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Insua-Summerhays B, Knowles Bevis B, Barlow PJ. What tools should be used to identify women in need of additional support in pregnancy? J Reprod Infant Psychol 2024; 42:234-268. [PMID: 35930009 DOI: 10.1080/02646838.2022.2103525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE This study aimed to identify and inform recommendation of self-report and interview-based instruments that are feasible, reliable and valid to evaluate the quality of the maternal-fetal relationship (MFR). BACKGROUND Several constructs predicting parent-infant interaction and later infant adjustment are used to assess mothers' thoughts and feelings towards their unborn baby, including reflective functioning, mind-mindedness, representation, and fetal attachment. As yet, there is no existing review comparing the quality and accessibility of instruments across each of these constructs. METHODS A systematic literature review was undertaken to synthesise psychometric information on measures reporting on the MFR. Searches of six databases were conducted. English articles were selected based on inclusion and exclusion criteria. The QATSDD checklist was used to assess study quality. RESULTS Of 669 studies identified, 28 met inclusion criteria. Thirteen different instruments were identified for evaluation. Reported reliability and validity varied significantly across instruments, as well as availability for research and/or clinical use. CONCLUSION Suggestions for research and clinical practice include further evaluation of the psychometric properties of tools, particularly for self-report measures of reflective functioning, use of interviews to scaffold reflexivity, and development of clinical policies and procedures to clarify care pathways for expectant mothers needing further support.
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Affiliation(s)
- Bryony Insua-Summerhays
- Department of Social Policy and Intervention, Oxford Institute of Clinical Psychology Training and Research, Isis Education Centre, Warneford Hospital, Headington, UK
| | - Becca Knowles Bevis
- Department of Social Policy and Intervention, Oxford Institute of Clinical Psychology Training and Research, Isis Education Centre, Warneford Hospital, Headington, UK
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Kautz SV, Bosk EA, Mendez A, Pomales H. Strategies and Adaptations to an Integrated Substance Use and Infant Mental Health Treatment Program During COVID-19. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:17-34. [PMID: 37773312 DOI: 10.1007/s10488-023-01300-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/01/2023]
Abstract
The COVID-19 pandemic resulted in increased parenting stress and substance use. At the same time that mental health and social service needs increased, access to services, including among those receiving treatment, decreased due to stay-at-home orders. Few programs were equipped or prepared to translate their interventions to a virtual format at the start of the pandemic. There is a critical need to identify effective adaptations to substance use and family-focused treatment during the COVID-19 pandemic. Effective program adaptations have continued relevance for the expansion of access to family-focused addiction services beyond the pandemic itself, particularly for rural or other hard to reach populations. Seventy-three semi-structured interviews were conducted with the five agencies participating in the implementation of the In-Home Recovery Program (IHRP), an in-home, substance use disorder (SUD) treatment program. Using a rapid analysis approach two coders analyzed interviews for recurring concepts and themes. Facilitators for adapting services included: (1) the introduction of virtual toxicology screens, (2) helping parents access technology, (3) assisting parents with non-identified children to decrease their stress, and (4) anticipating reoccurrences of substances during the pandemic. Barriers to adapting services included: (1) engaging young children in virtual treatment, (2) privacy, and (3) engaging in telehealth with parents experiencing domestic violence or reoccurrence of substances. Findings reveal virtual substance use treatment is possible. Facilitators to adaptation such as providing access to technology and virtual toxicology screens demonstrate the feasibility and acceptability of utilizing telehealth interventions for substance use. Barriers to adaptations were primarily related to the infant mental health component. Telehealth is likely not appropriate for children below the age of five. Individual sessions focusing on caregiving, rather than dyadic treatment may be more suitable to virtual formats.
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Affiliation(s)
- Sarah V Kautz
- School of Social Work, Rutgers, The State University of New Jersey, 390 George Street, Room 713, New Brunswick, NJ, 08901, USA.
| | - Emily A Bosk
- School of Social Work, Rutgers, The State University of New Jersey, 390 George Street, Room 713, New Brunswick, NJ, 08901, USA
| | - Alicia Mendez
- School of Social Work, Rutgers, The State University of New Jersey, 390 George Street, Room 713, New Brunswick, NJ, 08901, USA
| | - Hannah Pomales
- School of Social Work, Rutgers, The State University of New Jersey, 390 George Street, Room 713, New Brunswick, NJ, 08901, USA
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Wang X, Liu Q, Merrin GJ, Keller A, Yoon D, Henderson A. Harsh parenting among veterans: parents' military-related PTSD, mentalization, and pre-military trauma. Front Psychol 2023; 14:1283801. [PMID: 38169711 PMCID: PMC10758459 DOI: 10.3389/fpsyg.2023.1283801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Objectives Veteran parents experiencing posttraumatic stress disorder (PTSD) may resort to harsh parenting. The indirect pathway from parental military-related PTSD to harsh parenting, and the moderating role of parents' pre-military trauma histories, has been less explored. Informed by mentalization theory, as well as trauma-sensitive and posttraumatic growth perspectives, we aim to explore the associations between veteran parents' military-related PTSD, mentalization, harsh parenting, and prior trauma before military service. Methods Data were collected from an online research panel of 509 veteran parents with children under 10. We employed Structural Equation Models to test indirect and moderating effects. Results We identified an indirect effect of parental pre-mentalization from military PTSD to harsh parenting [corporal punishment: b = 0.35, p < 0.001, 95% CI (0.23, 0.46); psychological aggression: b = 0.14, p < 0.001, 95% CI (0.09, 0.19)]. Multi-group analysis on four parent groups (parents with only pre-military physical trauma, parents with only pre-military psychological trauma, parents with both pre-military physical and psychological trauma, and parents with no pre-military physical or psychological trauma) highlighted differences in these associations, particularly between parents with only pre-military physical trauma and those without any physical and psychological trauma. The military-related PTSD effects on psychological aggression, corporal punishment, and pre-mentalization were all significantly higher for parents without pre-military physical and psychological trauma. Conclusion Modifying parents' interpretation of their child's mental states can potentially counteract the effects of veterans' military PTSD on harsh parenting. Family-based programs should be created considering veteran parents' pre-military trauma histories.
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Affiliation(s)
- Xiafei Wang
- School of Social Work, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, United States
| | - Qingyang Liu
- Department of Human Development and Family Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, United States
| | - Gabriel J. Merrin
- Department of Human Development and Family Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, United States
| | - Amanda Keller
- Department of Social Work, McGill University, Montreal, QC, Canada
| | - Dalhee Yoon
- Department of Social Work, Binghamton University-State University of New York, Binghamton, NY, United States
| | - Ava Henderson
- School of Social Work, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, United States
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Borelli JL, DeCoste C, McMahon TJ. Enhancing parental reflective functioning: A special tribute to the life and work of Nancy E. Suchman, PhD. Infant Ment Health J 2023; 44:137-141. [PMID: 36857483 DOI: 10.1002/imhj.22049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 03/03/2023]
Abstract
Nancy E. Suchman's contributions to the fields of infant mental health, maternal reflective functioning, and attachment-based intervention will have long-lasting impacts. In particular, through the development and dissemination of her intervention program, Mothering from the Inside Out (MIO), she innovated a way of working with mothers with substance use disorders that represented a paradigm shift within the field of addiction. In this introduction to the special issue, written to honor her life and work, we review Nancy's background and briefly describe her academic accomplishments. The special issue contains nine qualitative and quantitative research reports written by Nancy's colleagues and their collaborators. All nine papers pertain to the theme of understanding, measuring, and promoting parents' capacity for reflective functioning. Four provide findings that advance our understanding of parental reflective functioning. The other five highlight insights from continuing evaluations of MIO, including new adaptations of the model. To introduce the special issue, we provide an overview of the scope of the work done within these projects. Finally, the special issue concludes with two commentaries contributed by Linda Mayes and Arietta Slade, leading scholars within the field who were also Nancy's close colleagues. Both provide insight into Nancy's impact on the field.
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Affiliation(s)
- Jessica L Borelli
- Department of Psychological Science, School of Social Ecology, University of California, Irvine, California, USA
| | - Cindy DeCoste
- Yale School of Nursing, West Haven, Connecticut, USA
| | - Thomas J McMahon
- Department of Psychiatry and Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
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Lowell AF, Suchman NE, Byatt N, Feinberg E, Friedmann PD, Peacock-Chambers E. Parental substance use and home visiting programs: Implementation considerations for relationship-based treatment. Infant Ment Health J 2023; 44:166-183. [PMID: 36859776 PMCID: PMC10050092 DOI: 10.1002/imhj.22041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/03/2023] [Indexed: 03/03/2023]
Abstract
Home visiting programs can provide critical support to mothers in recovery from substance use disorders (SUDs) and young children prenatally exposed to substances. However, families impacted by maternal SUDs may not benefit from traditional child-focused developmental home visiting services as much as families not impacted by SUDs, suggesting the need to adjust service provision for this population. Given the need to implement tailored services within home visiting programs for families impacted by SUDs, we sought to investigate the implementation barriers and facilitators to inform future integration of a relationship-based parenting intervention developed specifically for parents with SUDs (Mothering from the Inside Out) into home visiting programs. We conducted nine interviews and five focus groups with a racially diverse sample (N = 38) of parents and providers delivering services for families affected by SUDs in the USA. Qualitative content analysis yielded three most prominent themes related to separate implementation domains and their associated barriers and facilitators: (1) engagement, (2) training, and (3) sustainability. We concluded that the home visiting setting may mitigate the logistical barriers to access for families affected by SUDs, whereas relationship-based services may mitigate the emotional barriers that parents with SUDs experience when referred to home visiting programs.
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Affiliation(s)
- Amanda F. Lowell
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nancy E. Suchman
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Emily Feinberg
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Peter D. Friedmann
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
| | - Elizabeth Peacock-Chambers
- Department of Pediatrics, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
- Department for Healthcare Delivery and Population Science, Springfield, Massachusetts, USA
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Peacock-Chambers E, Clark MC, Moran M, Lowell A, Zayde A. Training home visitors in mentalization-based practice: A qualitative case study of clinical supervision in mothering from the inside out. Infant Ment Health J 2023; 44:184-199. [PMID: 36807353 PMCID: PMC10084677 DOI: 10.1002/imhj.22039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/05/2022] [Indexed: 02/22/2023]
Abstract
Attachment-based interventions are important for improving parent-child outcomes. These interventions must be scaled and made available to under-resourced communities. An important part of scaling these interventions is delineating and reproducing high-quality training, including clinical training which often requires the completion of a supervised case. However, descriptions and guidelines for clinical training are frequently broad or not available in the literature. A detailed description of clinical training could lead to further research to improve the effectiveness and dissemination of evidence-based interventions. Mothering from the Inside Out (MIO) is an attachment-based parenting intervention effective at reducing substance use and depression, improving caregiving, and enhancing child attachment. It is now being brought from research to community settings. This paper outlines the didactic and clinical training components of MIO. We then present a qualitative case study of one community-based counselor participating in the clinical training of MIO and employ qualitative methods to describe the main themes that arose during the training. We aim to illustrate how the trainer assisted the counselor in implementing the core components of MIO, which included (a) refining the language used in MIO sessions, (b) making space to explore mental states, and (c) addressing trauma. We conclude by presenting the implications of these findings.
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Affiliation(s)
- Elizabeth Peacock-Chambers
- Department of Pediatrics, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
- Department of Healthcare Delivery and Population Science, Springfield, Massachusetts, USA
| | - Maria Carolina Clark
- Department of Healthcare Delivery and Population Science, Springfield, Massachusetts, USA
| | - Michael Moran
- Department of Healthcare Delivery and Population Science, Springfield, Massachusetts, USA
| | - Amanda Lowell
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Amanda Zayde
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
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Sorsa M, Hohenthal M, Pikulinsky M, Sellergren H, Puura K. Qualitative description of outreach and engagement in perinatal substance treatment in Finland. Subst Abuse Treat Prev Policy 2023; 18:6. [PMID: 36681846 PMCID: PMC9862241 DOI: 10.1186/s13011-022-00513-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/29/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Women with perinatal substance problems experience a multitude of barriers to care. They have specific early intervention needs, they endure societal stigma, and both substances and mental health issues influence the way they navigate within support and treatment systems. Early interventions for women with perinatal substance problems are underresearched contexts. The aim of the study is to describe building relationships and engagement within an outreach and low threshold service encounter tailored for pregnant women with SUD (substance use disorder). METHODS The data consist of online written narratives from 11 workers involved in the program and feedback from 504 families in the recovery process comprising 228 open-ended answers. The data were analyzed with a thematic analysis. RESULTS The programs are characterized by flexibility and the implementation of inclusive ways to approach families. The themes for enhancing relationships and engagement within outreach and low threshold programs are Acceptance and attitude: a sensitive approach of approval; flexibility within strictness to allow for diversity and individuality; availability and space to ensure a trustful atmosphere; negotiating via doing to build connections; and everyday life changes: imagining recovery. The themes represent the need of being available, focusing on the worker's attitudes and building connections by doing together, and visioning recovery together. CONCLUSIONS The study results can add to the understanding of SUD outreach and low threshold work during pregnancy. The elements described in this study need further theoretical development, research and critical assessment. Building relationships during pregnancy were characterized by connecting within everyday life situations and supporting the development of an attachment relationship between the baby and the parents. To promote recovery, a comprehensive approach in which substance-related issues and mental health conditions are interconnected can be favored. Engaging early on during pregnancy might enhance success during future rehabilitation.
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Affiliation(s)
- Minna Sorsa
- Child Psychiatry, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
- Nursing Science, Faculty of Social Sciences, Tampere University, Biokatu 12, FM 5 (4-306), SF-33520 Tampere, Finland
| | - Maria Hohenthal
- The Federation of Mother and Child Homes and Shelters, Helsinki, Finland
| | - Miia Pikulinsky
- The Federation of Mother and Child Homes and Shelters, Helsinki, Finland
| | - Hanna Sellergren
- The Federation of Mother and Child Homes and Shelters, Helsinki, Finland
| | - Kaija Puura
- Child Psychiatry, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
- Faculty of Medicine and Health Technology, TamCAM Research Centre, Tampere University, Tampere, Finland
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Lindblom J, Pajulo M, Nolvi S, Tervahartiala K, Karlsson H, Karlsson L, Korja R. Early pathways of maternal mentalization: Associations with child development in the FinnBrain birth cohort study. Front Psychol 2022; 13:855190. [PMID: 36582339 PMCID: PMC9792295 DOI: 10.3389/fpsyg.2022.855190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
Parental mentalization refers to a parents' capacity and interest to consider the individual experience and mental state underlying the behaviors of the child. Higher mentalization is considered a key aspect for parental sensitivity in interaction, fostering child's socioemotional and self-regulatory development. Yet, previous studies have not examined the dynamic pathways through which the maternal mentalization may develop, nor their effects on child development. Thus, in the current person-oriented study, first, we identify distinct profiles and longitudinal trajectories of maternal mentalization from pregnancy to child's 2 years of age. Second, we test how the profiles and trajectories associate with children's internalizing and externalizing problems, social-emotional competence and effortful control at the age of 2 years. Third, we examine how the profiles and trajectories associate with contextual demographic and child related. The substudy was part of the FinnBrain Birth Cohort and included families from general population (n = 2,687). Mothers reported their parental reflective functioning (PRF) at late pregnancy, 6 months and 2 years of child's age. Both mothers (n = 1,437) and fathers (n = 715) reported the developmental child outcomes at the child's age of 2 years. Latent Profile Analysis and Latent Transition Analysis were used to identify PRF profiles and trajectories. The results showed decreasing heterogeneity in PRF from pregnancy to child's age of 6 months and 2 years (i.e., four, three and two latent classes, respectively). Most mothers progressed towards high PRF over time. Second, the profiles and trajectories depicting high PRF associated with child high social-emotional competence at the age of 2 years, yet no clear positive effects were found on child's problems and effortful control. The group of mixed PRF trajectories showed strongest association with child's internalizing and externalizing problems. Finally, there were theoretically meaningful associations between the PRF trajectories and both the contextual (e.g., parity) and child related (e.g., infant temperament) factors. This was the first study to explore the early unfolding of maternal mentalization. The results are discussed in relation with the potential mechanisms accounting for child development and with the nature and limitations of self-reported parental mentalization.
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Affiliation(s)
- J. Lindblom
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland,Faculty of Social Sciences, Tampere University, Tampere, Finland,*Correspondence: J. Lindblom,
| | - M. Pajulo
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland,Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - S. Nolvi
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland,Turku Institute for Advanced Studies, University of Turku, Turku, Finland,Department of Psychology and Speech Language Pathology, University of Turku, Turku, Finland
| | - K. Tervahartiala
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland,Centre for Population Health Research, University of Turku and Turku University, Turku, Finland
| | - H. Karlsson
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland,Centre for Population Health Research, University of Turku and Turku University, Turku, Finland,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - L. Karlsson
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland,Centre for Population Health Research, University of Turku and Turku University, Turku, Finland,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - R. Korja
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland,Department of Psychology and Speech Language Pathology, University of Turku, Turku, Finland
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Lowell AF, Yatziv T, Peacock-Chambers E, Zayde A, DeCoste C, Suchman N, McMahon TJ. Reflective functioning in mothers with addictions: Differential relationships involving family history of mental illness and substance use. Front Psychol 2022; 13:911069. [PMID: 36312152 PMCID: PMC9614557 DOI: 10.3389/fpsyg.2022.911069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Parental reflective functioning (RF) is often cited as an important domain in which mothers with addictions struggle in their roles as parents, though the links between addiction and RF remain unclear. Exposure to attachment trauma associated with parental mental illness and substance use is commonly associated with both addiction and lower RF. We thus examined how family history of parental mental illness and substance use may relate to the RF of mothers with addictions. One hundred ninety-four mothers in outpatient substance use treatment completed the Parent Development Interview and provided information about whether their mothers and fathers experienced mental illness or problems with substance use. Univariate ANOVAs revealed an interaction between family history of maternal mental illness and maternal substance use. Among mothers with a history of maternal substance use, those with a history of maternal mental illness had higher RF than those who had no history of maternal mental illness. Among mothers who did not report a family history of maternal mental illness, mothers who had a family history of maternal substance use exhibited significantly lower RF than mothers with no family history of maternal substance use. Exposure to paternal mental illness or substance use was not associated with mothers' RF. These findings highlight the importance of disentangling the contributions of attachment trauma to mothers' RF and utilizing interventions that support mothers' capacity to reflect about how their early experiences of being cared for by a mother with a mental illness or addiction may impact their current caregiving behaviors.
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Affiliation(s)
- Amanda F. Lowell
- Child Study Center, School of Medicine, Yale University, New Haven, CT, United States
| | - Tal Yatziv
- Child Study Center, School of Medicine, Yale University, New Haven, CT, United States
| | - Elizabeth Peacock-Chambers
- Department of Pediatrics, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, United States
| | - Amanda Zayde
- Montefiore Medical Center, Bronx, NY, United States
- Albert Einstein College of Medicine, New York, NY, United States
| | - Cindy DeCoste
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
| | - Nancy Suchman
- Child Study Center, School of Medicine, Yale University, New Haven, CT, United States
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
| | - Thomas J. McMahon
- Child Study Center, School of Medicine, Yale University, New Haven, CT, United States
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
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10
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Flykt M, Belt R, Salo S, Pajulo M, Punamäki RL. Prenatal Reflective Functioning as a Predictor of Substance-Using Mothers' Treatment Outcome: Comparing Results From Two Different RF Measures. Front Psychol 2022; 13:909414. [PMID: 35959038 PMCID: PMC9359121 DOI: 10.3389/fpsyg.2022.909414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Mothers with prenatal substance use disorder (SUD) often show broad deficits in their reflective functioning (RF), implying severe risk for the relationship with their baby. Two different types of prenatal maternal RF may be important for parenting: adult attachment-focused-RF (AAI-RF), regarding parent's own childhood experiences, and parenting-focused RF (PRF) regarding their own current process of becoming a parent. However, their inter-relations and potentially different roles for parenting intervention outcomes are not clear. This study examined the associations between mothers' prenatal AAI-RF and pre- and post-natal PRF, and their role in mother-infant interaction and substance use as treatment outcomes. The participants were 57 treatment-enrolled pregnant mothers with SUD and 50 low-risk comparison mothers. AAI-RF was measured with the Adult Attachment Interview. For a subsample of 30 mothers with SUD, PRF was measured with Pregnancy Interview (during pregnancy/pre-intervention), and with Parent Development Interview at 4 months (during intervention). Mother-infant interaction was measured with Emotional Availability Scales at 4 and 12 months (post-intervention), and maternal substance use by post-natal substance relapses. Prenatal AAI-RF and pre- and post-natal PRF were highly associated with each other. Only higher prenatal PRF predicted better mother-infant interaction quality at 4 months and less substance use during the child's first year. Interestingly, prenatal PRF and AAI-RF predicted opposite changes in mother-infant interaction: lower prenatal PRF, but higher AAI-RF predicting more positive change. AAI-RF was especially associated with a change in maternal intrusiveness and hostility, indicating that it represents a more general regulatory tendency. Further studies are needed in larger and lower-risk samples. Our results suggest, however, that AAI-RF and PRF are partially distinct and should be uniquely targeted in perinatal interventions.
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Affiliation(s)
- Marjo Flykt
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Faculty of Social Sciences, Department of Psychology, Tampere University, Tampere, Finland
- *Correspondence: Marjo Flykt
| | - Ritva Belt
- Department of Social Services, Tampere, Finland
| | - Saara Salo
- Faculty of Education, University of Helsinki, Helsinki, Finland
| | - Marjukka Pajulo
- Faculty of Medicine, Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Raija-Leena Punamäki
- Faculty of Social Sciences, Department of Psychology, Tampere University, Tampere, Finland
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Garon-Bissonnette J, Duguay G, Lemieux R, Dubois-Comtois K, Berthelot N. Maternal childhood abuse and neglect predicts offspring development in early childhood: The roles of reflective functioning and child sex. CHILD ABUSE & NEGLECT 2022; 128:105030. [PMID: 33752901 DOI: 10.1016/j.chiabu.2021.105030] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/01/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Recent evidence suggests that offspring of mothers having been exposed to childhood abuse and neglect (CA&N) are at increased risk of developmental problems and that boys are more affected by maternal CA&N than girls. Since impairments in reflective functioning (RF) have been associated with maternal CA&N and offspring development, RF could represent a key mechanism in these intergenerational risk trajectories. OBJECTIVE This study evaluated mediating (RF) and moderating (child sex) mechanisms in the association between maternal CA&N and child development. PARTICIPANTS AND SETTING In a longitudinal setting, 111 mothers completed measures during pregnancy and between 11 and 36 months postpartum. METHODS CA&N and impairments in RF were assessed during pregnancy and offspring development was measured during the longitudinal follow-up using the Ages and Stages Questionnaires (ASQ-3). Child development was operationalized in two ways: using the global score at the ASQ-3 and using a dichotomous score of accumulation of delays across domains of development. RESULTS Structural equation modeling indicated that RF mediated the association between maternal CA&N and offspring development. Child sex moderated the association between CA&N and the clustering of developmental problems (Wald = 5.88, p = 0.02), with boys being particularly likely to accumulate developmental delays when their mother experienced CA&N (RR = 2.62). Accumulation of developmental problems was associated with impairments in maternal RF in girls and with maternal exposure to CA&N in boys. CONCLUSIONS Results provide novel insights on the role of mentalization and child sex in the association between maternal CA&N and child development.
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Affiliation(s)
- Julia Garon-Bissonnette
- Department of Psychology, Université du Québec à Trois-Rivières, Canada; Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Canada; Groupe de recherche et d'intervention auprès des enfants vulnérables et négligés, Canada; Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Canada
| | - Gabrielle Duguay
- Department of Psychology, Université du Québec à Trois-Rivières, Canada; Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Canada; Groupe de recherche et d'intervention auprès des enfants vulnérables et négligés, Canada
| | - Roxanne Lemieux
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Canada; Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Canada; Groupe de recherche et d'intervention auprès des enfants vulnérables et négligés, Canada; Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Canada
| | - Karine Dubois-Comtois
- Department of Psychology, Université du Québec à Trois-Rivières, Canada; Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Canada; Groupe de recherche et d'intervention auprès des enfants vulnérables et négligés, Canada
| | - Nicolas Berthelot
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Canada; Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Canada; Groupe de recherche et d'intervention auprès des enfants vulnérables et négligés, Canada; Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Canada.
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12
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Milligan K, Rodrigues ER, Daari-Herman L, Urbanoski KA. Parental Reflective Function in Substance Use Disorder: Individual Differences and Intervention Potential. CURRENT ADDICTION REPORTS 2021. [DOI: 10.1007/s40429-021-00391-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Abstract
Abstract
Purpose of Review
Maternal prenatal substance use presents a multilevel risk to child development and parenting. Although parenting interventions are increasingly integrated into substance use treatment, prenatal parenting processes have not received equal attention within these interventions. This article aims to synthesize the evidence on the specific prenatal risk factors affecting the development of early parenting of substance-using mothers, as well as interventions focusing on those factors.
Recent Findings
Both neurobiological and psychosocial risk factors affect the prenatal development of parenting in the context of maternal substance use. Maternal–fetal attachment, mentalization, self-regulation, and psychosocial risks are important in treatment and highly intertwined with abstinence. Although parenting interventions seem to be highly beneficial, most studies have not differentiated between pre- and postnatal interventions or described pregnancy-specific intervention elements.
Summary
Due to the salience of pregnancy in treating substance-using parents, interventions should begin prenatally and include pregnancy-specific parenting focus. Further research on prenatal interventions is warranted.
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14
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Lowell AF, Peacock-Chambers E, Zayde A, DeCoste CL, McMahon TJ, Suchman NE. Mothering from the Inside Out: Addressing the Intersection of Addiction, Adversity, and Attachment with Evidence-Based Parenting Intervention. CURRENT ADDICTION REPORTS 2021; 8:605-615. [PMID: 34306964 PMCID: PMC8280593 DOI: 10.1007/s40429-021-00389-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 02/07/2023]
Abstract
Purpose of Review Mothers with substance use disorders are often referred for parenting support, though commonly available programs may miss the mark for families impacted by addiction. This may be related to a lack of attention to children's emotional needs, mothers' histories of adversity, and the neurobiological differences seen in mothers with addictions. We review the implications of addiction, adversity, and attachment for parenting interventions. We then describe Mothering from the Inside Out (MIO), an evidence-based parenting intervention designed specifically for mothers with addictions. Recent Findings Evidence from clinical trials suggests that MIO improves outcomes for two generations: both mothers with addictions and their children. Recent trials demonstrate that MIO may be delivered effectively by community-based clinicians and may be beneficial for parents with other chronic stressors. Summary Addressing addiction, adversity, and attachment simultaneously may have a positive synergistic effect. Future research should study the implementation of MIO in real-world settings and examine the impact of MIO on maternal neurobiology.
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Affiliation(s)
- Amanda F. Lowell
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06520 USA
| | - Elizabeth Peacock-Chambers
- Department of Pediatrics, University of Massachusetts Medical School-Baystate, Springfield, MA USA
- Institute for Healthcare Delivery and Population Science, Springfield, MA USA
| | - Amanda Zayde
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | - Cindy L. DeCoste
- Yale Department of Psychiatry, Yale School of Medicine, New Haven, CT USA
| | - Thomas J. McMahon
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06520 USA
- Yale Department of Psychiatry, Yale School of Medicine, New Haven, CT USA
| | - Nancy E. Suchman
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06520 USA
- Yale Department of Psychiatry, Yale School of Medicine, New Haven, CT USA
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15
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Stormshak EA, Matulis JM, Nash W, Cheng Y. The Family Check-Up Online: A Telehealth Model for Delivery of Parenting Skills to High-Risk Families With Opioid Use Histories. Front Psychol 2021; 12:695967. [PMID: 34305753 PMCID: PMC8294463 DOI: 10.3389/fpsyg.2021.695967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Growing opioid misuse in the United States has resulted in more children living with an adult with an opioid use history. Although an abundance of research has demonstrated a link between opioid misuse and negative parenting behaviors, few intervention efforts have been made to target this underserved population. The Family Check-Up (FCU) has been tested in more than 25 years of research, across multiple settings, and is an evidence-based program for reducing risk behavior, enhancing parenting skills, and preventing the onset of substance use. It is designed to motivate parents to engage in positive parenting practices and to change problematic parenting and has been tested across a variety of ages including early childhood and adolescence. It is highlighted in NIDA’s Principles of Substance Use Prevention for Early Childhood: A research-based guide as one of only three effective selective prevention programs for substance abuse among families with young children. Recently, we developed an online version of the FCU that has now been adapted for early childhood and families with opioid use histories. The online platform and telehealth model allow for wide-scale dissemination, ease of training with community providers, and increased public health reach for families in remote, rural areas. This is particularly important when targeting families with opioid misuse and addiction because there are high rates of addiction in remote areas, yet few services available. In this article, we describe the FCU Online and review new content in the model that targets a population of young adult parents with substance abuse histories, including opioid use. New modules include content focused on harm reduction for this high-risk population of parents, such as safety in the home, substance use while parenting, and managing conflict with partners and friends.
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Affiliation(s)
- Elizabeth A Stormshak
- Prevention Science Institute, University of Oregon, Eugene, OR, United States.,Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, United States
| | - Jordan M Matulis
- Prevention Science Institute, University of Oregon, Eugene, OR, United States.,Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, United States
| | - Whitney Nash
- Prevention Science Institute, University of Oregon, Eugene, OR, United States
| | - Yijun Cheng
- Prevention Science Institute, University of Oregon, Eugene, OR, United States.,Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, United States
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16
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Psychometric properties of the prenatal-parental reflective functioning questionnaire in Iranian mothers and fathers. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01909-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Øie MG, Aarnes IE, Eilertsen LH, Söderström K, Ystrom E, Håkansson U. High levels of the openness trait are associated with better parental reflective functioning in mothers with substance use disorders. Addict Behav Rep 2020; 12:100318. [PMID: 33364326 PMCID: PMC7752705 DOI: 10.1016/j.abrep.2020.100318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
Mothers with high levels of Openness had better parental reflective functioning. Mothers with low Openness need training in interpreting mental states in their children. It is important to assess the mothers personality before selecting form of treatment.
Aims Mothers with substance use disorders (SUD) often show impairments in parental reflective functioning (PRF), which may have adverse effects on their capacity for sensitive caregiving. Parenting personality is also associated with caregiving. However, no studies have investigated how these individual factors may contribute to variance in PRF in mothers with SUD. In this study PRF and personality were assessed in 43 mothers with SUD. Methods PRF was assessed by the Parent Development Interview. Personality traits were assessed by the Revised Neuroticism-Extraversion-Openness Personality Inventory. Results The results indicate that higher levels of the Openness trait are associated with better PRF. Conclusion Mothers low in Openness may need more specific and situational training in interpreting mental states in their children. Highly open mothers with SUD will likely need more help distinguishing the child’s mental states from their own, and might need help to maintain mutuality and regulating the intensity of their responses to the child’s behavior.
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Affiliation(s)
- Merete Glenne Øie
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
| | | | | | | | - Eivind Ystrom
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway.,Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,Pharmacoepidemiology & Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Ulrika Håkansson
- Inland Norway University of Applied Sciences, Lillehammer, Norway
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18
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Milligan K, Meixner T, Tremblay M, Tarasoff LA, Usher A, Smith A, Niccols A, Urbanoski KA. Parenting Interventions for Mothers With Problematic Substance Use: A Systematic Review of Research and Community Practice. CHILD MALTREATMENT 2020; 25:247-262. [PMID: 31610688 DOI: 10.1177/1077559519873047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Women with problematic substance use are frequently referred to interventions to promote positive parenting. Parenting interventions that attend to the unique risks faced by this population may enhance engagement and outcomes. While reviews of extant parenting interventions in the research literature have been undertaken, no studies have examined parenting interventions being implemented in community practice and the extent to which these are informed by current research. We systematically compared parenting interventions offered in 12 maternal substance use treatment programs in one Canadian province with those described in the research literature (K = 21). Few parenting interventions were replicated, either within or across the two samples. However, parenting interventions within both samples were largely similar in their objectives. Across both research and community samples, approximately half of the interventions were developed or adapted for a problematic substance use population. Parenting knowledge, psychosocial risk, and maternal emotional regulation were most commonly addressed. Risks pertaining to the impact of drug craving and substance-related changes in neurobiology associted with parenting were less commonly addressed. Findings highlight current strengths and limitations of parenting interventions within research and community settings, with recommendations offered for future research and knowledge translation.
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Affiliation(s)
- Karen Milligan
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Tamara Meixner
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Monique Tremblay
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Lesley A Tarasoff
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Amelia Usher
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Ainsley Smith
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Alison Niccols
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen A Urbanoski
- Canadian Institute for Substance Use Research, University of Victoria, British Columbia, Canada
- Department of Public Health and Social Policy, University of Victoria, British Columbia, Canada
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19
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Tantawi-Basra T, Pezaro S. Supporting childbearing women who are at risk of having their baby removed at birth. ACTA ACUST UNITED AC 2020. [DOI: 10.12968/bjom.2020.28.6.378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Applications for babies to be taken in to care at birth are at a national high. This results in significantly impaired life outcomes. Aims To identify therapeutic mechanisms and interventions to support those at risk of having their baby removed from them at birth and explore the literature in this area. Findings Overall, eight articles including a total of 2 539 participants were selected for inclusion, reporting outcomes from Canada, Australia, England, the Netherlands and US. Findings were categorised into three overarching themes and seven subthemes. Conclusion A cycle of maltreatment model is presented. Social stigma, distrust of services and inequalities remain significant barriers to help-seeking. The development of trusting professional relationships, goal setting and early and sustained interventions may be key in developing effective future interventions of support.
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Affiliation(s)
| | - Sally Pezaro
- School of nursing, midwifery and health faculty of health and life sciences, Coventry University
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20
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Kristiansen VR, Handeland TB, Lau B, Søderstrøm K, Håkansson U, Øie MG. Trauma in childhood and adolescence and impaired executive functions are associated with uncertain reflective functioning in mothers with substance use disorder. Addict Behav Rep 2020; 11:100245. [PMID: 32467834 PMCID: PMC7244921 DOI: 10.1016/j.abrep.2019.100245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/17/2019] [Accepted: 12/26/2019] [Indexed: 01/18/2023] Open
Abstract
Uncertain reflective function in mothers with SUD are associated with trauma during childhood and adolescence. Impaired executive functions are significantly associated with uncertain reflective function. Certain reflective function is not associated with executive functions or trauma.
Aims Impairments in reflective functioning are known to have adverse effects on the ability to display sensitive parenting as a caregiver. Several factors are associated with impairments in reflective functioning, such as impaired executive functioning and experienced trauma. We investigated how these factors contribute to an impaired reflective functioning style, such as pathological certain or uncertain reflective functioning. Extreme scores on these two subscales reflect two kinds of impairments in reflective functioning. We assessed executive functions, reflective functioning, and trauma in 43 mothers diagnosed with substance use disorders (SUD). Methods Certain or uncertain reflective functioning were assessed using the Reflective Functioning Questionnaire 8 (RFQ-8). Executive functions and trauma were assessed by administering various questionnaires, interviews and neuropsychological tests. Results High uncertain reflective functioning was more than six times as common (odds ratio) in mothers reporting high amounts of trauma in childhood and adolescence compared with mothers reporting low amounts of trauma. Impaired executive functions were also significantly associated with high uncertain reflective functioning. Certain reflective functioning did, however, not show any significant associations. Conclusion When the SUD mothers give information about relational trauma in childhood and adolescence, it might therefore be worth investigating and addressing the potential tendency to have an uncertain reflective functioning style.
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Affiliation(s)
| | | | - Bjørn Lau
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Lovisenberg Hospital, Oslo, Norway
| | | | - Ulrika Håkansson
- Innland Norway University of Applied Sciences, Lillehammer, Norway
| | - Merete Glenne Øie
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
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21
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Barone L, Carone N. Childhood abuse and neglect experiences, Hostile-Helpless attachment, and reflective functioning in mentally ill filicidal mothers. Attach Hum Dev 2020; 23:771-794. [PMID: 32253983 DOI: 10.1080/14616734.2020.1738510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The present study represents the first empirical investigation of the mechanisms - a Hostile-Helpless (HH) attachment and reflective functioning (RF) - through which childhood abuse and neglect (CA&N) experiences may impact a mother's likelihood to commit filicide. The sample was comprised of 46 mentally ill mothers. Differences in attachment-derived risk variables between filicidal mothers (FM) and non-filicidal mothers (NFM) were also examined. FM (n = 23) reported lower RF, higher HH attachment, and a more severe history of CA&N, compared to NFM (n = 23), but did not differ on the severity of childhood experiences of loss of and/or separation from attachment figures. Bayesian analysis indicated that the mediated effect of more severe CA&N on the likelihood of committing filicide through higher HH attachment was significantly amplified by lower RF. A developmental interpretation of filicide is proposed and clinical implications for prevention and attachment-based interventions with at-risk mother-child dyads are discussed.
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Affiliation(s)
- Lavinia Barone
- Department of Brain and Behavioral Sciences, Lab on Attachment and Parenting - LAG, University of Pavia, Pavia, Italy
| | - Nicola Carone
- Department of Brain and Behavioral Sciences, Lab on Attachment and Parenting - LAG, University of Pavia, Pavia, Italy
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22
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The effectiveness of Nurture and Play: a mentalisation-based parenting group intervention for prenatally depressed mothers. Prim Health Care Res Dev 2019; 20:e157. [PMID: 31839012 PMCID: PMC7003526 DOI: 10.1017/s1463423619000914] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM This randomised control trial (RCT) study examined the effectiveness of a mentalisation-based perinatal group intervention, Nurture and Play (NaP), in improving mother-infant interaction quality and maternal reflective functioning and in decreasing depressive symptoms. BACKGROUND Few preventive prenatal interventions have been developed for primary health care settings for mothers with depressive symptoms. Furthermore, previous prenatal intervention studies have only concentrated on reducing depressive symptoms and have not directly addressed enhancing optimal parenting qualities. METHODS The participants were 45 pregnant women with depressive symptoms. Women in the randomly assigned intervention group (n = 24) participated in the manualised, short-term NaP intervention group from pregnancy until the baby's age of seven months, whereas control group women received treatment as usual (TAU). Maternal emotional availability (EA), reflective functioning (RF) and depressive symptoms were measured before the intervention and at the infants' 12 months of age, and changes were evaluated using repeated measure analyses of variances (ANOVAs). FINDINGS The results showed that the intervention group displayed higher maternal sensitivity and RF and more reduction in depressive symptoms than the control group when babies were 12 months old. These findings provide preliminary support for the effectiveness of the NaP intervention.
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23
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Handeland TB, Kristiansen VR, Lau B, Håkansson U, Øie MG. High degree of uncertain reflective functioning in mothers with substance use disorder. Addict Behav Rep 2019; 10:100193. [PMID: 31193539 PMCID: PMC6536670 DOI: 10.1016/j.abrep.2019.100193] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 05/02/2019] [Accepted: 05/16/2019] [Indexed: 11/20/2022] Open
Abstract
AIMS Having a substance use disorder (SUD) is associated with impaired reflective functioning (RF) or mentalizing, implying reduced capacity to reflect on internal mental states of the self and others. This has adverse effects on parenting and the child's development. High uncertain RF style prevents an adequate RF due to a concrete, rigid way of mentalizing. High certain RF style prevents adequate RF by making individuals too certain that their view of the world is the true and only one, thereby implying no need to mentalize others' state of mind. We investigated the degree of certain RF and uncertain RF in mothers with SUD with the recently developed screening measure Reflective Functioning Questionnaire-8 (RFQ). Further, we measured the concurrent validity of the RFQ and the more commonly used Parent Development Interview (PDI) measuring a one-dimensional scale of RF. METHODS We used the RFQ-8 to investigate the degree of certain RF (RFQc) and uncertain RF (RFQu) in 43 mothers with SUD. We measured the concurrent validity of the RFQ and the more commonly used PDI. RESULTS Our sample had considerably higher uncertain RF compared to certain RF. The RFQu was significantly negatively associated with maternal RF measured with the PDI, while the RFQc was not. CONCLUSION High degree of uncertain RF in mothers with SUD was associated with an impaired maternal RF (PDI). Administering the RFQ-8 before treatment might be an effective way to screen for uncertain RF deficit, pinpointing what should be the focus in the mentalization-based therapy.
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Affiliation(s)
| | | | - Bjørn Lau
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Research, Lovisenberg Hospital, Oslo, Norway
| | - Ulrika Håkansson
- Inland Norway University of Applied Sciences, Lillehammer, Norway
| | - Merete Glenne Øie
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
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24
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Håkansson U, Watten RG, Söderström K, Øie MG. The association between executive functioning and parental stress and psychological distress is mediated by parental reflective functioning in mothers with substance use disorder. Stress Health 2019; 35:407-420. [PMID: 30977584 PMCID: PMC9328653 DOI: 10.1002/smi.2868] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/02/2019] [Accepted: 04/07/2019] [Indexed: 12/05/2022]
Abstract
Mothers with a substance use disorder (SUD) have been found to exhibit heightened experience of stress and deficits in executive functioning (EF) and in parental reflective functioning (PRF). Although experiences of stress, EF and PRF are important for caregiving capacities; no studies have explored associations between the phenomena in mothers with SUD. This study aimed to examine the association between EF (working memory, inhibition, and cognitive flexibility) and different forms of stress (parental stress, general life stress, and psychological distress) in 43 mothers with SUD with infants. We further aimed to investigate whether PRF had a mediating function between EF and the experience of stress. The mothers completed self-report questionnaires regarding experiences of different types of stress, and we also used neuropsychological tests to assess EF and a semistructured interview to assess PRF. Results identified problems in EF were associated with higher parental stress and psychological distress but not with general life stress. Cognitive flexibility contributed uniquely to variance in parental stress, whereas working memory was a unique contributor to variance in psychological distress. PRF had a mediating function between EF and parental stress and between EF and psychological distress. Findings highlight the importance of considering individual differences in PRF when targeting EF in interventions trying to reduce the experience of parental stress and psychological distress in mothers with SUD.
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Affiliation(s)
- Ulrika Håkansson
- Department of PsychologyInnland Norway University of Applied SciencesLillehammerNorway
| | - Reidulf G. Watten
- Department of PsychologyInnland Norway University of Applied SciencesLillehammerNorway
| | - Kerstin Söderström
- Department of PsychologyInnland Norway University of Applied SciencesLillehammerNorway,Division of Mental Health CareInnlandet Hospital TrustLillehammerNorway
| | - Merete Glenne Øie
- Department of PsychologyUniversity of OsloOsloNorway,Research DivisionInnlandet Hospital TrustLillehammerNorway
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25
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Stover CS, McMahon TJ, Moore K. A randomized pilot trial of two parenting interventions for fathers in residential substance use disorder treatment. J Subst Abuse Treat 2019; 104:116-127. [PMID: 31370975 PMCID: PMC6699774 DOI: 10.1016/j.jsat.2019.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 11/24/2022]
Abstract
Residential substance misuse treatment programs for men typically do not integrate treatment for intimate partner violence (IPV) or parenting despite significant overlap between substance misuse, IPV and child maltreatment. A randomized trial compared two fatherhood focused interventions in 6-month residential substance misuse treatment programs. Fathers for Change (F4C) is an integrated intervention targeting IPV and child maltreatment. Dads 'n' Kids (DNK) is a psychoeducational intervention focused on child development and behavioral parenting skills. Sixty-two fathers were randomly assigned to F4C or DNK. They received 12 weeks of individual treatment while in the residential facility and were offered 4 aftercare sessions following discharge. They were assessed prior to treatment, at the time of residential discharge, following completion of the intervention booster sessions, and 3 months following intervention. Overall, both groups showed significant reductions in affect dysregulation, anger, and IPV. F4C fathers showed significantly greater decreases in affect dysregulation problems. There were no significant differences between groups on IPV but men who received F4C may have been less likely to use substances after leaving residential treatment. Integration of fatherhood focused interventions were possible and welcomed by residents at the facilities. F4C showed some benefit over DNK in terms of affect dysregulation symptoms and substance use relapse.
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Affiliation(s)
- Carla Smith Stover
- Yale University School of Medicine, Child Study Center, New Haven, CT, USA; University of South Florida, Department of Mental Health Law and Policy, Tampa, FL, USA.
| | - Thomas J McMahon
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA; Yale University School of Medicine, Child Study Center, New Haven, CT, USA
| | - Kathleen Moore
- University of South Florida, Department of Mental Health Law and Policy, Tampa, FL, USA
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26
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Aktar E, Qu J, Lawrence PJ, Tollenaar MS, Elzinga BM, Bögels SM. Fetal and Infant Outcomes in the Offspring of Parents With Perinatal Mental Disorders: Earliest Influences. Front Psychiatry 2019; 10:391. [PMID: 31316398 PMCID: PMC6610252 DOI: 10.3389/fpsyt.2019.00391] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/17/2019] [Indexed: 12/16/2022] Open
Abstract
Mental illness is highly prevalent and runs in families. Mental disorders are considered to enhance the risk for the development of psychopathology in the offspring. This heightened risk is related to the separate and joint effects of inherited genetic vulnerabilities for psychopathology and environmental influences. The early years of life are suggested to be a key developmental phase in the intergenerational psychopathology transmission. Available evidence supports the idea that early exposure to parental psychopathology, during the pregnancy and first postpartum year, may be related to child psychological functioning beyond the postpartum period, up to adulthood years. This not only highlights the importance of intervening early to break the chain of intergenerational transmission of psychopathology but also raises the question of whether early interventions targeting parental mental disorders in this period may alleviate these prolonged adverse effects in the infant offspring. The current article focuses on the specific risk of psychopathology conveyed from mentally ill parents to the offspring during the pregnancy and first postpartum year. We first present a summary of the available evidence on the associations of parental perinatal mental illness with infant psychological outcomes at the behavioral, biological, and neurophysiological levels. Next, we address the effects of early interventions and discuss whether these may mitigate the early intergenerational transmission of risk for psychopathology. The summarized evidence supports the idea that psychopathology-related changes in parents' behavior and physiology in the perinatal period are related to behavioral, biological, and neurophysiological correlates of infant psychological functioning in this period. These alterations may constitute risk for later development of child and/or adult forms of psychopathology and thus for intergenerational transmission. Targeting psychopathology or mother-infant interactions in isolation in the postnatal period may not be sufficient to improve outcomes, whereas interventions targeting both maternal psychopathology and mother-infant interactions seem promising in alleviating the risk of early transmission.
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Affiliation(s)
- Evin Aktar
- Clinical Psychology Unit, Department of Psychology, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Jin Qu
- Department of Psychology, Clarion University of Pennsylvania, Clarion, PA, United States
| | - Peter J Lawrence
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Marieke S Tollenaar
- Clinical Psychology Unit, Department of Psychology, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Bernet M Elzinga
- Clinical Psychology Unit, Department of Psychology, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Susan M Bögels
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
- Developmental Psychology, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
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Wall-Wieler E, Roos LL, Brownell M, Nickel NC, Chateau D, Nixon K. Postpartum Depression and Anxiety Among Mothers Whose Child was Placed in Care of Child Protection Services at Birth: A Retrospective Cohort Study Using Linkable Administrative Data. Matern Child Health J 2019; 22:1393-1399. [PMID: 30006727 DOI: 10.1007/s10995-018-2607-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives This study examines whether mothers involved with child protection services (CPS) at the birth of their first child had higher rates of postpartum depression and anxiety. Methods A retrospective cohort of mothers whose first child was born in Manitoba, Canada between April 1, 1995 and March 31, 2015 is used. Postpartum depression and anxiety among mothers whose first child was placed in care at birth (n = 776) was compared with mothers who received services from CPS (but whose children were not placed in care) (n = 4,270), and a 3:1 matched group of mothers who had no involvement with CPS in the first year of their firstborn's life (n = 2,328). Adjusted odds ratios (AOR) of depression and anxiety diagnoses in the first year postpartum were obtained from logistic regression models. Adjusted rate ratios (ARR) of antidepressant use obtained using Poisson models. Results Mothers whose children were taken into care have greater odds of having a postpartum depression or anxiety diagnosis than mothers receiving services (AOR = 1.31; 95% CI 1.08-1.59) and those not involved with CPS (AOR = 2.13; 95% CI 1.67-2.73). Among mothers who had a postpartum depression or anxiety diagnosis, mothers whose children were placed in care had significantly higher rates of antidepressant use than mothers receiving services only (ARR = 2.00; 1.82, 2.19) and mothers who were not involved with CPS (ARR = 2.42; 95% CI 1.94-3.51). Conclusions for Practice Targeted programs should be implemented to address postpartum mental illness among mothers who are involved with CPS at the birth of their child.
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Affiliation(s)
- Elizabeth Wall-Wieler
- Department of Community Health Sciences, University of Manitoba, S110-750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada.
| | - Leslie L Roos
- Department of Community Health Sciences, University of Manitoba, S110-750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
| | - Marni Brownell
- Department of Community Health Sciences, University of Manitoba, S110-750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
| | - Nathan C Nickel
- Department of Community Health Sciences, University of Manitoba, S110-750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
| | - Dan Chateau
- Department of Community Health Sciences, University of Manitoba, S110-750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
| | - Kendra Nixon
- Department of Social Work, University of Manitoba, 500C Tier Building, Winnipeg, MB, Canada
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Andrews NCZ, Motz M, Pepler DJ, Jeong JJ, Khoury J. Engaging mothers with substance use issues and their children in early intervention: Understanding use of service and outcomes. CHILD ABUSE & NEGLECT 2018; 83:10-20. [PMID: 29958135 DOI: 10.1016/j.chiabu.2018.06.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/20/2018] [Accepted: 06/20/2018] [Indexed: 06/08/2023]
Abstract
Mothers who use substances need integrated, multi-sectoral intervention services to support substance use discontinuation. We explored mothers' service use at Breaking the Cycle, an early intervention and prevention program for pregnant and parenting women and their young children in Toronto, Canada. We conducted retrospective analyses of families' service records and client charts (N = 160). Aims were to 1) describe women's use of service, 2) examine how early engagement of pregnant women related to postnatal service use, and 3) examine the circumstances in which women ended their service relationship with Breaking the Cycle. Specifically, we examined circumstances at service ending relating to women's service goals; custody status with children; and global substance-use, parent-child relationship, and child development outcomes. We found that these vulnerable women were actively engaged in many services and for a long duration, early engagement was associated with greater service use, and greater service use was associated with more positive circumstances upon ending service. Results provide support for a relational approach to service that promotes not only the relationship between mother and child, and mother and service provider, but also highlights relationships among staff, between staff and management, and between community partners as integral to effective service delivery. Integrating positive relationships at all levels is critical to support vulnerable families with complex needs.
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Affiliation(s)
- Naomi C Z Andrews
- Mothercraft, Early Intervention Department, 860 Richmond Street West, Toronto, Ontario, M6J 1C9, Canada; York University, Department of Psychology, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada.
| | - Mary Motz
- Mothercraft, Early Intervention Department, 860 Richmond Street West, Toronto, Ontario, M6J 1C9, Canada
| | - Debra J Pepler
- York University, Department of Psychology, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
| | - Jessica J Jeong
- York University, Department of Psychology, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
| | - Jennifer Khoury
- Ryerson University, Department of Psychology, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Canada
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Wall-Wieler E, Roos LL, Brownell M, Nickel NC, Chateau D. Predictors of having a first child taken into care at birth: A population-based retrospective cohort study. CHILD ABUSE & NEGLECT 2018; 76:1-9. [PMID: 28992512 DOI: 10.1016/j.chiabu.2017.09.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/26/2017] [Accepted: 09/29/2017] [Indexed: 06/07/2023]
Abstract
The objective of this study is to determine which maternal events and diagnoses in the two years before childbirth are associated with higher risk for having a first child taken into care at birth by child protection services. A population-based retrospective cohort of women whose first child was born in Manitoba, Canada between 2002 and 2012 and lived in the province at least two years before the birth of their first child (n=53,565) was created using linkable administrative data. A logistic regression model determined the adjusted odds ratios (AOR) of having a child taken into care at birth. Characteristics having the strongest association with a woman's first child being taken into care at birth were mother being in care at the birth of her child (AOR=11.10; 95% CI=8.38-14.71), substance abuse (AOR=8.94; 95% CI=5.08-15.71), schizophrenia (AOR=6.69; 95% CI=3.89-11.52) developmental disability (AOR=6.45; 95% CI=2.69-14.29), and no prenatal care (AOR=5.47; 95% CI=3.56-8.41). Most characteristics of women deemed to be at high risk for having their child taken into care at birth are modifiable or could be mitigated with appropriate services.
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Affiliation(s)
- Elizabeth Wall-Wieler
- Department of Community Health Sciences, University of Manitoba, S110-750 Bannatyne Avenue, R3E 0W3, Winnipeg, Manitoba, Canada.
| | - Leslie L Roos
- Department of Community Health Sciences, University of Manitoba, S110-750 Bannatyne Avenue, R3E 0W3, Winnipeg, Manitoba, Canada; Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, R3E 3P5, Winnipeg, Manitoba, Canada
| | - Marni Brownell
- Department of Community Health Sciences, University of Manitoba, S110-750 Bannatyne Avenue, R3E 0W3, Winnipeg, Manitoba, Canada; Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, R3E 3P5, Winnipeg, Manitoba, Canada
| | - Nathan C Nickel
- Department of Community Health Sciences, University of Manitoba, S110-750 Bannatyne Avenue, R3E 0W3, Winnipeg, Manitoba, Canada; Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, R3E 3P5, Winnipeg, Manitoba, Canada
| | - Dan Chateau
- Department of Community Health Sciences, University of Manitoba, S110-750 Bannatyne Avenue, R3E 0W3, Winnipeg, Manitoba, Canada; Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, R3E 3P5, Winnipeg, Manitoba, Canada
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Paris R, Sommer A, Marron B. Project BRIGHT: An Attachment-Based Intervention for Mothers with Substance Use Disorders and Their Young Children. MOTHERHOOD IN THE FACE OF TRAUMA 2018. [DOI: 10.1007/978-3-319-65724-0_12] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Roosa Ordway M, McMahon TJ, De Las Heras Kuhn L, Suchman NE. IMPLEMENTATION OF AN EVIDENCED-BASED PARENTING PROGRAM IN A COMMUNITY MENTAL HEALTH SETTING. Infant Ment Health J 2018; 39:92-105. [PMID: 29283178 PMCID: PMC6311699 DOI: 10.1002/imhj.21691] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The process of mental health intervention implementation with vulnerable populations is not well-described in the literature. The authors worked as a community-partnered team to adapt and pilot an empirically supported intervention program for mothers of infants and toddlers in an outpatient mental health clinic that primarily serves a low-income community. We used qualitative ethnographic methods to document the adaption of an evidence-based intervention, Mothering from the Inside Out, and the pilot implementation in a community mental health clinic. Seventeen mothers and their identified 0- to 84-month-old children were enrolled in the study. Key lessons from this implementation include (a) the importance of formative work to build community relationships and effectively adapt the intervention to meet the needs of the therapists and their clients, (b) the importance of designing plans for training and reflective supervision that fit within the flow of the clinic and can tolerate disruptions, and (c) that use of an interdisciplinary approach is feasible with the development of a plan for communication and the support of a trained reflective clinical supervisor. These key lessons advance the scientific knowledge available to healthcare managers and researchers who are looking to adapt mental health clinical interventions previously tested in clinical trials to implementation in community settings.
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Massey SH, Decety J, Wisner KL, Wakschlag LS. Specification of Change Mechanisms in Pregnant Smokers for Malleable Target Identification: A Novel Approach to a Tenacious Public Health Problem. Front Public Health 2017; 5:239. [PMID: 28975128 PMCID: PMC5610685 DOI: 10.3389/fpubh.2017.00239] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/23/2017] [Indexed: 12/20/2022] Open
Abstract
Maternal smoking during pregnancy (MSDP) continues to be a leading modifiable risk factor for perinatal complications and a range of neurodevelopmental and cardio-metabolic outcomes across the lifespan. Despite 40 years of intervention research less than one in five pregnant smokers who receive an intervention quit by delivery. Within this context, recognition of pregnancy is commonly associated with abrupt suspension or reduction of smoking in the absence of intervention, yet has not been investigated as a volitional target. The goal of this article is to provide the empirical foundation for a novel direction of research aimed at identifying malleable targets for intervention through the specification of behavior change mechanisms specific to pregnant women. To do so, we: (1) summarize progress on MSDP in the United States generated from conventional empirical approaches to health behavior change; (2) discuss the phenomenon of spontaneous change in the absence of intervention among pregnant smokers to illustrate the need for mechanistic specification of behavior change motivated by concern for fetal well-being; (3) summarize component processes in neurobiological models of parental and non-parental social behaviors as a conceptual framework for understanding change mechanisms during pregnancy; (4) discuss the evidence for the malleability of these processes to support their translational relevance for preventive interventions; and (5) propose a roadmap for validating the proposed change mechanism using an experimental medicine approach. A greater understanding of social and interpersonal processes that facilitate health behavior change among expectant mothers and how these processes differ interindividually could yield novel volitional targets for prenatal interventions. More broadly, explicating other-oriented mechanisms of behavior change during pregnancy could serve as a paradigm for understanding how social and interpersonal processes positively influence health behaviors across the lifespan.
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Affiliation(s)
- Suena H. Massey
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL, United States
| | - Jean Decety
- Department of Psychology, University of Chicago, Chicago, IL, United States
| | - Katherine L. Wisner
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lauren S. Wakschlag
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL, United States
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Myra SM, Ravndal E, Torsteinsson VW, Øfsti AK. Pregnant substance abusers in voluntary and coercive treatment in Norway: Therapists' reflections on change processes and attachment experiences. J Clin Nurs 2017; 27:e959-e970. [PMID: 28880415 DOI: 10.1111/jocn.14067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2017] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To explore therapists' discourses on treatment processes, when working with pregnant substance abusers in voluntary and coercive treatment, and looking for the clinical implications of these discourses. BACKGROUND Treatment of substance use disorder faces many challenges. One is pregnancy and motherhood, which are vulnerable and complex processes. The literature emphasises lack of optimal and knowledge-based treatment for this group. DESIGN The study follows a Foucauldian inspired discourse analysis. METHOD Forty therapists from four different residential units in Norway, offering both voluntary and coercive treatment of pregnant women with substance use disorders, were interviewed in focus groups. The semi-structured interview schedule focused on exploring how therapists' discourses on change processes and relationship experiences informed their clinical practice. RESULTS How to start "healthy" attachment processes between the pregnant woman and the unborn child was the dominant discourse among the therapists. Another important theme was coercion, and whether that as a contextual frame was negative or positive in creating attachment between mother and child. Other discourses were varieties of understanding attachment when the mothers had difficulties with substance abuse, the mothers' own attachment histories, and social and cultural challenges. CONCLUSION Systematic work with attachment issues between the pregnant woman and her unborn child was the dominant perspective of nearly all the therapists. The contextual factors in the lives of the women were less prioritised, even though they are of decisive importance for the relationship between mother and child. RELEVANCE TO CLINICAL PRACTICE Treatment professionals need to focus more on the discursive dilemmas encountered in the relation between substance use disorders and the unborn child.
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Affiliation(s)
- Siv M Myra
- Faculty of Social Work, VID Specialized University, Oslo, Norway.,UiO: Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Edle Ravndal
- UiO: Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Vigdis W Torsteinsson
- Regional Centre for Child and Adolescent Mental Health, Southern and Eastern Norway, Oslo, Norway
| | - Anne Ks Øfsti
- Faculty of Social Work, VID Specialized University, Oslo, Norway
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Zand DH, Chou JL, Pierce KJ, Pennington LB, Dickens RR, Michael J, McNamara D, White T. Parenting self-efficacy and empowerment among expectant mothers with substance use disorders. Midwifery 2017; 48:32-38. [DOI: 10.1016/j.midw.2017.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 02/28/2017] [Accepted: 03/05/2017] [Indexed: 11/16/2022]
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Hatzis D, Dawe S, Harnett P, Barlow J. Quality of Caregiving in Mothers With Illicit Substance Use: A Systematic Review and Meta-analysis. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2017; 11:1178221817694038. [PMID: 28469425 PMCID: PMC5398331 DOI: 10.1177/1178221817694038] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/25/2017] [Indexed: 12/31/2022]
Abstract
Background: The quality of caregiving in mothers with substance abuse problems appears to be compromised. However, divergent findings, methodological variability, and sample characteristics point to the need for research synthesis. Methods: A comprehensive systematic search was undertaken. Studies were eligible if they (1) compared substance-misusing mothers with non–substance-misusing mothers, (2) involved children from birth to 3 years, and (3) maternal sensitivity and child responsiveness were measured using observational methodology. Results: A global meta-analysis for maternal sensitivity (n = 24 studies) and child responsiveness (n = 16 studies) on 3433 mother-infant dyads yielded significant population effect sizes and significant heterogeneity. Subgroup analyses found reduced heterogeneity when the meta-analysis was conducted on studies where groups were matched on key demographic characteristics; although the effect size was small, it was still significant for maternal sensitivity but not child responsiveness. Conclusions: Compromised quality of caregiving is found in high-risk, substance-misusing mothers, emphasising the importance of early intervention that draws from attachment-based interventions.
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Affiliation(s)
- Denise Hatzis
- School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Sharon Dawe
- School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia.,Australian Centre for Child Protection, University of South Australia, Adelaide, SA, South Australia
| | - Paul Harnett
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Jane Barlow
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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Myra SM, Ravndal E, Torsteinsson VW, Wiig EM. Pregnant substance-abusing women in involuntary treatment: Attachment experiences with the unborn child. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.1515/nsad-2016-0023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Use of coercion against pregnant women who misuse substances was legalised in Norway in 1996. The background for the law was that substance abuse during pregnancy represents a significant health problem for the child. Aim The main aim of this study was to explore if an attachment between the mother and her unborn child was possible in a context of coercion as experienced from the woman's perspective. The women had many challenges, such as lack of social support and poor living conditions. Material Data were collected in eight qualitative in-depth interviews. Findings The main findings show how involuntary detention enabled safety for and connection with the unborn child. Within this context, the pregnant substance-abusing women's own relational experiences and developmental histories represent the most significant barrier for their ability to bond with the expected child. Conclusions The study underlines the importance of helping women with their own attachment experiences in order to break the generational transference of risk and pathology, and in this way, start the attachment process to the unborn child during the coerced treatment stay. Implications of the findings are discussed.
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Affiliation(s)
- Siv Merete Myra
- Department of Social Work and Family Therapy VID Specialized University, Oslo; Norwegian Centre for Addiction Research University of Oslo
| | - Edle Ravndal
- Norwegian Centre for Addiction Research University of Oslo
| | | | - Eli Marie Wiig
- Clinical Medicine University of Oslo; Borgestadklinikken, Skien, Telemark, Norway
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Camoirano A. Mentalizing Makes Parenting Work: A Review about Parental Reflective Functioning and Clinical Interventions to Improve It. Front Psychol 2017; 8:14. [PMID: 28163690 PMCID: PMC5247433 DOI: 10.3389/fpsyg.2017.00014] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/03/2017] [Indexed: 01/08/2023] Open
Abstract
In the last decade several studies have investigated the role of parental reflective functioning (RF), defined as the parental ability to understand his/her child’s mental states, on the child’s development. Herein, a narrative review on parental RF is presented aimed at (1) presenting an overview of the existing empirical studies, (2) pinpointing unrequited questions, and (3) identifying future research directions. Specifically, the current review focused on (a) the impact of parental RF on the quality of caregiving and the child’s attachment security, (b) the effect of parental RF on the child’s emotion regulation and the child’s RF, (c) maternal RF in women with a history of neglect and abuse, (d) the efficacy of mentalization-based clinical interventions, and (e) the recently developed Parental Reflective Questionnaire. The following terms “maternal RF,” “paternal RF,” “parental RF,” “parental mentalization,” “maternal mentalization,” and “paternal mentalization” were searched in titles, abstracts, and main texts using Medline, Web of Science, and Scopus databases. Next, a search in Mendeley was also conducted. Inclusion criteria comprised original articles if they refer to the RF Scale (Fonagy et al., 1998) and were published in an English language, peer-reviewed journal before July, 2016. According to exclusion criteria, dissertations, qualitative or theoretical papers, and chapters in books were not taken into account. The review includes 47 studies that, taken together, supported the notion that higher parental RF was associated with adequate caregiving and the child’s attachment security, whereas low maternal RF was found in mothers whose children suffered from anxiety disorders, impairment in emotion regulation, and externalizing behaviors. In addition, higher parental RF was associated with better mentalizing abilities in children. However, unexpected findings have emerged from the most recent randomized controlled trials that tested the efficacy of mentalization-based interventions in high risk samples of mothers, raising questions about the suitability of the verbal measures in capturing the mentalizing processes at the root of the parental capacity to be adequately responsive to the child’s emotional needs.
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Lewin L, Farkas K, Niazi M. Mother-Child Relational Quality of Women in Substance Abuse Treatment. J Am Psychiatr Nurses Assoc 2017; 23:50-60. [PMID: 27738085 DOI: 10.1177/1078390316673715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mothers who abuse substances are more likely to have impaired parenting and lose custody of their young children. OBJECTIVE The pilot study described mother-child relational quality of women in substance abuse treatment. The identification of mothers' perceptions of being parented, current level of depression, discrete and potentially modifiable mothering behaviors, and self-appraisals of their role. DESIGN The descriptive study implemented audio-video-recorded mother-child interactions for coding. RESULTS Twenty-nine dyads participated with children age 4 weeks to 5 years. Mothers had lower levels of caring from their parents and moderate depression that was correlated with many of the relational quality behaviors. Eleven of 29 maternal behaviors were coded as concerning. Reflections by mothers revealed modest, yet confident self-appraisals of their maternal role. CONCLUSIONS Women who experienced higher depression demonstrated lower maternal quality. Some maternal behaviors were identified as less optimal although many were strengths.
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Affiliation(s)
- Linda Lewin
- 1 Linda Lewin, PhD, PMHCNS-BC, Wayne State University, Detroit, MI, USA
| | - Kathleen Farkas
- 2 Kathleen Farkas, PhD, LISW, Case Western Reserve University, Cleveland, OH, USA
| | - Maryam Niazi
- 3 Maryam Niazi, RN, MSN, PMHNP-BC, Access Ohio, Columbus, OH, USA
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Parolin M, Simonelli A. Attachment Theory and Maternal Drug Addiction: The Contribution to Parenting Interventions. Front Psychiatry 2016; 7:152. [PMID: 27625612 PMCID: PMC5004230 DOI: 10.3389/fpsyt.2016.00152] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 08/18/2016] [Indexed: 12/31/2022] Open
Abstract
Children's emotional and relational development can be negatively influenced by maternal substance abuse, particularly through a dysfunctional caregiving environment. Attachment Theory offers a privileged framework to analyze how drug addiction can affect the quality of adult attachment style, parenting attitudes and behaviors toward the child, and how it can have a detrimental effect on the co-construction of the attachment bond by the mother and the infant. Several studies, as a matter of fact, have identified a prevalence of insecure patterns among drug-abusing mothers and their children. Many interventions for mothers with Substance Use Disorders have focused on enhancing parental skills, but they have often overlooked the emotional and relational features of the mother-infant bond. Instead, in recent years, a number of protocols have been developed in order to strengthen the relationship between drug-abusing mothers and their children, drawing lessons from Attachment Theory. The present study reviews the literature on the adult and infant attachment style in the context of drug addiction, describing currently available treatment programs that address parenting and specifically focus on the mother-infant bond, relying on Attachment Theory.
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Affiliation(s)
- Micol Parolin
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy
| | - Alessandra Simonelli
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy
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SUBSTANCE-ABUSING PREGNANT WOMEN: PRENATAL INTERVENTION USING ULTRASOUND CONSULTATION AND MENTALIZATION TO ENHANCE THE MOTHER-CHILD RELATIONSHIP AND REDUCE SUBSTANCE USE. Infant Ment Health J 2016; 37:317-34. [DOI: 10.1002/imhj.21574] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 03/23/2016] [Accepted: 04/18/2016] [Indexed: 02/05/2023]
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Håkansson U, Halsa A, Söderström K, Skårderud F, Øie MG. Keeping Mind in Mind: Mentalizing and Executive Functioning in Substance-Abusing Infant Mothers: Effect on Dyadic Relationship and Infant Outcome. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2016; 9:93-8. [PMID: 26819554 PMCID: PMC4720184 DOI: 10.4137/sart.s23502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/01/2015] [Accepted: 10/02/2015] [Indexed: 11/18/2022]
Abstract
Although it is well documented that maternal substance abuse has a negative effect on the mother–child interaction, less is known about the pathways through which the interaction is compromised. The main objective of this research proposal is to describe an ongoing research project that focuses on associations between maternal executive function and the quality of mother–infant interaction when the mother has a history of substance abuse. We will also investigate the effects of multiple variables, including maternal relationship experiences, personality disposition, parental stress, comorbid mental illness, and addiction severity, on the dyadic interaction and child functioning. A group of 40–50 mothers with substance abuse problems and their infants aged 6–18 months will be included. The mothers will be assessed with neuropsychological tests, clinical interviews, self-administered questionnaires, and dyadic interaction observations as well as observation and assessment of child functioning. We will use a cross-sectional correlational design. The inclusion of the participants will end in October 2015. Further knowledge about the variables that are important for the mother–infant relationship can inform future research and clinical practice.
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Affiliation(s)
| | - Astrid Halsa
- Lillehammer University College, Lillehammer, Norway
| | - Kerstin Söderström
- Lillehammer University College, Lillehammer, Norway.; Division Mental Health Care, Innlandet Hospital Trust, Lillehammer, Norway
| | - Finn Skårderud
- Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - Merete Glenne Øie
- Research Division, Innlandet Hospital Trust, Lillehammer, Norway.; Institute of Psychology, University of Oslo, Oslo, Norway
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Abstract
A sensitive, secure, and consistent relationship with their mother is critical for young children. There is a dearth of knowledge about the quality of mothering of young children by women with bipolar disorder. These mothers are frequently challenged, unable to provide consistency, and are at risk for loss of child custody. The model described in this article reflects a critical analysis of conceptual and empirical literature regarding mothering quality, resourcefulness, disorder severity, medication adherence, social supports, and child-rearing beliefs. The model can provide a conceptual framework for research, direct the selection of research instruments, and hypothesize the relationships among constructs.
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Affiliation(s)
- Linda C Lewin
- a Wayne State University , College of Nursing , Detroit , Michigan , USA
| | - Thomas N Templin
- a Wayne State University , College of Nursing , Detroit , Michigan , USA
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43
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Paris R, Herriott A, Holt M, Gould K. Differential responsiveness to a parenting intervention for mothers in substance abuse treatment. CHILD ABUSE & NEGLECT 2015; 50:206-17. [PMID: 26455262 DOI: 10.1016/j.chiabu.2015.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/10/2015] [Accepted: 09/14/2015] [Indexed: 05/04/2023]
Abstract
This study examines the relationship between levels of psychological distress in substance-dependent mothers and their differential response to a dyadic parent-child intervention. A sample of 66 mothers who were receiving treatment for substance abuse, as well as a simultaneous parenting intervention, were interviewed pre and post-treatment on measures of psychological distress, adult and child trauma history, parental reflective functioning, and child social-emotional development. Additionally, clinicians provided assessments of the parent-child relationships. As anticipated, trauma histories for mothers and children, children's social emotional development, and parental reflective functioning were associated with aspects of maternal psychological distress. Kruskal-Wallis and subsequent Wilcoxson signed rank tests revealed that women with highest levels of baseline psychological distress showed significant improvements in psychological functioning post-treatment while women with moderately elevated levels of psychological distress did not. Women who were most distressed at baseline showed increased levels of parental reflective functioning post-treatment while women with moderate and lower levels of baseline psychological distress showed improvements on clinician-rated assessments of parent-child relationships. Chi Square analyses showed that parents who endorsed the highest levels of distress at baseline reported that their children's risk status regarding social-emotional development decreased post-treatment. Despite similarities in substance dependence, mothers in this sample had different needs and outcomes in the context of this parenting intervention due to variation in mental health. Given this variation, parenting interventions for substance-dependent mothers need to account for the individual differences in levels of psychological distress.
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Affiliation(s)
- Ruth Paris
- Boston University, School of Social Work, 264 Bay State Road, Boston, MA 02215, USA
| | - Anna Herriott
- Boston University, School of Social Work, 264 Bay State Road, Boston, MA 02215, USA
| | - Melissa Holt
- Boston University, School of Education, 2 Silber Way, Boston, MA 02215, USA
| | - Karen Gould
- Institute for Health and Recovery, 349 Broadway, Cambridge, MA 02139, USA
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44
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J Haabrekke K, Siqveland T, Smith L, Wentzel-Larsen T, Walhovd KB, Moe V. Mother-Child Interaction and Early Language Skills in Children Born to Mothers with Substance Abuse and Psychiatric Problems. Child Psychiatry Hum Dev 2015; 46:702-14. [PMID: 25300194 DOI: 10.1007/s10578-014-0512-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This prospective, longitudinal study with data collected at four time points investigated how maternal psychiatric symptoms, substance abuse and maternal intrusiveness in interaction were related to early child language skills. Three groups of mothers were recruited during pregnancy: One from residential treatment institutions for substance abuse (n = 18), one from psychiatric outpatient treatment (n = 22) and one from well-baby clinics (n = 30). Maternal substance abuse and anti-social and borderline personality traits were assessed during pregnancy, postpartum depression at 3 months, maternal intrusiveness in interaction at 12 months, and child language skills at 2 years. Results showed that the mothers in the substance abuse group had the lowest level of education, they were younger and they were more likely to be single mothers than the mothers in the two other groups. There was a significant difference in expressive language between children born to mothers with substance abuse problems and those born to comparison mothers, however not when controlling for maternal age, education and single parenthood. No group differences in receptive language skills were detected. Results further showed that maternal intrusiveness observed in mother-child interaction at 12 months was significantly related to child expressive language at 2 years, also when controlling for socio-demographic risk factors. This suggests that in addition to addressing substance abuse and psychiatric problems, there is a need for applying treatment models promoting sensitive caregiving, in order to enhance child expressive language skills.
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Affiliation(s)
- Kristin J Haabrekke
- National Network for Infant Mental Health, the Center for Child and Adolescent Mental Health, Oslo, Norway,
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45
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Ordway MR, Webb D, Sadler LS, Slade A. Parental Reflective Functioning: An Approach to Enhancing Parent-Child Relationships in Pediatric Primary Care. J Pediatr Health Care 2015; 29:325-34. [PMID: 25661692 PMCID: PMC4478122 DOI: 10.1016/j.pedhc.2014.12.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/16/2014] [Accepted: 12/23/2014] [Indexed: 01/21/2023]
Abstract
The current state of science suggests that safe, responsive, and nurturing parent-child relationships early in children's lives promotes healthy brain and child development and protection against lifelong disease by reducing toxic stress and promoting foundational social-emotional health. Pediatric health care providers (HCPs) have a unique opportunity to foster these relationships. However, such a role requires a shift in pediatric health care from a focus only on children to one that includes families and communities, as well as the inclusion of children's social and emotional health with their physical health. To foster healthy parent-child relationships, HCPs must develop the expertise to integrate approaches that support the family's socioemotional health into pediatric primary care. This article suggests ways in which pediatric HCPs can integrate a focus on parental reflective functioning into their clinical work, helping parents to understand some of the thoughts and feelings that underlie their children's behavior.
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46
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Pajulo M, Tolvanen M, Karlsson L, Halme-Chowdhury E, Öst C, Luyten P, Mayes L, Karlsson H. THE PRENATAL PARENTAL REFLECTIVE FUNCTIONING QUESTIONNAIRE: EXPLORING FACTOR STRUCTURE AND CONSTRUCT VALIDITY OF A NEW MEASURE IN THE FINN BRAIN BIRTH COHORT PILOT STUDY. Infant Ment Health J 2015; 36:399-414. [DOI: 10.1002/imhj.21523] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Linnea Karlsson
- University of Turku and National Institute for Health and Welfare, Helsinki
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47
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Horton E, Murray C. A quantitative exploratory evaluation of the circle of security-parenting program with mothers in residential substance-abuse treatment. Infant Ment Health J 2015; 36:320-36. [PMID: 25916412 DOI: 10.1002/imhj.21514] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Maternal substance abuse is a risk factor for child maltreatment, child attachment insecurity, and maladaptive social information processing. The aim of this study was to conduct a quantitative exploratory evaluation of the effectiveness of an attachment-based parent program, Circle of Security-Parenting (COS-P; G. Cooper, K. Hoffman, & B. Powell, 2009), with a community sample of 15 mothers in residential treatment for substance abuse. Participants attended nine weekly group sessions and were given three measures at pretest and posttest: the Emotion Regulation Questionnaire (J.J. Gross & O.P. John, 2003), the Parent Attribution Test (D. Bugental, ), and the Parenting Scale (D.S. Arnold, S.G. O'Leary, L.S. Wolff, & M.M. Acker, 1993). The results indicate that mothers who attended the majority of group sessions showed greater improvements on all three variables. Participants who attended some of the sessions showed some improvements on the measures, but participants who did not attend the group sessions had no improvements, and on some measures, declined significantly. Further analyses of demographic data indicates that participants with more education, no personal history of child maltreatment, less time in the residential program, and lower social desirability scores demonstrated more positive outcomes. These findings suggest that the COS-P may positively impact parental risk factors associated with child maltreatment and maladaptive social information processing in the context of residential substance-abuse treatment.
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48
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Neger EN, Prinz RJ. Interventions to address parenting and parental substance abuse: conceptual and methodological considerations. Clin Psychol Rev 2015; 39:71-82. [PMID: 25939033 DOI: 10.1016/j.cpr.2015.04.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 01/28/2015] [Accepted: 04/18/2015] [Indexed: 10/23/2022]
Abstract
Parental substance abuse is a serious problem affecting the well-being of children and families. The co-occurrence of parental substance abuse and problematic parenting is recognized as a major public health concern. This review focuses on 21 outcome studies that tested dual treatment of substance abuse and parenting. A summary of theoretical conceptualizations of the connections between substance abuse and parenting provides a backdrop for the review. Outcomes of the dual treatment studies were generally positive with respect to reduction of parental substance use and improvement of parenting. Research in this area varied in methodological rigor and needs to overcome challenges regarding design issues, sampling frame, and complexities inherent in such a high-risk population. This area of work can be strengthened by randomized controlled trials, use of mixed-methods outcome measures, consideration of parent involvement with child protective services, involvement of significant others in treatment, provision of concrete supports for treatment attendance and facilitative public policies.
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Affiliation(s)
- Emily N Neger
- Parenting & Family Research Center, University of South Carolina, United States.
| | - Ronald J Prinz
- Parenting & Family Research Center, University of South Carolina, United States
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49
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Basnet S, Onyeka IN, Tiihonen J, Föhr J, Kauhanen J. Characteristics of drug-abusing females with and without children seeking treatment in Helsinki, Finland. Scand J Public Health 2015; 43:221-8. [DOI: 10.1177/1403494814567754] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2014] [Indexed: 11/17/2022]
Abstract
Aims: This study characterizes treatment-seeking female users of illicit drugs in Finland, and examines possible differences among women with or without children under 18. Methods: The subjects were 2526 drug-using clients from the Helsinki metropolitan area, who sought treatment at Helsinki Deaconess Institute between 2001 and 2008. A total of 775 (30.6%) were females with complete information regarding their parental status. Of these, 225 (29%) had children under 18. The proportion of women with children varied between 20% and 30% annually, except in 2006, when it peaked at 40.5%. Results: Women with children were more likely to be somewhat older ( p<0.001), married or cohabiting ( p<0.001), homeless ( p=0.007), unemployed ( p<0.001), and living with other illicit drug users ( p=0.014), compared with those without children. Self-referral and referral to treatment by child healthcare services were more common among those who had children ( p<0.001). A higher proportion of women with children reported use of opiates as the primary drug ( p<0.001), and used them more often intravenously ( p=0.001), and daily ( p=0.007), during the previous month. However, polydrug use ( p=0.607) and sharing of needles/syringes ( p=0.945) were similar in both groups. Prevalence of hepatitis B and C ( p=0.041 and p<0.001, respectively) were more common in females with children. Among women who had children, 34.2% had children living within the same household, 37.3% in foster care, and 22.7% elsewhere. Conclusions: Women with children had more risky drug consumption patterns, and were more likely to live with other drug users; this creates an unhealthy environment for child rearing.
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Affiliation(s)
- Sushil Basnet
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ifeoma N. Onyeka
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- National Institute for Health and Welfare, Helsinki, Finland
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jaana Föhr
- Helsinki Deaconess Institute, Helsinki, Finland
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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50
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Perry N, Newman LK, Hunter M, Dunlop A. Improving antenatal risk assessment in women exposed to high risks. Clin Child Psychol Psychiatry 2015; 20:84-105. [PMID: 23982989 DOI: 10.1177/1359104513499355] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antenatal substance use and related psychosocial risk factors are known to increase the likelihood of child protection involvement; less is known about the predictive nature of maternal reflective functioning (RF) in this population. This preliminary study assessed psychosocial and psychological risk factors for a group of substance dependent women exposed to high risks in pregnancy, and their impact on child protection involvement. Pregnant women on opiate substitution treatment (n = 11) and a comparison group (n = 15) were recruited during their third trimester to complete measures of RF (Pregnancy Interview), childhood trauma, mental health and psychosocial assessments. At postnatal follow-up, RF was reassessed (Parent Development Interview - Revised Short Version) and mother-infant dyads were videotaped to assess emotional availability (EA). Child protection services were contacted to determine if any concerns had been raised for infant safety. Significant between-group differences were observed for demographics, psychosocial factors, trauma and mental health symptoms. Unexpectedly, no significant differences were found for RF or EA between groups. Eight women in the 'exposed to high risks' group became involved with child protection services. Reflective functioning was not significantly associated with psychosocial risk factors, and therefore did not mediate the outcome of child protection involvement. Women 'exposed to high risks' were equally able to generate a model of their own and their infants' mental states and should not be seen within a deficit perspective. Further research is required to better understand the range of risk factors that predict child protection involvement in high risk groups.
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Affiliation(s)
- Natasha Perry
- Newcastle Community Health Centre, Hunter New England Local Health District, Newcastle, New South Wales, Australia University of Newcastle, New South Wales, Australia
| | - Louise K Newman
- Centre for Developmental Psychiatry & Psychology, Melbourne, Victoria, Australia
| | - Mick Hunter
- University of Newcastle, New South Wales, Australia
| | - Adrian Dunlop
- Newcastle Community Health Centre, Hunter New England Local Health District, Newcastle, New South Wales, Australia University of Newcastle, New South Wales, Australia
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