Program Profile: Engaging Moms Program for Mothers in Family Drug Court (Miami, Fla.)

This is a gender-specific, family-based intervention designed to help drug-using mothers who participate in family drug court to maintain their parental rights. The program is rated Ineffective. The program had no statistically significant effects on child welfare outcomes, self-reported drug use, physical child abuse potential, overall psychological stress, self-reported alcohol use, family and social functioning, psychiatric problems, and urinalysis results.

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals

The Engaging Moms Program (EMP) is a gender-specific, family-based intervention designed to help substance-abusing mothers participating in family drug court to maintain their parental rights. The program is designed to support mothers succeed in family drug court by helping them comply with all court orders, attend court sessions, remain drug-free, and demonstrate the capacity to parent their children.

Program Components/Program Theory

EMP was created using the theory and method of Multidimensional Family Therapy (Liddle, Dakof, and Diamond 1991). The program was initially developed to facilitate treatment entry and retention for mothers of substance-exposed infants, but was adapted for use in family drug court. EMP’s program theory maintains that change in six core areas is essential for drug-using mothers to achieve sobriety and adequately care for their children. These six core areas of change include

• The mother’s motivation and commitment to succeed in drug court and to change her life
• The emotional attachment between the mother and her children
• Relationships between the mother and her family
• Parenting skills
• The mother’s romantic relationships
• Emotional regulation, problem-solving, and communication skills

To help mothers achieve change in these core areas, EMP counselors hold integrated individual and family sessions with the mother and her family (e.g., individual sessions with the mother, individual sessions with her family/partner, and family and couples sessions). The EMP intervention is organized into three stages.

Stage 1. Alliance and Motivation. During the first stage, EMP counselors focus on 1) building a strong therapeutic relationship with the mother and her family, and 2) enhancing the motivation of the mother and her family to participate in family drug court and to change. Counselors provide support to the mother and her family by highlighting strengths and competence, building confidence in the program, offering compassion, and maintaining a nurturing attitude throughout. Counselors enhance motivation by highlighting the pain, guilt, and shame that the mother and her family have experienced and the high stakes involved (such as losing a child to the child welfare system), while at the same time creating positive expectations and hope.

Stage 2. Behavioral Change. The second stage focuses on the behavioral change of the mother and her family/spouse. Counselors begin by trying to enhance the emotional attachment between the mother and her children by working individually with the mother to help her explore her maternal role. The mother-and-children sessions are also designed to enhance the mother’s commitment to her children. In addition, counselors focus on enhancing the attachment between the mother and her family and/or spouse. They work on helping the family restrain from negativity and instead offer instrumental and emotional support to the mother. Significant attention is devoted to repairing the mother’s relationship with her family, which may have been damaged by past hurts, betrayals, and resentments.

The sessions address romantic relationships, typically with men, which are often a source of pain and distress for many mothers involved in the child welfare system. Mothers in the program work with a counselor to conduct a relationship life review, which includes examining tensions between having a romantic relationship and being a mother. The counselor helps the mother examine the choices she has made with regard to romantic relationships and teaches her how to make better decisions for herself and her children. Counselors also help the mother deal with any slips, mistakes, setbacks, or relapses in a nonpunitive and therapeutic manner.

Finally, EMP counselors facilitate the mother’s relationship with treatment/service providers and drug court personnel, including the judge, child welfare workers, and attorneys. Counselors conduct “shuttle diplomacy” between the mother and service providers, which is designed to prevent and resolve any problems and allow the mother to make the most use of the services being provided to her. In addition, counselors facilitate the therapeutic jurisprudence in the courtroom by preparing mothers for court appearances and advocating for the mother in front of the judge and during weekly drug court case reviews.

Stage 3. Launch to an Independent Life. In the final stage of the program, EMP counselors work with the mother to prepare her for an independent life. This includes developing a practical and workable routine for everyday life; addressing how the mother will balance self-care, children, and work; outlining a plan to address common emergencies with children and families; and addressing how the mother will deal with potential problems, mistakes, slips, and relapses.

Study

Dakof and colleagues (2010) used a randomized trial to examine the effectiveness of the Engaging Moms Program (EMP), compared with the Intensive Case Management Services (ICMS) program on child welfare, recovery, and family functioning outcomes. The EMP intervention was implemented in a dependency drug court (DDC) at the State of Florida 11th Circuit Judicial Juvenile Court in Miami, Fla. All mothers accepted into the DDC were eligible to participate in the study. To be eligible, mothers had to

• Be 18 years or older
• Have at least one child adjudicated dependent
• Have a diagnosis of substance abuse or dependence
• Have a potential for family reunification
• Voluntarily enroll in drug court after consulting with their attorney

Parents with severe cognitive, emotional, or physical disorders—or who had their parental rights previously terminated— were considered ineligible for reunification. Study staff met with mothers who were referred upon enrollment in drug court. Mothers were advised that participation in the study was voluntary and did not influence their status in drug court or their child welfare cases generally. Mothers who participated in the study were adjudicated in a single drug court with one judge presiding and received the same types of substance abuse treatment, parenting interventions, and other services as ordered by the judge.

Mothers were expected to follow the same basic requirements of participating in family drug court (i.e., completing drug treatment and remaining drug-free; completing parenting classes and demonstrating adequate parenting skills; participating in educational/vocational training, and domestic violence or other counseling as ordered by the judge; obtaining adequate and stable housing; and being in school or gainfully employed). The DDC program was a 12- to 15-month program organized into four phases. Progression through the phases was related to the mother's level of substance abuse treatment and compliance with court orders. Mothers were drug tested (urine screens) at each court hearing and in their substance abuse treatment programs. The only difference between the treatment and control groups was the intervention administered by the drug court counselors: EMP (treatment group) versus ICMS (control group).

After baseline assessment, mothers were randomly assigned to either EMP (n = 31) or ICMS (n = 31). A randomization program was used to ensure equivalence on four key variables: 1) age, 2) ethnicity, 3) number of children, and 4) years of drug use. Treatment group mothers were on average 29.1 years old, and were 45 percent Black, 36 percent Hispanic, and 19 percent White. Control group mothers were on average 31.2 years old, and were 39 percent Black, 35 percent Hispanic, and 26 percent White. Mothers in both groups had low median monthly incomes (average of $561), high unemployment (71 percent), and an average of 2.5 children.

All mothers were assessed at 3, 6, 9, 12, and 18 months following intake, regardless of the extent of their participation in drug court. The drug court was designed to last between 12 and 15 months; therefore, the 18-month follow up was subsequent to drug court participation. All data, except for child welfare outcomes, were collected during face-to-face interviews with participants at intake and the follow-up periods. Child welfare outcome measures were obtained from court records and included permanency outcomes such as sole custody, joint custody, or permanent guardianship with family members without termination of the mother’s parental rights. The Addiction Severity Index was used to assess self-reported drug use, alcohol use, family and social relations, and psychiatric problems. Urinalysis was conducted at each assessment point to identify the presence of alcohol, cannabis, amphetamines, barbiturates, benzodiazepines, cocaine, opiates, and phencyclidine (PCP). The Brief Child Abuse Potential (B-CAP) 24-item risk scale was used to measure physical child abuse potential. The Global Severity Index (GSI) of the Brief Symptom Inventory (BSI) was used to measure overall psychological distress.

Individual participants’ change was analyzed using the latent growth curve modeling method. Effect sizes were calculated using Feingold’s (2009) method for growth curve modeling. An intent-to-treat design was used to analyze the data. The study authors did not conduct subgroup analyses.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Cohen, Jeri B., Gayle A. Dakof, and Eliette Duarte. 2011. “Dependency Drug Court: An Intensive Intervention for Traumatized Mothers and Young Children.” In Joy D. Osofsky (ed.). Clinical Work With Traumatized Young Children. New York, N.Y.: Guilford Press, 252–68.

Dakof, Gayle A., Tanya J. Quille, Manuel J. Tejeda, Linda R. Alberga, Emmalee Bandstra, and Jose Szapocznik. 2003. “Enrolling and Retaining Mothers of Substance-Exposed Infants in Drug Abuse Treatment.” Journal of Consulting and Clinical Psychology 71(4):764–72.

Dakof, Gayle A., Jeri B. Cohen, and Eliette Duarte. 2009. “Increasing Family Reunification for Substance-Abusing Mothers and Their Children: Comparing Two Drug Court Interventions in Miami.” Juvenile and Family Court Journal 60(4):11–23.

Feingold, A. 2009. “Effect Sizes for Growth-Modeling Analysis for Controlled Clinical Trials in the Same Metric as for Classical Analysis.” Psychological Methods 14:43−53.

Liddle, Howard A., Gayle A. Dakof, and Guy S. Diamond. 1992. “Adolescents and Substance Abuse: Multidimensional Family Therapy in Action.” In E. Kaufman and P. Kaufman (eds.). Family Therapy Approaches of Drug and Alcohol Problems (2nd Edition). Boston, MA: Allyn & Bacon.