Solution-Focused Brief Therapy to Improve Child Well-Being and Family Functioning Outcomes with Substance Using Parents in the Child Welfare System

Background: Substance use is identified or suspected in 66% of all substantiated child protective cases and 79% of cases where children are removed from their homes. Substance abusing parents are more likely to neglect their children by providing inadequate shelter and having less economic stability. Providing effective treatment to address substance use and family functioning problems continues to be a challenge for social workers. This study evaluates the effectiveness of Solution-Focused Brief Therapy (SFBT) for child welfare involved parents receiving outpatient substance abuse treatment as compared to treatment-as-usual (TAU). The hypotheses examined are:

1. Do parents receiving SFBT counseling improve on child well-being outcomes compared to parents receiving TAU counseling?
2. Do parents receiving SFBT counseling improve on family functioning outcomes compared to parents receiving TAU counseling?

Methods: Randomized controlled trial design was used with half the counselors at a substance abuse counseling agency trained in SFBT while the others continued TAU, which was cognitive behavioral therapy (CBT) and occasionally CBT combined with motivational interviewing (MI). Both CBT and CBT paired with MI are considered mainstay treatment approaches in outpatient substance abuse and widely used.Parents with children in out-of-home care due to substance use and a case plan goal of reunification were recruited. Child well-beingwas examined with Behavior Rating Inventory of Executive Function- Parent Report (BRIEF-PR) and Child Behavior Checklist- School Age (CBCL-SA). Family functioning was examined with Adult-Adolescent Parenting Inventory (AAPI-2) and Center for Epidemiologic Studies-Depression Scale (CES-D). Mixed linear models tested within and between-group changes using intent-to-treat analysis (N=180). Hedges’s geffect sizes examined magnitude of treatment effects.

Results:Follow-up main effects for child well-being outcomes were consistently negative, indicating that scale scores decreased between entry and exit. There were no significant follow-up x treatment interactions indicating that participants exhibited lower levels at posttest irrespective of study condition. Within-group effect sizes for BRIEF-PR were small for both SFBT (0.024 to 0.267) and control groups (0.136 to 0.363). Within-group effect sizes for CBCL-SA total problems were small for both SFBT (0.365) and control groups (0.257). Follow-up main effects for family functioning outcomes showed consistent improvements on the AAPI-2 and CES-D with no significant follow-up x treatment interactions indicating that participants exhibited improvements at posttest irrespective of study condition. SFBT group within-group effect sizes on the AAPI-2 ranged from small (0.006) to medium (0.620) as did the control group (0.023-0.624). Within-group effect sizes for SFBT group on CES-D was near medium (0.428) while control group was smaller (0.314).

Implications:Given the need for more intervention research in child welfare and substance abuse treatment, this study shows SFBT to be an effective intervention for helping families around child well-being and family functioning outcomes similar to current evidence-based approaches. Many clients prefer not to explore past or current traumatic events in an effort to reprocess them as a criterion for moving forward in counseling treatment. Further, many clinicians desire choice in therapeutic tools, particularly ones that emanate from a solution-based orientation.  SFBT provides one such alternative.