Examining the Structural Components of a Private-Public-Academic Partnership for Family Focused Substance Use Treatment and Their Impact on Implementation Outcomes

Background and Purpose:

With more young families affected by parents’ substance use disorders (SUDs), programs are challenged to provide accessible, effective dyadic treatment to caregivers and their young children. Even though an estimated 70% of women who enter treatment for SUDs are parents, traditional programs typically view these clients as individuals rather than as caregivers in a family system. Opportunities to include parenting in SUDs treatment are seen as adjunctive or do not occur at all. At the same time, decades of research identifies the cumulative negative impacts of caregiver SUDs on children’s emotional, cognitive and physical development. Accordingly, sustained intervention within family systems is necessary to interrupt the relational and developmental consequences of problematic parenting behaviors that often occur as a result of, and alongside, caregiver substance misuse. The In-Home Recovery Program (IHRP) is an in-home treatment program for caregivers with SUDs and their children (0-3), adapted from the Family-Based Recovery Program, designed to address these impacts. Currently being piloted through a public-private-academic partnership, IHRP represents an innovative intervention and a unique approach to funding and providing this type of service. Little is known, however, about the features of these types partnerships and how their structure impacts implementation and program outcomes. This work seeks to advance our understanding in this area.

Methods:

Utilizing ethnographic participant-observation, we examine implementation barriers and facilitators. Documents analyzed include meeting notes, email exchanges, informal conversations, and formal observations of leadership and implementation meetings over a seven month period. Participants include representatives from the New Jersey Department of Children and Families, The Nicholson Foundation, Preferred Behavioral Health Group, and Rutgers School of Social Work.

Results:

IHRP is relationship-based, premised on the idea that secure relationships are one mechanism for client change. Close attention to building relationships across all stakeholders has been a key part of implementation, representing a parallel process by which the core tenets of IHRP are modeled. Multiple formal processes including monthly meetings between leadership and staff at all partner organizations and other regular meetings among sub-teams provide a foundation for strong relationships between all those involved in IHRP. This framework has facilitated 1) the creation of a process for trauma-informed substantiations, 2) decreased involvement from child protection service (CPS) workers in cases as intensive support is provided by IHRP teams and then case progress is shared with CPS, 3) and the lifting of 43% of safety plans within the first two months of treatment.

Conclusion and Implications:

Initial results indicate that a public-private-academic could be a powerful approach to implementing in-home substance use treatment programs for caregivers with SUDs. This framework provides support for intensive communication between service providers and CPS, which in turn, allow for the continued in-home treatment of caregivers with SUDs preventing out-of-home placement. Increased communication also allows for change to routine approaches to CPS involved families as evidenced by new processes for trauma-informed substantiation which builds on IHRP principles. These changes could extend beyond the IHRP program itself, creating implementation impacts that spark larger system change.