A Mindfulness-Based Intervention to Improve Family Functioning Among Child Welfare-Involved Families with Substance Use

Despite the frequent co-occurrence of parental substance misuse and child maltreatment, the field lacks feasible and effective intervention and strategies designed to meet the complex needs of child welfare-involved families with substance misuse. Mindfulness demonstrates promise in cultivating awareness and self-regulatory capacities, thereby reducing stress and substance use and improving parent-child interactions. The purpose of this mixed methods, randomized clinical trial was to evaluate the feasibility and acceptability of Mindfulness-Oriented Recovery Enhancement adapted for child welfare families (MORE-CW), and to test initial treatment effects on proximal (i.e., parental stress, autonomic activity during a stress-induced state and recovery [heart rate variability], coping, and mindfulness) and distal (i.e., parental substance misuse, child maltreatment potential, parent-child relationships, and child well-being) domains of family functioning. The final sample consisted of 21 child welfare-involved parents with children aged 0-18, recruited through child welfare caseworker and health department nurse referral. The feasibility and acceptability component of the study was determined by the proportion of families recruited, randomized, and retained, and by participant satisfaction. Enrollment included 33 parents, 28 of which were randomly assigned to either the experimental (n = 15) or wait-list control group (n = 13). Of those assigned to the intervention group, 73% completed the program. Acceptability was determined by a program satisfaction survey and qualitative feedback. Findings show that the program was well-received and highly rated by participants, indicating that MORE-CW is a viable form of intervention for this sample. Outcomes were assessed at pre- and post-assessment as well as during weekly intervention sessions. Independent samples t-tests on difference scores (post assessment - pre assessment) indicated several significant between-group effects, with MORE-CW reducing parenting stress, child abuse potential, and child behavior problems, and improving mindfulness. Moreover, results of the repeated measures ANCOVAs indicated statistically significant group by time differences on participant heart rate variability from pre- to post-assessment. There were no significant between-group differences with regard to coping, substance misuse, and parent-child relationships. Qualitatively, intervention participants were queried at the start of each session regarding experiences of stress and use of mindfulness-based coping and parenting techniques. Themes that emerged from participant narratives included stressors from physical health, finances, personal relationships, and competing pressures from service providers. With regard to mindful practice, participants most frequently used mindful breathing and reappraisal to reduce distress and increased attention to children\u27s needs. In sum, this preliminary study shows promising support for the feasibility, acceptability, and preliminary effectiveness of MORE-CW for improving multiple domains of family functioning among child welfare-involved families with substance misuse. Future research efforts may benefit from further program development and evaluation, and replication studies with larger sample sizes