Training Mothers Recovering from Substance Abuse to Identify and Treat Their Children's Illnesses

IntroductionChild maltreatment includes harmful acts committed against children (acts of commission), as well as negligent behaviors (acts of omission) that affect a child's well-being. These might include physical abuse, failure to provide for a child's emotional and physical needs (neglect), psychological abuse, and sexual mistreatment (1). In 2011, an estimated 3.7 million children had at least one report to Child Protective Services, of which, 18.5% were substantiated. Over 78.5% of these substantiated cases were attributed to neglect (2). Medical neglect accounts for a relatively small percentage of general child maltreatment, however, this type of neglect was associated with 96 of the 151 (or 7.6%) child fatalities in 2011 (2). Medical neglect is defined as the existence of unmet basic health needs and is typically the result of the failure to heed signs of illness or the failure to follow medical advice once sought (3,4).The association of child maltreatment and, in adolescent and adult years, high-risk behaviors, including early initiation of substance use, substance abuse, depression, cardiovascular disease, and early mortality is well documented (5-7). Although all forms of maltreatment may produce negative physical and mental health outcomes, neglect is of particular concern because of its high prevalence.Parental substance abuse increases the likelihood of child medical neglect and places the health of a child in jeopardy (7,8). According to the National Survey on Drug Use and Health, in 2009 approximately 22.6 million Americans over the age of 12 years were classified as substance abusers or substance dependent (9). The 2002-2007 data from the same survey indicated that over 8.3 million children under 18 years of age (11.9%) lived with at least one parent who was substance dependent on or abused alcohol or an illicit drug during the past year (10).The relationship between parental substance abuse and the perpetration of child neglect is well- documented. Ondersma (8) investigated factors common in families with low socioeconomic status (substance abuse, negative life events, depression, and social isolation), and explored the factors' ability to predict the occurrence of neglect. Substance abuse was found to be the strongest predictor of neglect. Specifically, a child in a family with a history of substance abuse was 18.35 times more likely to experience neglect. Brown and colleagues (11) examined demographic, familial, parenting, and child factors association with neglect and found that maternal sociopathy (i.e., alcohol, substance abuse, or problems with the police) produced the highest odds ratio for neglect. Paternal sociopathy also produced significantly predicted neglect. Among substance abusing mothers, parenting skills such as feeding, knowledge of child development, and care for newborns were low, but showed a significant increase after receiving a parenting intervention tailored to substance abusing mothers in treatment (12). Thus, mothers struggling with substance abuse issues fared well in parenting interventions and show an increase in skill demonstration.SafeCare®, an evidence-based parent-training intervention, is delivered in the home to mothers at- risk for abuse and neglect and has proven effective in increasing health knowledge and skills (13-15). SafeCare focuses on improving parental skills in three core areas: parent-child/parent-infant interactions, home safety and child health. The Health Module teaches parents to use professionally validated health reference materials, preventative techniques, how to identify symptoms of childhood illnesses or injuries, and when to seek professional treatment by following the steps of a task analysis. Further, interventions targeting parents' health literacy may improve parents' understanding of their child's health needs, thus reducing the occurrence of medical neglect.In the prevention of medical neglect, health literacy becomes relevant. …