Motivational Treatment to Prevent Alcohol-Exposed Pregnancy:
A Randomized, Controlled Efficacy Trial with Women Being Released from Jail
Patricia Dolan Mullen, Dr.P.H.
Alcohol exposure in utero, even before pregnancy is recognized, increases the risk of lifelong cognitive deficits and behavioral disorders. We randomized women at risk of an alcohol-exposed pregnancy (AEP) before jail and not planning a pregnancy ≤6 months postrelease to (1) a transtheoretical model-based motivational treatment with transition assistance and contraception education/services (n=133 TX) or (2) information only (n=83 Controls). Timeline follow-back interviews determined pregnancy risk and drinking; followup data were divided into successive 30-day periods, each classified as a failure if any risk drinking or unprotected sex occurred. Women in the treatment group had less AEP and pregnancy risk in months 5–6 and less risk drinking in all months. In this sample at high psychosocial risk, changing drinking may be more feasible than preventing an unplanned pregnancy, in part because many women in the treatment group were ineligible for effective contraceptives. These results are similar to a second trial using a motivational intervention without transition assistance.
Responsive Parenting Support During the Prison Nursery and
Mary W. Byrne, Ph.D., M.P.H.
One hundred pairs of women inmates and their infants coresiding in a prison nursery are enrolled in a National Institute of Nursing Research-funded longitudinal study throughout their nursery stay and 1st reentry year (Maternal and Child Outcomes of a Prison Nursery Program). Repeated measures of maternal qualities, child development, and mother-child interaction are recorded through questionnaires, indepth interviews, participant observations, and videotaping. Based on grounded theory ("Choosing the Parenting Self") identified in this investigator’s previous studies, an intervention tailored to observed and expressed needs, is implemented by advanced practice nurses. Weekly prison visits are made to the study pairs, and phone and mail interactions are continued following the return of the infant to the free community. Home and office visits occur at 6 and 12 months after release. Preliminary findings indicate that developmental milestones are achieved and that secure attachment can be established during the prison stay and maintained in reentry. Both are compromised should separations from the mother occur. The majority of children have remained with their mother following reentry. Future research should longitudinally expand this unique database of women inmates who are not separated at birth from their child, continue community support during the toddler reentry year, and compare outcomes with the growing body of research in this field.
Motivational Parent Management Training: An Efficacy Trial for Offenders Living with Children
Lew I. Bank, Ph.D.
The community corrections population and its children are at extreme risk for antisocial behavior, substance abuse, internalizing disorders, school failure, poor peer relations, and other negative outcomes. We have created a cognitive restructuring-parent management training (PMT) curriculum that is tailored to the needs of offenders supervised in the community and their families. We draw from beliefs that have resulted in antisocial behavior and negative consequences at the outset and then focus increasingly on parenting beliefs and behaviors, the home practice of PMT strategies and skills, and the use of those skills in the home and community. We are in year 2 of a 5-year project funded by the National Institute on Drug Abuse to test the efficacy of this intervention program. A total of 180 families are being randomly assigned to Motivational Parents Management Training (MPMT) vs. Community as Usual (CAU). To participate, the primary parent must be currently—or within the prior 2 years—supervised in the community and must live with or have regular contact with one or more children as old as 15 years. We hypothesized that both parents and children assigned to MPMT will have better outcomes than CAU participants for arrests, substance abuse, school and employment success, and executive function. Initial data will be presented, and the challenges and successes will be discussed.
Incarcerated Addicted Mothers and their 10- to 14-Year-Old Children
Thomas E. Hanlon, Ph.D.
This presentation reports on the experiences and difficulties associated with the implementation of two prevention programs, one involving a parenting program targeting incarcerated urban, African-American mothers and the other a program conducted in the community targeting their 10- to 14-year-old children. In both instances, formidable challenges surfaced during the course of the study that provide considerable insight into some of the intricacies and pitfalls that are likely to be encountered in conducting systematic evaluations in these separate settings and populations, particularly in studies concerned with followup evaluations and analyses. Suggestions concerning these findings that could profitably be considered in future studies in this vitally important area of prevention research are discussed.
Engaging Moms Program: Research Results and Introduction to an Intervention for Substance-Abusing Mothers
Gayle A. Dakof, Ph.D.
The number of women involved with the criminal justice system has increased tremendously over the past decade. A large proportion of female offenders not only have significant substance abuse, health, mental health, economic, and family problems but also are mothers of children younger than age 18, which suggests that the consequences of their drug use and incarceration are apt to be far reaching. The Engaging Moms Program (EMP) is a family-based intervention designed to help mothers be successful in substance abuse treatment and in family drug court. EMP focuses on helping the mother change her life so that she can provide a safe and nurturing home for her children and herself. Two studies have been done on EMP. The first found that EMP was considerably more effective than usual community services in enrolling drug-abusing mothers in treatment, and the second study (currently ongoing) likewise found that EMP was more effective than intensive case management services in helping mothers succeed in drug court. Given these promising results, it seems reasonable to speculate that EMP might be a beneficial intervention for mothers involved with the criminal justice system. Research results and an overview of core clinical interventions will be presented.