Improving Parent-Child Relationships in Recovery: Exploring Strategies for Integrating An Evidence-Based Parenting Intervention Into Residential Substance Abuse Treatment

Background and Purpose: Parental substance abuse not only affects the addicted person but also profoundly impacts theparent-child relationship and child well-being (Suchman, et al., 2005). Children who grow up with parents who abuse substances are at-risk for developmental challenges, post-traumatic stress disorder, and other health and mental healthissues that can affect them across the lifespan (van der Kolk, 2005). However, substance abuse services have historically focused exclusively on the adult client's recovery, failing to address the harmful effects of substance abuse and trauma on young children. This occurs despite the existence of promising family-focused interventions (Bromberg, 2010). To bridge this service gap, a community-academic collaborative developed and evaluated Project BRIGHT. In the intervention social workersdelivered an adaptation of Child-Parent Psychotherapy (CPP, Lieberman & Van Horn, 2005) in eight Family Residential Treatment (FRT) programs to mothers and children birth to five. CPP, an evidenced-based dyadic intervention, strengthens the parent-child relationship to lessen trauma-based symptoms and build a child's resilience.

As part of a larger process and outcome evaluation, researchers were interested in assessing a number of systems components based on program design and implementation: training andsupervision of residential staff in addressing mothers’ and children’s trauma histories and parent-child attachment; fidelity to the evidence-based model; and barriers and facilitators to enhancing substance abuse treatment with a parentingintervention.

Methods: Mixed qualitative methods were used to obtain staff perspectives on the experience of implementing Project BRIGHT. Semi-structured interviews were conducted with 57residential staff (including line-staff, clinicians and administrators) at eight FRTs throughout Massachusetts during the 3 years of program implementation. During the final year of the program, one focus group was conducted with BRIGHTsocial workers. Questions addressed perceived experiences of BRIGHT with regard to implementation, training, and impact.Interviews were audiotaped and transcribed verbatim. Transcripts were analyzed by three coders using grounded theory techniques (Charmaz, 2006).

Findings: Findings from the interview and focus group datafocused on facilitators, barriers, and suggestions for integrating a trauma-informed evidence-based practice into a residentialtreatment program. Residential staff and BRIGHT staff reported that relationship building at the micro level, buy-in at multipleorganizational levels and appreciation of BRIGHT’s different approach to clinical work and training were necessary components to integrating BRIGHT. The main barrier was lack of organizational capacity, including limitations on space,scheduling, and time for FRT-BRIGHT staff interactions.BRIGHT social workers discussed the necessity of adapting CPP to this specific population and context. Both residential and BRIGHT staff perceived a need for more training and strategic planning to ensure sustainability of BRIGHT.

Conclusions and Implications: Through use of qualitative analysis and a systems-perspective, study findings highlightfactors that aided and hindered a successful merging of practicesand philosophies in order to bring a parenting focused EBP intoan established residential treatment program for substance abuse. As social work strives to maximize the use of EBPs in community settings, these “real world” findings can be utilized to shape developing programs for maximum efficacy and sustainability.