use drugs, suggested that drug use did not affect fertility intentions.…”

Risk of Psychosocial Problems in Children Whose Parents Receive Outpatient Substance Abuse Treatment

“…Conversely, improvements in the living environment and wellbeing of CSAP can positively affect recovery of parents in treatment (Lander, Howsare, & Byrne, 2013). Due to this interplay, paying attention to parenthood and parenting issues during treatment may not only contribute to parents' recovery from substance abuse but may also prevent mental health disorders in a new generation (Niccols et al, 2012).…”

“…Possibly due to the above-mentioned difficulties with implementing routine assessments of client's children and family situations, collection of data on the mental health of CSAP at the point when their parents receive treatment has been limited (Niccols et al, 2012;Oliveros & Kaufman, 2007;Reedtz, Lauritzen, & Van Doesum, 2012). More research on this subject is needed for two reasons.…”