Relationship-Focused Intervention for Maternal Substance Abuse Improves Child Mental Health

Relationship-Focused

Intervention for Maternal

Substance Abuse Improves

Child Mental Health

‘

Mary Motz, Ph.D., C.Psych. Mothercraft/Breaking the Cycle

Stacey D. Espinet, Ph.D. Mothercraft/Breaking the Cycle

Debra Pepler Ph.D., C.Psych.

Breaking the Cycle

BTC is an early intervention program that

supports the mental health and development

of infants and young children who are at-risk

for poor outcomes due to maternal

substance use, through supporting the

mental health & relationship capacity of their

mothers.

 Children age 0-6 years who are at risk for poor

mental health and developmental outcomes due to maternal substance use in the pre/prenatal periods, and their biological mothers.

 Women who are pregnant or parenting children

6-years and younger who are experiencing

problems related to substance use or recovery and who desire support in this area

PROGRAM

CONTEXT

Importance of Early Intervention

(Center for Disease Control and Prevention, 2013)

Infant Mental Health

Infant mental health is the developing capacity of the child from birth to age 3 to:

•Experience, regulate, and express emotions;

•Form close and secure interpersonal

relationships; and

•Explore the environment and learn all in the

context of family, community and cultural expectations for young children. IMH is

synonymous with healthy social and emotional development.

Mother-Child Dyad

CHILD

MOTHER

Poverty Relationship

Relationship-Focused

Intervention

Relationship-Focused

Intervention (RFI)

Theoretical Frameworks



Relational Theory



Attachment Theory



Developmental-Contextual Theory

BTC programs specific to fostering mother-child relationship, delivered through home visits or in centre-based groups:

 Learning Through Play Program®

 Parent-Child Mother Goose Program®

 Make the Connection Parenting Program ®

 Supporting Security (Wittenberg, 2010)

 Interaction Guidance (McDonough, 2000)

 Watch, Wait, and Wonder (Muir et al., 1999)

 Infant-Parent Psychotherapy (Fraiberg et al., 1975)

Specific Relationship-Focused

Treatments and Approaches

Mental Health Diagnoses and the

Mother-Child Relationship

RESEARCH

STUDY

Intervention for women which recognizes the

parenting role

Increased Relationship Capacity

RFI/BTC CI

Reduction in Substance Use Increase in Confidence Resisting Use Improvement in Mental Health Symptoms

Expected Outcomes

Relationship-Focused at all levels of service

Comparing RFI/BTC and CI

> Reduction in Substance Use

> Improvement in Mental Health Symptoms

Methods

T1

T2

RFI/BTC

121

54

CI

50

21

Participants (n)

Measures

Maternal Addiction

• Drug Taking Confidence Questionnaire (DTCQ; Sklar & Turner, 1999)

• Addiction Severity Index (ASI; McLellan et al.,1992) Maternal Mental Health

• The Center for Epidemiologic Studies Depression Scale (Radloff, L.S., 1977)

• Beck Anxiety Inventory (BAI; Beck, 1993) Maternal Relationship Capacity

• Adult Attachment Scale - revised (R-AAS; Collins, 1996)

• Perceived Social Support Scale (friends & family (PSS-fa/ PPS-fr; Procidano & Heller, 1983)

Child Self-Regulation (ONLY IN RFI/BTC)

• Child Behavior Checklist (CBCL; Achenbach, 1991)

Addiction Severity

Addiction Severity (ASI)

0 0.1 0.2 0.3 0.4 1 2 M ea n S co re s RFI/BTC CI

Confidence Resisting Substances (DTCQ) 50 55 60 65 70 75 80 85 90 1 2 M ea n S co re s RFI/BTC CI

Mental Health Improvements:

0 10 20 30 40 50 60 Per cen ta ge Clinical T1 Clinical T2 RFI/BTC CI P<.01 0 5 10 15 20 25 30 35 40 45 Per cen ta ge Severe T1 Severe T2 RFI/BTC CI Depression Anxiety

AAS

Capacity to be Close to Others

2.5 2.75 3 3.25 3.5 1 2 M ea n S co re s RFI/BTC CI

Relationship Capacity

Perceived Social Support: Family

5 7 9 11 13 15 1 2 M ea n S co re s RFI/BTC CI

Improvement in Relationship Capacity

Predicts Child Self-Regulation (RFI/BTC)

Increase in Maternal Relationship Capacity over time Decrease in Child Impulsivity & Externalizing Behaviours

Clinical Implications

Effective interventions for children at-risk for poor

mental health and developmental outcomes include a comprehensive range of integrated services which:

 Are relationship focused at all levels of service

development and delivery

 Integrate child and adult services

 Address mental health, including maternal

loss/trauma and substance use

 Provide opportunity for modeling and practicing

relationships

Thank you

This research was funded by the Canadian Institutes for Health Research – Institute for Gender and Health and by Mothercraft, Toronto, Canada.

This research was conducted through the partnership of

Mothercraft, York University, the University of Toronto, and