Mindfulness Builds Positive Parenting for Moms in Opioid Use Treatment
I’m delighted to share the results of a research study on a mindfulness-based parenting (MBP) intervention for mothers in treatment for opioid use disorders. With the abundance of news reports about the opioid epidemic, it’s heartening to share some good news regarding families affected by opioid misuse. This study is of special interest to me because it was carried out at the women’s substance abuse treatment center in Philadelphia where I worked for nine years. As someone who formerly worked in this challenging field, I found this article inspiring. This relatively brief and inexpensive MBP group intervention produced an incredibly large change in the parenting behavior of mothers who struggled with multiple risk factors.
Those who follow the KIPS Blog may recall a previous guest post that described the MBP group intervention conducted at Thomas Jefferson University’s MATER program in Philadelphia. It’s exciting to see that the results are now published. In the recent article in the Journal of Addiction Medicine, titled Impact of Mindfulness-Based Parenting on Women in Treatment for Opioid Use Disorder, Meghan Gannon, PhD, MSPH, Principal Investigator Diane Abatemarco, PhD, MSW, and their colleagues detailed the theoretical model of the intervention, the MBP curriculum, and the observed parenting quality outcomes as measured by KIPS.
The MBP group intervention produced a remarkable increase in quality of parenting behaviors (measured by KIPS). Mothers with higher ACEs who attended more group sessions showed greater improvement in parenting. Mothers with higher mindfulness improved their parenting behavior at a greater rate.
Since these are such important findings, let’s take a closer look.
Who Participated in the Study?
The study included 160 women who participated in the trauma-informed, MBP intervention and medication-assisted treatment at MATER who were pregnant, parenting or working toward reunification with their children. Only English-speaking mothers with children ages 3 months to 4 years were eligible for the study. The mothers averaged 31 years old, were primarily Caucasian and non-Hispanic, and reported 70% high school or more education. Among the study participants, 9% were employed, 48% lived with a partner or were married, and they had an average of 2-3 children.
The research team studied the impact of the MBP intervention on the mothers’ observed parenting behaviors as well as their associations with mothers’ self-reports of Adverse Childhood Experiences (ACEs) and mindfulness in parenting.
What Did They Do?
MBP Group. The mothers participated in a 12-week group that met 2 hours per week guided by a curriculum focused on attentive listening, acceptance without judgment, emotional awareness of self and child, self-regulation, and compassion for self and child. The article outlines the teaching method, process, group practice and home practice strategies used for each of these topics and describes the weekly session format. During the MBP group sessions, mothers engaged in mother/baby education and practice, learning about the impact of trauma, and mindfulness meditation. An MBP teacher and a clinician from the drug treatment program co-facilitated each session to ensure support for any clinical needs elicited during the sessions. Follow-up support was provided by the clinical staff if needed. See the earlier blog for Diane’s and Meghan’s description of the MBP group intervention.
Data Collection. Before the intervention, the research team collected the following self-reports from mothers:
- Sociodemographic survey regarding mothers and their children
- Adverse Childhood Experiences tool
- Interpersonal Mindfulness in Parenting (IM-P) survey
(See JAM article for details and references for measures.)
To measure parenting outcomes, the research team conducted observational parenting assessments using KIPS to assess each mother’s quality of parenting behavior during 20 minutes of unscripted parent-child interaction with a standard set of age appropriate toys. After the MBP intervention was finished, the KIPS, ACEs and IM-P measures were collected again.
What Were the Key Findings?
Moving From Low to Moderate Quality Parenting. Comparison of KIPS overall mean scores pre and post intervention indicated that the mothers’ quality of parenting improved significantly after participating in the MBP group, moving from low quality (mean = 2.47) at baseline to moderate quality (mean = 3.59) on the KIPS 5-point scale post-intervention.
Regression Interactions. The mothers reported highly traumatic histories with 57% listing 4 or more traumatic childhood events, compared to the general population where only 16% report in this range. The analyses showed a significant 3-way Time x ACEs x Attendance interaction. Higher baseline ACEs and higher MBP group attendance predicted mothers’ improved KIPS scores post-intervention. There were a few intriguing twists in the results regarding ACEs and attendance which you can read in the article. The analyses also showed a significant 2-way interaction of Time x Mindful Parenting, indicating that higher mindfulness in parenting from pre- to post-intervention predicted mothers’ improved quality of parenting behaviors at a greater rate than those with lower mindful parenting reports.
Digging Deeper into Parenting Behaviors. To understand which aspects of mothers’ behaviors were impacted by MBP group intervention, the researchers dug deeper into pre-post changes and the interactions with Time, ACEs, and Mindful Parenting for three components of KIPS behaviors categorized as Building Relationships, Promoting Learning and Supporting Confidence (see KIPS behaviors). Each of the three subcategories showed what the research team considered a “large clinically significant increase” and several similar interaction patterns as found with the overall KIPS scores. Read the details in the JAM article.
What Do the Results Mean for Families and Practitioners?
This study is unique because it offered a detailed account of the MBP group process and curriculum inside the “black box”, and presented both observational and self-reports of parenting outcomes. It examined the parenting outcomes of an innovative trauma-informed MBP group intervention with mothers in treatment for opioid use disorders. Surprisingly, little information is available regarding how parenting skills are addressed (e.g., services, process, curricula) and the parenting outcomes within treatment programs.
In this study, we see that MBP group attendance made a clear difference. Mothers with a higher accumulation of ACEs who attended more group sessions showed more improvements in parenting behaviors. Curiously, the type of substance abuse treatment (outpatient/residential) in which mothers were enrolled showed no significant differences in this study. This suggests that MBP group intervention can be used effectively in both treatment settings.
The researchers concluded that Mindfulness-Based Parenting groups which are trauma-informed can show meaningful improvements in the quality of parenting behavior for mothers enrolled in treatment programs for opioid use disorders. As the authors stated, further research with randomized trials would be useful in determining the MBP group effects on families with different demographics and the sustainability of the changes in mindfulness and parenting behavior.
As someone who has observed many parents, I consider the average change from a 2.5 to 3.6 on the KIPS scale a palpable improvement. This should lead to major changes in the parent-child relationships of these families, and in the long term, should promote healthier development for the children. Thus, the MBP intervention has the potential for immediate, long-term, and possibly intergenerational impact.