Background: Pregnant and postpartum women with substance use disorders are a highly vulnerable population, especially when this is compounded by homelessness or unstable housing, justice involvement, and/or co-occurring mental health challenges. The MIRRORS (Maternal Initiative for Reflective Recovery-Oriented Residential Services) program provided expanded and enhanced residential substance use disorder treatment, prevention and recovery support for women and children through integrated, trauma-informed care and services strengthened by a comprehensive and coordinated family systems approach. This paper describes the program and provides evaluation of the outcomes. Methods: Pregnant and postpartum women (n = 215) were assessed at 3 time points: intake, discharge and 6-months post-intake using standardized measures of family functioning, parenting, recovery capital, and other outcomes. Multilevel modeling was employed to examine individual differences in trends over time. Results: Over 80% of participants reported that the MIRRORS program enhanced their recovery treatment experience. Women reported significant improvements in general family functioning, problem solving, behavioral control, affective responsiveness, and communication. Participants also reported increased recovery capital and improved parental monitoring over time. Conclusions: Outcomes indicate that the MIRRORS program was effective in improving family functioning and reducing substance use, thus enhancing women's functioning and recovery.
ClarkHW.Residential substance abuse treatment for pregnant and postpartum women and their children: treatment and policy implications. Child Welfare. 2001;80(2):179–198.
2.
HollemanWL, BrayJH, DavisL, HollemanMC.Innovative ways to address the mental health and medical needs of marginalized patients: collaborations between family physicians, family therapists, and family psychologists. Am J Orthopsychiatry. 2004;74(3):242–252.
3.
Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2018.
4.
LipariRN, Van HornSL.Children living with parents who have a substance use disorder. In: CBHSQ Report. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2017.
5.
DakofGA, QuilleTJ, TejedaMJ, AlbergaLR, BandstraE, SzapocznikJ.Enrolling and retaining mothers of substance-exposed infants in drug abuse treatment. J Consult Clin Psychol. 2003;71(4):764–772.
6.
SAMHSA. Addressing Fetal Alcohol Spectrum Disorders (FASD). Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014.
7.
Child Welfare Information Gateway. Parental Substance Use and the Child Welfare System. Washington, DC: US Department of Health and Human Services, Children's Bureau; 2014.
8.
GrellaCE, HserY-I, HuangY-C.Mothers in substance abuse treatment: differences in characteristics based on involvement with child welfare services. Child Abuse Negl. 2006;30(1):55–73.
9.
BarnardM, McKeganeyN.The impact of parental problem drug use on children: what is the problem and what can be done to help?Addiction. 2004;99(5):552–559.
10.
Child Welfare Information Gateway. Protecting Children in Families Affected by Substance Use Disorders. Washington, DC: US Department of Health and Human Services, Children's Bureau; 2009.
11.
U.S. Department of Health and Human Services. Blending Perspectives on Building Common Ground. A Report to Congress on Substance Abuse and Child Protection. Washington, DC: US Government Printing Office; 1999.
12.
RyanJP, MarshJC, TestaMF, LoudermanR.Integrating substance abuse treatment and child welfare services: findings from the Illinois alcohol and other drug abuse waiver demonstration. Soc Work Res. 2006;30(2):95–107.
13.
SmithBD, TestMF.The risk of subsequent maltreatment allegations in families with substance-exposed infants. Child Abuse Negl. 2002;26(1):97–114.
14.
SuchmanNE, DeCosteC, LeighD, BorelliJ.Reflective functioning in mothers with drug use disorders: implications for dyadic interactions with infants and toddlers. Attach Hum Dev. 2010;12(6):567–585.
15.
CasanuevaC, RingeisenH, WilsonE, SmithK, DolanM.NSCAW II Baseline Report: Child Well-Being. Washington, DC: US Department of Health and Human Services; 2011.
16.
SamuelsBH.Introduction-addressing trauma to promote social and emotional well-being: a child welfare imperative. Child Welfare. 2011;90(6):19–28.
17.
KempSP, MarcenkoMO, HoagwoodK, VesneskiW.Engaging parents in child welfare services: bridging family needs and child welfare mandates. Child Welfare. 2009;88(1):101–126.
18.
MarcenkoMO, LyonsSJ, CourtneyM.Mothers’ experiences, resources and needs: the context for reunification. Child Youth Serv Rev. 2011;33(3):431–438.
19.
ChemtobCM, GriffingS, TullbergE, RobertsE, EllisP.Screening for trauma exposure, and posttraumatic stress disorder and depression symptoms among mothers receiving child welfare preventive services. Child Welfare. 2011;90(6):109–127.
20.
FlukeJD, ShustermanGR, HollinsheadDM, YuanY-YT.Longitudinal analysis of repeated child abuse reporting and victimization: multistate analysis of associated factors. Child Maltreat. 2008;13(1):76–88.
21.
GreenfieldL, BurgdorfK, ChenX, PorowskiA, RobertsT, HerrellJ.Effectiveness of long-term residential substance abuse treatment for women: findings from three national studies. Am J Drug Alcohol Abuse. 2004;30(3):537–550.
BavolekSJ, KeeneRG.Adult-Adolescent Parenting Inventory: AAPI-2: Assessing High-Risk Parenting Attitudes and Behaviors. Park City, UT: Family Development Resources, Incorporated; 1999.
25.
HetheringtonEM.I. Coping with marital transitions: a family systems perspective. Monogr Soc Res Child Dev. 1992;57(2–3):1–14.
26.
Center for Substance Abuse Treatment. CSAT GPRA Client Outcome Measures for Discretionary Programs. Rockville, MD: CSAT; 2013.
27.
EpsteinNB, BishopDS, LevinS.The McMaster model of family functioning. J Marital Fam Ther. 1978;4(4):19–31.
28.
MillerIW, EpsteinNB, BishopDS, KeitnerGI.The McMaster family assessment device: reliability and validity. J Marital Fam Ther. 1985;11(4):345–356.
29.
MansfieldAK, KeitnerGI, DealyJ.The family assessment device: an update. Fam Process. 2015;54(1):82–93.
30.
RidenourTA, DaleyJ, ReichW.Factor analyses of the family assessment device. Fam Process. 1999;38(4):497–510.
31.
WennigerWFm, HagemanWJJM, ArrindellWA.Cross-national validity of dimensions of family functioning: first experiences with the Dutch version of the McMaster Family Assessment Device (FAD). Pers Individ Dif. 1993;14(6):769–781.
32.
GuadaJ, BrekkeJS, FloydR, BarbourJ.Assessing the family functioning of inner-city African-American families living with schizophrenia with the McMaster Family Assessment Device. Soc Work Ment Health. 2010;8(3):238–253.
33.
RonconeR, RossiL, MuiereEThe Italian version of the family assessment device. Soc Psychiatry Psychiatr Epidemiol. 1998;33(9):451–461.
34.
GroshkovaT, BestD, WhiteW.The Assessment of Recovery Capital: properties and psychometrics of a measure of addiction recovery strengths. Drug Alcohol Rev. 2013;32(2):187–194.
35.
VilsaintCL, KellyJF, BergmanBG, GroshkovaT, BestD, WhiteW.Development and validation of a Brief Assessment of Recovery Capital (BARC-10) for alcohol and drug use disorder. Drug Alcohol Depend. 2017;177:71–76.
36.
BavolekSJ, KeeneRG.Adult-Adolescent Parenting Inventory (AAPI-2) Assessing High-Risk Parenting Attitudes and Behaviors: AAPI Online Development Handbook. Park City, UT: Family Development Resources, Incorporated; 2010.
37.
NajavitsLM.Seeking safety: an evidence-based model for substance abuse and trauma/PTSD. In: Therapist's Guide to Evidence-Based Relapse Prevention. Amsterdam, The Netherlands: Elsevier; 2007:141–167.
38.
SAMHSA. National Registry of Evidence-Based Programs and Practices. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2016.
39.
BavolekSJ. Nurturing the families of Hawaii: Program to build nurturing parenting skills for the prevention of child abuse and neglect. Final Report for FY 2008-09 submitted to Department of Human Services, Honolulu, HI. August, 2009
40.
DiClementeCC.Prevention and harm reduction for chemical dependency: a process perspective. Clin Psychol Rev. 1999;19(4):473–486.
41.
MillerWR, RollnickS.Motivational Interviewing: Helping People Change. New York, NY: Guilford Press; 2012.
42.
ProchaskaJO, VelicerWF, RossiJSStages of change and decisional balance for 12 problem behaviors. Heal Psychol. 1994;13(1):39–46.
43.
BatesD, MächlerM, BolkerB, WalkerS. Fitting linear mixed-effects models using lme4. Published June 23, 2014. Accessed March 22, 2021. https://arxiv.org/abs/1406.5823.
44.
FettersMD, CurryLA, CreswellJW.Achieving integration in mixed methods designs-principles and practices. Health Serv Res. 2013;48(6):2134–2156.
45.
BrayJH, AdamsGJ, GetzJG, BaerPE.Developmental, family, and ethnic in influences on adolescent alcohol usage: a growth curve approach. J Fam Psychol. 2001;15(2):301–314.
46.
WebbJA, BrayJH, GetzJG, AdamsG.Gender, perceived parental monitoring, and behavioral adjustment: influences on adolescent alcohol use. Am J Orthopsychiatry. 2002;72(3):392–400.
