Relationship-Focused Intervention for Substance-Involved Women and Their Children

Children of substance-using mothers experience both internal and external barriers to optimal development and mental health. High quality caregiving is protective for these children; however, substance-using women may experience difficulty providing consistent and sensitive care due to past experiences and current life stressors. The first objective of this study was to provide a profile of substance-using women to contextualize their presenting concerns, risk factors, and treatment needs. The second and third objectives of this study were to assess improvements in parent functioning, that is the cognitive component of parenting, as well as parent behaviour as a result of an integrated relationship-focused intervention and to explore the association between parent functioning and behaviour and child behaviour problems. The final objective of this study was to explore the concordance of changes in mothers and childrens relationship skills and to identify patterns of change in the mother-child relationship. Case examples are provided to help contextualize the changes in relationship skills over time and with treatment. Mother-child dyads were recruited from Breaking the Cycle, a program for mothers with substance use problems and their young children. Sample A comprised 136 mothers and 122 children for whom intake questionnaires were available. Of these women and children, 59 mother-child dyads completed a free-play observation approximately one year after intake (Sample B) and 27 dyads completed a second free-play observation two years after intake (Sample C). The profile of substance-using women in this sample was characterized by high levels of relationship risks, mental health difficulties, and other life stressors. Longer periods of enrolment in the program were associated with higher levels of parent functioning and more emotionally available parenting behaviours two years after intake. Better parent functioning, in turn, was associated with fewer child behaviour problems two years after intake. Contrary to predictions, parent behaviour was not predictive of child behaviour problems. Several patterns of change within the mother-child relationship were observed. Overall, mothers and children were significantly more likely to be concordant in their changes in relationship skills (i.e., both increasing or both decreasing) than discordant indicating that mothers and children develop and change together. Limitations and clinical implications are discussed.