(FIRST) Promoting healthy mother-child relationships: A pragmatic clinical trial for women in opioid treatment and their infants

Opioid misuse during pregnancy is an alarming public health problem resulting in maternal and child health disparities. SAMHSA (2017) reported that an annual average of 21 000 pregnant women misused opioids in the past month (based on 2007-2012 data).1 They subsequently gave birth to substance exposed newborns (SEN) who were at risk for NAS. Additionally SAMHSA has deemed women who misuse opioids and their children a top priority.2 In Massachusetts (site of proposed project) the increase in SEN births is 5 times the national average.3 Often mothers with opioid use disorders (OUDs) struggle and can be disengaged and severely challenged as parents leading to possible child maltreatment and poor long-term outcomes. Although there are evidence-based home visiting programs offered nationally through HRSA's Maternal Infant and Early Childhood Home Visiting (MIECHV) initiative none of them were developed to directly address SUDs or OUDs. In order to deal with this crisis address health disparities and the HHS clinical priority of opioid abuse and focus on the MCHB goal of promoting environments that support maternal and child health we must identify pragmatic community-based parenting interventions for women with OUDs and their children. Our primary overall goal aligns with MCHB Strategic Research Issue #IV by promoting the healthy development of MCH populations and major goals of Healthy People 2020 for promoting nurturing families and safe and supportive environments. We propose an intervention for both mother and infant designed to improve that relationship by increasing maternal sensitivity and parenting capacities thereby reducing child injuries from maltreatment and promoting healthy child development. This proposed project will conduct a two-armed pragmatic randomized controlled trial (RCT) for 100 pregnant women receiving treatment for OUDs. We will determine the effectiveness of an evidence-informed parenting intervention (BRIGHT) compared to enhanced Treatment as Usual (TAU+). BRIGHT a parent-infant home-based intervention will be offered from the 3rd trimester of pregnancy until the infant is 9 months old. TAU+ will consist of standard referrals to social services plus child development handouts. Both groups will be assessed in-person at baseline (3rd trimester) and when the child is 2 and 9 months. Brief follow-up phone assessments will be conducted when the child is 6 and 12 months. By conducting a pragmatic RCT of an evidenceinformed therapeutic parenting intervention (BRIGHT) compared to enhanced Treatment as Usual (TAU+) we aim to improve parent-child relationships and parenting capacities and reduce child maltreatment (Goal 1); enhance overall maternal mental health and maintenance in OUD treatment (Goal 2); and improve infant social-emotional development (Goal 3) in pregnant/parenting women receiving treatment for OUDs. Additionally with an advisory panel of consumers researchers and public health officials we plan to translate findings into practice and policy through dissemination at the local regional and national levels to stakeholders concerned about women with OUDs and their infants (Goal 4).

Bosk EA, Paris R, Hanson KE, Ruisard D, Suchman N. Innovations in child welfare interventions for caregivers with substance use disorders and their children, Children and Youth Services Review. 2019;101, 99-112. DOI:10.1016/j.childyouth.2019.03.040 June 2019

Paris R, Bartlett JD, Beaugard, C. (2019). Early childhood risk factors, prevention and intervention. In M. Vaughn, C. Salas-Wright, & D. Jackson (Eds.), Routledge International Handbook of Delinquency and Health, 1st Edition. Routledge.2019 DOI:10.4324/9780429289194 August 2019