PERINATAL AND FAMILY SERVICES

Family Treatment

This webpage identifies the major literature in the field of perinatal and family services: family treatment. The time frame is from January 2000 through December 2014.

Center for Substance Abuse Treatment. (2004). Substance abuse treatment and family therapy. Treatment Improvement Protocol (TIP) Series, No. 39. DHHS Publication No. (SMA) 04-3957. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Family therapy has a long and solid history within the broad mental health field. Substance abuse treatment, on the other hand, developed in considerable isolation. This TIP represents advice on how both fields can profit from an understanding and incorporating the methods and theories of the other field. The primary audience for this TIP is substance abuse treatment counselors; family therapists are a secondary audience. This TIP addresses how substance abuse affects the entire family and how substance abuse treatment providers can use principles from family therapy to change the interactions between family members. The TIP provides basic information about family therapy for substance abuse treatment professionals and basic information about substance abuse for family therapists. The TIP presents the models, techniques, and principles of family therapy, with special attention to the stages of motivation as well as to treatment and recovery. Discussion also focuses on clinical decision-making and training, supervision, cultural considerations, special populations, funding, and research. The TIP concludes with policy and program issues for administrators and trainers to consider for effectively joining family therapy and substance abuse treatment.

Choi, S., Huang, H. & Ryan, P. J. (2012). Substance abuse treatment completion in child welfare: Does substance abuse treatment completion matter in the decision to reunify families? Children and Youth Services Review, 34(9), pp. 1639-1645. DOI: 10.1016/j.childyouth.2012.04.022

This study investigates 1) factors associated with family reunification and 2) the role of treatment completion in relation to mothers’ treatment progress and family reunification. Results reflect that variables such as age and marital history were related to family reunification. This current study provided important empirical evidence for the link between family reunification and treatment completion. Improvements in the delivery of treatment services to mothers in child welfare are discussed.

Comiskey, C. M. (2013). A 3 year national longitudinal study comparing drug treatment outcomes for opioid users with and without children in their custodial care at intake. Journal of Substance Abuse Treatment, 44(1), pp. 90-96.

The aim of this research was to measure the longitudinal effects of having children in a client's custodial care, on opioid treatment outcomes. At 1 year significantly fewer of those with children in their care were using heroin, benzodiazepines and cannabis but having children in a client's care at intake was a significant and positive predictor of using other opioids at 1 year. Analysis revealed a significant reduction in the proportion using alcohol in the last 90 days and in the mean days of alcohol usage among those with no children in their care. Results demonstrate that having children in a client's care improves outcomes for heroin use but also suggest the possible use of substitution substances.

Corless, J., Mirza, K. A. H., & Steinglass, P. (2009). Family therapy for substance misuse: The maturation of a field. Journal of Family Therapy, 31(2), pp. 109–114.

The authors reflect on the maturation of the family therapy for substance misuse. They mentioned that determining if a clinical field has reached a state of maturation include organizing ideas and themes, and compelling evidence. They presented the challenges regarding family therapy approaches to substance misuse which include the more effective translation of research findings into clinical practice, and additional research to pin down the essential ingredients of effective family therapy.

Crane, D. R. (2010). Cost-effectiveness of Family-based substance abuse treatment. Journal of Marital and Family Therapy, 36(4), pp. 486-98.

In order to compete in a financially sensitive health care system, family systems-based treatments must demonstrate effective clinical results as well as cost-effectiveness. Cost-effectiveness research can demonstrate to health care insurers and policy makers which treatments are viable options for implementation. The present literature review identified eight cost-effectiveness family-based substance abuse treatment studies. The results suggest that certain family-based treatments are cost-effective and warrant consideration for inclusion in health care delivery systems.

D'Andrade, A. C., & Chambers, R. M. (2012). Parental problems, case plan requirements, and service targeting in child welfare reunification. Children and Youth Services Review, 34(10), pp. 2131–2138. DOI: 10.1016/j.childyouth.2012.07.008

This is a descriptive study using case file data to examine the relationship between parental problems and case plan requirements for a sample of parents reunifying with their children in one large urban California County. Findings show that most reunifying parents had multiple problems, and were required to attend approximately 8 service events per week. There was a positive correlation between the total number of concerns (treatment problems and life challenges) and required weekly service events. 85% of parents were ordered treatment services for all their identified problems, and over 30% were ordered services targeting problems they were not previously aware of. Overall, 58% of parents were ordered both all appropriate and only appropriate services. Discussion on implications for policy and practice include the need for models of service delivery that limit the burden of accessing multiple service locations for reunifying parents.

Dauber, S., Neighbors, C., Dasaro, C., Riordan, A., & Morgenstern, J. (2012). Impact of intensive case management on child welfare system involvement for substance-dependent parenting women on public assistance. Children and Youth Services Review, 34(7), pp. 1359-1366. DOI: 10.1016/j.childyouth.2012.03.020

This study examined the impact of intensive case management (ICM) on decreasing child welfare system involvement in substance-dependent parenting women. This study tested whether ICM had downstream impacts on child welfare outcomes not directly targeted by the intervention. An initial positive effect of ICM was found on child placements, but its impact lessened over time and was likely due to the increased contact with case managers that occurred early in the study. Overall, minimal benefits of ICM were found, suggesting that while ICM was effective in the areas of treatment engagement and abstinence, there were no downstream benefits for child welfare outcomes. Implications of findings in terms of increased need for cross-system collaboration are discussed.

Diamond, G., & Josephson, A. (2005). Family-based treatment research: A 10-year update. Journal of the American Academy of Child and Adolescent Psychiatry, 44(9), pp. 872-887.

This article provides an update on the state of the art of family-based treatment research. The authors reviewed randomized clinical trials conducted in the past 10 years that included parents as a primary participant in treatment of child and adolescent psychiatric problems. The results indicate that family treatments have proven effective with externalizing disorders, particularly conduct and substance abuse disorders, and in reducing the comorbid family and school behavior problems associated with attention-deficit/hyperactivity disorder. The authors conclude that for many disorders, family treatments can be an effective stand-alone intervention or an augmentation to other treatments. They state that engaging parents in the treatment process and reducing the toxicity of a negative family environment can contribute to better treatment engagement, retention, compliance, effectiveness, and maintenance of gains.

Estefan, L. F., Coulter, M. L., VandeWeerd, C. L., Armstrong, M., & Gorski, P. (2012). Receiving therapeutic services: experiences of parents involved in the child welfare system. Children and Youth Services Review, 34(8), pp. 1399-1417.

This article presents the findings of a study which examined the experiences of parents involved with child welfare services mandated to attend a variety of therapeutic services. The authors’ findings suggest that while therapeutic services meet the needs of the families, parents are not empowered to influence the service plan; additionally they face barriers to receiving services, and the case plans often do not take into account systemic family issues.

Gordon, D. M., Oliveros, A., Hawes, S. M., Iwamoto, D. K., & Rayford, B. S. (2012). Engaging fathers in child protection services: A review of factors and strategies across ecological systems. Children and Youth Services Review, 34(8), pp. 1399-1417.

This article reviews the literature concerning paternal engagement in child and family services around an ecological model that examines paternal engagement from individual, family, service provider, program, and community and policy levels. Authors consider factors and strategies along a continuum of engagement through intent to enroll, enrollment, and retention. This review advances theory by elucidating key factors that foster father engagement. The review also highlights the gaps in the literature and provides strategies for how researchers can address these areas. Future directions in the arenas of practice and policy are discussed.

Henderson, C. E., Rowe, C. L., Dakof, G. A., Hawes, S. W., & Liddle, H. A. (2009). Parenting practices as mediators of treatment effects in an early-intervention trial of multidimensional family therapy. American Journal of Drug & Alcohol Abuse, 35(4), pp. 220-226.

This study examined parenting practices as mediators of treatment effects in an early-intervention trial comparing Multidimensional Family Therapy (MDFT), and a peer group intervention. Results show that MDFT was more effective than active treatments as well as services as usual in decreasing substance use and improving abstinence rates. Findings indicate that change in MDFT occurs through improvements in parenting practices. These results set the foundation for examining family factors as mediators in other samples.

Herrenkohl, T. I., Lee, J. O., Kosterman, R. & Hawkins, D. J. (2012). Family influences related to adult substance use and mental health problems: A Developmental analysis of child and adolescent predictors. Journal of Adolescent Health, 51(2), ), pp. 129–135 DOI: 10.1016/j.jadohealth.2011.11.003

This study investigated measures of family conflict, family management, and family involvement at ages 10–12, 13–14, and 15–18 years as predictors of adult depression, anxiety, and substance use disorder symptoms classes at age 27. Results show that family conflict is the strongest and most consistent predictor of the adult mental health and substance use classes. Family management, but not family involvement, was also predictive of the adult outcome classes. Conclusions: It is important to lessen family conflict and improve family management to prevent later mental health and substance use problems in adulthood.

Hill, L. G., Goates, S. G., & Rosenman, P. (2010). Detecting selection effects in community implementations of family-based substance abuse prevention programs. American Journal of Public Health, 100(4), pp. 623-30.

To calculate valid estimates of the costs and benefits of substance abuse prevention programs, selection effects must be identified and corrected. A supplemental comparison sample is typically used for this purpose, but in community-based program implementations, such a sample is often not available. The authors present an evaluation design and analytic approach that can be used in program evaluations of real-world implementations to identify selection effects, which in turn can help inform recruitment strategies, pinpoint possible selection influences on measured program outcomes, and refine estimates of program costs and benefits. The results indicate that the program's participants differed significantly from the population at large.

Jackson, V. (2004). Residential treatment for parents and their children: The Village experience. NIDA Science & Practice Perspectives, 2(2), pp. 44-53. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851019

The Village South, Inc., in Miami, Florida, offers comprehensive substance abuse treatment and prevention services to adults, adolescents, and children. The Village’s Families in Transition (FIT) program, launched in the early 1990s as one of the Nation’s first 11 federally funded programs for women with children, and has provided services to nearly 800 parents and approximately 2,000 children. This article discusses the philosophy behind FIT’s family focused residential treatment program, characterizes its participants, describes its challenges and successes, and points out research needs that have come to light through experience with mothers and children in treatment.

Klostermann, K., & O’Farrell, T. (2013). Treating substance abuse: partner and family approaches. Social Work in Public Health, 28(3-4), pp. 234-247. DOI: 10.1080/19371918.2013.759014

The purpose of this article is to 1) discuss how substance abuse affects the family; 2) present the models of marital and family approaches that have been used with substance-abusing clients; 3) discuss potential barriers to marriage and family therapy implementation and 4) explore possible future directions with respect to partner-and-family –involved therapies with clients who abuse substances. Authors conclude that the role of the family in the development and maintenance of substance abuse should be a vital part of treatment.

Knight, K. E., Menard, S., & Simmons, S. B. (2014). Intergenerational Continuity of Substance Use. Substance Use & Misuse, 49, pp. 221-233. DOI:10.3109/10826084.2013.824478.

The goal of this article is to address a gap in current knowledge on whether, when, and how strongly intergenerational continuity of substance use exists when examining age-equivalent and developmentally specific stages of the life course. Results suggest that intergenerational risk may be reduced if substance use can be curtailed in adolescence.

Lam, W. K. K., Fals-Stewart, W., & Kelley, M. L. (2009). Parent training with behavioral couples therapy for fathers' alcohol abuse: Effects on substance use, parental relationship, parenting, and CPS involvement. Child Maltreatment, 14(3), pp. 243-254.

This pilot study examined effects of Parent Skills with Behavioral Couples Therapy (PSBCT) on substance use, parenting, and relationship conflict among fathers with alcohol use disorders. Male participants (N = 30) entering outpatient alcohol treatment, their female partners, and a custodial child (8 to 12 years) were randomly assigned to (a) PSBCT; (b) Behavioral Couples Therapy (BCT); or (c) Individual-Based Treatment (IBT). Children were not actively involved in treatment. Parents completed measures of substance use, couples' dyadic adjustment, partner violence, parenting, and Child Protection Services (CPS) involvement at pretreatment, post treatment, 6- and 12-month follow-up. PSBCT was comparable to BCT on substance use, dyadic adjustment, and partner violence; both groups showed clinically meaningful effects over IBT. Compared to BCT, PSBCT resulted in larger effect sizes on parenting and CPS involvement throughout follow-up. PSBCT for fathers may enhance parenting couple- or individual-based treatment, and warrant examination in a larger, randomized efficacy trial.

McComish, J. F., Greenberg, R., Ager, J., Essenmacher, L., Orgain, L. S., & Bacik, W. J. (2003). Family-focused substance abuse treatment: A program evaluation. Journal of Psychoactive Drugs, 35(3), pp. 321-331.

This article presents findings from a three-year evaluation of a family-focused residential treatment program for women and their children. Longitudinal assessment of the mothers indicated that their psychosocial status and parenting attitudes improved over time. Additionally, the mothers remained in treatment longer. At intake, as a group, the children who were birth to three years of age did not exhibit developmental delay. Developmental concerns were identified for some children in the areas of motor and/or language development. The results reported here provide beginning evidence that family-focused treatment improves retention, psychosocial functioning, and parenting attitudes of pregnant and parenting women. They also support the evidence that having children on site improved retention in treatment for pregnant and parenting women, as well as self-esteem, depression, and parenting. This study also provides a mechanism for early identification and intervention for children.

Moore, J., & Finkelstein, N. (2001). Parenting services for families affected by substance abuse. Child Welfare, 80(2), pp. 221-238.

This article describes the development, implementation, and replication of a group-based parenting program for families affected by substance abuse, the Nurturing Program for Families in Substance Abuse Treatment and Recovery. Preliminary results indicate that this program improves parenting, as measured on objective scales; enhances parents' satisfaction and competence, as measured by participant reports; and is based on principles demonstrated to be effective in reducing risk of both child abuse and neglect and substance abuse for both parents and children. The development of a parenting program specifically for families affected by substance abuse enhances opportunities for substance abuse and child welfare systems to work together for the families they both serve.

Oliveros, A., & Kaufman, J. (2011). Addressing substance abuse treatment needs of parents involved with the child welfare system. Child Welfare, 90(1), pp. 25-41.

This article reviews the available research on families with substance abuse problems involved with the child welfare system and identifies gaps in the research needed to further refine practices in this area. The authors’ findings suggest that Family Treatment Drug Courts (FTDC) might be the most effective intervention at improving outcomes for these families.

Peled, E., Gavriel-Fried, B., & Katz, N. (2012). ‘‘I’ve Fixed Things Up’’: Paternal identity of substance-dependent fathers. Family Relations, 61(5), pp. 893 – 908. DOI: 10.1111/j.1741-3729.2012.00729.x

This study deals with how substance-dependent men perceive their paternal identity. The study included in-depth semi-structured interviews with 12 Israeli fathers enrolled in methadone maintenance treatment. Content analysis revealed that participants had undergone a process of parental identity formation composed of four distinct stages: absence, awakening, taking responsibility, and resolution to re-form oneself as a father. The discussion highlights the developmental nature of this process. Also discussed are the effects of three factors on the formation of paternal identity: the treatment for addiction, the subjects’ newfound identity as ‘‘clean addicts,’’ and social perceptions and discourses about fatherhood and addiction.

Postmus, J. L., Huan, C. C., & Mathisen-Stylianou, A. (2012). The impact of physical and economic abuse on maternal mental health and parenting. Children and Youth Services Review, 34(9), pp. 1922-1928. DOI: 10.1016/j.childyouth.2012.06.005

This article examined the long-term impact of intimate partner violence (IPV) on maternal depression and parenting. Findings demonstrated that economic and psychological abuse at Year 1 had significant effects on the likelihood of mothers experiencing depression and spanking their children at Year 5. Psychological abuse experiences at Year 1 had a significant effect on the level of engagement with their children at Year 5. However, experiences of physical violence at Year 1 did not significantly impact mothers' depression or parenting. In addition, the results indicated that both the level and change of economic abuse increased the odds of mothers experiencing depression at Year 5. Similarly, both the level and change of psychological abuse decreased the odds of mothers engaging with their children at Year 5. Finally, the level of economic and psychological abuse at Year 1 increased the odds of the use of spanking in Year 5. These results suggest that there are long-term effects of economic and psychological abuse on mothers' depression and parenting. Future research should focus on understanding the impact of abuse, specifically of economic abuse, among families that are victims of interpersonal violence.

Riger, S., & Bennett, L. W. (2014). Barriers to addressing substance abuse in domestic violence court. American Journal of Community Psychology, 53(1), pp. 208-217. DOI: 10.1007/s10464-014-9636-4.

This article presents the results of a qualitative study of a domestic violence court in a large mid-western metropolitan area including interviews of key informants to better understand how the Court treats substance abuse. Results reflect that substance abuse typically is not identified among perpetrators or survivors going through the Court unless it is mentioned in a police report. Barriers to identification are the organization of the Court, bounded definition of actors’ roles in the Court, limited resources, and negative attitudes towards survivors. These results suggest that specialized courts that attend to only one problem may overlook the possibility of addressing issues that commonly co-occur.

Robertson, A. S., & Haight, W. (2012). Engaging child welfare-involved families impacted by substance misuse: Scottish policies and practices. Children and Youth Services Review, 34(10), pp. 1992–2001. DOI: 10.1016/j.childyouth.2012.06.006

This study explores Scottish child welfare policies, beliefs and practices for engaging substance-involved families in child welfare services. Scottish approaches for engaging families are highly focused on child well‐being and relationship characteristics, prevention, resilience and recovery. Many of these strategies are designed to change a deeply embedded problem of substance misuse, and considerable effort and resources have been targeted for long-term change. These initiatives are important to examine because, if successful, they may be helpful for understanding relational characteristics in other cultural contexts particularly those using holistic and differential approaches in child welfare.

Rowe, L. C. (2012). Family therapy for drug abuse: review and updates 2003–2010. Journal of Marital and Family Therapy, 38(1), pp. 59-81 DOI: 10.1111/j.1752-0606.2011.00280.x

This article is a review of the literature on family therapy for drug abuse and issue recommendations for new research, and practice implications of these findings. Adolescent-focused family-based models that attend to the ecology of the teen and family show the most consistent and strongest findings in recent studies. Adult-focused models based on behavioral and systems theories of change also show strong effects with drug abusers and their families. The overarching conclusion is that family-based models are not only a viable treatment alternative for the treatment of drug abuse, but are now consistently recognized among the most effective approaches for treating both adults and adolescents with drug problems.

Schumacher, A. J. & Holt, J. D. (2012). Domestic violence shelter residents’ substance abuse treatment needs and options. Aggression and Violent Behavior, 17(3), pp. 188-197. DOI: 10.1016/j.avb.2012.01.002

This article reviews, identifies, and synthesizes the findings of studies in which alcohol and other substance use, problem use, or diagnoses in shelter residents was assessed. Despite methodological limitations, this body of studies provides compelling evidence that a substantial number of domestic violence shelter residents (22–72%) have current or past problems with alcohol or other substances and may benefit from treatment. The second goal of the current review was to provide an overview of the availability and limitations of options that are currently available to address domestic violence shelter residents' substance abuse treatment needs. Although substance abuse is a largely under-met need of women seeking domestic violence shelter, promising findings from model integrated treatment programs, as well as the knowledge gained through implementation of these programs provide useful future directions for addressing these co-occurring issues.

Storhaug, A. S., & Øien, K. (2012). Fathers' encounters with the Child Welfare Service. Children and Youth Services Review, 34(1), pp. 296–303 DOI: 10.1016/j.childyouth.2011.10.031

This article's focus was father primary caretakers who were or had been in contact with the Child Welfare Services in Norway, and who had children with women who were unable to take care of them, either because of substance abuse or mental health problems. Authors analyzed how these fathers experienced being met and assessed as caregivers by the Child Welfare Service, as well as how they experienced their own competency as caregivers. The results showed to be consistent with the discourses on “fathers as a threat”, “fathers as irrelevant” and “fathers as better than mothers”. The goal of the article was to increase awareness about fathers who are in contact with the Child Welfare Service so that they are met in a way that helps to support them in their role as fathers for the benefit of their children.

Stover, C. S., Hall, C., McMahon, T. J., & Easton, J. C. (2012). Fathers entering substance abuse treatment: An examination of substance abuse, trauma symptoms and parenting behaviors. Journal of Substance Abuse Treatment, 43(3), pp. 335-343.

This article does the following: (a) examine differences in symptoms of men presenting for SA assessment based on fatherhood status and (b) determine how posttraumatic stress disorder (PTSD) symptoms and severity of SA were associated with parenting for men who were fathers. Results of the study reflect that there were no differences in severity of alcohol or drug use between fathers and non-fathers; however, fathers with more PTSD symptoms reported greater severity of alcohol and drug use. Among the fathers, PTSD symptoms correlated significantly and positively with negative parenting behaviors, whereas SA did not. Fathers with more significant PTSD symptoms were more likely to want help with parenting. The authors conclude that further exploration of the impact of trauma-related symptoms on the parenting behaviors of substance-abusing men is warranted.

Stover, C. S., Easton, C. J., & McMahon, T. J. (2013). Parenting of men with co-occurring intimate partner violence and substance abuse. Journal of Interpersonal Violence, 28(11), pp. 2290-2314. DOI: 10.1177/0886260512475312

This article looks at mediators of differences in parenting behavior of fathers and the emotional-behavioral problems of their children for men with co-occurring SA and IPV. Results reflect that men with co-occurring SA + IPV had significantly less positive co-parenting and more negative parenting behaviors than community control fathers. Negative parenting and co-parenting were mediated by the fathers’ avoidant attachment problems. SA + IPV fathers also reported more emotional and behavioral problems in their children. These results suggest areas of potential focus in interventions with fathers who have co-occurring SA + IPV issues. Focus on attachment difficulties with his co-parent, which may include affect regulation, coping with emotions, and communication skills training related to co- parenting, may yield significant changes in parenting behaviors and ultimately child functioning.

Van Ryzin, M. J., Fosco, G. M., & Dishion, T. J. (2012). Family and peer predictors of substance use from early adolescence to early adulthood: An 11-year prospective analysis. Addictive Behaviors, 37(12), pp. 1314–1324 DOI: 10.1016/j.addbeh.2012.06.020

The focus of this study was social influences on substance use from early adolescence to early adulthood, using a diverse sample of early adolescents followed from age 12 to age 23. The authors tested direct and indirect effects of parental monitoring, family relationship quality, and association with deviant peers on change in substance use across time. The results suggested that parental monitoring and family relationship quality indirectly predicted later substance use by way of deviant peers, implying that an important aspect of the family context is its influence on choice of friends and peer group composition. Implications for family-based prevention and intervention are discussed.

Wong, J. (2009). Understanding and utilizing parallel processes of social interaction for attachment-based parenting interventions. Clinical Social Work Journal, 37(2), pp. 163-174.

In an effort to meet both the parenting and treatment needs of substance-abusing women who are parents, residential drug treatment programs have been struggling to find the best approach. A qualitative-quantitative study of the parenting experience of mothers in residential drug treatment programs housing both mothers and their children found that relational processes characterized how these mothers perceived parenting as well as treatment. The findings presented the interplay and mutuality between a mother’s interactions (natural or facilitated) with the external social world that includes her child and those connected to the treatment facility and the internal formation of her sense of herself, her child, and others, along with the changes in both areas that took place in the facility. These findings lend important support to the use of attachment-based parenting interventions in residential drug treatment programs by drawing on these relational processes.

Worley, L. L. M., Conners, N. A., Crone, C. C., Williams, V. L., & Bokony, P. A. (2005). Building a residential treatment program for dually diagnosed women with their children. Archives of Women's Mental Health, 8(2), pp. 105-111.

The epidemic of drug and alcohol abuse in our nation impacts millions of women, mothers, and children. Addicted mothers with complex problems and numerous co-morbidities present unique treatment challenges. This intergenerational cycle of abuse and addiction is difficult to stop. Arkansas CARES (Center for Addictions Research Education and Services, referred to in this article as CARES) initially was created to treat addicted pregnant and postpartum women and their infants. CARES evolved into a residential treatment program for dually diagnosed mothers with their children. The purpose of this study is to share a glimpse inside the treatment program and lessons learned along the way in an effort to assist others who are interested in building treatment programs for addicted women with their children.

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