IDEAS home Printed from https://ideas.repec.org/a/wly/camsys/v20y2024i3ne1413.html
   My bibliography  Save this article

Psychosocial, pharmacological, and legal interventions for improving the psychosocial outcomes of children with substance misusing parents: A systematic review

Author

Listed:
  • Elizabeth Eggins
  • David B. Wilson
  • Joseph Betts
  • Sara Roetman
  • Ned Chandler‐Mather
  • Bronwyn Theroux
  • Sharon Dawe

Abstract

Background Parental substance misuse is a pervasive risk factor for a range of detrimental outcomes for children across the life course. While a variety of interventions have been developed for this population, the existing evidence‐base requires consolidation and consideration of the comparative effectiveness of different interventions to facilitate evidence‐informed decisions between different intervention approaches. Objectives This review aimed to use network meta‐analysis to synthesise the comparative effectiveness of psychosocial, legal, and pharmacological interventions for improving outcomes for children with substance misusing parents. Network meta‐analysis was not possible; however, we synthesised the effects of a broad range of interventions on child psychosocial outcomes. Another aim was to examine potential moderators of the effects, yet this was also not possible due to data limitations. A secondary objective was to qualitatively synthesise economic, treatment completion, and treatment acceptability information for included studies. Search Methods Searches were performed in November 2020 and again in April 2021. Encompassing multiple disciplines, we searched 34 databases, 58 grey literature repositories, and 10 trial registers. Supplementary hand searches were conducted on 11 journals, along with harvesting the references of all included studies and existing reviews, and forward citation searching each report of all included studies. Study authors were contacted to obtain missing data. Selection Criteria Eligible studies included randomised and quasi‐experimental evaluations of psychosocial, pharmacological, and/or legal interventions using either a placebo, no treatment, waitlist control, treatment‐as‐usual, or alternative treatment as a comparison condition. Study participants needed to be comprised of families with children under the age of 18 with one or more currently substance‐misusing parents (or caregivers). Studies were required to evaluate the eligible intervention using a child‐focused psychosocial outcome. If reported in eligible studies, the following secondary outcomes were also synthesised in the review: cost‐effectiveness, treatment completion, length of time in treatment and acceptability of treatment (e.g., participant perspectives of the intervention). There were no restrictions placed on publication status or geographic location, however only research written in English was included. Data Collection and Analysis Standard methodological procedures were followed across all stages of the review, as guided by the published protocol for the review (Eggins et al., 2020). Due to the inability to conduct network meta‐analyses, random effects pairwise meta‐analyses with inverse variance were used to synthesise effects when two or more studies with conceptually similar interventions and outcomes were available. Results of the meta‐analyses are displayed in forest plots, and separate analyses are provided for conceptually distinct outcomes and time‐points of measurement. Sensitivity analyses are used to explore possible sources of heterogeneity in the absence of sufficient studies to conduct subgroup analyses. Main Results 99 studies (reported in 231 documents) met review inclusion criteria, encompassing 22,213 participants. Most studies were conducted in the United States (k = 76), almost half were randomised controlled trials (k = 46), and the most common comparator was treatment‐as‐usual (k = 50). Interventions were evaluated using a large range of child psychosocial outcomes which broadly fell under: (a) child welfare; (b) child development; (c) child emotional and behavioural; and (d) educational domains. Intervention models were rarely only legal or pharmacological in nature, with most studies evaluating integrated psychosocial treatments with either pharmacology, coordinated health care, case‐management, and/or judicial or child welfare oversight and coordination. Thirty‐six meta‐analyses and 227 single effect sizes were used to appraise the effectiveness of included interventions, based on 68 studies with sufficient data for effect size calculation. The size and direction of the effects varied across interventions, type of outcomes, and time‐point of measurement. Twenty‐seven meta‐analyses and 186 single effect sizes suggested null effects. Only five single effect size estimates based on three studies indicated negative effects including: higher depressive and somatisation symptoms (parent‐report), hopelessness (child‐report), educational achievement difficulties (parent‐report), and substantiated child protection reports for those engaged with interventions versus treatment‐as‐usual or no treatment. Nine meta‐analyses and 36 single study effect estimates suggest that psychosocial, pharmacological and/or legal interventions have a positive effect on a range of specific child welfare, developmental, and emotional/behavioural outcomes for children. The risk of bias varied across domains and studies, which further lowers confidence in the results. Based on a subset of included studies, treatment completion tends to vary, yet cost‐benefits can be achieved when intervening with children whose parents misuse substances. Authors' Conclusions Despite a large body of evaluation evidence, disparate outcomes, and missing data precluded analyses to formally examine the comparative effectiveness of psychosocial, legal, and pharmacological interventions for improving outcomes for children with substance misusing parents. The large amount of unreported (missing) data meant that many effect estimates were underpowered due to single studies and small sample sizes. The review findings suggest that interventions for families affected by parental substance misuse can be effective when they holistically address multiple domains such as parent wellbeing/mental health, parenting, children's wellbeing, and/or other factors impacting family wellbeing (e.g., housing).

Suggested Citation

  • Elizabeth Eggins & David B. Wilson & Joseph Betts & Sara Roetman & Ned Chandler‐Mather & Bronwyn Theroux & Sharon Dawe, 2024. "Psychosocial, pharmacological, and legal interventions for improving the psychosocial outcomes of children with substance misusing parents: A systematic review," Campbell Systematic Reviews, John Wiley & Sons, vol. 20(3), September.
  • Handle: RePEc:wly:camsys:v:20:y:2024:i:3:n:e1413
    DOI: 10.1002/cl2.1413
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/cl2.1413
    Download Restriction: no

    File URL: https://libkey.io/10.1002/cl2.1413?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Gilbert, Neil, 2012. "A comparative study of child welfare systems: Abstract orientations and concrete results," Children and Youth Services Review, Elsevier, vol. 34(3), pages 532-536.
    2. Huang, Hui & Ryan, Joseph P., 2011. "Trying to come home: Substance exposed infants, mothers, and family reunification," Children and Youth Services Review, Elsevier, vol. 33(2), pages 322-329, February.
    3. Marsh, Jeanne C. & Ryan, Joseph P. & Choi, Sam & Testa, Mark F., 2006. "Integrated services for families with multiple problems: Obstacles to family reunification," Children and Youth Services Review, Elsevier, vol. 28(9), pages 1074-1087, September.
    4. Brandy R. Maynard & Kristen E. Brendel & Jeffery J. Bulanda & David Heyne & Aaron M. Thompson & Therese D. Pigott, 2015. "Psychosocial Interventions for School Refusal with Primary and Secondary School Students: A Systematic Review," Campbell Systematic Reviews, John Wiley & Sons, vol. 11(1), pages 1-76.
    5. Brook, Jody & McDonald, Thomas P. & Yan, Yueqi, 2012. "An analysis of the impact of the Strengthening Families Program on family reunification in child welfare," Children and Youth Services Review, Elsevier, vol. 34(4), pages 691-695.
    6. Ryan, Joseph P. & Victor, Bryan G. & Moore, Andrew & Mowbray, Orion & Perron, Brian E., 2016. "Recovery coaches and the stability of reunification for substance abusing families in child welfare," Children and Youth Services Review, Elsevier, vol. 70(C), pages 357-363.
    7. Elizabeth Eggins & Sharon Dawe & David B. Wilson & Ned Chandler‐Mather & Joseph Betts, 2020. "PROTOCOL: Psychosocial, pharmacological and legal interventions for improving the psychosocial outcomes of children with substance misusing parents," Campbell Systematic Reviews, John Wiley & Sons, vol. 16(3), September.
    8. Anthony Petrosino & Claire Morgan & Trevor A. Fronius & Emily E. Tanner‐Smith & Robert F. Boruch, 2012. "Interventions in Developing Nations for Improving Primary and Secondary School Enrollment of Children: A Systematic Review," Campbell Systematic Reviews, John Wiley & Sons, vol. 8(1), pages -192.
    9. Suzanna Fay & Elizabeth Eggins, 2019. "PROTOCOL: Family treatment drug courts for improving parental legal and psychosocial outcomes," Campbell Systematic Reviews, John Wiley & Sons, vol. 15(1-2), June.
    10. Haight, Wendy & Black, James & Sheridan, Kathryn, 2010. "A mental health intervention for rural, foster children from methamphetamine-involved families: Experimental assessment with qualitative elaboration," Children and Youth Services Review, Elsevier, vol. 32(10), pages 1446-1457, October.
    11. Williams, Gabriela & Tonmyr, Lil & Jack, Susan M. & Fallon, Barbara & MacMillan, Harriet L., 2011. "Determinants of maltreatment substantiation in a sample of infants involved with the child welfare system," Children and Youth Services Review, Elsevier, vol. 33(8), pages 1345-1353, August.
    12. repec:mpr:mprres:4988 is not listed on IDEAS
    13. Marsh, Jeanne C. & Smith, Brenda D. & Bruni, Maria, 2011. "Integrated substance abuse and child welfare services for women: A progress review," Children and Youth Services Review, Elsevier, vol. 33(3), pages 466-472, March.
    14. Johnson-Motoyama, Michelle & Brook, Jody & Yan, Yueqi & McDonald, Thomas P., 2013. "Cost analysis of the strengthening families program in reducing time to family reunification among substance-affected families," Children and Youth Services Review, Elsevier, vol. 35(2), pages 244-252.
    15. Zhang, Jing & Slesnick, Natasha, 2020. "Academic performance and delinquent and aggressive behaviors among children with substance using mothers," Children and Youth Services Review, Elsevier, vol. 109(C).
    16. Eldred, Lindsey M. & Gifford, Elizabeth J., 2016. "Empirical evidence on legal levers aimed at addressing child maltreatment," Children and Youth Services Review, Elsevier, vol. 60(C), pages 11-19.
    17. Moore, Kathleen & Sharp, Amanda & Alitz, Paige & Yampolskaya, Svetlana & Kleinman, Mary & Carlson, Melissa & Argerious, Alexa, 2020. "Reconsidering success for an integrated family dependency treatment court," Children and Youth Services Review, Elsevier, vol. 114(C).
    18. Davidson, Ryan D. & Tomlinson, Claire S. & Beck, Connie J. & Bowen, Anne M., 2019. "The revolving door of families in the child welfare system: Risk and protective factors associated with families returning," Children and Youth Services Review, Elsevier, vol. 100(C), pages 468-479.
    19. Bosk, Emily A. & Paris, Ruth & Hanson, Karen E. & Ruisard, Debra & Suchman, Nancy E., 2019. "Innovations in child welfare interventions for caregivers with substance use disorders and their children," Children and Youth Services Review, Elsevier, vol. 101(C), pages 99-112.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Elizabeth Eggins & Sharon Dawe & David B. Wilson & Ned Chandler‐Mather & Joseph Betts, 2020. "PROTOCOL: Psychosocial, pharmacological and legal interventions for improving the psychosocial outcomes of children with substance misusing parents," Campbell Systematic Reviews, John Wiley & Sons, vol. 16(3), September.
    2. Johnson-Motoyama, Michelle & Brook, Jody & Yan, Yueqi & McDonald, Thomas P., 2013. "Cost analysis of the strengthening families program in reducing time to family reunification among substance-affected families," Children and Youth Services Review, Elsevier, vol. 35(2), pages 244-252.
    3. Debra A. Strong & Russell Cole & Angela V. D'Angelo & Juliette Henke, "undated". "2012 and 2014 Regional Partnership Grants to Increase the Well-Being of and to Improve the Permanency Outcomes for Children Affected by Substance Abuse: Third Annual Report to Congress," Mathematica Policy Research Reports 25fb6c26bc6a435fbfa9abfd8, Mathematica Policy Research.
    4. Collins, Cyleste C. & Bai, Rong & Fischer, Robert & Crampton, David & Lalich, Nina & Liu, Chun & Chan, Tsui, 2020. "Housing instability and child welfare: Examining the delivery of innovative services in the context of a randomized controlled trial," Children and Youth Services Review, Elsevier, vol. 108(C).
    5. Rushovich, Berenice & Sepulveda, Kristin & Efetevbia, Victoria & Malm, Karin, 2021. "A post-reunification service model: Implementation and population served," Children and Youth Services Review, Elsevier, vol. 122(C).
    6. Estefan, Lianne Fuino & Coulter, Martha L. & VandeWeerd, Carla L. & Armstrong, Mary & Gorski, Peter, 2012. "Receiving mandated therapeutic services: Experiences of parents involved in the child welfare system," Children and Youth Services Review, Elsevier, vol. 34(12), pages 2353-2360.
    7. Lecompte, Vanessa & Pascuzzo, Katherine & Hélie, Sonia, 2023. "A look inside family reunification for children with attachment difficulties: An exploratory study," Children and Youth Services Review, Elsevier, vol. 154(C).
    8. El Assli, Hicham & Merzouki, Mohamed & Chigr, Fatiha & Aimrane, Abdelmohcine & Najimi, Mohamed, 2020. "Status of addictions to psychoactive substances among students in the province of Béni Mellal, Morocco," Children and Youth Services Review, Elsevier, vol. 117(C).
    9. Jedwab, Merav & Chatterjee, Anusha & Shaw, Terry V., 2018. "Caseworkers' insights and experiences with successful reunification," Children and Youth Services Review, Elsevier, vol. 86(C), pages 56-63.
    10. Grant, Therese & Christopher Graham, J. & Ernst, Cara C. & Michelle Peavy, K. & Brown, Natalie Novick, 2014. "Improving pregnancy outcomes among high-risk mothers who abuse alcohol and drugs: Factors associated with subsequent exposed births," Children and Youth Services Review, Elsevier, vol. 46(C), pages 11-18.
    11. Davidson, Ryan D. & Tomlinson, Claire S. & Beck, Connie J. & Bowen, Anne M., 2019. "The revolving door of families in the child welfare system: Risk and protective factors associated with families returning," Children and Youth Services Review, Elsevier, vol. 100(C), pages 468-479.
    12. Pierce, Barbara J. & Muzzey, Finneran K. & Bloomquist, Kori R. & Imburgia, Teresa M., 2022. "Effectiveness of Family Centered Treatment on reunification and days in care: Propensity score matched sample from Indiana child welfare data," Children and Youth Services Review, Elsevier, vol. 136(C).
    13. Karatekin, Canan & Hong, Saahoon & Piescher, Kristine & Uecker, Jill & McDonald, Jeff, 2014. "An evaluation of the effects of an integrated services program for multi-service use families on child welfare and educational outcomes of children," Children and Youth Services Review, Elsevier, vol. 41(C), pages 16-26.
    14. Lin, Yu-An & Hedeker, Donald & Ryan, Joseph P. & Marsh, Jeanne C., 2020. "Longitudinal analysis of need-service matching for substance-involved parents in the child welfare system," Children and Youth Services Review, Elsevier, vol. 114(C).
    15. Bywaters, Paul & Brady, Geraldine & Sparks, Tim & Bos, Elizabeth & Bunting, Lisa & Daniel, Brigid & Featherstone, Brid & Morris, Kate & Scourfield, Jonathan, 2015. "Exploring inequities in child welfare and child protection services: Explaining the ‘inverse intervention law’," Children and Youth Services Review, Elsevier, vol. 57(C), pages 98-105.
    16. Garcia Quiroga, Manuela & Hamilton-Giachritsis, Catherine, 2014. "“In the name of the children”: Public policies for children in out-of-home care in Chile. Historical review, present situation and future challenges," Children and Youth Services Review, Elsevier, vol. 44(C), pages 422-430.
    17. Diana N. Teixeira & Isabel Narciso & Margarida R. Henriques, 2022. "Driving for Success in Family Reunification—Professionals’ Views on Intervention," IJERPH, MDPI, vol. 19(24), pages 1-20, December.
    18. Balsells, Maria Àngels & Pastor, Crescencia & Mateos, Ainoa & Vaquero, Eduard & Urrea, Aida, 2015. "Exploring the needs of parents for achieving reunification: The views of foster children, birth family and social workers in Spain," Children and Youth Services Review, Elsevier, vol. 48(C), pages 159-166.
    19. Adelman, Melissa A. & Holland, Peter A., 2015. "Increasing access by waiving tuition : evidence from Haiti," Policy Research Working Paper Series 7175, The World Bank.
    20. Ogbonnaya, Ijeoma Nwabuzor & Keeney, Annie J., 2018. "A systematic review of the effectiveness of interagency and cross-system collaborations in the United States to improve child welfare outcomes," Children and Youth Services Review, Elsevier, vol. 94(C), pages 225-245.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:camsys:v:20:y:2024:i:3:n:e1413. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: https://doi.org/10.1111/(ISSN)1891-1803 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.