(Withdrawn) An Innovative Integrated Intervention to Treat Trauma, Substance Use, and Parenting

Background and Significance: Caregivers with a substance use disorder (SUD) represent a significant cause of entry into the child welfare system (CWS) and involve approximately 50-80% of cases. As a group, caregivers with a SUD are more likely to utilize a range of maladaptive parenting strategies that can negatively impact children’s development. Research has clearly established the need for integrated substance use, trauma, and parenting interventions, yet few of these programs exist and even fewer studies have been conducted to assess their efficacy. This research examines changes in client reports of their mental health symptoms and parenting attitudes and behaviors after their participation in an integrated substance use, trauma, and parenting treatment program at a northeastern mental health treatment agency. The goal of this work is to assess whether this approach shows promise and to build the evidence base for addressing substance use, trauma, and parenting concurrently.

Methods: To provide integrated substance use disorder, parenting, and trauma treatment, one mental health agency in the northeastern United States integrated a trauma intervention, the Attachment, Regulation and Competency Model (ARC) into their substance use and parenting programs. This integration took place across the agency’s continuum of care (residential, outpatient, and in-home programs). Clinicians were trained in the ARC model via a series of day-long in-person trainings and then received supportive consultation and training for three years. Clinicians administered the PFS, PHQ-9, UCLA PTSD, GAD-7, and AAPI to assess changes in substance use clients’ mental health symptoms and parenting attitudes and behaviors. 421 clients were administered measures at each session for five timepoints in clinical sessions. Clients included both child welfare involved and non-involved families, primarily had a high school education/GED, were unemployed, and had an average income of less than $20,000 per year. Data was collected between 2017 and 2022.

Results: Clients experienced a 22% reduction in reported depressive symptomatology (from 5.8 to 4.5) and a 52% reduction in anxiety symptoms (from 6.7 to 3.2), between the beginning and end of treatment. The UCLA-PTSD indicated higher post-traumatic symptomology across treatment for clients who started with high and low severity symptoms, 20.6 to 25. Scores on parenting attitudes and behavior measures also exhibited changes, including a 26% client reported increases in parental empathy (from 5.7 to 7.2).

Conclusion and Implications: Data analysis reveals positive trends for clients who received integrated substance use, trauma, and parenting treatment at this agency. Most clients reported reductions in their mental health symptoms and endorsed support for more effective parenting strategies between admission and discharge across all programs. Results provide important developmental and relational context to the potential mechanisms of effectiveness in implementation of ARC for parents with SUD. This study provides support for a different approach to substance use disorder treatment that considers the unique needs of parents and children.