I. INTRODUCTION... CAPP... Overview of the Report

Transcription

1 .I METHODOLOGY Research Instruments Findings Infant/ChildDevelopment TABLE OF CONTENTS ACKNOWLEDGMENTS 111 EXECUTIVE SUMMARY I. INTRODUCTION..... CAPP Overview of the Report II. PARENTING COMPONENT Goals Services for Women in Treatment..... Parenting Skills Group Modifications Collaboration OtherGroups and Auxiliary Services Services for the Infants/Children Aftercare Services Individualized Services Aftercare Group The Residential Programs Similarities Differences XIII Questions Women Participating in the Parenting Program Women Infants in Aftercare Design Parenting Skill Training on Women IntakeInterview AAPI Hudson NCAST Index Feeding of Self-Esteem Scale (Nursing (lse) Child Assessment Satellite Training Participant Feeding Evaluation Scale) of the Parenting Training CAPPAftercareForm Child Development Knowledge Index FindingsonInfants v

2 Missing No Control Data Groups Birth Outcome Data Collection Form Pediatric Form Bayley Scales of Mental and Motor Development Measures not Reported Data Collection Analytical Considerations Timing Issues on Women's Measurements.... Timing Issues on the Infant/Child Measurements Analyses Nurturing Program Participants Infant/Child Development Aftercare Participants Sample Sizes/Findings on Women Sample Sizes/ Findings On Infants/Children... Analyses of Sample Attrition Effects Collective and Separate Findings IV. CHARACTERISTICS OF THE WOMEN Sample Socio- Demographic Characteristics..... Age/Marital Status/Race Living Arrangement Education/Employment Income Criminal Justice Involvement.... Site Differences Drug and Alcohol Use LifetimeUse Current Age of First Use Use Treatment History Substance Abuse Treatment.... Self-Help Groups Other Treatment Children Custody Prior to Admission..... Children's Current Living Situation Pregnancy Prenatal Care Substance Use During Pregnancy Childhood Background Caretakers vi

3 BeliefinCorporaIPunishment New elacsgnideftsacn New Instability Childhood Abuse Parental/Sibling Substance Abuse Site Differences V OUTCOME Length of MEASURES Stay..... ON... WOMEN Overview of Outcome Findings Hudson Index of Self-Esteem (ISE) New Day Women, Inc Adult-Adolescent Parenting Inventory Inappropriate Expectations New Day Women, Inc Lack of Empathy Towards Children's Needs New Day Women, Inc Day Women, Inc New Day Parent-Child Role Reversal Women, Inc..... Day Women, Inc Participants I Ratings of the Parenting Program P artlclpants.. ' Ignoring Using TimeOut omments Irritating Behavior c GivingPraiseandRewards. DeflningRules Stating Consequences/Following Through with Consequences Setting Up Routines Appropriate Expectations Improved Communication/Empathy Improved Patience/Responsibility Positive Time with Children Physical Involve Children Punishment in Decision Making General Improvement in Parenting Impact on Mother Relationship Between Client Characteristics and Improvement in AAPI... Relationship Between Improvements in Self-Esteem and Parenting Skills VII

4 eracretfa Participants Relapse OUTCOME MEASURES ON INFANT AND CHILD DEVELOPMENT Birth Outcomes Birth Status/Gestational Age InfantDeath Birth Measurements Birth Weight Birth Length/Head Circumference ragpa Scores Relationship Between Maternal Substance Abuse and Birth Outcome... Follow-Up on Low Birth Weight Infants Weight for Age Z score Infant Development WeightforLengthZscore LengthforAgeZscore Through Age One Bayley Scales of Mental and Motor Development Development of Physical Systems Heart Chest Abdomen Muscle tone Reflex Bayley Scores State and Parenting Control Skills NEMOW Participation IN AFTERCARE in Aftercare Length and Level of Participation Program Nurturing Program Completers Characteristics of Women in Aftercare Age/Race/Ethnicity Education/Income Marital Status/Children Substance Abuse Significant Differences Problems After Program Discharge Financial Problems Relationships with Adults Relationship with Children Housing Problems Medical Problems Other Length of Time to Relapse/Description and Analyses SurvivaIAnalysisl Survival Analysis VIII

5 semoctuo for Women Women in Aftercare Survival Analysis Other Changes in the Women I s Lives. Living with Children Employment School Public Assistance VIII. FACTORS PREDICTING RETENTION IN NURTURING PROGRAM Participants Versus Non-Participants Length of Participation Variables Examined Factors Related to Participation/Both Programs Daily Drug Use History of Drug Use Number of Drugs Used Education 98 Factors Related to Length of Participation/Women, Inc Factors Related to Length of Participation/New Day Time 1 Drop-outs 98 Time3Completers 99 Time 1 and Time 3 versus Time 2 Educational Effect EducationaIEffect 99 IX. SUMMARY DISCUSSION Parenting Quality of Skills Mother-Child Interaction..... Program Differences/Self-Esteem Program Summary Differences/ of Outcome AAPI for Mothers Outcomes Birth for Outcomes. Infants Retention Child in the Development Nurturing Program Participation Length of Participation Implications for Findings on Retention... Additional Findings on Parenting Component... Additional Research Implications References Appendices Appendix A Demographic Characteristics of Women Alcohol and Drug Use IX

6 xidnepa B 1sisylanAIavivruS Survival gnirutrun Program - Women Inc. Table 3 Treatment History Table 4 Children and Custody Table 5 Pregnancy History Table 6 Childhood Background Significant Site Differences in Client Characteristics xidnepa Table C 1 Significant Differences in Length of Stay/Completion of Table 3 Appendix D. Table 3 Table 4 Table 5 Table 6 Table 7 Table 8 Appendix E. Appendix F.. Table 3 Table 4 Table 5 Table 6 Table 7 Appendix G.. Table 3 Table 4 Table 5 Treatment Outcome Values for Clients Who Completed the Nurturing Program - New Day Outcome Values for Clients Who Completed the Nurturing Program - Women, Inc Abdomen Cardiac WeightforAgeZ-Score LengthforAgeZ-Score for Abnormalities Abnormalities. Length Z-Score , MuscularAbnormalities Reflex Abnormalities State Control Abnormalities Significant Site Differences Between Aftercare Participants Ys. Pregnant Non-Participants Testing Homogeneity of Survival Curve Analysis 2 - Length < 6 Months Survival Analysis 2-6 Months:::; Length < 12 Months. Survival Analysis 2 - Length ~ 12 Months Survival Analysis 3 - Nurturing Program Completers... Survival Analysis 3 - Non-Completers Odds Ratios for Participants in the Nurturing Program - New Day Odds Ratios for Participants in the Nurturing Program - Women, Inc Odds Ratios for Length of Participation in the Odds Ratios for Length of Participation in the Nurturing Program - New Day Odds Ratios for Education Level: Selected Participants - New Day x

7 I. INTRODUCTION Among the most preventable causes of birth defects are those related to drug and alcohol use during pregnancy Despite this, specific services for chemically-dependent pregnant women have historically been lacking and access to substance abuse treatment facilities is still limited for this population. The issue of pregnant substance abusing women and their children has aroused a great deal of concern in recent years (Finkelstein, 93, 94) Substance abuse during pregnancy has been associated with a variety of serious long and short-term consequences for both the mother and child. For the child, maternal substance use increases the risk for adverse birth outcomes such as low birth weight, prematurity, fetal distress, congenital malformations, stillbirth and neurobehavioral dysfunction In later life, the child may continue to display developmental and behavioral problems due to an unsupportive home environment or inappropriate parent/child interaction patterns (Chasnoff, 89; Chavkin, 90; Kronstadt, 90; Robins & Mills, 93; Streissguth & LaDue, 87; Zukerman & Bersnahan, 91) Chemically-dependent pregnant and parenting women may also be particularly prone to experiencing difficulties in parenting A combination of factors may contribute to this emotional instability; lack of social and economic resources, including social supports; a childhood history which included few, if any, positive role models for parenting; and having a high-risk infant who may be irritable and unresponsive as well as possibly having other children affected by substance abuse in the home (Burns& Burns, 88; Chasnoff et al 88; Chasnoff, 91; Hutchens & Alexander, 90; Simons, et al., 88). Research

8 suggests that developing effective parenting skills not only benefits the child, but may also improve the mother's self-esteem and sense of competence (Bauman& Dougherty, ; Egeland & Erickson, 90; Leif, 85; Zuckennan & Bersnahan, 91), In a previous study (Nanson, et at., 81), parenting training was found to be the most effective component of an intervention to help children with Fetal Alcohol Syndrome. Our study examines the efficacy of implementing a parenting component in residential treatment programs for pregnant and parenting chemically-dependent women. The findings described in this paper suggest that services such as parenting training should be a regular component of substance abuse treatment for pregnant and parenting women. CAPP The parenting component reviewed in this paper is part of the CAPP (Coalition on Addiction, Pregnancy and Parenting) program located in Cambridge, Massachusetts. CAPP began as a five-year service demonstration project funded by the Department of Health and Human Services, Center for Substance Abuse Prevention (CSAP).! One of CAPP's central goals is to increase pregnant and parenting women's access to substance abuse services throughout Massachusetts through advocacy, legislative efforts, training, case management and by demonstration of the effectiveness of implementing a parenting component for pregnant and parenting women in two residential treatment programs. Five organizations worked collaboratively with CAPP to implement and evaluate the parenting program 1) Women, Inc.; 2) New Day of the Women's Alcoholism Program of CASPAR, Inc.; 1 CAPP also receives funding from the Massachusetts Department of Public Health, Bureau of Substance Abuse Services and other local funding sources. The Massachusetts Health Research Institute administers CAPP's federal funding. 2

9 3) Children's Hospital; 4) The Fetal Alcohol Education Program, Boston University School of Medicine; and 5) Health and Addictions Research, Inc. Overview of the Report Section II provides a brief description of the parenting program and the two residential programs Section III reviews the methodologies used to study the impact of the parenting component. The remainder of the paper focuses on the women who were admitted to the parenting component between January 1, 90 - August 31, 93 and the infants born to these women while they were in residential treatment. Sections IV and V describe the characteristics of women in the parenting program and changes they underwent in parenting skills and self-esteem. Quality of mother-child interaction and the women's perceptions of changes in their parenting skills are also described Section VI outlines the birth outcomes and subsequent mental and physical development of the infants born to these women. Section VII provides follow-up data on a select sample of the women who either left or completed residential treatment. Section VIII examines factors that predicted retention in the Nurturing Program The final section discusses the implications of the findings 3