Substance‐abusing mothers in residential treatment with their babies: Importance of pre‐ and postnatal maternal reflective functioning

Abstract

A residential treatment program has been developed specifically for substance-abusing pregnant and parenting women in Finland, focusing on simultaneously supporting maternal abstinence from substances and the mother–baby relationship. The aims of the study are to explore maternal pre- and postnatal reflective functioning and its association with background factors, maternal exposure to trauma, and psychiatric symptoms, postnatal interaction, child development, and later child foster care placement. Participants were 34 mother–baby pairs living in three residential program units during the pre- to postnatal period. We employed self-report questionnaires on background, trauma history, and psychiatric symptoms (Brief Symptom Inventory: L.R. Derogatis, 1993; Edinburgh Postnatal Depression Scale: J.L. Cox, J.M. Holden, & R. Sagovsky, 1987; Traumatic Antecedents Questionnaire: B. Van der Kolk, 2003), videotaped mother–child interactions coded for sensitivity, control, and unresponsiveness (Care Index for Infants and Toddlers: P. Crittenden, 2003); a standardized test of child development (Bayley Scales of Infant Development-II: N. Bayley, 1993); and semistructured interviews for maternal reflective functioning (Pregnancy Interview: A. Slade, E. Bernbach, J. Grienenberger, D.W. Levy, & A. Locker, 2002; Parent Development Interview: A. Slade et al., 2005). Pre- and postnatal maternal reflective functioning (RF) was on average low, but varied considerably across participants. Average RF increased significantly during the intervention. Increase in RF level was found to be associated with type of abused substance and maternal trauma history. Mothers who showed lower postnatal RF levels relapsed to substance use more often after completing a residential treatment period, and their children were more likely to be placed in foster care. The intensive focus on maternal RF is an important direction in the development of efficacious treatment for this very high risk population.

Patterns of polydrug use among pregnant substance abusers

“…Most of the women with children in our study (83%) had children placed in child protection services. This was also the case for all of the women with children in the Finnish study (Pajulo et al, 2012). Three of the eight women included in a study of pregnant women in compulsory care in Norway already had children; two had lost custody due to their own drug abuse.…”

“…The smoking rate in this study was 59%, but it is likely to have been substantially higher; daily smoking rates among female clients and younger clients in compulsory care are around 90% (National Board of Institutional Care, 2016a). In a Danish study of pregnant women the smoking rate was 84% (Irner et al, 2012), and all of the women in the Finnish study were defined as ''excessive smokers'' (Pajulo et al, 2012). These exceptionally high levels need to be addressed clinically, politically and scientifically.…”

“…However, only 4% of the women in this age group stated alcohol as their primary drug compared to one in five in our study. In the Finnish study of pregnant women, 20% were also defined as having primarily ''alcohol problems'' (Pajulo et al, 2012), while the primary drugs in the Danish study of pregnant women in treatment were alcohol and cannabis (Irner et al, 2012). Such comparisons are somewhat tricky, though, as they probably also reflect differences in the treatment context and how the women were recruited.…”

“…In Norway, reports on polydrug use have been included in studies on pregnant women in opioid maintenance treatment (OMT: Lund et al, 2013;Lund et al, 2012), in followup studies of children born to substanceabusing mothers and in studies of pregnant substance abusers in residential settings, including involuntary treatment (Haabrekke, Slinning, Walhovd, Wentzel-Larsen, & Moe, 2014;Myra, Ravndal, Torsteinsson, & Wiig, 2016). We also find data on polysubstance use in some Finnish studies of pregnant or postpartum women in residential care (Pajulo, 2001;Pajulo et al, 2012). A Danish study by Irner, Teasdale, Nielsen, Vedal, and Olofsson (2012) has actually highlighted the scope and type of substances used by a group of women attending treatment for substance abuse.…”

Literature Review of Early Childhood Music Therapy Between 1990-2012

“…However, when looking at those authors' texts who mentioned some aspects, it would appear that psychodynamic approaches were in the minority and the focus when carrying out early childhood music therapy was usually on creative and improvisational music therapy. This could explain why the concepts of reflective function, mentalization, and parent´s representations were absent, even though these issues are currently an important focus for early interaction research worldwide (Fonagy, 2012;Pajulo et al, 2012;Philipp, 2012;Solbakken et al, 2011).…”