WELL Child
The Institute for Health and Recovery (IHR), through the WELL Child Study, assessed the effectiveness of services for children ages 5 to 10 of women who enrolled in the WELL Project’s trauma-informed, integrated services for women with co-occurring disorders and histories of violence. Children’s services were provided at 2 WELL Project local study sites: CAB in Northeast MA and SSTAR in Fall River. Previous to the WELL Child Project, little, if any, specific trauma-informed services were provided to children of these age groups within CAB or SSTAR.
Children, whose mothers/caretakers were enrolled in the WELL Project, who had at least weekly contact with their mother/caretaker and were between 5 and 10 years old were eligible to participate in the Study’s services, with consent of their mothers/caretakers and/or legal guardians. This study had three components: Assessment, Resource Coordination and provision of a skills and resiliency building group. Each child received a comprehensive assessment conducted by the Study Director. Following assessment with both mother and child independently, children were assigned a Child Clinician/Advocate who served as a care coordinator with responsibility for service planning, advocacy and referral. Children participated in an age-specific skill-building group focused on expressing feelings, protecting one’s self, having a positive experience, and strengthening self-esteem through improving communication, problem-solving and cognitive coping skills. The groups helped children to identify violent behavior and appropriately develop safety plans for themselves. Two groups were available: one for children from five to seven years old and one serving eight to ten year olds. The Child Clinician Advocate, as well as the C/S/R Coordinator and local site staff, facilitated the ten-group sessions format, with two additional booster sessions.
The total sample in the WELL Child Study was 46, with 25 children in the integrated condition and 21 children in the comparison condition. Twenty-four (52%) of these children were aged 5-7 at time of study recruitment, whereas 22 (48%) were aged 8-10. Just over three-quarters (76%) were White, 28% Black/African American, 4% American Indian, 2% Native Hawaiian/Other Pacific Islander, 2% Asian and 15% Other, with the total over 100% because a single child can belong to more than one category. 15% were Latino/a (see Evaluation section for more demographics).
Study outcomes included safety planning and self care; improved relationships; and increased self-awareness, self-worth, and self-identity. Outcomes for children receiving services were compared with outcomes of similar children whose mothers/caretakers received services as usual at Spectrum Health Systems. Sixty children were enrolled in the WELL Child Study; 30 in the Intervention Condition and thirty in the Comparison Condition. Cross Site Study Outcomes were: At 6 months, children’s involvement in the standardized intervention lead to comparable, but not better, improvement than those receiving treatment-as-usual and mother’s outcomes significantly affected children’s outcomes. At 12 months, children’s involvement in the intervention lead to sustained improvement as compared to children receiving treatment-as-usual and mother’s outcomes did not play a significant role in sustaining children’s positive outcomes.
Building Family Recovery
The Institute for Health and Recovery, in collaboration with the Family Nurturing Center and Harvard Street Neighborhood Health Center/FIRST, Inc., established a coalition of community stakeholders who evaluate and disseminate community-based family strengthening programs to prevent and/or reduce substance abuse for families in which at least one parent has a diagnosis of substance abuse and is participating in outpatient substance abuse treatment. The project was named "Preventing Substance Abuse by Building Family Recovery". Stakeholders who served on the coalition were, in addition to the partners, the area offices of the Massachusetts Department of Social Services, Parents Anonymous, community Early Intervention and youth substance abuse prevention organizations, and consumers.
This project aimed at preventing youth substance abuse by improving the quality of the parent-child relationship through parent behavior training and skill building. Parent substance abuse is also targeted by improving parents' coping skills, and thus, reducing risk of relapse.
The intervention also increased the capacity of substance abuse treatment programs in the community to offer family strengthening services and include family recovery in programmatic goals. Collaboration in service design and delivery was enhanced by the inclusion of stakeholders on the coalition which reviewed, selected, adapted, and implemented the intervention.
At the time the project began, there were few, if any, community-based family strengthening services tailored specifically to the needs of families affected by parental substance abuse. This project developed a model to fill that gap.
Services provided included: needs assessment, staff training, development of culturally responsive adaptations to the selected program, and implementation of a family-based group intervention. The intervention included three group programs: one for parents only, and two programs of a parent group with concurrent children's groups. The combined parents and children's groups also included a family meal and activity time.
The effectiveness of the program was measured by the administration of standard pre-post evaluation instruments and participant evaluations of the program, with a three-month follow-up focus group and administration of evaluation instruments.
Building Family Recovery was funded by the federal Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Prevention and was evaluated by Donna Caldwell, a researcher from the National Perinatal Information Center and Brown University. The project ended in 2001.