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Table 2 Study Characteristics

From: Integrated programs for women with substance use issues and their children: a qualitative meta-synthesis of processes and outcomes

Author(s) Setting/Program Elements Objective Research Method Study Participants Qualitative Data Source(s)
Nardi [27, 28] Midwestern city, USA
An intensive outpatient perinatal addiction treatment program for pregnant and parenting women and their children newborn to 3 years of age
Services included: a therapeutic nursery; detoxification program; medical services; 12-step program and other addiction education programs; outpatient services (transportation, child care and meal support); chemical dependency treatment, parenting training program; counseling and psychotherapy; and skills training
To explore the nature of parenting and addiction recovery for pregnant and parenting women in an addiction treatment program Mixed methods combining grounded theory methodology with quantitative methods of descriptive and differential statistics N = 17
Low-income, single women 20-37 years old, with a mean age of 28 years
Most (82%) were African American, lived in the inner city, and were involved with child protection services
Single semi-structured interviews, participant observation, field notes, client records (medical records, infant birth records, therapy treatment notes, program progress notes)
Nardi [29] As above To explore the nature of parent-infant interaction during the first year in a perinatal addiction treatment program As above As above As above
Baldwin et al. [44] Western USA
Mom Empowerment, Too! (ME2) Program, a community-based intervention with multiple program modalities delivered by pubic health nurses including: home visits; case management; resource referrals; and a series of 16 educational-support sessions focused on substance use, pregnancy, nutrition, self-nurturance, responsible parenting, development of life skills, problem solving, and stress management
Children participated in a program focused on child health and development
To examine women's experiences in a community-based program for young mothers (and their children ages birth to 5 years) involved in substance abuse and their perceptions of risk and health promoting behaviours before and during the intervention program Qualitative description using ethnographic interview techniques within a participatory action research process N = 42
Low-income, pregnant women and mothers 18 to 33 years old
Most (83%) were European American, 14% were Hispanic, and 0.02% were African American
Semi-structured interviews at each of the 16 program sessions
Howell & Chasnoff [46] Eastern USA
Evaluation of five Improve Care for Pregnant Substance Abusers demonstration sites funded by the Health Care Financing Administration in Maryland, Massachusetts, New York, South Carolina, and Washington
These state-developed programs provided services to improve access to care for pregnant substance abusers by providing enhanced services and coordinated prenatal and substance abuse care
To identify factors in women's lives that facilitate or act as barriers to the treatment process and to describe successful program components that addressed the needs of the population Qualitative description Three types of participants:
1. Program administrators (n = 25)
2. Care providers (n = 147)
3. Pregnant and postpartum women (n = 88)
Program providers included registered nurses, physicians, case managers, outreach workers, and therapists
Thirty-three focus groups were conducted across the five sites including: 5 groups of program administrators; 16 groups of providers; and 12 groups of women participating in the programs
Schretzman [39] New York City, USA
Casa Rita residential program for homeless pregnant women and mothers with addiction problems and their children
Program components included: individual, group and family therapy; on-site child care; and private residential accommodation
To identify factors associated with successful treatment outcomes and to identify factors that both support and challenge participants' post-treatment experiences Mixed methods with a qualitative case study conducted concurrently with a descriptive quantitative study N= 20 women who had completed the program and remained alcohol and drug free at the time of the study Single in-depth, semi-structured interviews
Salmon et al. [43] San Jose, California, USA
An intensive, 9-month outpatient drug treatment program for pregnant women and parenting substance abusing women
The program was based on a 'one-stop shopping model' and on-site services included: child care; transportation to and from the program; individual and group counseling; a 12-step recovery program; education on a variety of health and social issues; parenting skills; development of life skills; referrals to community services; and intensive case management
To explore the perceptions of pregnant and parenting substance-abusing women in an outpatient drug rehabilitation program about provider and social support, and to identify program elements that supported maintaining their abstinence from substance use Qualitative description N = 20
Average age was 30 years; 55% of participants were Hispanic and 20% were Caucasian; average number of children was 3.3
The majority were single (70%) and unemployed with public assistance (95%)
Two semi-structured questionnaires with open-ended questions and structured questions on demographics and drug history completed during a private interview
Kunkel [37] Abbotsford, British Columbia, Canada
A residential treatment facility for addicted women and their children offering a 10-week program
Treatment services included: daily counseling and psycho-educational groups; individual counseling; parenting training; an exercise program; and support meetings
On-site licensed daycare was provided
To understand mothers' lived experiences of participating in a residential treatment program with their children, and to study the impact of the involvement of children in their mothers' residential addiction treatment program on both the experience of treatment and on recovery Phenomenology N = 6
Age range 21-36 years; five women were Caucasian and one was Aboriginal
In-depth, open-ended interviews during week 8 of the program and a follow-up interview 1 month following treatment discharge
Simpson [38] Windsor, Ontario, Canada
A community-based harm reduction treatment model that offered outpatient services for chemically dependent pregnant women and parenting mothers
The 17-week program offered: addictions, parenting, children's, and health programming; support for accessing transportation, housing, and food; and a parenting program delivered one afternoon a week
To explore women's life situations and perspectives of the impact of the parenting program on their parenting style and relationship with children Mixed methods, predominantly qualitative description informed by case study and phenomenological approaches N = 7 who completed the 17-week parenting program module; most continued to attend the program for support
Average age of study participants was 35 years; six mothers were Caucasian and one mother was Aboriginal
Single semi-structured interviews 3 months after program completion
Sword et al. [42] Hamilton, Ontario, Canada
New Choices, a comprehensive community-based "one stop" program of service delivery for women with substance use issues who are pregnant or parenting young children
Program components included: addiction groups and counseling; nutrition counseling and skill development; parenting education; peer support; and an enriched children's program
Linkages with prenatal services, a physician, and a perinatal home visitation program also were available
To describe mothers' experiences of participating in the community-based treatment program and to understand their perceptions of how the program influenced changes in their lives and the lives of their children Qualitative exploratory N = 11 women ages 21 to 36 years who had completed at least 3 months of the program Seven women new to the program completed an in-depth individual interview and seven women participated in a single focus group post program involvement
Two of the seven women completed a follow-up interview at 3, 6, and 12 months post program involvement, four women completed two follow-up interviews, and one women completed one follow-up interview
Motz et al. [18] Toronto, Ontario, Canada
Breaking the Cycle, a community-based early identification and prevention program for pregnant women and mothers who are using alcohol or other substances, and their young children
The program provided mothers with a single point of access to a range of multi-sectoral, integrated services: individual and group addiction treatment; parenting programs; child care; child development services; health/medical services; Fetal Alcohol Spectrum Disorder diagnostic clinic; mental health counseling; case management; parent-infant counseling; home visitation; pregnancy outreach; and instrumental support
To explore factors influencing women's progress through and satisfaction with the treatment program services Program evaluation using mixed methods, including a qualitative descriptive component N = 19
Demographics specific to the women who participated in the focus groups were not provided
Three separate focus groups:
1. Women participating in the pregnancy outreach program (n = 7)
2. Women recently transferred to ongoing/active service (n = 5)
3. Women receiving ongoing/active service for more than 12 months
de Guzman et al. [40] New York City, USA
Family First Intervention, a multi-session, individually-based behavioural intervention program for mothers with patterns of problem drinking who infected with or at-risk for HIV
The intervention consisted of 14 sessions; the first seven sessions supported mothers in reducing or eliminating problem drinking and/or drug use and the final seven sessions focused on the development of skills for parenting adolescents
To examine program participants' experiences in the program and to describe their perceptions of intervention processes that influenced behavioural changes related to substance use, parenting behaviours, coping, and social support networks Qualitative exploratory N = 25 selected from a larger intervention trial
The full sample comprised women of colour, with 64% African American, 32% Latina and 4% multiracial; average age was 41 years
All were receiving Medicaid and 60% were HIV infected
Single in-depth semi-structured interviews after completion of the final quantitative follow-up (12 to 20 months after the last intervention session)
Polansky et al. [41] Philadelphia, USA
A publicly funded residential treatment program for women with addictions and their children
Program elements included: weekly individual psychotherapy; family therapy; a 12-step group program for treating addiction; a trauma group; a healthy relationships group; a parenting group with an emphasis on psycho-education; and an optional 6-week attachment-based parenting group
To explore mothers' experiences of participating in the attachment-based parenting group and their perceptions of how the group influenced interactions with their children and children's behaviour Qualitative exploratory N = 7
All, with one exception, were African American; six women were in their 20 s or 30 s and one woman was in her 40 s
Single semi-structured interviews 1 to 3 weeks following completion of the parenting group
Wong [31] New York City, USA
Participants were recruited from four residential programs providing addiction treatment services to mothers and their children
All of the programs offered both substance abuse treatment and parenting programming
To explore mothers' perceptions of the supportive function of the treatment program and how it affected their parenting experiences and outcomes Mixed methods, predominately qualitative exploratory with a descriptive quantitative component N = 10 women 25 to 45 years of age who had completed at least 3 months of treatment Three in-depth, semi-structured interviews, participatory observation, and field notes
Wong [30] As above To explore how substance-abusing mothers perceived their parenting experiences within the social context of a residential treatment program As above As above As above