Family-Based Recovery: An Innovative Model for Integrating Substance Use Disorder Treatment with Infant Mental Health

Background and Purpose:  Children of parents with Substance Use Disorders (SUDs) may experience disruptions in caregiving, developmental delays, and cognitive, social-emotional and health problems. However, outpatient treatment programs focus on a caregiver’s individual recovery and may either postpone parent/child dyadic work or not include it in their service array. This staggered approach does not take into account a child’s developmental needs. Outcomes of one clinical model suggest that parents can successfully engage in concurrent SUD treatment and attachment-focused dyadic work.

Methods: Since 2007, the Family-Based Recovery (FBR) model has provided in-home treatment, three days a week for up to 12 months, to mothers and fathers with SUDs and a child under the age of 3. Most parents are referred by child protective services. Model components are: substance use treatment/individual psychotherapy, attachment-focused parent-child treatment and case management. Data were collected from all parents (N=1,548) enrolled in treatment across 11 clinical teams. At intake and 90-day intervals, parents completed measures to assess depression (Edinburgh Depression Scale), stress (Parenting Stress Index-Short Form), reflective capacity (Parental Reflective Functioning Questionnaire) and a self-reported measure of relationship quality with their child (Postpartum Bonding Questionnaire). Toxicology screens were conducted at each visit.

Results:Analysis of pre-post paired scores of the measures reveals improvement in parental well-being. Parents’ self-report of depressive symptoms on the EDS and total stress and parental distress on the PSI-SF show the greatest improvement. More modest changes were seen in PBQ and PRFQ scores. The largest effect sizes were observed for the PSI measures of total stress (d=.31), and parental distress (d=.36), as well as the total score on the EDS measure of depression (d=.29). At intake, 50% of clients’ toxicology screens were positive which decreased to 15% at week 20.  Child outcomes include: 90% were up to date on their medical care, and 81% were living with a biological parent. Seventy-seven percent of families did not have a mandated report of abuse or neglect filed against them during treatment. 

Conclusions and Implications: Outcome data and pre/post analysis of indices of parental well-being suggest that FBR is a promising practice for simultaneous in-home treatment of parental substance use and parent/child dyadic work. The model has shifted social work practice with families and made treatment more accessible.  On a systems level, FBR has help inform child welfare workers’ approach to supporting families with SUDs. A randomized control study, part of a social impact bond project, is currently underway comparing treatment outcomes and child welfare re-involvement for families enrolled in FBR versus those receiving treatment in the community.