This pilot randomized trial examined the feasibility and efficacy of administering a brief home-based parenting program to mothers of infants at risk for problematic parenting due to substance use disorders. Participants were 21 mothers of 1- to 20-month-old infants, living with their infants while receiving residential substance use treatment. Upon enrollment into the study, mothers were randomly assigned to the program group (n = 11) or control group (n = 10). Program mothers received 10, 1-hour home visits delivered approximately weekly by one of two trained interventionists. The intervention program was the manualized Attachment and Biobehavioral Catch-up (“ABC”) program. Control mothers also received a brief intervention, consisting of 10, 15-minute weekly home visits, delivered by the same interventionists, in which the mothers were given a developmentally appropriate book for their child and asked if they had any questions about their relationship with their infant.

Assessments for all mothers included a pre-intervention/enrollment interview and a post-intervention observation and interview assessment. The enrollment interview included basic demographic questions about the mother and her child and a range of standard psychosocial assessments tapping childhood trauma, mental health symptoms, interest in treatment, and insightfulness about their children’s behaviors and motivations. The post-intervention assessment addressed parenting self-efficacy, infant social competence and self-regulation/dysregulation, and mothers’ insightfulness about children’s behaviors and motivations. In addition, the Maternal Behavior Q-sort (MBQS) assessment of parenting was completed by a trained observer. A Certificate of Confidentiality was requested in order to collect data on participants’ substance use. Qualitative, ethnographic data, originally planned to be collected live, during ABC intervention sessions, will instead be coded from videotaped ABC sessions (according to the ABC protocol, all ABC sessions are videotaped).

Interventionist Selection and Training: Two interventionists were selected, hired, and trained in the ABC program during a 4-day training led by its developer, Mary Dozier (University of Delaware). The 2 interventionists received regular phone- and web-based supervision for approximately one year, and both became certified ABC providers.

Establishment of Partnerships with Residential Substance Abuse Treatment Facilities: Partnerships with two local residential substance abuse treatment facilities were established. At each facility, these partnerships permitted recruitment and random-assignment implementation of program/control group intervention and research activities.

Participant Enrollment, Intervention, and Research Activities: Following approval of the intervention research protocol from the Duke University IRB (Nov. 11, 2009, protocol # 2971), participant enrollment began (please see attached Enrollment forms). A total of 21 mothers were enrolled. Sixteen of these 21 mothers (76%) completed all intervention sessions and post-intervention research activities (n’s = 8 program, 8 control participants).

At enrollment, mothers ranged in age from 19 to 43 years (M = 33 years). Their children, 62% of whom were male, ranged in age from 1 to 21 months (M = 10 months). Most of the mothers (86%) were white, most (86%) had at least a high school diploma/GED, and 91% were receiving public assistance. Most (88%) were single, divorced, or widowed. Almost all (95%) experienced at least one form of maltreatment during their childhood. Sixty-six percent of the mothers reported symptoms of clinical depression, and 33% reported symptoms of generalized anxiety disorder. ABC and control mothers did not differ significantly at enrollment on any demographic or psychosocial characteristics. The children of the mothers in the ABC group were significantly older than the children of the control mothers, however.

Mothers remained in residential substance abuse treatment for an average of one year (M = 11.5 months, s = 3.4). There were no program group differences in duration of substance abuse treatment. As hypothesized, mothers in the ABC group were observed to behave more sensitively and supportively towards their infants, according to the MBQS (t = 1.37, p ≤ .10, 1-tailed; controlling for child age did not change this effect). There were no other post-intervention program group differences.

In sum, it is feasible to administer the ABC program, through randomized trial, to mothers with substance abuse disorders in residential substance abuse treatment with their infants. Both the programs and the mothers welcomed the parenting services and tolerated random assignment. The positive effects of the ABC program on observed parenting supports program efficacy among very high risk mothers and is consistent with ”increasing the salience of non-drug reinforcers” (Volkow et al., 2004) for this population. These findings, along with the short (yet intensive) duration of the ABC program, its portability, and its relatively low cost (estimated at $1200 per participant, after training @ $5000/clinician) make it an ideal add-on to residential substance abuse “treatment as usual” for new mothers and their infants, in an integrated (substance abuse + parenting) treatment model.

Below is a list of papers and presentations that emanated from this project: