Tackling child neglect in Scotland 2: rapid review of intervention literature

Family Based or Parent Therapies

60. Systemic interventions are effective in a proportion of cases of child abuse and neglect. Systematic narrative reviews concur that for physical child abuse and neglect, effective therapy is family-based and structured. It extends over periods of at least 6 months and addresses specific problems in relevant subsystems, including children’s post-traumatic adjustment problems; parenting skills deficits and the overall supportiveness of the family and social network (Carr 2012).

61. Parents under Pressure was developed in Australia as an intensive, home-based intervention that draws on attachment theory with its emphasis on the central importance of a safe and nurturing relationship between children and their primary carer(s). The parent’s capacity to provide consistent and appropriate parenting skills and be emotionally available to their children is dependent upon the parent’s ability to understand and manage their own emotional state. The construct of mindfulness is utilised as a way of helping parents to understand and manage affect and to be fully present in the current moment with their child. Each of these capabilities is first assessed and a treatment plan is developed collaboratively with the family in which clear goals for change are agreed to. The programme consists of up to 20 weeks of in-home sessions (mean 10.5) of one to two hours where families work with the PuP therapist. The therapeutic process is assisted by the use of a parent workbook that invites the parent to engage in a process of self-reflection and personal goal setting around a series of modules.

62. In relation to the impact of this programme for families who may be experiencing abuse and neglect, Dalziel and colleagues (2015) reported on a recent trial of methadone-maintained parents randomised to the Parents under Pressure programme. At a six-month follow-up, the average rates of expected abuse and neglect had reduced by almost 17% compared with a slight increase of 3% in the comparison group Dalziel et al. 2015). Use of this programme in the UK has been supported by the NSPCC, which is working with the University of Warwick to evaluate its impact.

63. Family Behaviour Therapy approach was adapted for use in a trial with 72 mothers evidencing drug abuse or dependence and child neglect (Donohue et al. 2014). The mothers were randomly assigned to family behaviour therapy ( FBT) or treatment as usual ( TAU). Participants were assessed at baseline, 6 months, and at 10 months. The findings from the trial suggested that FBT might be beneficial in mothers who have been referred by child protection services for child neglect and drug abuse.

64. Family Based Recovery is an intensive, long-term clinical treatment program that provides substance abuse treatment, individual psychotherapy, parent-child relational support and developmental guidance, and comprehensive case management in the home and community. FBR clinicians are trained to provide all aspects of the model, which allows for the seamless integration of treatment components. Staff facilitate a weekly, two-hour group for parents and their children. Group attendance is another form of positive reinforcement, as clients may attend only when they have a negative urine toxicology screen and breathalyser result. The group provides a forum where parents experience peer support and discuss the successes and challenges of recovery or parenting. Staff work with families for up to one year and with no more than 12 families at one time.

65. Preliminary outcome data (Hanson et al 2015) suggests that in many cases FBR engages, stabilises, and effectively treats parents and promotes healthy parent-child attachment. The results indicate that relationship-focused substance abuse treatment in the home that prioritizes the parenting experience can benefit families and has the potential to improve future outcomes for the next generation. The service intensity and close collaboration between FBR and staff allows children to remain in the home although depending on the level of risk, staff may develop a safety plan that requires the parent to have 24-hour supervision with their child during the initial phase of treatment. Another key finding was that providing services in the home eliminated barriers to treatment and facilitated client engagement. It demonstrates a willingness to join with the family in its environment, while team members experience a client’s daily life and gain deeper understanding of family functioning, values, and beliefs. Additionally, meeting several times a week promotes clients’ recovery from their substance use disorder and sense of self-efficacy in parenting.