Strategies and Adaptations to an Integrated Substance Use and Infant Mental Health Treatment Program during COVID-19

Background: The COVID-19 pandemic has resulted in increased parenting stress (Russell et al., 2020, Brown et al., 2020) and increased substance use (Czeisler et al., 2020, Vogel et al., 2021, Aponte-Melendez et al., 2021). At the same time mental health and social service needs increased, access to mental health services, even for those already receiving treatment decreased due to stay at home orders (Cioffi & Leve, 2020, Aponte-Melendez et al., 2021). Few mental health and substance use treatment programs were equipped to provide telehealth or to translate their interventions to a digital format. In this context, there is a critical need to understand how mental health and substance use treatment programs made adaptations to services during COVID-19. Lessons learned from these adaptations may provide insight into telehealth programs that can increase mental health and substance use treatment access and prepare for service use in future pandemics.

Methods: Data from this study is drawn from a larger project on the implementation of the In-Home Recovery Program, an in-home substance use and parent infant mental health treatment program for caregivers involved in the child welfare system. Seventy-three semi-structed interviews and ethnographic observations were conducted with the five agencies participating in the implementation process, which began in January 2020. Interviews focused on strategies and adaptations during COVID-19. Field notes and interviews were analyzed by two coders, using content analysis. A consensus coding process resolved coder disagreements. Analysis was aided by NVIVO 12 qualitative software.

Results: Data analysis reveals that there was no area in which service delivery was unaffected. Strategies to continue services included 1) the introduction of virtual toxicology screens, 2) paying for clients to access technology (e.g., phone bills) to participate in telehealth, 3) strategizing with families about how to assist older children that were not identified clients, 4) anticipating triggers for relapse in the context of the pandemic, and 5) providing space to process the impact of the pandemic. Challenges included: 1) difficulty engaging young children in virtual infant mental health services, 2) clinician stress, 3) client’s ability to find privacy in their homes, 4) difficulty engaging virtually with clients when they were struggling with reoccurrence of substances, and 5) ethics related to the virtual treatment of clients experiencing domestic violence.

Conclusion and Implications: Findings reveal that it is possible to provide virtual substance use treatment services. Strategies that focus on providing access to technology and virtual toxicology screens offer some possibilities for building telehealth interventions that treat substance use disorders. Less successful, however, were adaptations to the infant mental health component. Telehealth is likely not an appropriate medium for children below the age of five. Individual sessions with parents that make caregiving a focus, rather than dyadic treatment with young children may be more suitable to virtual formats. The COVID-19 pandemic created opportunities to try new modes of treatment out of necessity. Lessons learned from program adaptations could help strengthen the provision of substance use treatment using telehealth, which in turn, has the potential to increase access.