Study Review

Pre-birth substance misuse programmes

Integrated interventions targeting mothers with substance abuse issues aiming at improving parenting skills by providing in a “one stop” setting, addiction services as well as prenatal, parenting and child-related services.

Outcome Overall
effectiveness

This rating shows how effective the intervention is at achieving the evaluated outcome.

Click here for information about how effectiveness ratings are applied.

Strength of
evidence

This rating shows how confident we can be about a finding, based on how the research was designed and carried out.

Parenting outcomes Overall effectiveness: 1 (maximum 2) Strength of evidence : 1 (maximum 3)

Headline points

  • Integrated interventions to help mothers to cope with their substance misuse as well as to improve their parenting skills. These combine addiction services with prenatal, parenting and child-related services in a centralised ‘one-stop’ setting.
  • The Relational Psychotherapy Mothers’ Group and Washington State MOMs Project are two distinct integrated interventions based on capacity building, empowerment approach and a philosophy of recovery framework.
  • Evidence suggests that integrated programmes are associated with improvements in parenting skills. However, more robust research is needed that compares outcomes from integrated programmes with treatment as usual.
  • No research on these types of integrated interventions have been led in the UK.

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What is this?

  • Substance misuse is increasingly known to have different effects for men and women. In order to answer women’s unique risk factors, integrated interventions tailored to their needs have been developed. Women who misuse substances often have mental health issues, histories of physical or sexual abuse, they also often suffer from relationship problems such as domestic abuse and a lack of social support. Additionally,  women who are mothers may also have specific needs related to their parental role. Addiction may compromise their capacity to parent and access to  services may be complicated because of fear losing their children
  • Integrated interventions aim to help mothers to cope with their substance misuse as well as to improve their parenting skills. Such integrated interventions combine addiction services with pre-natal, parenting and child-related services in a centralised ‘one-stop’ setting.

How is it meant to work?

  • The Relational Psychotherapy Mothers’ Group uses a gender sensitive approach and, thus, only works with female therapists, psychologists and drug counsellors. The intervention aims at creating a positive environment based on the Rogerian constructs of acceptance, empathy and genuineness. This approach aims to create a setting in which women can consider the strengths and limitations of their current parenting approaches and develop more optimal approaches. This approach aims to empower women to change and build their capacity to make these changes.
  • The Washington State MOMs Project used a philosophy of recovery framework which encourages women to move forward, set new goals, and take part in relationships and activities that are meaningful. Using a multidisciplinary team, women were encouraged to restructure their behaviours and practice positive interactions in a safe and non-judgmental environment. Women were also encouraged to identify their defence mechanisms so that they would prevent destructive behaviours.

What are the evaluated outcomes?

  • Parenting outcomes

How effective is it?

Overall,  the integrated intervention approach had a positive effect on parenting outcomes, this is based on low strength of evidence. However, it is important to highlight that findings were mixed and therefore more research is needed to draw strong conclusions.

Mixed findings emerged for the Relational Psychotherapy Mothers’ Group. A study (Luthar and Suchman, 2000) showed that women who received the integrated treatment programme  did significantly better in terms of affective interaction scores than those who received the treatment as usual, however the effect was not present at a significant level anymore after six-months. A later study by the same author (Luthar et al., 2007) with a different sample displayed significant improvements in affective interaction, parental satisfaction and decreased child abuse risk scores between women who received the integrated treatment programme and the group which received the usual intervention. The Washington State MOMs Project studied by Huber (1999) did not demonstrate any effect on parenting outcomes.

The quality of evidence for the four randomised trials was rated as very low to moderate as the studies lacked detailed information and rigorousness regarding the study design and sample size were small.

Where has it been studied?

The four RCTs included in the systematic review all took place in the United States.

Who does it work for?

  • The meta analysis targeted interventions for women only, their average age was 29 to 36 years and most of them had experienced trauma, had mental health problems, and were unemployed, single mothers. The studies targeted mothers with a varied ethnical background, reflecting the location of the studies. One intervention targeted pregnant women while the three other interventions involved mothers with children of a wide age range (infant to adolescents).
  • The Relational Psychotherapy Mothers’ Group involved pregnant women and those with children up to sixteen years old.
  • For the Washington State MOMs Project, women involved were in their second or third trimester of pregnancy. Half of the women involved had previous Children’s Services involvement and around 79% had been in prison. Many of them are identified as homeless.

When, where and how does it work?

  • Programs were 3-12 months and had a high dropout rate
  • The Relational Psychotherapy Mothers’ Group lasts 24 weeks while the Washington State MOMs Project is a prenatal intervention.
  • The Mother’s and Toddlers Program and the Parent Education are two attachment based parenting interventions programs that have been associated with improved parenting outcomes, however these findings should be treated with caution as it is based on only one study.

What are the costs and benefits?

No costs and benefits analysis was conducted

How is it implemented?

The Relational Psychotherapy Mothers’ Group (RPMG) has been implemented as a set of services added to the standard treatment in methadone programs. The Washington State MOMs Project was based on the notion that providing addiction treatment during pregnancy would result in improved child development outcomes.

  • In the RPMG, mothers were assigned to weekly group meetings in addition to standard treatment at the Clinic for 24 weeks. The group size was 5 on average, ranging from 3 to 8. Group sessions were semi structured and open as drop in sessions. Sessions integrated mothers of children with a wide age span (between 0 and 16 years old) to enable guidance and sharing of experience between the participants. In addition, the standard treatment, used in methadone programs, included a weekly 1-hr counselling group and periodic meetings with case managers to secure basic needs.  Women accessed the intervention in an outpatient setting.
  • The Washington State MOMS project involved an integrated residential program, an integrated outpatient program, or a standard outpatient program. The integrated programs included prenatal care, maternal health care, parenting education and support, and children’s services.

Who can deliver it?

  • In RPMG, the standard intervention was delivered by case managers, while the counselling groups were led by certified drug clinicians. The RPMG  intervention was conducted by six female masters and doctoral level therapists (one therapist per group).
  • No details are given for the Washington State MOMS project.

 

What are the training and supervision requirements?

  • The clinicians of the RPMG interventions received weekly supervision from licensed clinical psychologists. The support involved reviewing videotaped sessions, providing individual feedback and reviewing treatment approaches.
  • No details are given for the Washington State MOMS project.

What supports good implementation?

  • A therapist’s manual detailed the outline of each session topic for the group sessions of the RPMG.  Licensed clinical psychologists with expertise in the interventions provided support and monitoring of the work of the clinicians providing the group sessions.
  • No details are given for the Washington State MOMS project.

In summary...

  • Evidence is mixed on the effectiveness of interventions targeting mothers with substance abuse and integrating as well prenatal, parenting and child-related services.
  • In particular, there is little evidence regarding parenting outcomes of mothers who have substance misuse issues.
  • Further research is needed with a larger sample and relevant comparison group to evaluate the effectiveness of such integrated programs, especially on outcomes regarding the mothers and child. No studies have been led yet in the UK.

Further resources