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Until the late 1980s, most substance abuse treatment programming was based on a model of service for the single male, with little attention paid to parent-child relationships or indeed to other familial or affiliative relationships [Finkelstein 1996]. Few treatment programs existed for women, and most of those that did exist were also based on this "single individual" model. At the same time, the child welfare service system and the substance abuse treatment system, often serving the same clients, interacted peripherally, and it was uncommon to find joint program or service planning [Finkelstein 1993, 1994].
In the late 1980s, two factors arose that altered this picture. One was the growing recognition that substance abuse treatment for women had to address relational issues, including parenting, to fully respond to women's needs and therefore promote successful treatment outcomes. At nearly the same time, the crack "epidemic" raised serious concerns about the effects of perinatal exposure to drugs and the need to provide specialized substance abuse treatment for pregnant and parenting women. This "epidemic" highlighted the fact that a large proportion of child welfare caseloads were families affected by substance abuse, a fact that continues to be true, with estimates that up to 80% of the caseloads are currently affected by substance abuse [CWLA 1998].
The demonstration project, which was the impetus for the development of this program, was innovative in its integration of parenting and parent-child services into substance abuse treatment. One effect of this integration was to increase coordination and planning with child welfare agencies serving the same families. Initially this coordination occurred between the programs involved in the demonstration project and local child welfare agencies. The demonstration project, however, heralded an increase in substance abuse treatment programs serving women with children and families, leading to more systemic coordination. In light of the time limits imposed by the Adoption and Safe Families Act (EL. 105-89) and the steady high percentage of child welfare involved families affected by substance abuse, improvement and expansion in coordination and joint service planning becomes critical.
Families affected by substance abuse benefit in several ways from developing nurturing family relationships [Camp & Finkelstein 1997; de Cubas 1993] and particularly from enhancing parents' substance abuse treatment. Treatment and relapse prevention reports emphasize the importance of supporting the ability to form and maintain mutual and empathic relationships; the ability to experience success and enjoyment as parents; and the ability to cope with daily life stresses as crucial programmatic components [Bry et al. 1998; Camp & Finkelstein 1997; Castellani et al. 1997; Van Bremen & Chasnoff 1994].
For parents, family life and family relationships are critical areas for building coping skills. Incorporating these areas of concern into treatment programs can promote successful treatment and reduce relapse risk by keeping parents in treatment longer, as well as by increasing their self-esteem and sense of competence as parents [Camp & Finkelstein 1997; Chassin et al. 1991; U.S. Department of Health and Human Services 1999; Van Bremen & Chasnoff 1994]. Promoting nurturing parent-child relationships reduces both the risk of substance abuse for both parent and child, as well as intergenerational patterns of violence, abuse, and neglect.
The CAPP project selected the Nurturing Program for Parents of Children Birth to Five Years Old, by Stephen Bavolek, Ph.D., for use in the structured parenting skills group, one component of the program of services. The Nurturing Program has a well-established history as an effective intervention for improving parenting skills and reducing risk of child maltreatment, as well as a validated, reliable measure of effectiveness instrument, the Adult Adolescent Parenting Inventory (AAPI).
To make the Nurturing Program more responsive to the needs of the target population--parents in substance abuse treatment--strategic modifications were undertaken:
These adaptations addressed important intergenerational factors associated with substance abuse and with child abuse and neglect, the transmission of patterns of child maltreatment, and the increased risks of alcohol or drug abuse faced by children of substance-abusing parents. The adaptations also maintained adherence with the core domains of the Nurturing Program, that is: (1) enhancing appropriate developmental expectations; (2) increasing empathy for children's points of view; (3) valuing and using alternatives to corporal punishments; and (4) establishing and maintaining appropriate roles.
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