Exploring Feasibility, Acceptability and Appropriateness of an Infant Mental Health Intervention within Substance Use Treatment

Background and Purpose: Infants and young children growing up in families where a parent has a substance use disorder (SUD) are at increased risk of developmental challenges, child maltreatment and strained attachment relationships (Salo & Flykt, 2013). This is true in part because of the trauma and interpersonal violence that is associated with substance misuse and the difficulties often noted in the parent-child relationships (Kaltenbach, 2013). Yet, substance use disorder (SUD) treatment programs have only begun to include a focus on parenting through dyadic infant mental health (IMH) interventions to address these challenges (Pajulo, et al, 2006; Hanson, et al., 2015). Furthermore, no studies have examined the feasibility of enhancing substance use treatment with evidence-based/evidence-informed IMH programs by assessing SUD treatment staff perspectives on these interventions. Part of evaluating implementation of any new social work practice includes attending to the process involved (Proctor, et al., 2010). Therefore, this study aimed to explore the perspectives of staff from SUD treatment programs regarding the feasibility, acceptability and appropriateness of a newly implemented IMH intervention for mothers and young children.

Methods: Seventy-one semi-structured interviews were conducted with varied staff from eight residential and three outpatient opioid treatment programs where a trauma-focused evidence-informed IMH intervention, BRIGHT, was implemented with mothers and young children as an addition to typical services. Questions addressed perceived experiences of BRIGHT with regard to implementation and impact. Trained research assistants conducted interviews, which were audiotaped and transcribed verbatim. Four coders analyzed the transcripts in consultation with the study PI, using qualitative data management software and a thematic analysis approach (Braun & Clarke, 2006).

Findings: Overall, findings suggested that offering an IMH intervention within SUD treatment was acceptable, appropriate and feasible, although residential programs described greater investment than outpatient opioid treatment programs given their explicit commitment to serving women with young children. Facilitators of successful integration included relationship building with staff and buy-in at the organizational and interpersonal levels. Most program staff described the IMH clinicians as knowledgeable about young children, trauma, and attachment and many appreciated that a parenting focus could be important in the recovery process. A few staff acknowledged that an IMH approach was different from how they previously thought about parenting and SUD treatment. The main perceived barrier to implementation was limited organizational capacity.

Conclusions: Through using qualitative data analysis, study findings highlight the factors that aided and hindered the feasibility of implementing a trauma-focused IMH intervention within residential and outpatient opioid treatment programs. Findings support Proctor et al.’s (2010) ideas regarding the importance of specified process aspects of implementation outcomes. As social work strives to implement evidence-based and evidence-informed interventions to address the impact of trauma, interpersonal violence and substance use on the lives of parents and young children, these findings potentially can be utilized to shape developing programs.