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5 Targeted Interventions Supporting Parents of Children with Special Needs, Parents Facing Special Adversities, and Parents Involved with Child Welfare Services
Pages 229-324

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From page 229...
... These interventions target specific populations of interest named in the committee's statement of task (Box 1-2 in Chapter 1) , such as parents of children with disabilities, parents with mental health conditions, and parents with a history of substance abuse, as well as other populations of parents the committee believes also warrant specific attention based on its review of the evidence.
From page 230...
... Parent Voices [One parent noted that parents of special needs children need to take on many roles and responsibilities.] "With a special needs child, a parent has to learn to be patient, to be a nurse, to be a lawyer because I have to be a good mediator for all the things that happen to my child." -- Mother from Omaha, Nebraska Parents of Children with Developmental Disabilities Parents, and indeed family members, of children with developmental disabilities experience challenges that differ from those experienced by parents of typically developing children (Woodman, 2014)
From page 231...
... , drawing on definitions issued by the American Association on Intellectual and Developmental Disabilities (2013) and the Centers for Disease Control and Prevention (n.d.)
From page 232...
... . restricted, repetitive patterns of behavior, interests, or activities." For parents of children with developmental disabilities, the committee expands on the scope of parenting to encompass family-centered care as foundational for parenting practice (Dunst and Trivette, 2010)
From page 233...
... In all cases, the findings reviewed here are from studies that employed randomized controlled trials, high-quality quasi-experimental designs, and/or highquality meta-analyses published in peer-reviewed journals. Intervention Strategies Interventions designed to support parents of children with developmental disabilities fall into four overlapping areas: family systems programs, instructional programs, interactional programs, and positive behavior support.
From page 234...
... conducted randomized controlled trials to examine the effects of mindfulness-based stress reduction techniques, and found significantly positive effects on stress reduction and associated variables (e.g., personal growth)
From page 235...
... . Other studies have documented the positive effects of early intensive behavior therapy delivered by parents.
From page 236...
... . In a randomized controlled study, Durand and colleagues (2013)
From page 237...
... Individual randomized controlled studies (Sofronoff et al., 2011) and a meta-analysis (Tellegen and Sanders, 2013)
From page 238...
... These interventions have included applications of general parent management training to parents of children with challenging behavior, as well as parent training developed specifically for this population. Triple P One of the most frequently used and internationally replicated interventions for helping parents prevent and address behavioral challenges in their children is Triple P (Sanders et al., 2008)
From page 239...
... Further, the commentary notes that most of the studies reviewed included maintenance probes many of which showed that post-treatment improvements were maintained over various lengths of follow-up. With regard to author affiliation, the commentary states that while developers are often authors of evaluations of Triple P and other parenting programs, the claim that most Triple P evidence is authored by affiliates of the program is untrue (Sanders et al., 2012)
From page 240...
... . Variants of Triple P have been developed for parents of children with developmental disabilities (Stepping Stones Triple P)
From page 241...
... state and is delivered in a variety of education, health, and social service settings. A systematic review and meta-analysis of 39 randomized controlled
From page 242...
... Findings suggested that all groups showed short- and long-term improvement, but there was no intervention effect. In a randomized controlled trial (independent from the developer, Webster-Stratton)
From page 243...
... The entire intervention is typically delivered in weekly 1-hour sessions over a 15-week period in an outpatient clinic or school setting. PCIT has been applied with families with a history of child abuse, as well as families of children who have developmental disabilities or were exposed to substances prior to their birth (National Registry of Evidence-based Programs and Practices, 2016c; Parent-Child Interaction Therapy International, 2015)
From page 244...
... They found that both groups of mothers reported positive effects on their parenting, with no difference between versions at postintervention or 6-month follow-up groups. Other interventions for externalizing behavior Although Triple P, The I ­ncredible Years, and PCIT have the strongest evidence of efficacy, documented through randomized controlled studies and international replications, a variety of other interventions have been designed to promote parenting (primarily behavior management)
From page 245...
... and complete parent training "homework" compared with the control group of fathers who only received parent behavioral training. Intervention Strategies: Parents of Children with Internalizing Behavior and Mental Illness Internalizing behavior and mental illness are manifest in young children primarily as anxiety and depression.
From page 246...
... . It has been tested in a randomized controlled trial involving mothers of children newly diagnosed with cancer at hospitals/cancer centers in the United States and Israel (Sahler et al., 2002)
From page 247...
... . Some have evaluated parenting training designed to support effective early parenting skills, while others have looked at psychosocial support for parents to prevent or address posttraumatic stress or depressive symptoms.
From page 248...
... PARENTS FACING SPECIAL ADVERSITIES This section reviews programs addressing the needs of parents facing special adversities related to mental illness, substance abuse disorders,
From page 249...
... . Again, even when individuals do receive services, the services generally focus on the presenting problem but do not address parenting issues; in fact, individuals receiving treatment for mental health or substance abuse disorders frequently are not asked whether they are parents.
From page 250...
... . In addition, many adults living with mental illness, substance abuse, developmental disabilities, or intimate partner violence are cognizant that their condition negatively influences other people's beliefs about their parenting abilities.
From page 251...
... This section reviews the available evidence on interventions designed specifically to support parents facing adversities related to mental illness, substance abuse disorders, intimate partner violence, and parental developmental disabilities, since each has unique needs that should be considered in offering services to strengthen and support parenting. As noted, many parents face two or more of these challenges, and some face nearly all of them.
From page 252...
... But the same report describes a number of promising two-generational programs focused on prevention and emphasizes the potential for helping parents with treatment and parenting programs. For individuals with mental illness, being a parent is not only a challenge but also often one of the most rewarding parts of their lives (Dolman et al., 2013; Lacey et al., 2015; Wittkowski et  al., 2014)
From page 253...
... There have been few high-quality large-scale evaluations of interventions designed for parents with mental illness and even fewer of those for parents with severe mental illness. The 2009 IOM and NRC report notes that few studies of parental depression focus on parental outcomes or issues specific to parents (Institute of Medicine and National Research Council, 2009)
From page 254...
... A systematic review of the impact of maternal-infant dyadic interventions on postpartum depression included 19 single group pre-post and randomized controlled studies. The author concluded that strategies focused on the dyad and maternal coaching were most effective at reducing psychiatric symptoms and demonstrated modest improvements in the mother-child relationship and maternal responsiveness (Tsivos et al., 2015)
From page 255...
... . A randomized controlled trial enrolled women in home visiting programs who were identified as being at risk for perinatal depression (Tandon et al., 2014)
From page 256...
... Unfortunately, interventions to support and strengthen parenting for parents with severe mental illness have typically not been rigorously evaluated using the types of well-designed randomized controlled trials used to test other parenting interventions described in this report, and this is an identified area of need (Schrank et al., 2015)
From page 257...
... Interventions and treatment for parents with mental illness have been found to significantly reduce the risk of children developing the same mental health problems as well as behavior challenges. A meta-analysis included 1,490 children in 13 randomized controlled trials of interventions with cognitive, behavioral, or psychoeducational elements for parents with a variety of mental illnesses and substance use problems (Siegenthaler et al., 2012)
From page 258...
... Parents with or Recovering from Substance Abuse Disorders Like mental health conditions, substance use and abuse can affect parenting attitudes and practices, as well as engagement and retention in parenting programs. It has been estimated that nearly 22 million Americans have a substance use disorder (Center for Behavioral Health Statistics and Quality, 2015)
From page 259...
... . The few studies that have been conducted on parenting and substance use/abuse have focused primarily on adults entering treatment, who account for a relatively small share of the broader population of parents with substance abuse disorders (Mayes and Truman, 2002)
From page 260...
... . Parenting status is nonetheless frequently neglected in the development of treatment interventions for parents with substance abuse, and rarely are critical needs for child care or children's services taken into account in developing services and parenting programs for these parents (Finkelstein, 1994, ­ 1996)
From page 261...
... Described below are interventions for substance abuse that include a specific focus on parenting. Residential Treatment Programs for Mothers with Their Children The standard of care for women's residential treatment for substance abuse disorders has shifted over the past 15-20 years from mothers being treated in single-adult programs apart from their children to women and children residing together and mothers receiving integrated addiction treatment and parenting education and services (Bromberg et al., 2010)
From page 262...
... Parenting Skills Training for Parents with or Recovering from Substance Abuse Disorders While research has demonstrated that family and parenting skills can be improved when specific parenting programs are integrated into treatment for substance abuse (Camp and Finkelstein, 1997; Kerwin, 2005; Suchman
From page 263...
... . Developed by a university-based research team, the program has been able to gather higher-quality data relative to most other parenting programs that address parental substance abuse.
From page 264...
... Although not used solely with parents, its outcomes, in addition to reduction in intimate partner violence, have been found to include improvement in children's psychosocial functioning and decline in children's clinical impairment in randomized controlled research (Kelley and Fals-Stewart, 2002)
From page 265...
... A recent review of 21 outcome studies on parenting programs used in substance abuse disorder treatment included 17 different parenting inter­ ventions. Studies consisted of 9 randomized controlled trials, 3 quasi-­ experimental studies, and 9 studies with no comparison group.
From page 266...
... Grant Program, SAMHSA funded 12 grantees to develop integrated and coordinated approaches to care for parents with substance abuse disorders and child welfare involvement, as well as to expand and enhance services for children ages 0-17 in families participating in an FTDC. Specialized client outreach and engagement strategies, as well as strengthened care coordination, were part of the program design.
From page 267...
... Intimate partner violence often affects parenting capacity and can have a direct effect on children who witness its occurrence. While most attention has focused on the impact of physical intimate partner violence, children exposed to a parent's threatening or otherwise verbally abusing a partner also are at elevated risk for a variety of mental health and other developmental problems, especially when such behavior is frequent, intense, and poorly resolved (Geffner et al., 2014; Repetti et al., 2002)
From page 268...
... .5 Like parents with mental illness or substance abuse, parents experiencing intimate partner violence often feel ashamed and guilty about what has happened to their children. These feelings, plus fear of being reported to child welfare, discourage many victims from reporting the violence and may affect parents' willingness and capacity to engage in parenting programs, as well as other support services (Lieberman et al., 2005)
From page 269...
... . In some situations involving intimate partner violence, children are subjected to physical punishment that constitutes legal child abuse.
From page 270...
... Programs often focus solely on the intimate partner violence, without addressing parenting strategies in general or parenting behaviors that might buffer children from the risks stemming from the violence. Intimate partner violence raises a special issue with respect to interventions designed to strengthen and support parenting in these families, in that such interventions must consider the repetitive nature of the violence in many families, which may pose an ongoing threat to the safety of one of the adults.
From page 271...
... Increasing numbers of community programs outside of the shelter system work with mothers, couples, and children experiencing intimate partner violence. Mothers may enter these programs following a stay in shelter care; through a referral from police, a court, or a domestic violence support agency; or on their own initiative (few programs serve fathers who have been subject to intimate partner violence)
From page 272...
... In some states, a report of intimate partner violence can lead to involvement by child welfare services. There is high overlap between intimate partner violence and physical abuse of children, which often justifies that involvement.
From page 273...
... . PCIT, which works with families L in which intimate partner violence no longer exists, has been found in a non-­ randomized controlled study to be effective in helping children and reducing parental conflict as long as the violence has ceased (Timmer et al., 2010)
From page 274...
... Based on the preliminary results from these small-scale studies, the federal government funded two randomized trials of systemic interventions to prevent intimate partner violence: Couples Together Against Violence (CTAV) and Couple Care for Parents (CCP)
From page 275...
... . One randomized follow-up study found that the positive effects of home visitation were reduced when a mother was experiencing intimate partner violence, and for those experiencing high rates of intimate partner violence, the beneficial effects of home visiting in terms of preventing child abuse disappeared completely (Eckenrode et al., 2000)
From page 276...
... found three randomized controlled studies of such programs that met their criteria for inclusion. First, in a Canadian sample of mothers with intellectual disabilities and their children, Feldman and colleagues (1992)
From page 277...
... . These rapid repeat pregnancies have been linked to even poorer health, education, and economic outcomes for adolescent mothers and their children (Chen et al., 2007; Hoffman and Maynard, 2008; Manlove et al., 2000; Stevens-Simon et al., 2001)
From page 278...
... They also have worse employment outcomes and are at higher risk for mental illness and substance abuse in adulthood (Dahinten et al., 2007; Morinis et al., 2013; Pogarsky et al., 2006)
From page 279...
... . In one relatively large randomized trial involving primarily adolescent mothers, those who received NFP home visits had fewer births and longer intervals between births of first and second children at 7-year followup compared with mothers who did not receive visits (Olds et al., 2007)
From page 280...
... Other evidence-based home visiting programs that likely reach a large number of adolescent parents (e.g., Family Check-Up, Home Instruction for Parents of Preschool Youngsters [HIPPY] , Durham Connects)
From page 281...
... . A few well-supported parenting programs, such as NFP, take family-level functioning into account, but the committee was unable to identify any comparisons of the use and nonuse of multigenerational approaches.
From page 282...
... also show promise with respect to these outcomes, those preliminary findings need to be replicated. With respect to parent self-sufficiency, intensive home visiting in NFP is associated in several studies with improvements in indicators of economic well-being but not continued education, although CAMI and school-based interventions and child care have shown positive effects on continuation of schooling among adolescent mothers.
From page 283...
... . Although national data are lacking on the reasons for these reports, they appear to be strongly associated with maternal substance abuse (Wulczyn et al., 2002)
From page 284...
... Given the scope and impact on children of parental behaviors constituting "maltreatment," it is essential that these parents receive high-quality parenting interventions. An effective response by child welfare services is especially needed for parents of young children.
From page 285...
... The well-being of children was powerfully influenced by ongoing exposure to poverty, regardless of the poverty level in which they lived at the time of original placement or the placement type at the end of placement. Intervention Strategies According to the NSCAW, in about two-thirds of cases that enter child welfare services, a recommendation for parent training is made, and nearly three-fourths of cases also involve a referral for mental health counseling or substance abuse treatment for the caregiver (Dolan et al., 2011)
From page 286...
... Skills Training and Family-Centered Treatment for Families with a History of Child Maltreatment or with Child Maltreatment Risk Factors Three parent skills training programs reviewed earlier (PCIT, Incredible Years, and Triple P) , often delivered in a group setting, have been found in randomized controlled studies to be suitable for implementation in the child welfare context (Linares et al., 2006, 2012, 2015)
From page 287...
... The trainings focus on practices related to reducing the incidence of child maltreatment, enhancing home safety and supervision, and improving the parent-child relationship. SafeCare home visitors are required only to have a bachelor's degree, and the program uses competency-based training approaches that make its replication highly dependable and scalable.
From page 288...
... . One evaluation showed that MST was effective in addressing the dual needs of families involved with child welfare services and substance abuse (Swenson et al., 2009)
From page 289...
... (CEBC rating of 3) is a derivative of Multidimensional Treatment Foster Care created for use with children of elementary school age who are in out-of-home care supervised by child welfare services (California Evidence-Based Clearinghouse, 2016h)
From page 290...
... SUMMARY The following key points emerged from the committee's review of evidence-based and evidence-informed interventions for parents of children with special needs, parents facing special adversities, and parents involved with child welfare services. Parents of Children with Special Needs • The efficacy research on programs designed to promote different dimensions of parenting for young children with special needs suggests that efficacious programs and resources are available to support parenting knowledge, attitudes, and practices for these
From page 291...
... • Parent training in support of positive behavior, such as that pro vided by the widely used Triple P and Incredible Years, including in a group format, is associated with improved parent-child interac tions and reduced challenging behavior in children with develop mental disabilities. • Gaps in research and practice relevant to interventions for parents of children with developmental disabilities include the development and evaluation of interventions that take place in natural environ
From page 292...
... Multiple evaluations have found that therapy-based child management combined with play therapy (PCIT) , delivered in weekly sessions in outpatient and clinic settings to teach parents the skills to encourage prosocial behavior in their children, im proves parent-child interactions, imparts parenting skills related to gaining children's compliance, and reduces parental stress, among other benefits.
From page 293...
... • For parents with depressive disorders, interventions that combine mental health treatment and parenting support lead to better out comes in terms of reducing psychiatric symptoms and increasing maternal responsiveness relative to programs focused solely on mental illness. • Integrating parenting interventions and support into primary care may be an effective way of diagnosing and treating parents' mental health issues.
From page 294...
... Available data on interventions and treatment for parents with severe mental illness indicate an association with significantly reduced risk that children will develop the same mental health problems. Parents with or Recovering from Substance Use Disorders • Mothers who are permitted to reside with their children during substance abuse treatment are more likely to enter, remain in, and complete treatment and remain drug free for longer.
From page 295...
... • Few home visiting programs have focused on intimate partner violence, but many women who receive home visiting services re port incidents of domestic violence. Some home visiting programs are developing, implementing, and testing strategies for reducing intimate partner violence, but findings from evaluations of these strategies are not yet available.
From page 296...
... • Many adolescent parents face barriers to continuing their school ing, although many go on to complete their GED. There is some evidence that home visiting programs and school-based interven tions that provide child care have positive effects on continuation of schooling among adolescent mothers, but further research in this area is needed.
From page 297...
... • In families with a history of child maltreatment or at high risk for maltreatment, both skills training in home and community set tings that involves observation and corrective feedback and multi pronged family-system approaches that address trauma and other co-occurring challenges (e.g., substance use) can be effective for improving child behavior and the parent-child relationship, par ents' psychiatric distress, and behaviors associated with child mal treatment.
From page 298...
... A meta analytic review of domestic violence treatment. Clinical Psychology Review, 23(8)
From page 299...
... . Parent-child interaction therapy for disruptive behav ior in children with mental retardation: A randomized controlled trial.
From page 300...
... . Caseworker-perceived care giver substance abuse and child protective services outcomes.
From page 301...
... . National Intimate Partner and Sexual Violence Survey: 2010 Sum mary Report.
From page 302...
... . Parenting training for women in residential substance abuse treatment.
From page 303...
... . Residential substance abuse treatment for pregnant and postpartum women and their children: Treatment and policy implications.
From page 304...
... . A compre hensive substance abuse treatment program for women and their children: An initial evaluation.
From page 305...
... . Pre-conception to parenting: A systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness.
From page 306...
... . Substance abuse and intimate partner violence.
From page 307...
... . The culturally-adapted early pathways program for young Latino children in poverty: A randomized controlled trial.
From page 308...
... . The Effects of Intimate Partner Violence on Children.
From page 309...
... . Early pathways therapy for young children in poverty: A randomized controlled trial.
From page 310...
... . Mothers with serious mental illness: When symptoms decline does parenting improve?
From page 311...
... . Conjoint treatment of intimate partner violence: A cognitive behavioral approach.
From page 312...
... . A novel early intervention for preschool depres sion: Findings from a pilot randomized controlled trial.
From page 313...
... . Parent training for young children with developmental disabilities: Randomized controlled trial.
From page 314...
... . The link between substance abuse and posttraumatic stress disorder in women.
From page 315...
... . Interventions to address parenting and parental substance abuse: Conceptual and methodological considerations.
From page 316...
... Mayes (Eds.) , Parenting and Substance Abuse (pp.
From page 317...
... . Effectiveness and sustainability of residential substance abuse treatment programs for pregnant and parenting women.
From page 318...
... -based parent intervention on toddlers at risk for autism spectrum disorders: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 51(10)
From page 319...
... . Comprehensive treatment for co-occurring child maltreatment and parental substance abuse: Outcomes from a 24-month pilot study of the MST-Building Stronger Families Program.
From page 320...
... . Effects of behavioral marital therapy: A meta analysis of randomized controlled trials.
From page 321...
... . Systemic perspectives on intimate partner violence treatment.
From page 322...
... . Moderating the effects of childhood exposure to intimate partner violence: The roles of parenting characteristics and adolescent peer support.
From page 323...
... . Targeted Grants to Increase the Well-Being of, and to Improve the Permanency Outcomes for, Children Affected by Methamphetamine or Other Substance Abuse: Third Annual Report to Congress.
From page 324...
... . Effects of family treatment drug courts on substance abuse and child welfare outcomes.


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