One of These Things Is Not like the Other: How Evidence Based Substance Use Disorders Treatment and Infant Mental Health Treatments Are Often at Odds and What Programs Are Doing to Integrate Them

Background and Purpose

Intervening with caregivers who have Substance Use Disorders (SUDs) and their children poses unique challenges in social work. Typical interventions for SUDs emerge from an individualist approach and utilize strategies grounded in cognitive behavior therapies. In contrast, infant mental health (IMH) emphasizes establishing relational safety as a primary part of intervention and emerges from a psychodynamic perspective. Paradigmatic differences between these approaches means that simply adding IMH to treatment for SUDs is likely to be ineffective. Instead, integrating SUDs with IMH requires explicit negotiation of modalities with different frameworks for intervention. However, little is known about how this integration is best accomplished.This conceptual study identifies how integration of infant mental health interventions is occurring in practice within SUD programs. It examines points of tension and common elements across distinct approaches in order to clarify the evidence for different methods.  

Method

This qualitative study reviewed models for four integrated SUD and IMH programs. Thematic data analysis was conducted using program manuals and drawing on principles of content analysis using QSR NVivo software. A deductive codebook was established based on the authors’ knowledge of SUD and IMH treatment. In order ensure confirmability of results, two independent coders conducted the analysis. Discrepancies between coders was resolved using a consensus coding process.   

Findings

Within the field of IMH, there is no consensus on the best practices for the integration of treatment for SUDs with IMH. Specifically, disagreement centers around when and how to include the child(ren) in treatment. One program provides sequential treatment so that a parent must be in recovery prior to the start of dyadic work. Two others emphasize the importance of beginning dyadic and family work immediately to address the intersection of parenting, the caregivers SUD, and the child’s experience. Another program co-locates mothers in treatment with their children but provides limited adjunctive IMH work. Despite these differences, all programs targeted several common mechanisms for change and worked to build parental capacities for (1) emotion regulation, (2) caregiver attunement, (3) reflective functioning, (4) establishing relational safety, and (5) improving attachment between parent and child.

Conclusion and Implications

The translation and implementation of IMH principles into treatment for SUDs remain varied in social work practice. Social work must move towards better defined practice paradigms for effective intervention to identify which types of treatment programs are most appropriate for specific populations. Likely, there is no one size fits all approach to intervention for families struggling with the impact of SUDs. Conceptualizing services on a continuum model would allow for a diverse spectrum of interventions to fit different caregiver and child needs. Common elements suggest that there are unifying principles that underlie all effective programs that integrate SUD and IMH treatment and which social workers are well positioned to deliver.