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. York University/Hospital for Sick Children
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.
BTC Admission Criteria 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
Broader Context Family Context Maternal Context Mental Health Trauma History BTC Families
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. (Zero to Three, 2002)
Mother-Child Dyad CHILD Difficult Temperament Poor Regulation Health Problems Developmental Delays Relationship MOTHER at Risk Mental Health Sub. Use Recovery Abusive Relationships Poverty
Historical Interventions:
Contemporary Interventions:
Relationship-Focused Intervention
Relationship-Focused Intervention (RFI) Theoretical Organizational Programs and Services Mother and Child
Theoretical Frameworks Relational Theory Attachment Theory Developmental-Contextual Theory Historical Trauma Theory
Relational/Reflective Practice
Specific Relationship-Focused Treatments and Approaches 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)
Mental Health Diagnoses and the Mother-Child Relationship (Motz et al., 2013)
RESEARCH STUDY
Comparing RFI/BTC and CI CI RFI/BTC Intervention for women which recognizes the parenting role Relationship-Focused at all levels of service Expected Outcomes > Reduction in in Substance Use Use > Improvement Increase in Confidence in Mental Health Resisting Symptoms Use Improvement in Mental Health Symptoms Increased Relationship Capacity Child Self-Regulation
Participants (n) Methods T1 T2 RFI/BTC 121 54 CI 50 21
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) Behavior Rating Inventory of Executive Function (BRIEF; Gioia et al., 2000)
Addiction Severity Mean Scores 90 85 80 75 70 65 60 55 50 Confidence Resisting Substances (DTCQ) 1 2 RFI/BTC CI Mean Scores 0.4 0.3 0.2 0.1 0 Addiction Severity (ASI) 1 2 RFI/BTC CI
Mental Health Improvements: Depression Anxiety 60 45 50 40 35 Percentage 40 30 20 RFI/BTC CI Percentage 30 25 20 15 RFI/BTC CI 10 10 5 0 Clinical T1 Clinical T2 0 Severe T1 Severe T2 P<.01
Relationship Capacity Mean Scores AAS - Capacity to be Close to Others 3.5 3.25 3 2.75 2.5 1 2 RFI/BTC CI Mean Scores 15 13 11 9 7 5 Perceived Social Support: Family 1 2 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
CONCLUSIONS
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 Intervene through the mother-child relationship
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 Queen s University.