Development of a Parenting Intervention for Substance Dependent Mothers with Trauma Histories: Perspectives of Clients and Clinicians

Background: Mothers who are substance dependent typically have extensive trauma histories and mental health concerns (Kaltenbach, 2013). The complex intersection of problems associated with substance dependence and parenting necessitate interventions that support the mother in her recovery and relationship with her child. Such potential interventions are further complicated by mothers’ concerns about confidentiality due to fears of child protection involvement (Kuo et al., 2013), and difficulties forming identities as parents – challenges compounded by stigma surrounding substance misuse. Based on findings from a needs assessment and responding to a dearth of available interventions, a community agency launched an evidence-informed intervention to address the needs of mothers with young children who misused substances (Spielman et al., 2015).  This study utilizes qualitative individual and focus group data from clients and clinicians to understand their perceptions of the intervention.

Methods: Mothers who participated in a parenting intervention for women whose children aged three and under were exposed to substances in utero were invited to participate in an evaluation study.  Participants (M age=30 years) predominantly identified as white, were mostly high school educated and unemployed.  The majority of mothers reported heroin and polysubstance misuse. Participants had significant trauma histories and moderate levels of psychological distress.  Qualitative data were collected from a subset of the participants (n=16) through semi-structured interviews post-treatment. Interviews were also conducted with intervention providers – seven clinicians and one “mentoring mom” who offered peer support in recovery and parenting.  Finally, a focus group was held with seven providers.  The aims of the qualitative data collection were to understand the mothers’ perceptions of the intervention, as well as the providers’ perceptions of the goals of the intervention, and how those goals were approached.  Thematic coding using grounded theory techniques was conducted by three RAs with PI consultation.

Results: Mothers highlighted the usefulness of receiving both emotional support - including feeling as though the provider was someone they could trust - and tangible support such as help navigating public assistance.  Many mothers emphasized not only getting help in their parenting but also in feeling supported and believed in as a parent by their provider. Findings from the interviews and focus group with providers indicated an emphasis on relationship building while considering three main foci of the intervention: recovery, parenting, and mothers’ mental health. By addressing these issues in a safe, non-judgmental space, the providers subsequently aimed for greater capacity in the mothers to enhance their relationship with their child.

Conclusions: Mothers’ perception of support – both concrete and emotional – aligned with providers’ reported goals of the program that focus on fostering the child’s well-being through supporting the mother.  Importantly, the mothers emphasized how the providers’ belief in them as parents positively impacted their confidence and parenting abilities. Such confidence had likely been lacking given histories of trauma and substance misuse. Findings can inform the development of future social work interventions for substance dependent parents with trauma histories in emphasizing the importance of multifaceted levels of support based on the client’s individual needs.