Family-behavioural therapy programs are promising interventions for mothers with concurrent substance abuse and child neglect reports under child protective services

Date Published: 

Donohue, B., Azrin, N. H., Bradshaw, K., Van Hasselt, V. B., Cross, C. L., Urgelles, J., Romero, V., Hill, H.H., & Allen, D. N. (2014). A controlled evaluation of family behavior therapy in concurrent child neglect and drug abuse, Journal of Consulting and Clinical Psychology, 82(4), 706-720.

Reviewed by: 
Kara Fletcher

For the past two decades, researchers have emphasized the need for empirically based behavioural treatments to address child neglect and substance abuse. Using a controlled experimental design, the authors evaluated a family-based behavioural therapy program with mothers who were referred by Child Protective Services (CPS) for child neglect and drug abuse. Family Behaviour Therapy (FBT) is a cognitive behavioural model that focuses on skill development using behavioural role-playing, therapeutic assignments, and family support systems. In this study, mothers and their families were seen at home, and treatment occurred for 20, 75-minute sessions over a period of six months. The authors hypothesized that participants receiving FBT would have significantly better outcomes than participants in the treatment as usual group (TAU). They also hypothesized that mothers receiving FBT who did not expose their children to illicit drugs would have more improvement than mothers receiving FBT who did expose their children to illicit drugs and TAU participants.

Mothers referred for treatment of substance abuse and child neglect (n=72) were randomly assigned to family behavioural therapy (FBT) or treatment as usual (TAU). Groups were also divided by neglect type: child being exposed to drugs or other child neglect. Participants were assessed at baseline, 6 months, and 10 months post-randomization. Seventy-four percent of participants participated in both the 6 months and 10-month post-randomization assessments. Results demonstrated within-participant improvements from baseline to 6 and 10 months post-randomization for most measures. FBT appeared to be beneficial for mothers who were referred by CPS for child neglect and substance abuse, particularly mothers of children who were referred for non-drug-exposed child neglect. FBT showed promise in other domains including a reduction in hard drug use (g = 0.39, CI [.12, .90]), marijuana use (g = 0.41, CI [-.10, .92]), and decreased HIV risk behaviours, however FBT was found to only have incremental improvement over TAU.

Methodological notes: 

This was the first clinical outcome study that addressed substance abuse and child neglect. Future research and additional controlled trials are needed that incorporate larger samples sizes, direct assessment of behaviours, home conditions, etc. The FBT treatment approach was specifically tailored to accommodate the needs of CPS clientele referred for substance abuse, emphasizing the importance and benefit of treatments that are flexible to the unique needs of clients.