Factors contributing to dropout from a therapeutic parenting intervention for mothers with substance use disorders (SUDs)

• In Event: 2-039 - New Perspectives on Maternal Drug-use: Risk and Protective Factors for Parenting, Child Development and Interventions

Integrative Statement

Introduction:
Mothers with SUDs often contend with co-occurring mental health disorders, trauma histories, and trauma symptomology (Kaltenbach, 2013), all of which can contribute to difficulties with parenting and poor outcomes for children (Salo & Flykt, 2013). Therapeutic parenting interventions geared toward addressing the intersection of SUDs, trauma, and mental health have been found to be greatly beneficial to mothers’ well-being and to the parent-child relationship (Paris et al, 2015; Suchman et al, 2011). However, despite these positive findings engagement and/or retention in interventions remains a problem. Increased levels of psychological distress, such as anxiety, may contribute to high attrition rates among women in treatment for SUDs (Elmquist et al, 2016), but a fuller understanding of the factors that contribute to early dropout from parenting interventions is necessary.

Aims or hypotheses: This study sought to address the question of which factors contribute to dropout by using data from an evaluation study of a therapeutic parenting intervention for mothers in treatment for SUDs and their young children.

Study population:
Participants included 70 mothers (M=30 years old) with young children (M=34 months), predominantly white, unmarried, and unemployed. The majority of participants had a high school diploma or some college. All women reported a history of substance misuse; the majority reported heroin as their main problematic substance. Mothers reported high levels of traumatic experiences for both themselves and their children.

Methods:
Baseline data were used from a study of mothers with young children in methadone treatment participating in a dyadic parenting intervention. Measures were used to assess mothers’ lifetime heroin use (ASI), adult trauma history and symptoms (LSCR and PSS), adult mental health (BSI), emotion regulation (DERS), parental stress (PSI), parenting sense of competence (PSOC), and parental reflective functioning (PRFQ). Independent sample t-tests were computed to compare the baseline scores of participants who remained in the intervention over time (completing Time 1 and Time 2 assessments) and those who only completed Time 1 measures due to dropout.

Results and Discussion:
Participants who dropped out of the intervention had significantly higher psychological distress at baseline; more specifically, they were higher on somatization, obsessive compulsive symptoms, anxiety, hostility and psychoticism. They also reported significantly more difficulties with aspects of parental reflective functioning (prementalizing or negative attributions about the child) at baseline than those who remained in the program. Those who left the intervention did so early on, receiving significantly fewer number of treatment sessions than those who remained in the program. Mothers who dropped out of the intervention also appear to have used heroin slightly longer, had experienced slightly more traumatic events and had more trauma symptomatology, more difficulties with emotion regulation, lower sense of parenting competence, and higher parental stress, but not at statistically significant levels.

Addressing parenting challenges for mothers with SUDs is essential to promote optimal child growth and development. These findings detail the severity and type of psychological distress experienced by mothers who dropped out of a parenting intervention offering areas of potential focus for clinicians who struggle with client engagement and retention.

Authors

• Ruth Paris, Boston University School of Social Work
  Presenting Author

• Anna Herriott, Boston University School of Social Work
  Non-Presenting Author

• Mihoko Maru, Boston University School of Social Work
  Non-Presenting Author